Fluids and Barriers of the CNS

Purpose In idiopathic normal pressure hydrocephalus (iNPH), longitudinal monitoring of ventricular size is important for diagnosis and treatment follow-up. This study aimed to validate a fully automated AI model for CT ventricular volumetry with subcompartments and to compare AI-derived volume changes with routine radiology assessments. Methods This retrospective, single-center study included 88 patients with iNPH and 456 non-contrast-enhanced head CT examinations. The model was trained on 38 manually labeled CT scans with 12 ventricular subcompartments. Outcomes included segmentation accuracy, correspondence between AI-derived longitudinal ventricular volume changes and radiology report categories (decreased, unchanged, increased), radiologist detection thresholds for ventricular change, and paired pre- and postoperative volume changes in 22 patients with ventriculoperitoneal shunt. Results Mean segmentation accuracy was high (Dice, 0.83). 91% of 100 segmentations were rated as excellent by an expert neuroradiologist. AI-derived ventricular volume changes corresponded well to radiology report categories (median total ventricular volume changes of -17% in cases reported as decreased, 0% in unchanged cases, and +22% in increased cases; all p < 0.001). Radiologists reported ventricular volume change in 50% of cases at an AI-measured relative volume change of +/-6%, and in 90% of cases at +21% for enlargement and -18% for decrease. After shunt placement, ventricular volume decreased by -8% (median), with the largest relative reductions observed in the right temporal and occipital horns. Conclusions Automated AI-based ventricular segmentation on CT enables accurate and reproducible assessment of ventricular volume changes in iNPH and complements routine radiological evaluation for longitudinal and postoperative monitoring.

Understanding intracranial pressure (ICP) dynamics is essential for interpreting clinical infusion tests used in the diagnosis of cerebrospinal fluid circulation disorders. However, the complex coupling between vascular pulsations, cerebrospinal fluid flow, and intracranial compliance makes quantitative interpretation of these tests challenging. Here, I present a patient specific simulation framework based on an extended electrical analog model that reproduces intracranial pressure dynamics observed during clinical infusion tests. The model integrates physiological inputs including arterial blood pressure, heart rate, respiratory rhythm, and resistance to cerebrospinal fluid outflow derived from clinical data. Built upon the classical Ursino framework, the model incorporates several modifications enabling realistic representation of physiological pulsations and infusion test conditions. The resulting system functions as a hybrid electrical-numerical simulation model representing a simplified digital electrical twin of intracranial hydrodynamics. The model was validated using data from 21 clinical infusion tests performed in patients with suspected normal pressure hydrocephalus. Simulated intracranial pressure recordings were compared with clinical measurements using regression and residual analysis. The simulations demonstrated strong agreement with measured data, with a mean correlation coefficient of r = 0.95 (95% CI 0.94 - 0.96), mean residual values within -1.71 to +1.68 mmHg, and a mean root mean square error (RMSE) of 2.07 mmHg. These results demonstrate that the proposed model accurately reproduces the dynamic behavior of intracranial pressure observed during clinical infusion tests. The framework provides a physiologically grounded computational tool for studying patient specific intracranial dynamics and may support improved interpretation of infusion test results in clinical practice.

Objective: Shunt-dependent hydrocephalus is a common and costly complication of aneurysmal subarachnoid hemorrhage (aSAH), affecting up to 28% of survivors. Existing prediction tools, including the Chronic Hydrocephalus Ensuing from SAH Score (CHESS), have limited discriminative accuracy. We developed the CHECKMATE score, a clinically practical tool to improve prediction of ventriculoperitoneal shunt dependency after aSAH. Methods: In this multicenter retrospective cohort of 486 patients with aSAH from Mayo Clinic (January 1, 2006-December 31, 2021), we used multivariable logistic regression and machine learning to identify independent predictors of ventriculoperitoneal shunt placement. The CHECKMATE score was derived from 5 weighted variables: symptomatic hydrocephalus (10 points), intraventricular hemorrhage (5 points), SAH volume greater than 10 mL (3 points), neutrophil-to-lymphocyte ratio greater than 12 (2 points), and 10-year incremental age thresholds starting at older than 60 years (1 point each). Results: Of 486 patients (mean age, 56.3 years; 64.6% female), 137 (28.2%) required ventriculoperitoneal shunt placement. The CHECKMATE score achieved an area under the curve of 0.808 (compared to 0.737 for CHESS), with a sensitivity of 0.85, specificity of 0.67, and negative predictive value of 0.92 at the optimal cutoff of 14 points. Conclusions: The CHECKMATE score outperforms CHESS for predicting ventriculoperitoneal shunt dependency after aSAH and is easily used at the bedside. Its high negative predictive value helps identify low-risk patients who may benefit from earlier external ventricular drain weaning and shorter hospital stays.

