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From Genes and Mechanisms to Molecular-Targeted Therapies: The Long Climb to the Cure of Cerebral Cavernous Malformation (CCM) Disease

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Cerebral Cavernous Malformations (CCM)

Part of the book series: Methods in Molecular Biology ((MIMB,volume 2152))

Abstract

Cerebral cavernous malformation (CCM) is a rare cerebrovascular disorder of genetic origin consisting of closely clustered, abnormally dilated and leaky capillaries (CCM lesions), which occur predominantly in the central nervous system. CCM lesions can be single or multiple and may result in severe clinical symptoms, including focal neurological deficits, seizures, and intracerebral hemorrhage. Early human genetic studies demonstrated that CCM disease is linked to three chromosomal loci and can be inherited as autosomal dominant condition with incomplete penetrance and highly variable expressivity, eventually leading to the identification of three disease genes, CCM1/KRIT1, CCM2, and CCM3/PDCD10, which encode for structurally unrelated intracellular proteins that lack catalytic domains. Biochemical, molecular, and cellular studies then showed that these proteins are involved in endothelial cell-cell junction and blood–brain barrier stability maintenance through the regulation of major cellular structures and mechanisms, including endothelial cell-cell and cell-matrix adhesion, actin cytoskeleton dynamics, autophagy, and endothelial-to-mesenchymal transition, suggesting that they act as pleiotropic regulators of cellular homeostasis, and opening novel therapeutic perspectives. Indeed, accumulated evidence in cellular and animal models has eventually revealed that the emerged pleiotropic functions of CCM proteins are mainly due to their ability to modulate redox-sensitive pathways and mechanisms involved in adaptive responses to oxidative stress and inflammation, thus contributing to the preservation of cellular homeostasis and stress defenses.

In this introductory review, we present a general overview of 20 years of amazing progress in the identification of genetic culprits and molecular mechanisms underlying CCM disease pathogenesis, and the development of targeted therapeutic strategies.

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Acknowledgements

This work was supported by the Telethon Foundation (grant GGP15219 to SFR and LT), and the MIUR (Progetto Dipartimento di Eccellenza 2018-2022 to LT and FF).

The authors are grateful to CCM Italia, the Italian Research Network for Cerebral Cavernous Malformation (https://www.ccmitalia.unito.it), and the Associazione Italiana Angiomi Cavernosi (AIAC) Onlus (https://www.aiac.unito.it), including its president Massimo Chiesa, for fundamental collaboration and support. Special thanks also go to Santina Barbaro and Nicola Retta for their invaluable help. This chapter and the book are dedicated to the memory of Rosa Giunta, Fortunato Barbaro, and Adelia Frison.

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Authors and Affiliations

  1. Department of Clinical and Biological Science, School of Medicine and Surgery, University of Torino, Orbassano (Torino), Italy

    Saverio Francesco Retta & Andrea Perrelli

  2. CCM Italia Research Network, Torino, Italy

    Saverio Francesco Retta, Andrea Perrelli, Lorenza Trabalzini & Federica Finetti

  3. Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy

    Lorenza Trabalzini & Federica Finetti

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  1. Saverio Francesco Retta
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  2. Andrea Perrelli
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  3. Lorenza Trabalzini
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  4. Federica Finetti
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Correspondence to Saverio Francesco Retta .

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Editors and Affiliations

  1. Department of Biotechnology, Chemistry and Pharmacy, University of Siena, SIENA, Italy

    Lorenza Trabalzini

  2. Department of Biotechnology, Chemistry and Pharmacy, University of Siena, SIENA, Italy

    Federica Finetti

  3. Department of Clinical and Biological Sciences, School of Medicine and Surgery, University of Torino, ORBASSANO (TORINO), Italy

    Saverio Francesco Retta

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Retta, S.F., Perrelli, A., Trabalzini, L., Finetti, F. (2020). From Genes and Mechanisms to Molecular-Targeted Therapies: The Long Climb to the Cure of Cerebral Cavernous Malformation (CCM) Disease. In: Trabalzini, L., Finetti, F., Retta, S. (eds) Cerebral Cavernous Malformations (CCM) . Methods in Molecular Biology, vol 2152. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-0640-7_1

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  • DOI: https://doi.org/10.1007/978-1-0716-0640-7_1

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