Invasion and metastasis of glioblastoma-initiating cells (GICs) are thought to be responsible for the progression and recurrence of glioblastoma multiforme (GBM). A safe drug that can be applied during the rest period of temozolomide (TMZ) maintenance cycles would greatly improve the prognosis of GBM patients by inhibiting GIC invasion. Resveratrol (RES) is a natural compound that exhibits anti-invasion properties in multiple tumor cell lines. The current study aimed to evaluate whether RES can inhibit GIC invasion in vitro and in vivo. GICs were identified using CD133 and Nestin immunofluorescence staining and tumorigenesis in non-obese diabetic severe combined immunodeficient (NOD/SCID) mice. Invasive behaviors, including the adhesion, invasion and migration of GICs, were determined by tumor invasive assays in vitro and in vivo. The activity of matrix metalloproteinases (MMPs) was measured by the gelatin zymography assay. Western blotting analysis and immunofluorescence staining were used to determine the expression of signaling effectors in GICs. We demonstrated that RES suppressed the adhesion, invasion and migration of GICs in vitro and in vivo. Moreover, we proved that RES inhibited the invasion of GICs via the inhibition of PI3K/Akt/NF-κB signal transduction and the subsequent suppression of MMP-2 expression.

The role of statins in unruptured intracranial aneurysm (UIA) growth and rupture remains ambiguous. This study sought to determine whether atorvastatin is associated with aneurysm growth and rupture in patients harboring UIA <7 mm. This prospective, multicenter cohort study consecutively enrolled patients with concurrent UIA <7 mm and ischemic cerebrovascular disease from four hospitals between 2016 and 2019. Baseline and follow-up patient information was recorded. Because of the strong anti-inflammatory effect of aspirin, patients using aspirin were excluded. Patients taking atorvastatin 20 mg daily were atorvastatin users. The primary and exploratory endpoints were aneurysm rupture and growth, respectively. Among the 1087 enrolled patients, 489 (45.0%) took atorvastatin, and 598 (55%) took no atorvastatin. After a mean follow-up duration of 33.0 ± 12.5 months, six (1.2%) and five (0.8%) aneurysms ruptured in atorvastatin and non-atorvastatin groups, respectively. In the adjusted multivariate Cox analysis, UIA sized 5 to <7 mm, current smoker, and uncontrolled hypertension were associated with aneurysm rupture, whereas atorvastatin [adjusted hazard ratio (HR) 1.495, 95% confidence interval (CI) 0.417–5.356, p = 0.537] was not. Of 159 patients who had follow-up imaging, 34 (21.4%) took atorvastatin and 125 (78.6%) took no atorvastatin. Aneurysm growth occurred in five (14.7%) and 21 (16.8%) patients in atorvastatin and non-atorvastatin groups (mean follow-up: 20.2 ± 12.9 months), respectively. In the adjusted multivariate Cox analysis, UIAs sized 5 to <7 mm and uncontrolled hypertension were associated with a high growth rate; atorvastatin (adjusted HR 0.151, 95% CI 0.031–0.729, p = 0.019) was associated with a reduced growth rate. We conclude atorvastatin use is associated with a reduced risk of UIA growth, whereas atorvastatin is not associated with UIA rupture.

Objective: Somatic KRAS mutations have been identified in the majority of brain arteriovenous malformations (bAVMs), and subsequent in vivo experiments have confirmed that KRAS mutation in endothelial cells (ECs) causes AVMs in mouse and zebrafish models. Our previous study demonstrated that the KRAS^G12D mutant independently induced the endothelial-mesenchymal transition (EndMT), which was reversed by treatment with the lipid-lowering drug lovastatin. However, the underlying mechanisms of action were unclear. Methods: We used human umbilical vein ECs (HUVECs) overexpressing the KRAS^G12D mutant for Western blotting, quantitative real-time PCR, and immunofluorescence and wound healing assays to evaluate the EndMT and determine the activation of downstream pathways. Knockdown of SMAD4 by RNA interference was performed to explore the role of SMAD4 in regulating the EndMT. BAVM ECs expressing the KRAS^G12D mutant were obtained to verify the SMAD4 function. Finally, we performed a coimmunoprecipitation assay to probe the mechanism by which lovastatin affects SMAD4. Results: HUVECs infected with KRAS^G12D adenovirus underwent the EndMT. Transforming growth factor beta (TGF-β) and bone morphogenetic protein (BMP) signalling pathways were activated in the KRAS^G12D-mutant HUVECs and ECs in bAVM tissue. Knocking down SMAD4 expression in both KRAS^G12D-mutant HUVECs and ECs in bAVM tissues inhibited the EndMT. Lovastatin attenuated the EndMT by downregulating p-SMAD2/3, p-SMAD1/5 and acetylated SMAD4 expression in KRAS^G12D-mutant HUVECs. Conclusions: Our findings suggest that the KRAS^G12D mutant induces the EndMT by activating the ERK-TGF-β/BMP-SMAD4 signalling pathway and that lovastatin inhibits the EndMT by suppressing TGF-β/BMP pathway activation and SMAD4 acetylation.

