# Arteriovenous Malformations—Current Understanding of the Pathogenesis with Implications for Treatment

**Authors:** Katharina Schimmel, Md Khadem Ali, Serena Y. Tan, Joyce Teng, Huy M. Do, Gary K. Steinberg, David A. Stevenson, Edda Spiekerkoetter

PMC · DOI: 10.3390/ijms22169037 · International Journal of Molecular Sciences · 2021-08-21

## TL;DR

This paper reviews the current understanding of arteriovenous malformations, their causes, and treatment challenges.

## Contribution

The paper synthesizes preclinical and clinical findings to highlight gaps in AVM pathogenesis and treatment research.

## Key findings

- AVMs are present at birth and involve abnormal artery-vein connections.
- Current treatments are limited and AVMs can lead to severe health outcomes.
- Research gaps need to be addressed to develop effective therapies.

## Abstract

Arteriovenous malformations are a vascular anomaly typically present at birth, characterized by an abnormal connection between an artery and a vein (bypassing the capillaries). These high flow lesions can vary in size and location. Therapeutic approaches are limited, and AVMs can cause significant morbidity and mortality. Here, we describe our current understanding of the pathogenesis of arteriovenous malformations based on preclinical and clinical findings. We discuss past and present accomplishments and challenges in the field and identify research gaps that need to be filled for the successful development of therapeutic strategies in the future.

