Tu Tianqi, Peng Zhenghong, Zhang Lihan, Yang Jieru, Guo Kecheng, Tang Xiaogang, Ye Jiasen, Zhang Fan, Huang An, Yu Jiaxing, Huang Changren, Zhang Hongqi, Wang Donghai, Peng Jianhua, Jiang Yong
Department of Neurosurgery, The Affiliated Hospital Southwest Medical University, No. 25 of Taiping Street, Luzhou, 646000, Sichuan, China.
Laboratory of Neurological Diseases and Brain Function, the Affiliated Hospital, Southwest Medical University, Luzhou, China.
J Neuroinflammation. 2025 Apr 29;22(1):124. doi: 10.1186/s12974-025-03442-2.
Brain arteriovenous malformation (BAVM) is a complex cerebrovascular disease characterized by an abnormal high-flow vascular network, which increases the risk of hemorrhage, particularly in young individuals. Endothelial dysfunction has traditionally been considered the primary cause, while the contributions of the microenvironment and glial cells have not been fully explored. Astrocytes, as a key component of the central nervous system, play a crucial role in regulating neurovascular function, maintaining the integrity of the blood-brain barrier, and ensuring neural homeostasis. However, under the pathological conditions of BAVM, the phenotypic changes in astrocytes and their role in disease progression remain poorly understood. In our study, we emphasized the critical role of neuroinflammation and hypoxia in the progression of BAVM within its pathological microenvironment. Specifically, reactive astrocytes undergo phenotypic changes under these pathological conditions, significantly promoting vascular instability. Moreover, nitric oxide (NO) produced by BAVM endothelial cells activates signaling pathways that stabilize HIF-1α in astrocytes, initiating a "hypoxic" gene program under normoxic conditions. Furthermore, we discovered that COX-2, a direct target gene of HIF-1α, is upregulated in the BAVM microenvironment. These changes promoted endothelial dysfunction and vascular fragility, creating a vicious cycle that exacerbates hemorrhage risk. The application of COX-2 inhibitors significantly reduced neuroinflammation, stabilized blood vessels, and decreased hemorrhage risk. Our findings highlighted the crucial interaction between the BAVM microenvironment and astrocytes in driving disease progression, suggesting that COX-2 could be a potential therapeutic target for stabilizing BAVM vessels and reducing hemorrhagic events.
脑动静脉畸形(BAVM)是一种复杂的脑血管疾病,其特征是存在异常的高流量血管网络,这会增加出血风险,尤其是在年轻人中。传统上认为内皮功能障碍是主要原因,而微环境和神经胶质细胞的作用尚未得到充分探索。星形胶质细胞作为中枢神经系统的关键组成部分,在调节神经血管功能、维持血脑屏障的完整性以及确保神经内环境稳定方面发挥着至关重要的作用。然而,在BAVM的病理条件下,星形胶质细胞的表型变化及其在疾病进展中的作用仍知之甚少。在我们的研究中,我们强调了神经炎症和缺氧在BAVM病理微环境中疾病进展中的关键作用。具体而言,反应性星形胶质细胞在这些病理条件下会发生表型变化,显著促进血管不稳定。此外,BAVM内皮细胞产生的一氧化氮(NO)激活了稳定星形胶质细胞中HIF-1α的信号通路,在常氧条件下启动了一个“缺氧”基因程序。此外,我们发现HIF-1α的直接靶基因COX-2在BAVM微环境中上调。这些变化促进了内皮功能障碍和血管脆性,形成了一个恶性循环,加剧了出血风险。COX-2抑制剂的应用显著减轻了神经炎症,稳定了血管,并降低了出血风险。我们的研究结果突出了BAVM微环境与星形胶质细胞在推动疾病进展中的关键相互作用,表明COX-2可能是稳定BAVM血管和减少出血事件的潜在治疗靶点。