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Endothelial TLR4 and the microbiome drive cerebral cavernous malformations.

Alan T Tang | Jaesung P Choi | Jonathan J Kotzin | Yiqing Yang | Courtney C Hong | Nicholas Hobson | Romuald Girard | Hussein A Zeineddine | Rhonda Lightle | Thomas Moore | Ying Cao | Robert Shenkar | Mei Chen | Patricia Mericko | Jisheng Yang | Li Li | Ceylan Tanes | Dmytro Kobuley | Urmo Võsa | Kevin J Whitehead | Dean Y Li | Lude Franke | Blaine Hart | Markus Schwaninger | Jorge Henao-Mejia | Leslie Morrison | Helen Kim | Issam A Awad | Xiangjian Zheng | Mark L Kahn
Nature | 2017

Cerebral cavernous malformations (CCMs) are a cause of stroke and seizure for which no effective medical therapies yet exist. CCMs arise from the loss of an adaptor complex that negatively regulates MEKK3-KLF2/4 signalling in brain endothelial cells, but upstream activators of this disease pathway have yet to be identified. Here we identify endothelial Toll-like receptor 4 (TLR4) and the gut microbiome as critical stimulants of CCM formation. Activation of TLR4 by Gram-negative bacteria or lipopolysaccharide accelerates CCM formation, and genetic or pharmacologic blockade of TLR4 signalling prevents CCM formation in mice. Polymorphisms that increase expression of the TLR4 gene or the gene encoding its co-receptor CD14 are associated with higher CCM lesion burden in humans. Germ-free mice are protected from CCM formation, and a single course of antibiotics permanently alters CCM susceptibility in mice. These studies identify unexpected roles for the microbiome and innate immune signalling in the pathogenesis of a cerebrovascular disease, as well as strategies for its treatment.

Pubmed ID: 28489816

Research resources used in this publication

None found

Antibodies used in this publication

None found

Associated grants

  • Agency: NINDS NIH HHS, United States
    Id: P01 NS092521
  • Agency: NHLBI NIH HHS, United States
    Id: T32 HL007439
  • Agency: NINDS NIH HHS, United States
    Id: R01 NS100949
  • Agency: NINDS NIH HHS, United States
    Id: U54 NS065705
  • Agency: NINDS NIH HHS, United States
    Id: R01 NS075168
  • Agency: NIDDK NIH HHS, United States
    Id: R21 DK111755
  • Agency: NIDDK NIH HHS, United States
    Id: T32 DK007780
  • Agency: FIC NIH HHS, United States
    Id: F06 TW002300
  • Agency: National Institute of Health, International
    Id: T32HL07439
  • Agency: NINDS NIH HHS, United States
    Id: F30 NS100252
  • Agency: NIGMS NIH HHS, United States
    Id: T32 GM008076
  • Agency: NHLBI NIH HHS, United States
    Id: R01 HL136572
  • Agency: NHLBI NIH HHS, United States
    Id: R01 HL102138
  • Agency: NIAID NIH HHS, United States
    Id: R21 AI128060
  • Agency: NHLBI NIH HHS, United States
    Id: R01 HL094326
  • Agency: NIDDK NIH HHS, United States
    Id: P30 DK019525

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