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In the last years a lot of controversy has aroused in relation to brain AVM treatment. The ARUBA trial put the interventional treatment of AVMs in second position after conservative or natural history of this disease. Although there is still controversy and even not a general consensus about AVM treatment, what seems to be true is that we still don’t have a definite and low morbidity treatment for these vascular malformations.
The authors in this interesting paper, show us a different look and approach to AVM treatment. Using 148 AVM mouse model (Alk1-deficient) they studied the effects on induced AVMs of Thalidomide and Lenalidomide (a second generation immunomodulator -as Thalidomide-). One group of mice were treated with Thalidomide or Lenalidomide and the other with DMSO. Thalidomide and Lenalidomide demonstrated several effects on AVM vessels, increasing pericytes coverage and smooth muscle cells. Moreover, they reduce the risk of bleeding measured as iron deposits in the AVM surroundings and reduce the expression of several inflammatory mediators (as citokines and CD68+). Finally, investigators tested the expression of PDGFB and PDGFRB. The increase of their expression mimics the effect of the immunomodulatory drugs used in this paper, and this could explain one of their mechanisms on the AVM.