A growing number of studies indicate the possible involvement of astrocytes in triggering or modulating neurovascular coupling (NVC), i.e. the local dilation of blood vessels in the brain in response to neuronal activity. Astrocytes possess specialized subcellular compartments, named endfeet, that surround arterioles and capillaries, ideally positioned to mediate NVC. Various vasodilators have been shown to contribute to NVC, such as epoxyeicosatrienoic acid (EET), nitric oxide (NO), or prostaglandin E2 (PGE2), but the precise mechanisms underlying NVC and their variability remain to be fully elucidated. In particular, the involvement of astrocytes in this process is controversial. Recent translatome and proteomics data reveal that astrocytes and in particular endfeet are enriched in the proteins of the PGE2 pathway. However, how the latter could contribute to NVC remains to be characterized. Here, we develop a computational model of astrocyte-mediated NVC that recapitulates these findings and describes Ca2+ and PGE2 signaling in astrocytes, NO release by neurons, and arteriole diameter dynamics using ordinary differential equations. The model successfully reproduces the dynamics of arteriole diameter change during hyperemia from in vivo neocortical recordings in awake mice. Our simulations suggest that the astrocyte PGE2 pathway could be responsible for the late response of NVC at the arteriolar level. We further observe that PIP2-derived diacylglycerol plays a major role in driving arteriole diameter dynamics in our model, while phosphatidic acid-derived diacylglycerol, which is calcium-dependent, mainly acts as an amplifier of this response. Finally, a spatial implementation of the model using a simplified astrocyte geometry suggests that NVC is more efficient when synaptic stimulation occurs at the endfoot level rather than at other astrocytic compartments. Overall, this computational study suggests a partial role for astrocyte-mediated PGE2 release in NVC and points to astrocyte perivascular processes as sub-compartments that are ideally positioned and equipped to mediate NVC. Author summaryIn the brain, the local blood flow is regulated to meet neuronal energy demand by modulating the dilation of neighboring blood vessels. The mechanisms driving this process, known as neurovascular coupling (NVC), remain debated and are likely to differ depending on the physiological context. Recent evidence points to astrocytes, a cell type possessing specialized protrusions called "endfeet", that envelop the entire brain vascular tree. Contacts between synapses and endfeet have recently been reported, positioning the latter as ideal mediators of NVC. Here, we developed a computational model that simulates the signaling between neurons, astrocytes, and blood vessels. Our model successfully reproduces experimental recordings of blood vessels dilation in the brains of awake mice. Our simulations suggest that a specific signaling pathway in astrocytes, involving a molecule called prostaglandin E2, is a key driver of the late phase of NVC, occurring a few seconds after neuronal activity. Furthermore, our model indicates that the location of the stimulated synapses matters: signals sent to the astrocyte endfeet are particularly effective at controlling blood flow. This work helps clarify the active role of astrocytes in brain blood flow regulation, a process critical for healthy brain function.

With the increasing prevalence of subcutaneous administration of peptides, understanding their release and absorption is key to designing formulations with desired pharmacokinetics. Though the absorption of monoclonal anti-bodies (mAbs) has been widely explored through computational modeling, that of peptides remains poorly understood, as key features of peptide absorption, including concentration-dependent oligomerization and reversible binding with serum albumin and extracellular matrix, have not been captured. In this work, we present a first-of-its-kind approach to simulating subcutaneous administration of peptides that couples a high-fidelity tissue-level poroelastic model with a systemic compartment pharmacokinetic model. While accounting for competing binding and oligomerization tendencies of peptides, the model not only captures the process of injection but also tracks the absorption over subsequent days. We demonstrate the model using a single-dose administration of semaglutide and validate it against experimentally observed pharmacokinetic parameters. The results show the distribution of the different forms of the injected peptide throughout the body and describe the role of binding in sustaining its release. The model also reveals novel mechanisms, such as albumin-bound monomers enveloping the plume and the balance of oligomerization and binding in early stages of peptide absorption.

