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2014 ; 111
(50
): 18007-12
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Constitutively active Notch4 receptor elicits brain arteriovenous malformations
through enlargement of capillary-like vessels
#MMPMID25468970
Murphy PA
; Kim TN
; Huang L
; Nielsen CM
; Lawton MT
; Adams RH
; Schaffer CB
; Wang RA
Proc Natl Acad Sci U S A
2014[Dec]; 111
(50
): 18007-12
PMID25468970
show ga
Arteriovenous (AV) malformation (AVM) is a devastating condition characterized by
focal lesions of enlarged, tangled vessels that shunt blood from arteries
directly to veins. AVMs can form anywhere in the body and can cause debilitating
ischemia and life-threatening hemorrhagic stroke. The mechanisms that underlie
AVM formation remain poorly understood. Here, we examined the cellular and
hemodynamic changes at the earliest stages of brain AVM formation by time-lapse
two-photon imaging through cranial windows of mice expressing constitutively
active Notch4 (Notch4*). AVMs arose from enlargement of preexisting microvessels
with capillary diameter and blood flow and no smooth muscle cell coverage. AV
shunting began promptly after Notch4* expression in endothelial cells (ECs),
accompanied by increased individual EC areas, rather than increased EC number or
proliferation. Alterations in Notch signaling in ECs of all vessels, but not
arteries alone, affected AVM formation, suggesting that Notch functions in the
microvasculature and/or veins to induce AVM. Increased Notch signaling interfered
with the normal biological control of hemodynamics, permitting a positive
feedback loop of increasing blood flow and vessel diameter and driving focal AVM
growth from AV connections with higher blood velocity at the expense of adjacent
AV connections with lower velocity. Endothelial expression of constitutively
active Notch1 also led to brain AVMs in mice. Our data shed light on cellular and
hemodynamic mechanisms underlying AVM pathogenesis elicited by increased Notch
signaling in the endothelium.