gms | German Medical Science

Objective: Endothelial tight junction (TJ) expression in cerebral cavernous malformations (CCM) is mostly absent, which causes increased perilesional erythrocyte and fluid oozing. However, in a subset of CCM lesions, foci of preserved TJ staining are observed along endothelial cell contacts. We evaluated the clinical relevance of the focal TJ protein expression and the association with CCM bleeding propensity.

Method: Immunohistochemical staining for the TJ proteins claudin-5, occludin and ZO-1 was performed on 32 CCM specimens, surgically resected in the period 2008-2010. The patients were allocated in two groups according to TJ protein expression and the clinical and radiological parameters of aggressiveness were analyzed and compared.

Results: Complete absence was identified in 20 and focal TJ protein expression in 12 specimen. CCM’s with absent TJ immunoreactivity had significantly larger size (p=0.02) as well as higher propensity for development of frank hematomas (p=0.03) and perilesional edema (p=0.01). Symptom severity, multiplicity, DVA presence and CCM location did not show a significant difference depending on TJ expression.

Conclusions: In a univariate analysis we observed significantly lesser propensity for frank hematomas and perilesional edema as well as smaller size in CCM lesions with focal TJ expression. Although it cannot be used in predictive manner, the observed difference in TJ protein expression might be the rational for different bleeding propensity of the CCM lesions. This is a basis for further multivariate analyses of possible CCM biologic predictors.