Cerebral cavernous malformations are driven by ADAMTS5 proteolysis of versican

Courtney C. Hong, Alan T. Tang, Matthew R. Detter, Jaesung P. Choi, Rui Wang, Xi Yang, Andrea A. Guerrero, Carl F. Wittig, Nicholas Hobson, Romuald Girard, Rhonda Lightle, Thomas Moore, Robert Shenkar, Sean P. Polster, Lauren M. Goddard, Aileen A. Ren, N. Adrian Leu, Stephanie Sterling, Jisheng Yang, Li LiMei Chen, Patricia Mericko-Ishizuka, Lukas E. Dow, Hideto Watanabe, Markus Schwaninger, Wang Min, Douglas A. Marchuk, Xiangjian Zheng, Issam A. Awad, Mark L. Kahn*

*Corresponding author for this work
2 Citations (Scopus)


Cerebral cavernous malformations (CCMs) form following loss of the CCM protein complex in brain endothelial cells due to increased endothelial MEKK3 signaling and KLF2/4 transcription factor expression, but the downstream events that drive lesion formation remain undefined. Recent studies have revealed that CCM lesions expand by incorporating neighboring wild-type endothelial cells, indicative of a cell nonautonomous mechanism. Here we find that endothelial loss of ADAMTS5 reduced CCM formation in the neonatal mouse model. Conversely, endothelial gain of ADAMTS5 conferred early lesion genesis in the absence of increased KLF2/4 expression and synergized with KRIT1 loss of function to create large malformations. Lowering versican expression reduced CCM burden, indicating that versican is the relevant ADAMTS5 substrate and that lesion formation requires proteolysis but not loss of this extracellular matrix protein. These findings identify endothelial secretion of ADAMTS5 and cleavage of versican as downstream mechanisms of CCM pathogenesis and provide a basis for the participation of wildtype endothelial cells in lesion formation.

Original languageEnglish
Article number151938
JournalJournal of Experimental Medicine
Issue number10
Publication statusPublished - 2020

Research Areas and Centers

  • Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)
  • Centers: Center for Rare Diseases (ZSE)

DFG Research Classification Scheme

  • 206-06 Molecular and Cellular Neurology and Neuropathology


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