# Personalized hemodynamic and metabolic signatures of revascularization response in moyamoya disease

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2024 · $594,764

## Abstract

PROJECT SUMMARY
This work proposes a multi-site study between Vanderbilt University Medical Center (VUMC) and Johns Hopkins
University (JHU) that will apply novel neuroimaging and angiographic tools to test fundamental hypotheses
regarding how biomarkers of stroke risk, vascular steno-occlusion, and cerebrospinal fluid (CSF) motion inform
treatment candidacy and pathogenesis in North American patients with idiopathic moyamoya disease (MMD).
MMD has unknown etiology and is characterized by steno-occlusion of the supraclinoid internal carotid arteries
and proximal branches, subsequent development of collateral vessels, and more than a seven-fold risk increase
of stroke. Importantly, once thought to be a rare condition affecting primarily females of Asian ethnicity, or more
common as a syndromic complication of other disorders, MMD is being reported with increasing frequency in
North America. While much work has increased our understanding of cerebrovascular disease treatments
generally, MMD etiology remains unknown, animal disease models do not exist, biomarkers that may place
patients at highest risk for stroke have not been conclusively established, and randomized treatment trials have
not been performed. As randomized clinical trials of surgical revascularization vs. medical management are
unethical owing to the benefits that revascularization surgery is believed to confer for many patients, there is
now a need to accurately identify factors that underlie the North American phenotype and develop personalized
signatures of tissue physiology that inform neurological impairment and treatment response in these patients.
To address this need, Radiology, Neurology, and Neurosurgery faculty at VUMC and JHU have developed and
applied magnetic resonance imaging (MRI) and angiographic tools, on similar MRI and digital subtraction
angiography equipment, to help characterize the spectrum and hemodynamic origins of impairment in North
American MMD patients undergoing these indirect surgical revascularizations. Here, we propose to extend these
promising single center studies to evaluate generalizable and pre-surgical biomarkers of ischemic
symptomatology, surgical response, and cerebral ischemia by leveraging overlapping imaging equipment,
established investigators with ongoing collaborations, and two of the largest North American MMD treatment
centers. Additionally, we will explore new directions in this field, whereby we will evaluate whether neuroimaging
markers of aberrant neurofluid flow provide indicators of impaired cortical hemodynamics. Successful completion
should provide new technologies that can expand the diagnostic and surveillance imaging infrastructure for the
growing number of patients with idiopathic moyamoya disease.

## Key facts

- **NIH application ID:** 10890991
- **Project number:** 1R01NS133101-01A1
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Manus J Donahue
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $594,764
- **Award type:** 1
- **Project period:** 2024-05-01 → 2029-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10890991

## Citation

> US National Institutes of Health, RePORTER application 10890991, Personalized hemodynamic and metabolic signatures of revascularization response in moyamoya disease (1R01NS133101-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10890991. Licensed CC0.

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