Cerebral arteriovenous malformations. Part 1: cellular and molecular biology

Object. The scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression-and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs. Methods. A comprehensive literature review was conducted using PubMed to reveal the molecular biology of AVMs as it relates to their complex growth and behavior patterns. Results. Growth factors involved in AVMs include vascular endothelial growth factor, fibroblast growth factor, transforming growth factor beta, angiopoietins, fibronectin, laminin, integrin, and matrix metalloproteinases. Conclusions. Understanding the complicated molecular milieu of developing AVMs is essential for defining their natural history. Growth factors, extracellular matrix proteins, and other molecular markers will be the key to unlocking novel targeted drug treatments for these brain malformations. (DOI: 10.3171/2009.2.FOCUS09316)