YES1, a plasma-based biomarker for cavernous malformations.

OBJECTIVE: Cerebral cavernous malformations (CCMs) are low-flow vascular malformations commonly found in the central nervous system with the potential to cause neurological deficits, seizures, and headache through bleeding and growth. CCMs are typically assessed with imaging such as MRI or CT. However, there is a clinical need to reduce the cost, risk (with sedation/anesthesia in children), and travel associated with these imaging studies. Prior work from the authors' group and others have highlighted the potential utility of noninvasive biomarkers as tools to potentially complement the use of imaging. Here, the authors present YES1, a member of the Src family kinases, as a potential plasma-based biomarker associated with the presence of CCM. METHODS: Plasma samples from symptomatic patients with pathology-confirmed CCM (n = 16) (aged 1-22 years) and healthy matched control subjects (n = 24) (aged 1-19 years) were obtained and compared after institutional review board approval. Protein levels of CCM and control plasma were analyzed using the Olink Proximity Extension Assay (PEA), and ELISA was used to confirm findings. Patient-derived primary cells and CCM tissues were stained for YES1. CCM tissues were sequenced to evaluate the mutational profile of YES1. RESULTS: Compared to healthy controls, patients with CCM showed significantly higher levels of plasma YES1 (approximately 4.5-fold higher, p = 0.002). Analysis confirmed the presence of YES1 in the source CCM tissue, linking pathology with putative biomarker expression. Whole exome sequencing (WES) revealed functional mutations in the gene encoding for YES1, providing an avenue of investigation to explore and to explain the overexpression of YES1. CONCLUSIONS: Here, for the first time, the authors present a putative diagnostic biomarker for CCM, YES1, that was demonstrated to be significantly elevated in the plasma of affected patients, with high correlative expression in the source tissue. Together, these data further support the development of CCM-related noninvasive biomarkers and may add insight into their pathogenesis.