Fasudil decreases lesion burden in a murine model of cerebral cavernous malformation disease.
OBJECTIVE
Cerebral cavernous malformations (CCMs) are characterized by grossly dilated capillaries, associated with vascular leak and hemorrhage, and occur in sporadic or inherited (autosomal-dominant) forms with mutations in 1 of 3 gene loci (CCM 1, 2 or 3). We previously reported that the CCM1 protein (KRIT1) localizes to endothelial cell-cell junctions and loss of KRIT1 leads to junctional instability associated with activation of RhoA and its effector Rho kinase. Although Rho kinase inhibition has been proposed as potential therapy for CCM, there has been no demonstration of a therapeutic effect on CCM lesion genesis in vivo.


METHODS
Our recently generated a model of CCM1 disease (Ccm1(+/-)Msh2(-/-)) was treated with the Rho kinase inhibitor fasudil (100 mg/kg/day administered in drinking water from weaning to 5 months of age), or placebo, and blindly assessed CCM lesion burden by systematic survey of animals' brains. For comparison, we also assessed therapeutic effect in previously described Ccm2(+/-)Trp53(-/-) mice treated with the same dose and duration of fasudil and placebo.


RESULTS
Fasudil-treated Ccm1(+/-)Msh2(-/-) mice had a significantly decreased prevalence of CCM lesions compared with placebo controls. Lesions in treated animals were smaller and less likely associated with hemorrhage, inflammation, and endothelial proliferation and exhibited decreased expression of Rho kinase activation biomarkers. A therapeutic effect was also documented in Ccm2(+/-)Trp53(-/-) mice.


CONCLUSIONS
This represents the first report of therapeutic benefit of pharmacological therapy in development and progression of CCMs and indicates that Rho kinase activation is a critical step in CCM lesion genesis and maturation.
Molecular Genetics and Microbiology Department, Duke University Medical Center, Durham, NC, USA.
David A
DA
McDonald
Changbin
C
Shi
Robert
R
Shenkar
Rebecca A
RA
Stockton
Feifei
F
Liu
Mark H
MH
Ginsberg
Douglas A
DA
Marchuk
Issam A
IA
Awad
D019307:1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000818:Animals; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000235:genetics / Q000473:pathology; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000473:pathology; D002538:Intracranial Arteriovenous Malformations / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D000075927:KRIT1 Protein; D051379:Mice; D018345:Mice, Knockout; D008869:Microtubule-Associated Proteins / Q000235:genetics; D051718:MutS Homolog 2 Protein / Q000235:genetics; D010641:Phenotype; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016159:Tumor Suppressor Protein p53 / Q000235:genetics; D014665:Vasodilator Agents / Q000627:therapeutic use*; D054460:rho-Associated Kinases / Q000037:antagonists & inhibitors
D004791:Enzyme Inhibitors; D000075927:KRIT1 Protein; C491535:Krit1 protein, mouse; D008869:Microtubule-Associated Proteins; D011518:Proto-Oncogene Proteins; D016159:Tumor Suppressor Protein p53; D014665:Vasodilator Agents; D019307:1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine; D054460:rho-Associated Kinases; C497173:Msh2 protein, mouse; D051718:MutS Homolog 2 Protein; C049347:fasudil