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Hereditary hemorrhagic telangiectasia: from signaling insights to therapeutic advances
Tala Al Tabosh, … , Sophie Dupuis-Girod, Sabine Bailly
Tala Al Tabosh, … , Sophie Dupuis-Girod, Sabine Bailly
Published February 15, 2024
Citation Information: J Clin Invest. 2024;134(4):e176379. https://doi.org/10.1172/JCI176379.
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Review Series

Hereditary hemorrhagic telangiectasia: from signaling insights to therapeutic advances

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Abstract

Hereditary hemorrhagic telangiectsia (HHT) is an inherited vascular disorder with highly variable expressivity, affecting up to 1 in 5,000 individuals. This disease is characterized by small arteriovenous malformations (AVMs) in mucocutaneous areas (telangiectases) and larger visceral AVMs in the lungs, liver, and brain. HHT is caused by loss-of-function mutations in the BMP9-10/ENG/ALK1/SMAD4 signaling pathway. This Review presents up-to-date insights on this mutated signaling pathway and its crosstalk with proangiogenic pathways, in particular the VEGF pathway, that has allowed the repurposing of new drugs for HHT treatment. However, despite the substantial benefits of these new treatments in terms of alleviating symptom severity, this not-so-uncommon bleeding disorder still currently lacks any FDA- or European Medicines Agency–approved (EMA-approved) therapies.

Authors

Tala Al Tabosh, Mohammad Al Tarrass, Laura Tourvieilhe, Alexandre Guilhem, Sophie Dupuis-Girod, Sabine Bailly

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Figure 3

Therapeutic targets of antiangiogenic drugs tested in preclinical models and in HHT patients.

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Therapeutic targets of antiangiogenic drugs tested in preclinical models...
Figure shows the targets of drugs tested in completed clinical trials (red), drugs currently under testing or with a case report (orange), and drugs tested only in preclinical models (blue). For further details, see Table 1 and Table 2. Drugs have been developed to block VEGF-A signaling using neutralizing anti–VEGF-A mAbs (bevacizumab) or soluble trap/decoy receptors that bind VEGF-A (red), VEGF-B (yellow), and PlGF (blue) (aflibercept), or neutralizing anti-VEGFR2 antibodies (D5B1 and DC101). Drugs developed to block intracellular signaling, such as tyrosine kinase receptor inhibitors that block VEGFR2 activity but also other receptors, are currently undergoing testing: pazopanib (VEGFR, PDGFR, c-KIT, and FGFR) and nintedanib (VEGFR, PDGFR, and FGFR). Drugs have also been developed to block PI3K and AKT (VAD044), as well as mTORC1 (sirolimus) and calcineurin and FKBP12 (tacrolimus). Immunomodulatory imide drugs (IMIDS), such as thalidomide and pomalidomide, have been tested in HHT patients. Other drugs have been tested so far only in preclinical models, such as the neutralizing anti-Ang2 monoclonal antibodies (LC10) and inhibitors of CDK4/6 (palbociclib and ribociclib).

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ISSN: 0021-9738 (print), 1558-8238 (online)

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