The mechanisms driving interstitial fluid flow through brain parenchyma remain unresolved, limiting our understanding of how fluid transport contributes to glymphatic waste clearance and broader aspects of brain metabolism and neuronal activity. Existing theories based on diffusion or pressure gradients fail to explain sustained, directional flow through the tortuous extracellular space (ECS), particularly under normal physiologic conditions. Here we propose that electroosmosis, fluid motion driven by endogenous electric fields acting on charged brain tissue, provides a biophysically consistent mechanism for intraparenchymal interstitial fluid transport while generating pressure distributions favorable for periarterial influx and perivenous efflux. Using computational modeling informed by anatomical reconstructions of ECS microstructure and local field potential (LFP) recordings, we show that electroosmotic flow generates physiologically realistic velocities and reproduces brain state dependent differences in glymphatic transport, including the enhanced glymphatic flow observed during sleep compared to wakefulness. A physics-informed reduced-order model (ROM) further demonstrates that these microstructure-resolved results upscale consistently to tissue-level transport. Moreover, electroosmotic flow can induce directional pressure gradients across perivascular interfaces, facilitating both influx and efflux. This mechanism provides a unifying framework linking neuronal activity, parenchymal flow, and compartmental pressure regulation. In contrast, pressure gradients substantially larger than physiological estimates generated much smaller velocities and failed to account for the observed transport rates. These findings address a major gap in glymphatic physiology and suggest that modulation of electric field properties, via endogenous activity or external neuromodulation, could serve as a therapeutic strategy to enhance solute clearance in neurological disorders. Significance StatementA major challenge in brain physiology is the lack of a unifying physical model that explains how fluid moves through the narrow and tortuous extracellular space; a process essential for nutrient distribution and waste clearance. Existing frameworks cannot account for sustained, directional transport under normal physiological conditions. We show that electroosmosis (fluid motion generated when endogenous neuronal electric fields act on charged cellular surfaces) provides a biophysically consistent mechanism for this transport. Using realistic extracellular microstructures and a validated tissue scale reduced order model, our model reproduces experimentally observed brain state dependent transport. Establishing electroosmosis as a possible contributor to interstitial fluid movement offers a new conceptual basis for linking neuronal activity to fluid circulation and for guiding strategies to enhance brain clearance.

BackgroundtPA is used for the acute treatment of ischaemic stroke because it converts plasminogen to active plasmin, which breaks down clots. Previous studies show that tPA-activated plasminogen impairs brain endothelial barrier function. However, it is unclear whether the plasmin product of this reaction directly contributes to brain endothelial barrier deterioration. ObjectiveDetermine whether plasmin directly influences the human brain endothelial barrier. MethodsWe developed a new serum-free hCMEC/D3 culture model with ECIS real-time monitoring to establish how plasmin in isolation influences the brain endothelial barrier. ResultsECIS monitoring demonstrated that plasmin caused a concentration-dependent decline in hCMEC/D3 barrier integrity, which was primarily mediated by a reduction in endothelial cell-to-cell interactions. Whilst a decrease in membrane capacitance and increase in basolateral adhesion were also observed, these changes were less marked. The inclusion of 2-antiplasmin ameliorated the changes in hCMEC/D3 barrier properties, suggesting this response is mediated by plasmins proteolytic activity. Quantitative immunocytochemistry confirmed that plasmin stimulated a decline in the key junctional molecules, Claudin-5, VE-Cadherin (CD144), {beta}-Catenin, ZO-1 and PECAM-1 (CD31), which likely contributed to the deterioration of paracellular cell-to-cell interactions. Interestingly, using this serum-free model, tPA alone didnt influence hCMEC/D3 barrier properties, whilst tPA with plasminogen did, implicating plasmins involvement. ConclusionPlasmin directly impaired the barrier function of hCMEC/D3 brain endothelial cell monolayers by stimulating a decline in key junctional molecules. This plasmin-mediated brain endothelial barrier deterioration has important implications for tPA use and should be considered whilst designing safer thrombolytic treatment options for patients experiencing acute ischemic stroke.

