The cerebral cavernous malformation signaling pathway promotes vascular integrity via Rho GTPases

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Abstract
Cerebral cavernous malformation (CCM) is a life-threatening disorder in which blood vessels in the brain are prone to hemorrhage. Kevin Whitehead et al. now show that CCM2, mutations in which are associated with CCM, is needed for specific aspects of endothelial cell function involving RhoA GTPase. These defects can be partially restored by statin treatment, suggesting a potential therapeutic intervention for individuals with CCM. The role of CCM2 in the endothelium is also explored in another paper published in this issue of Nature Medicine, by Benjamin Kleaveland et al Cerebral cavernous malformation (CCM) is a common vascular dysplasia that affects both systemic and central nervous system blood vessels. Loss of function mutations in the CCM2 gene cause CCM. Here we show that targeted disruption of Ccm2 in mice results in failed lumen formation and early embryonic death through an endothelial cell autonomous mechanism. We show that CCM2 regulates endothelial cytoskeletal architecture, cell-to-cell interactions and lumen formation. Heterozygosity at Ccm2, a genotype equivalent to that in human CCM, results in impaired endothelial barrier function. On the basis of our biochemical studies indicating that loss of CCM2 results in activation of RHOA GTPase, we rescued the cellular phenotype and barrier function in heterozygous mice with simvastatin, a drug known to inhibit Rho GTPases. These data offer the prospect for pharmacological treatment of a human vascular dysplasia with a widely available and safe drug.