## Full-text entities

- **Genes:** MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, TGFB1 (transforming growth factor beta 1) [NCBI Gene 7040] {aka CAEND1, CED, DPD1, IBDIMDE, LAP, TGF-beta1}, Kdr (kinase insert domain protein receptor) [NCBI Gene 16542] {aka 6130401C07, Flk-1, Flk1, Krd-1, Ly73, VEGFR-2}, Smad1 (SMAD family member 1) [NCBI Gene 17125] {aka Mad1, Madh1, Madr1, Mlp1, MusMLP, dwf-A}, SMAD4 (SMAD family member 4) [NCBI Gene 4089] {aka DPC4, JIP, MADH4, MYHRS}, akt1 (AKT serine/threonine kinase 1) [NCBI Gene 101910198], ACVR2B (activin A receptor type 2B) [NCBI Gene 93] {aka ACTRIIB, ActR-IIB, HTX4}, Gdf2 (growth differentiation factor 2) [NCBI Gene 12165] {aka Bmp9}, EPHB4 (EPH receptor B4) [NCBI Gene 2050] {aka CMAVM2, HFASD, HTK, LMPHM7, MYK1, TYRO11}, Sele (selectin E) [NCBI Gene 25544], RET (ret proto-oncogene) [NCBI Gene 5979] {aka CDHF12, CDHR16, HSCR1, MEN2A, MEN2B, MTC1}, HHT3 (Osler-Rendu-Weber syndrome 3) [NCBI Gene 780903] {aka ORW3}, Vegfa (vascular endothelial growth factor A) [NCBI Gene 22339] {aka L-VEGF, Vegf, Vpf}, BMPR2 (bone morphogenetic protein receptor type 2) [NCBI Gene 659] {aka BMPR-II, BMPR3, BMR2, BRK-3, POVD1, PPH1}, ACVRL1 (activin A receptor like type 1) [NCBI Gene 94] {aka ACVRLK1, ALK-1, ALK1, HHT, HHT2, ORW2}, MAPK1 (mitogen-activated protein kinase 1) [NCBI Gene 5594] {aka ERK, ERK-2, ERK2, ERT1, MAPK2, NS13}, N (Notch) [NCBI Gene 31293] {aka 1.1, 16-178, 16-55, Ax, CG3936, CT13012}, Smad4 (SMAD family member 4) [NCBI Gene 17128] {aka D18Wsu70e, DPC4, Madh4}, Eng (endoglin) [NCBI Gene 13805] {aka CD105, Endo, S-endoglin}, BMP1 (bone morphogenetic protein 1) [NCBI Gene 649] {aka OI13, PCOLC, PCP, TLD}, BMP10 (bone morphogenetic protein 10) [NCBI Gene 27302], vegfaa (vascular endothelial growth factor Aa) [NCBI Gene 30682] {aka vegf, vegfa, wu:fj82c06}, Smad2 (SMAD family member 2) [NCBI Gene 17126] {aka 7120426M23Rik, Madh2, Madr2, Smad-2, mMad2}, RASA1 (RAS p21 protein activator 1) [NCBI Gene 5921] {aka CM-AVM, CMAVM, CMAVM1, GAP, PKWS, RASA}, KRAS (KRAS proto-oncogene, GTPase) [NCBI Gene 3845] {aka 'C-K-RAS, C-K-RAS, CFC2, K-RAS2A, K-RAS2B, K-RAS4A}, ENG (endoglin) [NCBI Gene 2022] {aka END, HHT1, ORW1}, GDF2 (growth differentiation factor 2) [NCBI Gene 2658] {aka BMP-9, BMP9, HHT5}, p38b (p38b MAP kinase) [NCBI Gene 34780] {aka 186F5S, BG:DS00797.3, CG7393, D-p38, D-p38 MAPK, D-p38b}, PTEN (phosphatase and tensin homolog) [NCBI Gene 5728] {aka 10q23del, BZS, CWS1, DEC, GLM2, MHAM}, Tgfbr1 (transforming growth factor, beta receptor I) [NCBI Gene 21812] {aka ALK5, Alk-5, ESK2, TGFR-1, TbetaR-I, TbetaRI}, MAPK14 (mitogen-activated protein kinase 14) [NCBI Gene 1432] {aka CSBP, CSBP1, CSBP2, CSPB1, EXIP, Mxi2}, map2k1 (mitogen-activated protein kinase kinase 1) [NCBI Gene 406728] {aka mek1, si:ch211-242m18.2, wu:fj56a12, wu:fj61b01, zgc:56557}, BRAF (B-Raf proto-oncogene, serine/threonine kinase) [NCBI Gene 673] {aka B-RAF1, B-raf, BRAF-1, BRAF1, NS7, RAFB1}, MAP2K7 (mitogen-activated protein kinase kinase 7) [NCBI Gene 5609] {aka JNKK2, MAPKK7, MEK, MEK 7, MKK7, PRKMK7}, Acvrl1 (activin A receptor, type II-like 1) [NCBI Gene 11482] {aka Acvrlk1, Alk1}, AKT1 (AKT serine/threonine kinase 1) [NCBI Gene 207] {aka AKT, PKB, PKB-ALPHA, PRKBA, RAC, RAC-ALPHA}, ELN (elastin) [NCBI Gene 2006] {aka ADCL1, SVAS, WBS, WS}, HHT4 (Telangiectasia, hereditary hemorrhagic, type 4) [NCBI Gene 791087], Mtor (mechanistic target of rapamycin kinase) [NCBI Gene 56717] {aka 2610315D21Rik, FRAP, FRAP2, Frap1, RAFT1, RAPT1}, Angpt2 (angiopoietin 2) [NCBI Gene 11601] {aka Agpt2, Ang-2, Ang2}, RPS6 (ribosomal protein S6) [NCBI Gene 6194] {aka S6, eS6}, PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) [NCBI Gene 5290] {aka CCM4, CLAPO, CLOVE, CWS5, HMH, MCAP}, MAP2K1 (mitogen-activated protein kinase kinase 1) [NCBI Gene 5604] {aka CFC3, MAPKK1, MEK1, MEL, MKK1, PRKMK1}, VEGFA (vascular endothelial growth factor A) [NCBI Gene 7422] {aka L-VEGF, MVCD1, VEGF, VPF}
- **Diseases:** fibrosis (MESH:D005355), Vascular anomalies (MESH:D020785), vascular defects (MESH:D057772), telangiectatic lesions (MESH:D001816), autosomal dominant syndrome (MESH:D030342), cancer (MESH:D009369), HHT type 2 (MESH:C537139), hematologic malignancies (MESH:D019337), mucocutaneous telangiectasias (MESH:D013684), autism spectrum disorder (MESH:D000067877), PHTS (MESH:D006223), bAVM hemorrhage (MESH:D020300), AVM (MESH:D002538), venous malformations (MESH:C563977), skin discoloration (MESH:D014075), embryonic lethality (MESH:D020964), benign and malignant tumors (MESH:D018198), thyroid (MESH:D013966), inflammation (MESH:D007249), IHCT (MESH:D006391), somatic disorders (MESH:D013001), HHT (MESH:D013683), head and neck AVMs (MESH:D006258), lymphatic malformations (MESH:D008209), blepharitis (MESH:D001762), Neural hyperplasia (MESH:D006965), pain (MESH:D010146), autosomal dominant condition (MESH:C566739), arteriovenous malformations (MESH:D001165), fistulas (MESH:D005402), cardiac failure (MESH:D006333), thrombosis (MESH:D013927), liver VMs (MESH:D017093), organ dysfunction (MESH:D009102), gastrointestinal bleeding (MESH:D006471), cardiac involvement (MESH:D006331), kidney (MESH:D007674), PAH (MESH:D000081029), tumor predisposition (OMIM:614327), tumorigenic disorders (MESH:D002471), stroke (MESH:D020521), hamartomatous vascular malformation (MESH:D054079), ischemia (MESH:D007511), pulmonary hypertension (MESH:D006976), brain abscess (MESH:D001922), vasculature malformation diseases (MESH:C565633), CMs (OMIM:163000), breast (MESH:D061325), trauma (MESH:D014947), AVMs (MESH:C564254), venous hypertension (MESH:D014647), cutaneous vascular lesions (MESH:D014652), abdominal pain (MESH:D015746), portal hypertension (MESH:D006975), hyperthermia (MESH:D005334), epistaxis (MESH:D004844), embolization (MESH:D004617), bleeding (MESH:D006470), hypoxemia (MESH:D000860), overgrowth syndromes (MESH:C537340)
- **Species:** Homo sapiens (human, species) [taxon 9606], Rattus norvegicus (brown rat, species) [taxon 10116], Danio rerio (leopard danio, species) [taxon 7955], Mus musculus (house mouse, species) [taxon 10090]
- **Cell lines:** ALK1iEC — Homo sapiens (Human), Ovarian endometriotic cyst, Telomerase immortalized cell line (CVCL_A9J8)

## Full text

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## References

125 references — full list in the complete paper: https://tomesphere.com/paper/PMC8396465/full.md

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Source: https://tomesphere.com/paper/PMC8396465