Another study, utilizing miRNA microarray analysis, found that miR‐3131, secreted by KRAS‐mutant ECs, can induce EndMT, with an increasing trend also observed in the peripheral blood of some patients with AVM. 105 Given that EndMT is associated with the bleeding phenotype, this study suggests that exosomes may help predict the bleeding risk of CVMs in a noninvasive manner.
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However, due to the short duration of medication and the small patient sample, only a trend toward reduced MMP‐9 levels was observed, which did not reach statistical significance. 208 Antiangiogenic drugs, such as bevacizumab, have been shown to reduce vascular density and dysplasia in a mouse model of brain AVM. 175 Furthermore, thalidomide reduced the burden of CD68+ cells and the expression of inflammatory cytokines in AVM lesions, although potential side effects cannot be ignored. 177 Regarding the immune microenvironment of CCM, the Kahn laboratory at the University of Pennsylvania reported a novel and intriguing role of the gut–brain axis in CCM pathogenesis.