Background: The hydrodynamic model of hydrocephalus proposes that ventriculomegaly is driven by exaggerated intraventricular pulsations rather than impaired CSF circulation alone. Under this model, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) treats hydrocephalus by creating a pulsation absorber and by reducing a primary source of intraventricular pulsation. However, direct intraoperative human evidence supporting this two-step mechanism is lacking. This study aimed to test the hypothesis that ETV followed by CPC would produce measurable, stepwise decreases in mean intraventricular pressure (ICP) and pulsation amplitude in infants with hydrocephalus. Methods: This single-institution proof-of-concept study included infants with symptomatic hydrocephalus undergoing ETV/CPC as the first definitive treatment. A fiber-optic ICP sensor was attached to the operative ventriculoscope and passively recorded mean and pulsatile ICP (pulsation amplitude) throughout the procedure. Longitudinal brain parenchymal volume (BPV) and cerebrospinal fluid volume (CSFV) were obtained through segmentation of clinically acquired T2-weighted MRI and converted to age- and sex-matched z-scores. All patients were followed for a minimum of 6 months postoperatively. Results: Five infants (median corrected age at ETV/CPC 8 months) were included. No surgical complications occurred, and no ETV/CPC failures were observed during follow-up. Overall, mean ICP decreased by 56-97% after the combined procedure in four patients. In three patients (Patients 1, 3, and 5), both mean ICP and pulsation amplitude decreased stepwise following ETV and then CPC, consistent with the hypothesized therapeutic mechanism. Patient 4 demonstrated a large reduction in mean ICP after ETV with minimal additional effect from CPC and no significant change in pulsation amplitude. Patient 2 demonstrated neither a reduction in mean ICP nor a meaningful change in pulsation amplitude after either procedure; this patient also had a delayed and atypical clinical response. Intracranial segmentation demonstrated BPV z-score stabilization within normal range and CSFV plateau in all patients after surgery. Conclusions: This proof-of-concept study provides the first direct intraoperative human evidence supporting the hydrodynamic mechanism of ETV/CPC in a subset of infant with hydrocephalus. Our findings suggest that determination of intraoperative ICP parameters is feasible, safe and might ultimately prove helpful in improving patient selection for ETV/CPC, warranting further investigation in larger cohorts.

Cerebral small vessel disease (cSVD) is a major contributor to stroke and cognitive decline, ultimately leading to vascular dementia (VaD). Genetic factors play a key role in the disease susceptibility and progression, and variants in COL4A1 cause one of the most common genetic cSVD. COL4A1 encodes the 1 subunit of type IV collagen, the principle extracellular matrix (ECM) protein in the basement membrane of vasculature. In the central nervous system (CNS), the neurovascular unit (NVU) has the unique astrocyte-derived parenchymal basement membrane (pBM), in addition to the vascular basement membrane (vBM), which together contributing to the regulation of the blood-brain barrier (BBB) function. However, the role of pBM in cSVD remains under investigated and poorly understood. The lack of relevant human models has limited our ability to dissect specific cell-cell and cell-matrix interactions, hindering the identification of effective therapeutic targets. In this study, we hypothesised that astrocyte-mediated ECM remodelling contributes to BBB dysfunction in COL4A1-associated cSVD. To investigate this, human induced pluripotent stem cells (hiPSCs) derived from a patient carrying the COL4A1G755R variant and its isogenic control line were differentiated into astrocytes and brain microvascular endothelial cells (BMECs). Comparing to isogenic controls, the COL4A1G755R astrocytes significantly reduced the expression of ECM-related genes and abnormally increased glutamate uptake. ECM preparations from COL4A1G755R astrocytes significantly damaged the tight junction (TJ) structure formed by control iPSC-derived BMECs and failed to rescue the compromised TJ integrity in COL4A1G755R BMECs. The secretome from COL4A1G755R astrocytes exaggerated the ECM abnormality in COL4A1G755R BMECs. Most importantly, reduced expression of HTRA1, a crucial serine protease known to regulate both ECM turnover and homeostasis, and increased TGF-{beta} signalling was observed in COL4A1G755R astrocytes. Functional rescue by recombinant human HTRA1 protein restored the disrupted TJ continuity in COL4A1G755R BMECs and normalized TGF-{beta} signalling and glutamate uptake in astrocytes. Together, these findings defined a previously unrecognised astrocyte-driven pBM mechanism in COL4A1-associated cSVD and highlight HTRA1 in ECM remodelling as a therapeutic target.

