Department of Dermatology, Division of Pediatric Dermatology, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, Stanford, California, USA.
Curr Opin Pediatr. 2019 Aug;31(4):498-508. doi: 10.1097/MOP.0000000000000794.
Vascular malformations (VaMs) are a consequence of disrupted morphogenesis that may involve arterial, capillary, venous, or lymphatic endothelium alone or in a combination. VaMs can have serious health impacts, leading to life-threatening conditions sometimes. Genetic mutations affecting proliferation, migration, adhesion, differentiation, and survival of endothelial cells, as well as integrity of extracellular matrix are believed to be the pathogenesis of these disorders. Here, we present an updated review of genetic mutations and potential therapeutic targets for VaMs.
Increased number of genetic mutations have been discovered in vascular anomalies via targeted deep sequencing. When a genetic defect is identified, it often presents in only a small percentage of cells within the malformation. In addition, mutations within the same gene may result in different clinical phenotypes. Management of VaMs can be challenging depending on the severity and functional impairment associated. There are no standard treatment algorithms available to date for VaMs, therefore the disorder has significant unmet clinical needs. Currently, the focus of therapeutic development is to target constitutively activated intracellular signaling pathways resulted from genetic mutations.
Knowledge about the genetic mutations and altered signaling pathways related to VaMs have improved our understanding about the pathogenesis of vascular anomalies and provided insights to the development of new targeted therapies.
血管畸形(VMs)是形态发生中断的结果,可能仅涉及动脉、毛细血管、静脉或淋巴管内皮细胞,或它们的组合。VMs 可能对健康有严重影响,有时会导致危及生命的情况。据信,影响内皮细胞增殖、迁移、黏附、分化和存活以及细胞外基质完整性的基因突变是这些疾病的发病机制。在这里,我们介绍了 VMs 的基因突变和潜在治疗靶点的最新综述。
通过靶向深度测序,在血管异常中发现了越来越多的基因突变。当确定存在遗传缺陷时,它通常只存在于畸形中一小部分细胞内。此外,同一基因内的突变可能导致不同的临床表型。根据与疾病相关的严重程度和功能障碍,VMs 的治疗管理可能具有挑战性。迄今为止,尚无针对 VMs 的标准治疗算法,因此该疾病存在重大未满足的临床需求。目前,治疗开发的重点是针对基因突变导致的持续激活的细胞内信号通路。
与 VMs 相关的基因突变和改变的信号通路的知识提高了我们对血管异常发病机制的理解,并为新的靶向治疗方法的发展提供了思路。