Moyamoya disease and angiogenesis: a quantitative analysis of key angiogenic markers

Moyamoya disease (MMD) is a cerebrovascular condition characterized by progressive narrowing of the internal carotid arteries and their adjacent branches. Aberrant angiogenesis plays a crucial role in its pathogenesis, contributing to both ischemic and hemorrhagic complications. This study aimed to identify potential biomarkers with prognostic value by investigating angiogenic markers in MMD patients. Paired blood and dura mater tissue samples were collected from MMD patients and healthy controls. Using quantitative reverse transcription-polymerase chain reaction, we analysed the expression levels of various angiogenic markers, including vascular endothelial growth factor, Transforming growth factor-β1, Basic fibroblast growth factor, Hypoxia-inducible factor 1-alpha, Platelet-derived growth factor, and Angiopoietin-1. VEGF and TGF-β1 expression were validated at the transcript level (qRT-PCR) in a separate cohort of MMD patients with VEGF further confirmed at the protein level using Enzyme-Linked Immunosorbent Assay. We observed significant increase in expression levels of VEGF, HIF-1α, TGF-β1, bFGF, PDGF and ANG-1 in the dura samples of MMD patients compared to controls. However, in serum samples, only VEGF, TGF-β1, and bFGF were found to be up-regulated. Validation revealed significant upregulation of VEGF and TGF-β1 at the transcript level, with VEGF also markedly elevated at protein level. Study highlights the upregulation of key angiogenic markers in MMD, with VEGF and TGF-β1 showing consistent elevation across tissue and serum samples. These findings suggest their potential role in MMD pathophysiology and as possible biomarkers for disease progression.