Targeting VEGF-mediated blood-brain barrier disruption in advanced cerebral leukodystrophy

IF 2.9 4区 医学 Q3 IMMUNOLOGY Journal of neuroimmunology Pub Date : 2024-06-13 DOI:10.1016/j.jneuroim.2024.578395
Ashish O. Gupta , Justin W. Furcich , David R. Nascene , Stephan Kemp , Carina J. King , Erin E. Nolan , Willa Durose , Bradley S. Miller , Paul J. Orchard , Troy C. Lund
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Abstract

The earliest clinical manifestation of cerebral adrenoleukodystrophy (CALD) is adrenal insufficiency (AI) characterized by elevations in ACTH and loss of cortisol. We showed high (though physiologically achievable) levels of ACTH increases endothelial permeability, increases anisotropy, and increases VEGF secretion. An ACBD1 knockout endothelial cell line had increased sensitivity to ACTH and VEGF. Inhibition of VEGF via application of anti-VEGF (bevacizumab) improved permeability. Six boys with advanced CALD were treated with bevacizumab combined with dexamethasone and ruxolitinib as immune suppressants. Most boys had decreases in gadolinium enhancement on MRI indicating improvement in endothelial function, though all boys continued to progress symptomatically.

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以晚期脑白质营养不良症中血管内皮生长因子介导的血脑屏障破坏为靶点
脑肾上腺白质营养不良症(CALD)最早的临床表现是以促肾上腺皮质激素(ACTH)升高和皮质醇丧失为特征的肾上腺功能不全(AI)。我们的研究表明,高水平(尽管在生理上可以达到)的促肾上腺皮质激素会增加内皮通透性、增加各向异性并增加血管内皮生长因子的分泌。ACBD1 基因敲除内皮细胞系对促肾上腺皮质激素和血管内皮生长因子的敏感性增加。通过应用抗血管内皮生长因子(贝伐单抗)抑制血管内皮生长因子可改善通透性。六名患有晚期 CALD 的男孩接受了贝伐单抗联合地塞米松和芦可利替尼作为免疫抑制剂的治疗。大多数男孩的磁共振成像上的钆增强都有所下降,这表明血管内皮功能有所改善,但所有男孩的症状仍在继续发展。
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来源期刊
Journal of neuroimmunology
Journal of neuroimmunology 医学-免疫学
CiteScore
6.10
自引率
3.00%
发文量
154
审稿时长
37 days
期刊介绍: The Journal of Neuroimmunology affords a forum for the publication of works applying immunologic methodology to the furtherance of the neurological sciences. Studies on all branches of the neurosciences, particularly fundamental and applied neurobiology, neurology, neuropathology, neurochemistry, neurovirology, neuroendocrinology, neuromuscular research, neuropharmacology and psychology, which involve either immunologic methodology (e.g. immunocytochemistry) or fundamental immunology (e.g. antibody and lymphocyte assays), are considered for publication.
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