Liver sinusoidal endothelial cells (LSEC) rapidly dedifferentiate in 2D-monoculture, losing their high endocytic activity and characteristic morphology, limiting their use in mechanistic studies. We established and validated culture conditions that preserve LSEC endocytic capacity for at least 10 days, enabling efficient in vitro siRNA-mediated gene silencing. Mouse LSEC were cultured in 5% oxygen, growth media partially exchanged daily and assessed for cell viability, endocytic capacity, morphology and ultrastructure. Despite typical culture-induced defenestration, the cells showed high viability and efficient endocytosis via scavenger-receptors. This allowed for siRNA-mediated mannose receptor knockdown exemplified by 96% and 76% reduction in Mrc1 mRNA and protein expression at 72h (validated by qPCR and Western blot), with functional assays confirming decreased mannose-receptor-mediated endocytosis. Extended maintenance of LSEC viability and functions, previously restricted to complex co-culture systems, provide a practical platform for investigating LSEC-specific molecular mechanisms and hepatic sinusoid physiology.

Accurate brain and cerebrospinal fluid (CSF) volume assessment is essential for pediatric hydrocephalus management. Current clinical practice relies on linear measurements that fail to capture complex three-dimensional ventricular morphology, while quantitative volumetric assessment remains limited by laborious processing and lack of clinically optimized automated tools. This study developed a rapid, automated AI-based intracranial segmentation model suitable for clinical workflows. We retrospectively analyzed 167 T2-weighted MRI scans from infants with hydrocephalus, randomly split into training (60%), validation (20%), and hold-out test (20%) sets. All scans were manually segmented into CSF, brain parenchyma, and background. Our model integrates DenseNet and U-Net architectures with feature smoothness regularization to enhance generalizability. Performance was evaluated using Dice scores and absolute relative volume error (ARVE) compared with state-of-the-art methods. The AI model achieved Dice scores of 95.7% for CSF and 96.4% for brain parenchyma on the hold-out test set, significantly outperforming FSL FAST (85.0% and 77.9%) and contemporary deep learning approaches (90.4% and 89.7%). Processing time was 0.8 seconds per scan using GPU acceleration. The model demonstrated consistent performance across different hydrocephalus etiologies and effectively handled challenging scenarios including noise, artifacts, and variable resolution. This study successfully developed a robust MRI segmentation model demonstrating superior accuracy and efficiency compared to existing methods. By incorporating domain-specific enhancements, the model enables rapid, clinically viable brain and CSF volume estimation for pediatric hydrocephalus care.

Intrathecal (IT) drug delivery is a critical technique for bypassing the blood-brain and blood-spinal cord barriers in preclinical CNS research. However, conventional rat catheterization methods suffer from high rates of neurologic complications, poor reliability, and unverified dosing due to epidural reflux and inconsistent supraspinal distribution. Our objective was to develop and validate an improved method for lumbar IT catheterization in rats that ensures distribution to the brain and to confirm supraspinal pharmacodynamic target engagement. We describe a refined microsurgical technique using dural puncture under direct visual control at the L6-S1 interlaminar space, a site chosen for its anatomical safety margin. The method uses a small-bore (0.33 mm OD) polyurethane (PU) catheter to minimize durotomy size, air-bubble tracking to compensate for catheter dead volume, and epidural sealing with Surgifoam(R) to minimize reflux. Visualization using Evans Blue dye confirmed complete neuraxial distribution from a single 30 {micro}L lumbar bolus injection, with dye reaching the ventral/dorsal brain cisterns. Pharmacodynamic validation of cortical exposure was achieved using an S6 kinase 1 (S6K1) inhibitor. Lumbar IT administration over a period of 6 hours via a pump resulted in significant supraspinal S6K1 engagement, demonstrated by a reproducible reduction in S6 phosphorylation in the cerebral cortex. HighlightsO_LIMethod for lumbar intrathecal catheterization in rats under direct visual control, using basic surgical tools C_LIO_LICNS distribution validated by Evans Blue dye reaching ventral and dorsal brain C_LIO_LIPharmacodynamic confirmation of supraspinal target engagement following lumbar intrathecal delivery of a small molecule kinase inhibitor C_LIO_LIServes as a faithful preclinical model for therapeutics intended for clinical intrathecal administration C_LIO_LIProvides a screening route for early-stage compounds not yet optimized for CNS penetrance, supporting efficacy testing prior to medicinal chemistry investment C_LI

