Cerebral cavernous malformations (CCMs) are common vascular anomalies that develop in the central nervous system and, more rarely, the retina. The lesions can cause headache, seizures, focal neurological deficits, and hemorrhagic stroke. Symptomatic lesions are treated according to their presentation; however, targeted pharmacological therapies that improve the outcome of CCM disease are currently lacking. We performed a high-throughput screen to identify Food and Drug Administration-approved drugs or other bioactive compounds that could effectively suppress hyperproliferation of mouse brain primary astrocytes deficient for CCM3. We demonstrate that fluvastatin, an inhibitor of 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase and the N-bisphosphonate zoledronic acid monohydrate, an inhibitor of protein prenylation, act synergistically to reverse outcomes of CCM3 loss in cultured mouse primary astrocytes and in Drosophila glial cells in vivo. Further, the two drugs effectively attenuate neural and vascular deficits in chronic and acute mouse models of CCM3 loss in vivo, significantly reducing lesion burden and extending longevity. Sustained inhibition of the mevalonate pathway represents a potential pharmacological treatment option and suggests advantages of combination therapy for CCM disease.cerebral cavernous malformations | fluvastatin | zoledronic acid | mevalonate pathway | high-throughput screen C erebral cavernous malformations (CCMs) are common vascular malformations that develop in the brain, spinal cord, and, more rarely, the retina (1, 2). The lesions consist of dilated sinusoidal channels lined with a single layer of endothelium devoid of vessel wall elements. CCM disease is often asymptomatic, but on occasion the lesions rupture leading to hemorrhagic stroke. Other common symptoms are headache, seizures, and focal neurological deficits. Treatment options include observation of asymptomatic lesions, antiepileptic medication, and surgical excision of lesions in patients with symptomatic or repetitive hemorrhages or intractable seizures; however pharmacological therapies that improve outcome are lacking. CCM disease is usually sporadic, although 20% of patients carry lossof-function mutations in one of three genes: CCM1 (also known as "KRIT1"), CCM2, and CCM3 (also known as "PDCD10") (3), which encode structurally unrelated cytoplasmic proteins with critical roles in endothelial cells (4) and, uniquely for CCM3, in neurons and astrocytes as well (5, 6). CCM3 loss in neural progenitors results in hyperproliferation/activation of brain astrocytes and enhanced activity of RhoA in vivo and increased proliferation and survival of primary astrocytes in vitro (5, 6). We took advantage of these well-defined cellular phenotypes of CCM3 loss to explore potential pharmacological treatment options for CCM. High-throughput screening of available drugs identified fluvastatin, a 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase inhibitor as a top candidate. In combination with the N-bisphosphonate zoledronic acid monohyd...