BACKGROUND: Cerebral cavernous malformations (CCMs) refer to vascular dysplasia primarily found in the brain, affecting ≈0.5% of the population. A somatic Map3k3 ^I441M mutation has been found in ≈40% of patients with sporadic CCMs, which were typically accompanied by somatic gain-of-function mutations in PIK3CA . Although mouse models of adeno-associated virus-BR1–mediated mutant overexpression have been reported, these models have limitations in representing clinical specimens of CCMs, which typically harbor single allele mutation in Map3k3 . A Map3k3 ^I441M knock-in murine model of CCMs has not yet been established. METHODS: The Map3k3 ^I441M knock-in mice were crossed with Cdh5 -creER ^T2 mice to induce mutant gene expression specifically in endothelial cells. Subsequently, Map3k3 ^I441M mice were bred with Pten ^fl/fl mice to generate Map3k3 ^I441M ; Pten ^fl/fl mice. In both murine models, CCM lesions were examined using magnetic resonance imaging, while single-cell RNA sequencing and immunostaining were utilized to investigate the pathomechanism of the mutation. Finally, we administered an mTOR (mechanistic target of rapamycin) inhibitor to explore its therapeutic effect on lesions of both murine models. RESULTS: Both endothelial Map3k3 ^I441M mutant juvenile mice and Map3k3 ^I441M ; Pten ^fl/fl mice developed abnormal lesions with human CCM characteristics. In Map3k3 ^I441M mice, the mutant promoted endothelial apoptosis, while activation of the PI3K (phosphatidylinositol 3-kinase) pathway was able to activate the downstream AKT (protein kinase B)/mTOR/p-S6 (phosphorylated S6 ribosomal protein) pathway and upregulate VEGFA (vascular endothelial growth factor A) expression, counteracting apoptosis, and facilitating lesion progression. The activation of PI3K signaling is required for Map3k3 ^I441M to generate CCM-like lesions in adult mice. Finally, we demonstrated that rapamycin effectively inhibited the formation of lesions in the Map3k3 ^I441M mice and Map3k3 ^I441M ; Pten ^fl/fl mice. CONCLUSIONS: Map3k3 ^I441M heterozygous is sufficient to induce lesions in juvenile mice, while the additional activation of PI3K signaling is required for the effective formation of CCMs at the adult stage. The Map3k3 ^I441M murine model provides a preclinical model for further mechanistic and therapeutic studies of CCMs.

Objective: Extra-axial cavernous hemangiomas (ECHs) are sporadic and rare intracranial occupational lesions that usually occur within the cavernous sinus. The aetiology of ECHs remains unknown. Methods: Whole-exome sequencing was performed on ECH lesions from 12 patients (discovery cohort) and droplet digital polymerase-chain-reaction (ddPCR) was used to confirm the identified mutation in 46 additional cases (validation cohort). Laser capture microdissection (LCM) was carried out to capture and characterise subgroups of tissue cells. Mechanistic and functional investigations were carried out in human umbilical vein endothelial cells and a newly established mouse model. Results: We detected somatic GJA4 mutation (c.121G>T, p.G41C) in 5/12 patients with ECH in the discovery cohort and confirmed the finding in the validation cohort (16/46). LCM followed by ddPCR revealed that the mutation was enriched in lesional endothelium. In vitro experiments in endothelial cells demonstrated that the GJA4 mutation activated SGK-1 signalling that in turn upregulated key genes involved in cell hyperproliferation and the loss of arterial specification. Compared with wild-type littermates, mice overexpressing the GJA4 mutation developed ECH-like pathological morphological characteristics (dilated venous lumen and elevated vascular density) in the retinal superficial vascular plexus at the postnatal 3 weeks, which were reversed by an SGK1 inhibitor, EMD638683. Conclusions: We identified a somatic GJA4 mutation that presents in over one-third of ECH lesions and proposed that ECHs are vascular malformations due to GJA4-induced activation of the SGK1 signalling pathway in brain endothelial cells.