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Inflammation in Cerebral Cavernous Malformations: Differences Between Malformation Related Epilepsy vs. Symptomatic
Jan Rodemerk1, Adrian Engel1, Julius L H Horstmann1
1Department of Neurosurgery and Spine Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.
Cells
|October 15, 2025
Summary
Inflammation in cerebral cavernous malformations (CCMs) involves COX-2 and NLRP3 pathways. Symptomatic hemorrhage in CCM patients shows higher inflammatory enzyme activity than epilepsy cases.
Area of Science:
- Neuroscience
- Vascular Biology
- Immunology
Background:
- Cerebral cavernous malformations (CCMs) are vascular anomalies linked to seizures, neurological deficits, and stroke.
- Genetic mutations (CCM1-3) can cause inherited CCMs, while inflammation is a known factor in their development.
- Understanding inflammatory differences between CCM hemorrhage and epilepsy is crucial.
Purpose of the Study:
- To investigate the inflammatory mechanisms and differences in cerebral cavernous malformations (CCMs) associated with hemorrhage versus epilepsy.
- To compare the expression of inflammatory enzymes Cyclooxygenase 2 (COX-2) and NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3) in CCM tissues.
Main Methods:
- Microsurgical resection of CCMs from 28 patients (10 epilepsy, 18 hemorrhage).
- Immunohistochemical staining for COX-2 and NLRP3 on CCM tissue samples.
- Correlation of imaging and clinical data with immunohistochemical findings using the Trainable Weka Segmentation algorithm.
Main Results:
- NLRP3-positive cells (mean 65.82%) were more abundant than COX-2-positive cells (mean 45.87%).
- No correlation was found between CCM volume and hemorrhage events.
- Symptomatic brain hemorrhage in CCM patients showed significantly higher upregulation of COX-2 (p < 0.001) and NLRP3 (p = 0.009) compared to epilepsy patients.
Conclusions:
- Inflammatory processes in CCMs are driven by multiple pathways, with consistent activation of COX-2 and NLRP3.
- Symptomatic hemorrhage in CCM patients exhibits increased inflammatory enzyme activity compared to epilepsy.
- No direct links were identified between NLRP3, COX-2 expression, and patient-specific radiological, pathological, or pre-existing conditions.
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