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Advanced Neurology

REVIEW ARTICLE
Potential therapeutic targets and medications

for arteriovenous malformations of the central
nervous system

1,2
Zhengsong Li , Yueshan Feng , Shiju Zhang , Yuan Zhou , Jiaxing Yu ,
1,2
1,2
1,2
1,2
Hongqi Zhang , and Tao Hong *
1,2
1,2
1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
2 International Neuroscience Institute, Beijing, China
Abstract

Arteriovenous malformations (AVMs) of the central nervous system are high-flow
arteriovenous shunts that lead to considerable risks of hemorrhagic stroke and
neurological deficits in young patients. Due to the complex angioarchitecture and
their close anatomical relationship with the brain and spinal cord, the management
of brain and spinal AVMs is challenging. Conventional invasive treatments, including
microsurgery, endovascular embolization, and stereotactic radiosurgery, are
associated with considerable risks and unsatisfactory efficacy. In addition, the lack
of medications for AVMs represents an unmet clinical need. In recent years, the
pathogenesis of AVMs has been progressively explored. The increased understanding
of the mechanisms of the formation, progression, and rupture of AVMs has opened
*Corresponding author: up several potential directions for AVM pharmacotherapy. In recent years, some
Tao Hong
(2030921@qq.com) promising drugs targeting angiogenesis, inflammation, vessel wall integrity, and
the mitogen-activated protein kinase (MAPK)-extracellular receptor kinase (ERK)
Citation: Li Z, Feng Y, Zhang S, signaling pathway have been tested in a series of clinical investigations. In this review,
et al., 2022, Potential therapeutic
targets and medications for we summarize the potential mechanisms, preliminary efficacy, and side effects of
arteriovenous malformations the candidate medications, including bevacizumab, minocycline or doxycycline,
of the central nervous system. thalidomide, and trametinib, in the treatment of brain and spinal AVMs.
Adv Neuro, 1(3): 211.
https://doi.org/10.36922/an.v1i3.211
Received: September 29, 2022 Keywords: Arteriovenous malformations; Therapeutic targets; Medication; Vascular
Accepted: November 29, 2022 integrity; Somatic mutations
Published Online: December 19,
2022
Copyright: © 2022 Author(s). 1. Introduction
This is an Open Access article
distributed under the terms of the Arteriovenous malformations (AVMs) are high-flow angiopathies that are characterized
Creative Commons Attribution by direct connections between arteries and veins . Although AVM lesions have been
[1]
License, permitting distribution,
and reproduction in any medium, detected in most bodily tissues, they are 20 times more likely to occur in the central
provided the original work is nervous system (CNS), as with brain arteriovenous malformations (BAVMs) and spinal
properly cited. cord arteriovenous malformations (SAVMs), than in other locations . Nearly 95% of
[2]
Publisher’s Note: AccScience cases of AVMs in the CNS are sporadic or single lesions, while the remaining cases
Publishing remains neutral with are genetic AVM syndromes, such as hereditary hemorrhagic telangiectasia (HHT),
regard to jurisdictional claims in
published maps and institutional capillary malformation-arteriovenous malformation (CM-AVM) syndrome, and
affiliations. neurofibromatosis [3,4] .

Volume 1 Issue 3 (2022) 1 https://doi.org/10.36922/an.v1i3.211