Treatment-induced neoangiogenesis in cerebral arteriovenous malformations.
We investigated the angiogenetic and proliferative activity of the endothelium of 30 consecutive surgical cases of AVM treated at our institution by immunohistochemical detection of the PCNA, MIB-1, Flk-1 and VEGF antibodies. Endothelial positive immunostaining was observed in 87% of the cases for PCNA, in 20% for MIB-1, and in 80% for Flk-1. Of 22 individuals treated with incomplete embolization prior to surgery, 17 showed an expression of VEGF (77%), but only two of the eight patients (25%) who were treated without prior embolization exhibited such an immunoreaction (P=0.0086). The proliferation and growth of cerebral AVMs is documented by endothelial expression of PCNA and MIB-1. The statistically significantly higher expression of VEGF in partially obliterated (embolized) AVMs is most likely caused by transient regional hypoxia within the AVM nidus that mediates neoangiogensis. It points out the clinical relevance of a complete occlusion in order to avoid neovascularization associated with subsequent morbidity and mortality.
Sure
U
U
Neurochirurgische Klinik, Philipps-Universität, Baldingerstrasse, 35033, Marburg, Germany. sure@post.med.uni-marburg.de
Butz
N
N
Siegel
A M
AM
Mennel
H D
HD
Bien
S
S
Bertalanffy
H
H
D034961:Antigens, Nuclear; D001921:Brain / Q000098:blood supply*; D001923:Brain Chemistry; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D016228:Endothelial Growth Factors / Q000096:biosynthesis; D006801:Humans; D007150:Immunohistochemistry; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D019394:Ki-67 Antigen; D008222:Lymphokines / Q000096:biosynthesis; D009389:Neovascularization, Pathologic / Q000378:metabolism*; D009687:Nuclear Proteins / Q000096:biosynthesis; D018809:Proliferating Cell Nuclear Antigen / Q000096:biosynthesis; D020794:Receptor Protein-Tyrosine Kinases / Q000096:biosynthesis; D017978:Receptors, Growth Factor / Q000096:biosynthesis; D040262:Receptors, Vascular Endothelial Growth Factor; D055502:Secondary Prevention; D015854:Up-Regulation; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D034961:Antigens, Nuclear; D016228:Endothelial Growth Factors; D019394:Ki-67 Antigen; D008222:Lymphokines; D009687:Nuclear Proteins; D018809:Proliferating Cell Nuclear Antigen; D017978:Receptors, Growth Factor; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D020794:Receptor Protein-Tyrosine Kinases; D040262:Receptors, Vascular Endothelial Growth Factor