Current data from our lab and others supports the hypothesis of angiogenesis and extracellular matrix (ECM) remodeling as essential processes in many CNS disorders, including moyamoya disease, involving vascular endothelial growth factor (VEGF), matrix metalloproteinases (MMPs), a multigene family of degradative enzymes and neutrophil gelatinase associated lipocalin (NGAL), an enzyme that binds with MMP-9 to protect it from degradation—and elevated levels of MMPs and VEGF have been reported in the serum of moyamoya disease patients (2, 4, 5, 22–30). This evidence concerns the gene MMP9 and central nervous system disorder.