Transcriptomic Profiling Associates Collagen-Rich Extracellular Matrix With Postoperative Angiogenesis in Moyamoya...

Indirect revascularization is an effective treatment for moyamoya disease (MMD), but the surgery effect depends on the collateral vessel formation. This study aimed to explore the molecular mechanisms associated with angiogenesis in the temporal muscle post-surgery. We employed a single-centre, prospective sampling, retrospective cohort design. Temporal muscle tissues were harvested during surgery, and comprehensive transcriptome-wide RNA sequencing was performed. Patients were categorized into Good (Matsushima Grade A, n = 13) and Poor (Matsushima Grade C, n = 12) collateralization groups based on postoperative angiography. Differentially expressed genes (DEGs) were analysed, and key findings were validated via quantitative real-time PCR (qPCR). A total of 25 patients were enrolled. Transcriptomic profiling revealed that pathways related to the extracellular matrix (ECM) and collagen family were significantly enriched in the Good group, suggesting a pivotal role for collagens in promoting postoperative angiogenesis. Subgroup analysis revealed distinct transcriptional profiles: paediatric patients exhibited a cluster characterized by high collagen expression alongside altered expression of genes related to mitochondrial electron transport. qPCR validation confirmed the upregulation of the core ECM component COL1A1 and the downregulation of the matrix-degrading enzyme MMP3 in the Good group, indicating active ECM remodelling within the temporal muscle. Collectively, these findings suggest that a collagen-rich ECM signature and the balance between collagen deposition and remodelling may modulate surgical efficacy in MMD.