Cerebral cavernous malformations (CCM) are common vascular lesions made of clusters of endothelia filled with blood that primarily affects the central nervous system. Loss-of-function mutations in the genes; KRIT1 ( Krev1 interaction trapped gene 1, CCM1), CCM2, or PDCD10 (Programmed cell death protein 10, CCM3) propel brain vascular changes marked by loss of endothelial tight and adherens junctions, altered basement membrane composition, increased angiogenesis, and altered number of intercellular signaling pathways (e.g., RhoA/ROCK,
Angiopoietin-2, reactive oxygen species (ROS), anti-coagulation pathway, and endothelial to mesenchymal transition (EndMT)). Moreover, our group, and others, demonstrated that increased vascular endothelial growth factor (VEGF) signaling and associated vascular permeability are significant contributors to CCM disease. Here we show that genetic inactivation of endothelial Pdcd10 in animals results in normoxic stability of hypoxia-inducible factor 1 α (HIF-1α). Our findings indicate that increase in HIF-1α leads to an upregulation of a hypoxic program with genes implicated in angiogenesis and cell metabolism. Furthermore, we show that an increase in COX-2, a direct HIF-1α target gene, contributes to brain lesion genesis because the administration of COX-2 inhibitor celecoxib significantly prevents CCM lesions in a pre-clinical mice model. Therefore, our findings support the hypothesis that components of the hypoxic program may represent potential therapeutic targets for CCM disease.