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      The Role of VEGF and KDR Polymorphisms in Moyamoya Disease and Collateral Revascularization

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          Abstract

          We conducted a case-control study to investigate whether vascular endothelial growth factor ( VEGF −2578, −1154, −634, and 936) and kinase insert domain containing receptor ( KDR −604, 1192, and 1719) polymorphisms are associated with moyamoya disease. Korean patients with moyamoya disease (n = 107, mean age, 20.9±15.9 years; 66.4% female) and 243 healthy control subjects (mean age, 23.0±16.1 years; 56.8% female) were included. The subjects were divided into pediatric and adult groups. Among the 64 surgical patients, we evaluated collateral vessel formation after 2 years and divided patients into good (collateral grade A) or poor (collateral grade B and C) groups. The frequencies and distributions of four VEGF (−2578, −1154, −634, and 936) and KDR (−604, 1192, and 1719) polymorphisms were assessed from patients with moyamoya disease and compared to the control group. No differences were observed in VEGF −2578, −1154, −634, and 936 or KDR −604, 1192, and 1719 polymorphisms between the control group and moyamoya disease group. However, we found the −634CC genotype occurred less frequently in the pediatric moyamoya group ( p = 0.040) whereas the KDR −604C/1192A/1719T haplotype increased the risk of pediatric moyamoya ( p = 0.024). Patients with the CC genotype of VEGF −634 had better collateral vessel formation after surgery. Our results suggest that the VEGF −634G allele is associated with pediatric moyamoya disease and poor collateral vessel formation.

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          Most cited references39

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          Vascular endothelial growth factor is a secreted angiogenic mitogen.

          Vascular endothelial growth factor (VEGF) was purified from media conditioned by bovine pituitary folliculostellate cells (FC). VEGF is a heparin-binding growth factor specific for vascular endothelial cells that is able to induce angiogenesis in vivo. Complementary DNA clones for bovine and human VEGF were isolated from cDNA libraries prepared from FC and HL60 leukemia cells, respectively. These cDNAs encode hydrophilic proteins with sequences related to those of the A and B chains of platelet-derived growth factor. DNA sequencing suggests the existence of several molecular species of VEGF. VEGFs are secreted proteins, in contrast to other endothelial cell mitogens such as acidic or basic fibroblast growth factors and platelet-derived endothelial cell growth factor. Human 293 cells transfected with an expression vector containing a bovine or human VEGF cDNA insert secrete an endothelial cell mitogen that behaves like native VEGF.
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            Vascular endothelial growth factor regulates endothelial cell survival through the phosphatidylinositol 3'-kinase/Akt signal transduction pathway. Requirement for Flk-1/KDR activation.

            Vascular endothelial growth factor (VEGF) has been found to have various functions on endothelial cells, the most prominent of which is the induction of proliferation and differentiation. In this report we demonstrate that VEGF or a mutant, selectively binding to the Flk-1/KDR receptor, displayed high levels of survival activity, whereas Flt-1-specific ligands failed to promote survival of serum-starved primary human endothelial cells. This activity was blocked by the phosphatidylinositol 3'-kinase (PI3-kinase)-specific inhibitors wortmannin and LY294002. Endothelial cells cultured in the presence of VEGF and the Flk-1/KDR-selective VEGF mutant induced phosphorylation of the serine-threonine kinase Akt in a PI3-kinase-dependent manner. Akt activation was not detected in response to stimulation with placenta growth factor or an Flt-1-selective VEGF mutant. Furthermore, a constitutively active Akt was sufficient to promote survival of serum-starved endothelial cells in transient transfection experiments. In contrast, overexpression of a dominant-negative form of Akt blocked the survival effect of VEGF. These findings identify the Flk-1/KDR receptor and the PI3-kinase/Akt signal transduction pathway as crucial elements in the processes leading to endothelial cell survival induced by VEGF. Inhibition of apoptosis may represent a major aspect of the regulatory activity of VEGF on the vascular endothelium.
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              Hypoxia-induced vascular endothelial growth factor expression precedes neovascularization after cerebral ischemia.

              We investigated the hypothesis that hypoxia induces angiogenesis and thereby may counteract the detrimental neurological effects associated with stroke. Forty-eight to seventy-two hours after permanent middle cerebral artery occlusion we found a strong increase in the number of newly formed vessels at the border of the infarction. Using the hypoxia marker nitroimidazole EF5, we detected hypoxic cells in the ischemic border of the neocortex. Expression of vascular endothelial growth factor (VEGF), which is the main regulator of angiogenesis and is inducible by hypoxia, was strongly up-regulated in the ischemic border, at times between 6 and 24 hours after occlusion. In addition, both VEGF receptors (VEGFRs) were up-regulated at the border after 48 hours and later in the ischemic core. Finally, the two transcription factors, hypoxia-inducible factor-1 (HIF-1) and HIF-2, known to be involved in the regulation of VEGF and VEGFR gene expression, were increased in the ischemic border after 72 hours, suggesting a regulatory function for these factors. These results strongly suggest that the VEGF/VEGFR system, induced by hypoxia, leads to the growth of new vessels after cerebral ischemia. Exogenous support of this natural protective mechanism might lead to enhanced survival after stroke.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                12 October 2012
                : 7
                : 10
                : e47158
                Affiliations
                [1 ]Department of Neurosurgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
                [2 ]Institute for Clinical Research, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
                [3 ]Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
                [4 ]Department of Neurology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
                [5 ]Department of Pediatric Neurosurgery, Severance Hospital, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
                University of Queensland, Australia
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: YSP DSK NKK. Performed the experiments: YSP YJJ HSK. Analyzed the data: YSP YJJ. Contributed reagents/materials/analysis tools: YSP SHO HSK WCK OJK TGK IBH JUC DSK. Wrote the paper: YSP YJJ DSK NKK.

                Article
                PONE-D-12-14534
                10.1371/journal.pone.0047158
                3470587
                23077562
                33b35292-bb94-4c0a-be12-96c43c929c48
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 May 2012
                : 10 September 2012
                Page count
                Pages: 9
                Funding
                This work was supported by the National Research Foundation of Korea (2010-0023851). The funders had no role in the study design or decision to publish.
                Categories
                Research Article
                Biology
                Computational Biology
                Population Genetics
                Genetic Polymorphism
                Evolutionary Biology
                Population Genetics
                Genetic Polymorphism
                Genetics
                Population Genetics
                Genetic Polymorphism
                Genomics
                Genome Sequencing
                Population Biology
                Population Genetics
                Genetic Polymorphism
                Medicine
                Cardiovascular
                Vascular Biology
                Neurology
                Cerebrovascular Diseases
                Ischemic Stroke

                Uncategorized
                Uncategorized

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