Reduced fluidity and viscosity have been demonstrated as biomechanical hallmarks of in vivo glioblastoma and are increasingly used as radiological imaging markers by magnetic resonance elastography (MRE). However, the biological origin and consequences of this unusual mechanical behavior remain unclear. Here, we show that two mechanisms which promote collective cell migration are present in patient gliomas and can be detected in vivo by MRE-based cerebral tomoelastography. Vimentin-driven extracellular matrix remodeling and cellular elongation, quantified by automated histological readings and nuclear aspect ratio (AR) measurements, correlate with decreased in-vivo tumor fluidity and viscosity. These observations in patients are supported by experiments in tissue-mimicking actin-vimentin gels, which mechanistically link the soft-solid viscoelastic signature of in vivo glioma to vimentin's migration-promoting role and to AR-based observations of cellular elongation in unjammed cancer cell clusters. Taken together, our results suggest in-vivo bulk tumor viscosity as a noninvasive biomechanical marker of collective cell migration and invasiveness in brain tumors.

Idiopathic normal pressure hydrocephalus (iNPH) is a globally growing neurological disorder in older adults, radiologically characterised by enlargement of ventricles. However, it remains unknown whether ventricular enlargement can produce biomechanical loading large enough to drive brain morphological changes and tissue damage. Here, we develop an anatomically detailed biomechanical model of ageing human brain and apply ventricular enlargement using a three-dimensional displacement field derived from MRI of iNPH patients and age-matched controls. The model accurately reproduces radiological markers of iNPH, including Evans index, callosal angle and high-convexity sulcal narrowing. It further predicts large mechanical strains in periventricular white matter, particularly within the corpus callosum and anterior thalamic radiations, tracts consistently implicated in iNPH imaging abnormalities. These findings provide strong evidence that ventricular enlargement induces mechanical strain that contributes to iNPH brain abnormalities, which can potentially be reversed by reducing strain following shunting surgery. The biomechanical brain model forms the foundation of a predictive digital platform and future "digital twin" technology to support diagnosis, patient stratification and treatment planning in iNPH. Key PointsO_LIWe develop an anatomically detailed biomechanical model of the brain, incorporating sulci, septum pellucidum and all four ventricles. C_LIO_LIA novel data-driven loading approach is introduced which uses 3D displacement fields from finite element-based registration of healthy and iNPH patient MRI, replacing the arbitrary pressure gradients of previous models. C_LIO_LIThe model predictions closely match established radiological markers measured in iNPH patients, including Evans index, callosal angle and high-convexity sulcal narrowing. C_LIO_LIVentricular enlargement generates large mechanical strains concentrated in periventricular white matter, providing a biomechanical explanation for the structural abnormalities observed in iNPH. C_LI

