Cargando…

Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?

Neurofibromatosis type 1 (NF1) is a neurocutaneous syndrome caused by pathogenic variants in the NF1 gene, encoding a multidomain inhibitor of Ras activity. Thus, NF1 is considered a RASopathy and drugs targeting the RAS/mitogen-activated protein kinase (MAPK) pathway, such as the MAP kinase (MEK) 1...

Descripción completa

Detalles Bibliográficos
Autores principales: Chelleri, Cristina, Scala, Marcello, De Marco, Patrizia, Traverso, Monica, Ognibene, Marzia, Bruno, Irene, Piccolo, Gianluca, Striano, Pasquale, Severino, Mariasavina, Zara, Federico, Diana, Maria Cristina, Pavanello, Marco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010568/
https://www.ncbi.nlm.nih.gov/pubmed/36923276
http://dx.doi.org/10.3389/fped.2023.1051026
_version_ 1784906202356908032
author Chelleri, Cristina
Scala, Marcello
De Marco, Patrizia
Traverso, Monica
Ognibene, Marzia
Bruno, Irene
Piccolo, Gianluca
Striano, Pasquale
Severino, Mariasavina
Zara, Federico
Diana, Maria Cristina
Pavanello, Marco
author_facet Chelleri, Cristina
Scala, Marcello
De Marco, Patrizia
Traverso, Monica
Ognibene, Marzia
Bruno, Irene
Piccolo, Gianluca
Striano, Pasquale
Severino, Mariasavina
Zara, Federico
Diana, Maria Cristina
Pavanello, Marco
author_sort Chelleri, Cristina
collection PubMed
description Neurofibromatosis type 1 (NF1) is a neurocutaneous syndrome caused by pathogenic variants in the NF1 gene, encoding a multidomain inhibitor of Ras activity. Thus, NF1 is considered a RASopathy and drugs targeting the RAS/mitogen-activated protein kinase (MAPK) pathway, such as the MAP kinase (MEK) 1/2 inhibitor Selumetinib, are promising therapeutic options to treat NF1-associated tumors, especially plexiform neurofibromas and optic way gliomas. However, surgical treatment is often required for NF1-related cerebrovascular manifestations, such as moyamoya syndrome (MMS). We report a case of an 8-year-old patient receiving Selumetinib at the dose of 25 mg/m2 orally 2 times a day as a treatment for many plexiform neurofibromas. He suffered from two close strokes and brain MRI revealed a severe cerebral vasculopathy consistent with MMS, with marked stenosis of both the internal carotid arteries. A two-step surgical revascularization procedure was performed, consisting of a direct by-pass with an encephalo-mio-synangiosis (EMS) followed by encephalo-duro-arterio-synangiosis (EDAS). Surprisingly, despite the surgical technical success, follow-up MRI revealed lack of the expected revascularization. Selumetinib is a powerful therapeutic option in the treatment of severe NF1-related tumors. However, our findings suggest that this drug may interfere with cerebral neovascularization in patients with MMS requiring surgical revascularization. This is supported by the crucial role of the Vascular-Endothelial Growth Factor (VEGF), whose signaling pathway involve MAPK, as promoter of the neovascularization. Our observations suggest to adopt an imaging surveillance strategy to prevent unfavorable surgical outcome in patients with NF1-associated MMS receiving Selumetinib, and that priority should be given to surgical revascularization.
format Online
Article
Text
id pubmed-10010568
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-100105682023-03-14 Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation? Chelleri, Cristina Scala, Marcello De Marco, Patrizia Traverso, Monica Ognibene, Marzia Bruno, Irene Piccolo, Gianluca Striano, Pasquale Severino, Mariasavina Zara, Federico Diana, Maria Cristina Pavanello, Marco Front Pediatr Pediatrics Neurofibromatosis type 1 (NF1) is a neurocutaneous syndrome caused by pathogenic variants in the NF1 gene, encoding a multidomain inhibitor of Ras activity. Thus, NF1 is considered a RASopathy and drugs targeting the RAS/mitogen-activated protein kinase (MAPK) pathway, such as the MAP kinase (MEK) 1/2 inhibitor Selumetinib, are promising therapeutic options to treat NF1-associated tumors, especially plexiform neurofibromas and optic way gliomas. However, surgical treatment is often required for NF1-related cerebrovascular manifestations, such as moyamoya syndrome (MMS). We report a case of an 8-year-old patient receiving Selumetinib at the dose of 25 mg/m2 orally 2 times a day as a treatment for many plexiform neurofibromas. He suffered from two close strokes and brain MRI revealed a severe cerebral vasculopathy consistent with MMS, with marked stenosis of both the internal carotid arteries. A two-step surgical revascularization procedure was performed, consisting of a direct by-pass with an encephalo-mio-synangiosis (EMS) followed by encephalo-duro-arterio-synangiosis (EDAS). Surprisingly, despite the surgical technical success, follow-up MRI revealed lack of the expected revascularization. Selumetinib is a powerful therapeutic option in the treatment of severe NF1-related tumors. However, our findings suggest that this drug may interfere with cerebral neovascularization in patients with MMS requiring surgical revascularization. This is supported by the crucial role of the Vascular-Endothelial Growth Factor (VEGF), whose signaling pathway involve MAPK, as promoter of the neovascularization. Our observations suggest to adopt an imaging surveillance strategy to prevent unfavorable surgical outcome in patients with NF1-associated MMS receiving Selumetinib, and that priority should be given to surgical revascularization. Frontiers Media S.A. 2023-02-27 /pmc/articles/PMC10010568/ /pubmed/36923276 http://dx.doi.org/10.3389/fped.2023.1051026 Text en © 2023 Chelleri, Scala, De Marco, Traverso, Ognibene, Bruno, Piccolo, Striano, Severino, Zara, Diana and Pavanello. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Chelleri, Cristina
Scala, Marcello
De Marco, Patrizia
Traverso, Monica
Ognibene, Marzia
Bruno, Irene
Piccolo, Gianluca
Striano, Pasquale
Severino, Mariasavina
Zara, Federico
Diana, Maria Cristina
Pavanello, Marco
Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?
title Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?
title_full Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?
title_fullStr Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?
title_full_unstemmed Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?
title_short Case report: Revascularization failure in NF1-related moyamoya syndrome after selumetinib: A possible pathophysiological correlation?
title_sort case report: revascularization failure in nf1-related moyamoya syndrome after selumetinib: a possible pathophysiological correlation?
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010568/
https://www.ncbi.nlm.nih.gov/pubmed/36923276
http://dx.doi.org/10.3389/fped.2023.1051026
work_keys_str_mv AT chellericristina casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT scalamarcello casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT demarcopatrizia casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT traversomonica casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT ognibenemarzia casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT brunoirene casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT piccologianluca casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT strianopasquale casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT severinomariasavina casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT zarafederico casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT dianamariacristina casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation
AT pavanellomarco casereportrevascularizationfailureinnf1relatedmoyamoyasyndromeafterselumetinibapossiblepathophysiologicalcorrelation