? PROJECT 3 Recent studies by our group and others have identified MEKK3-KLF2/4 signaling as the direct target of CCM complex function, and showed that loss of CCM function confers lesion formation through gain of MEKK3 signaling and elevated KLF2 and KLF4 expression in brain endothelial cells. Unexpectedly, we have also found that endothelial TLR4 activation by lipopolysaccharide derived from gram negative bacteria in the gut microbiome plays a central, upstream role in the activation of MEKK3-KLF2/4 signaling and CCM formation in both mice and humans. These findings have culminated in a now widely accepted model of CCM disease, but the downstream effectors by which KLF2 and KLF4 drive lesion formation remain unknown. Our preliminary studies reveal two new insights into the downstream events that drive CCM formation: 1) PI3K gain of function synergizes with CCM loss of function to drive lesion formation in mice and a majority of surgically resected human CCM lesions, and 2) ADAMTS cleavage of peri- vascular versican drives the CCM phenotype in mice. Project 3 will define the roles of PI3K signaling and versican proteolysis during CCM pathogenesis using established and newly developed mouse genetic models. These studies will strongly complement those in Project 1 and Core A that examine the PIK3CA mutations in human CCM lesions and a cell non-autonomous mechanism by which wild-type endothelial cells contribute to CCM lesions. Most importantly, we expect these studies to be rapidly translated to the clinic by providing support for the use of FDA-approved agents such as the PI3K pathway inhibitor rapamycin to treat CCM disease.

Public Health Relevance

? PROJECT 3 Cerebral cavernous malformation (CCM) is a common cause of stroke for which there is no drug therapy. Studies from our group and others over the past 5 years have defined an upstream pathway by which cerebral cavernous malformations arise, but the downstream mechanisms and potential downstream drug targets remain unknown. Our preliminary studies in mice and humans identify two novel downstream mechanisms for CCM formation: gain of PI3K signaling and proteolytic cleavage of the matrix proteoglycan versican. This proposal will use established and new mouse models to test the role of these downstream pathways and determine whether existing FDA-approved agents such as rapamycin can be used to treat CCM disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Program Projects (P01)
Project #
2P01NS092521-06
Application #
10022897
Study Section
Special Emphasis Panel (ZNS1)
Project Start
Project End
2025-05-31
Budget Start
2020-07-01
Budget End
2021-06-30
Support Year
6
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Duke University
Department
Type
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
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