Trauma to the spinal cord disrupts the blood-spinal cord barrier and triggers a secondary injury cascade characterized by inflammation and progressive neuronal and glial cell death. Therapeutic cytokines and growth factors have shown promise as a treatment in preclinical studies, though their clinical translation is limited by short protein half-lives and the need for invasive intraspinal administration. Lipid nanoparticle-mediated delivery of mRNA offers an alternative strategy that enables transient protein production. Here, we investigated whether intravenously administered mRNA-lipid nanoparticles could leverage the injury-induced disruption of the blood-spinal cord barrier to access the injured spinal cord for local transgene expression. After spinal cord injury in a rat, lipid nanoparticles loaded with reporter mRNA were administered intravenously, and transgene expression was quantified in the spinal cord and peripheral organs. Intravenous delivery within a 6-hours post-injury resulted in local transgene expression in the injured spinal cord, demonstrating that mRNA-lipid nanoparticles cross the disrupted blood-spinal cord barrier. Transgene expression was observed in astrocytes, oligodendrocytes, microglia, and neurons, detected within 3 hours and remained elevated for up to 5 days post-injury. These findings demonstrate that systemic mRNA-lipid nanoparticles delivery exploit transient blood-spinal cord barrier disruption to achieve local gene expression in the injured spinal cord.

Blood-brain barrier (BBB) breakdown is a critical pathological event driving secondary brain injury and poor outcomes following intracerebral hemorrhage (ICH). However, the mechanisms governing acute BBB breakdown after ICH remain incompletely understood. Here we demonstrate that the Sphk1-S1P-S1PR3 signaling plays a pivotal role in this process. Sphk1 expression was significantly upregulated in the perihematomal endothelial cells of both ICH patients and mice, with levels positively correlating with BBB dysfunction severity and poor clinical outcomes. Using endothelial-specific genetic gain- and loss-of-function approaches, we found that Sphk1 knockdown attenuated BBB leakage, reduced hematoma volume and brain edema, preserved tight junction integrity, and improved neurological function at 1-day post-ICH, whereas Sphk1 overexpression exacerbated these pathological features. Mechanistically, transcriptomic profiling of perihematomal endothelial cells revealed that prior to its established role in Nlrp3-mediated pyroptosis, Sphk1 promotes early BBB breakdown by regulating the Bsg-MMP-9 axis. Endothelial-specific Bsg deletion completely abrogated the deleterious effects of Sphk1, confirming Bsg as an indispensable intermediary through which Sphk1 signals to MMP-9. ATAC-seq and dual-luciferase assays further demonstrated that Sphk1-generated S1P signals through S1PR3 to activate HIF-1, which directly binds the Bsg promoter to drive its transcription, ultimately promoting MMP-9-mediated tight junction degradation. These findings delineate a complete hierarchical signaling cascade from metabolic enzyme to transcriptional regulation and subsequent barrier injury, establishing the Sphk1-Bsg-MMP-9 axis as a promising therapeutic target for ICH. One sentence summaryThis work identifies an early and pivotal mechanism of blood-brain barrier breakdown after intracerebral hemorrhage, demonstrating that Sphk1-generated S1P signals through S1PR3 to activate HIF-1, which directly transactivates Bsg expression, leading to MMP-9-mediated tight junction degradation, thereby establishing a novel hierarchical axis with therapeutic potential.

BackgroundThe formation of a patent vascular lumen is fundamental to circulatory function, a process governed by cytoskeletal dynamics and mechanosensory signalling. Endothelial cilia are present during blood vessel lumen development, but their precise functional role remains poorly understood. Understanding how cilia coordinate with endothelial cytoskeletal and signalling pathways is critical for elucidating mechanisms of vascular morphogenesis. MethodsWe have established a microfluidic system that recapitulates endothelial tube formation under fluid flow, enabling pharmacological and genetic manipulation with real-time visualisation of tube behaviour. Cilia, cytoskeletal dynamics, and lumen development were analysed in vitro, and in vivo. ResultsEarly perfusion in the microfluidic system induced a hierarchical vascular network. Inhibiting Rho-kinase (ROCK) or knocking down ciliary components (IFT88 and RPGRIPL1) suppressed lumen formation. ROCK inhibition or genetic ablation disrupted cilia in endothelial and non-endothelial cells, associated with LIM-kinase inhibition. Crucially, ROCK2 genetic ablation caused endothelial cilia loss, misorientation, and abrogated lumen formation, leading to haemorrhages and compromised vascular integrity in vivo. ConclusionsOur findings unveil a previously unrecognised co-regulation between cilia and ROCK signalling essential in vascular lumen formation.

