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Endothelial estrogen receptor alpha (ESR1) regulates cerebral cavernous malformation pathogenesis via MEKK3-KLF signaling pathway.

Overview

Authors: Hamidreza Sadegh1, Liwenyu Chen2, Suyun Yu2, Sobia Idrees1, Matthew Foley3, Keshav Raj Paudel1,4, Jia Li5, Yang Zhao2,6, Jaesung P Choi1,7
  1. Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute and University of Technology Sydney (UTS), Sydney NSW, Australia
  2. School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China
  3. Sydney Microscopy & Microanalysis, The University of Sydney, Camperdown, NSW, Australia
  4. NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
  5. Curtin Medical School, Curtin Medical Research Institute, Curtin University, Bentley, WA, Australia
  6. Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China
  7. School of Biomedical Sciences, UNSW Sydney, Kensington, NSW, Australia
Dates: received 15 December 2025; accepted 30 June 2026; published online 6 July 2026; in print July 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1177/0271678x261468891 · PMID 42410678 · PMCID PMC13388494 · OpenAlex W7167627986
Open access: hybrid, a free copy (OpenAlex)
Status: data only
Categories: mouse (organism), stroke (population), cellular / molecular (subfield)
Methods: Statistics, Connectivity
Keywords: Cerebral cavernous malformation, KRIT1, ESR1, estrogen, stroke
Topic: Vascular Malformations Diagnosis and Treatment (Neurology, Medicine), according to OpenAlex
Funding: University of New South Wales; university of technology sydney; National Natural Science Foundation of China (82274233); NSW Health
Citations: not cited yet (Europe PMC); 39 references in the paper

Abstract

Cerebral cavernous malformations (CCMs) are common brain hemangioma that can occur sporadically or be inherited. CCM is one of the major causes of hemorrhagic stroke and neurological deficits in children. There are no pharmacological treatments for CCM. Clinical observations suggest that estrogen may have important roles in CCM, however, it has not been investigated. Hence, we investigated the role of estrogen and its nuclear receptors estrogen receptor-α (Esr1) in experimental CCM. To determine the role of endothelial ESR1 in CCM, we crossed homozygous endothelial Esr1 (Esr1fl/fl) mice into Ccm1iECKO mice. Micro-computed tomography (micro-CT) imaging was used to analyze CCM burden. To determine the therapeutic potential of estrogen, we treated Ccm1iECKO mice with estradiol (E2, a clinically approved estrogen). Gene and protein expressions were assessed in human umbilical vein endothelial cells (HUVECs). Homozygous deletion of endothelial Esr1 in Ccm1iECKO mice significantly increased CCM lesion volume compared to littermate controls. KLF2/4 and downstream expressions in HUVECs were further increased by ESR1 depletion. This correlated with increased lesion burden in Ccm1iECKOEsr1fl/fl mice. Furthermore, we demonstrated E2 treatment in Ccm1iECKO mice prevented CCM pathogenesis by normalizing KLF2/4 and downstream expressions. Our study demonstrates ESR1 as a novel targeted therapeutic option for CCM.

Reproduced under the paper's license (CC BY), from the paper cited above.

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Version 1, 27 September 2026: the first record

Recorded: type, language, journal, pages, dates, 9 authors, 5 keywords, 4 funders, 39 references.

Cite

This paper

Sadegh, H., Chen, L., Yu, S., Idrees, S., Foley, M., Paudel, K. R., Li, J., Zhao, Y., & Choi, J. P. (2026). Endothelial estrogen receptor alpha (ESR1) regulates cerebral cavernous malformation pathogenesis via MEKK3-KLF signaling pathway. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 0271678X261468891. https://doi.org/10.1177/0271678x261468891

BibTeX

@article{sadegh2026endothelial,
author = {Sadegh, Hamidreza and Chen, Liwenyu and Yu, Suyun and Idrees, Sobia and Foley, Matthew and Paudel, Keshav Raj and Li, Jia and Zhao, Yang and Choi, Jaesung P},
title = {{Endothelial estrogen receptor alpha (ESR1) regulates cerebral cavernous malformation pathogenesis via MEKK3-KLF signaling pathway}},
journal = {Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism},
year = {2026},
month = jul,
pages = {0271678X261468891},
publisher = {SAGE Publications},
issn = {0271-678X},
doi = {10.1177/0271678x261468891},
url = {https://doi.org/10.1177/0271678x261468891},
pmid = {42410678},
pmcid = {PMC13388494}
}

RIS

TY - JOUR
AU - Sadegh, Hamidreza
AU - Chen, Liwenyu
AU - Yu, Suyun
AU - Idrees, Sobia
AU - Foley, Matthew
AU - Paudel, Keshav Raj
AU - Li, Jia
AU - Zhao, Yang
AU - Choi, Jaesung P
TI - Endothelial estrogen receptor alpha (ESR1) regulates cerebral cavernous malformation pathogenesis via MEKK3-KLF signaling pathway
T2 - Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
J2 - J Cereb Blood Flow Metab
PY - 2026
DA - 2026/07/06
SP - 0271678X261468891
SN - 0271-678X
PB - SAGE Publications
DO - 10.1177/0271678x261468891
UR - https://doi.org/10.1177/0271678x261468891
LA - en
ER -

CSL-JSON

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