ObjectiveHereditary hemorrhagic telangiectasia (HHT) is a vascular genetic disorder caused by endothelial cell dysfunction and characterized by telangiectasias and arteriovenous malformations (AVMs). HHT results primarily from loss-of-function mutations affecting components of the BMP9-ALK1-ENG-SMAD signaling cascade, a pathway essential for endothelial quiescence and vascular homeostasis, and currently lacks a cure. Here, we investigated whether nitazoxanide, an orally bioavailable drug with extensive clinical use, can modulate endothelial signaling relevant to HHT. Approach and ResultsNitazoxanide treatment activated SMAD1/5/8 signaling and increased expression of the downstream target ID1 in endothelial cells, while concurrently inhibiting mTOR signaling, indicating a dual modulatory effect on pathways implicated in HHT pathogenesis. In vivo, nitazoxanide activated SMAD signaling in BMP9/10-immunoblocked mice and significantly reduced AVM formation and hypervascularization. Importantly, nitazoxanide restored SMAD1/5/8 activation and ID1 expression in patient-derived blood outgrowth endothelial cells harboring loss-of-function mutations in ALK1 or SMAD4, which exhibit impaired BMP signaling. ConclusionThese findings identify nitazoxanide as a pharmacological modulator capable of activating BMP-SMAD signaling while restraining mTOR activity, thereby overcoming key signaling defects in HHT endothelial cells. Collectively, our results highlight nitazoxanide as a promising therapeutic candidate to target endothelial dysfunction in HHT.

The middle cerebral artery (MCA) is critical for cerebral blood flow autoregulation and a primary site of cerebrovascular pathology in stroke, Alzheimers disease, and vascular dementia. Pressure myography enables precise ex vivo quantification of MCA structure and function, but requires accurate anatomical identification and careful vessel handling to ensure reproducibility across diverse rat genetic models. This chapter provides a comprehensive, step-by-step protocol for isolating and cannulating the rat MCA M2 segment for pressure myography. We detail precise anatomical landmarks to ensure consistent vessel selection across strains. The protocol includes optimized solutions, cannulation techniques, and pressure protocols validated across multiple rat models, including transgenic (TgF344-AD), diabetic (T2DN), consomic (SS.5BN, FHH.1BN), and genome-edited strains. Extensive troubleshooting notes address common technical challenges, including vessel viability assessment, pressure integrity, and strain-specific autoregulatory ranges. This methodology bridges molecular genetic findings with fundamental cerebrovascular physiology, enabling researchers to characterize myogenic reactivity, passive mechanical properties, and structural remodeling in rat models of cerebrovascular disease.

The endothelial cells (ECs) that line blood vessels continuously sense and respond to the physical forces exerted by blood flow. In vivo, pulsatile arterial flow interacts with vessel curvature, branching and other anatomical features to generate complex local hemodynamic environments that dictate the magnitude, direction, pulsatility, and oscillatory nature of wall shear stress experienced by ECs. Currently, accessible and reproducible in vitro models of complex pulsatile flow that recapitulate in vivo vascular anatomy remain limited. Here, we combine a novel rotational-flow endothelial culture platform with detailed computational fluid dynamics (CFD) modeling to characterize four well geometries designed to generate distinct hemodynamic environments. CFD analyses demonstrate that these geometries intrinsically generate pulsatile flow and produce reproducible spatially distinct regions of wall shear stress magnitude, pulsatility, and oscillatory shear within a single culture well. Endothelial alignment mapping and functional assays reveal region-specific cellular responses to the predicted local flow conditions that closely corresponded to the predicted local hemodynamic environment, linking complex flow patterns to endothelial adaptation. The technical advancements of our modeling efforts should support a faster, cheaper, simpler, and--importantly--validated framework for future investigation into EC mechanobiology under complex flow conditions. HIGHLIGHTSO_LISimple engineered well geometries generate distinct hemodynamic microenvironments, mimicking in vivo vascular structures, using a conventional orbital shaker. C_LIO_LIComputational fluid dynamics (CFD) reveals spatially distinct patterns of wall shear stress, pulsatility, and oscillatory shear applied to ECs within individual culture wells. C_LIO_LIHigh average wall shear stress and elevated oscillatory shear index induces a unique perpendicular alignment of ECs to the dominant flow vector. C_LI