Journal of Cerebral Blood Flow & Metabolism

BackgroundCerebral ischemia-reperfusion injury (CIRI) is a major determinant of poor outcome after recanalization therapy in acute ischemic stroke. Microglial functional heterogeneity underpins neuroinflammation, yet the molecular mechanisms governing microglial phenotypic transitions remain incompletely understood. Metabolite-driven post-translational modifications (PTMs) have emerged as key regulators of microglial metabolism and inflammation, but whether PTM regulatory enzymes form co-expression modules that define microglial states is unknown. MethodsWe analyzed single-cell RNA-seq datasets from five GEO studies (GSE174574, GSE227651, GSE245386, GSE267240, GSE319237) covering tMCAO reperfusion and permanent ischemia models. Microglia were purified using double filtration (P2ry12/Tmem119/Cx3cr1+, Cd68/Adgre1/Ly6c-). PTM enzyme co-expression modules were identified by non-negative matrix factorization (NMF). Spatiotemporal dynamics were assessed by module projection across timepoints (Sham, 1d, 3d, 7d) and pseudotime analysis. Independent validation was performed in an additional tMCAO dataset (GSE245386). Sex differences were explored in a mixed-sex permanent ischemia dataset (GSE267240). ResultsThree robust PTM enzyme co-expression modules were identified: Metabolic stress-associated (M1), Pro-inflammatory-associated (M2), and Reparative-associated (M3). M1 was enriched in TCA cycle enzymes, M2 in inflammatory pathways (leukocyte activation, chemotaxis), and M3 in vascular development and translation. Module proportions and scores showed dynamic transitions: M1 decreased after reperfusion, M2 peaked at day 1-3, and M3 slightly increased at day 7. Independent validation in GSE245386 yielded high module conservation (cosine similarity = 0.874). Sex-specific differences in module distribution were observed in permanent ischemia ({chi}2 = 14.98, p = 0.00056). ConclusionsPTM enzyme co-expression modules delineate metabolic, pro-inflammatory, and reparative microglial states in CIRI with distinct spatiotemporal dynamics. This transcriptional framework supports the "PTM enzyme code" hypothesis and provides stage-specific targets for stroke therapy.

BackgroundQuantitative cerebral blood flow (CBF) measured with [15O]water positron emission tomography (PET) is the reference standard for quantifying brain perfusion. However, clinical interpretation of individual CBF measurements is limited by the absence of large normative datasets accounting for physiological variability across the adult lifespan. Long-axial field-of-view PET enables high-sensitivity quantitative [15O]water perfusion imaging without arterial blood sampling, allowing normative characterization of cerebral perfusion at unprecedented scale. The aim of this study was to establish normative and covariate-adjusted models of cerebral blood flow across the adult lifespan using total-body [15O]water PET. MethodsQuantitative CBF measurements were obtained in 302 neurologically healthy adults (age 21-86 years) using total-body [15O]water PET. Linear mixed-effects models were used to evaluate the effects of age, sex, body mass index (BMI), and blood hemoglobin concentration on CBF and to generate normative prediction models across the adult lifespan. Between-subject and within-subject variability were estimated from repeated scans in a subset of participants (n=51). ResultsMean grey matter CBF was 46.1 mL/(min*dL), with substantial inter-individual variability but high within-subject reproducibility (intraclass correlation coefficients 0.78-0.89). Advancing age was associated with a decline in CBF of approximately 7% per decade (p_FDR < 10-12). Higher BMI was associated with lower CBF (approximately -6% per 10 kg/m2; p_FDR < 0.01). Women exhibited higher CBF than men (approximately 7.5%), but this difference was largely explained by lower blood hemoglobin concentration in women. Covariate-adjusted models were used to generate normative predictions and prediction intervals describing expected CBF across adulthood. ConclusionThis study establishes a normative database of quantitative cerebral blood flow across the adult lifespan using high-sensitivity [15O]water PET. Age, BMI, and hemoglobin are major determinants of inter-individual variability in CBF. The resulting generative models provide a quantitative reference framework for interpreting cerebral perfusion measurements and may enable automated detection of abnormal brain perfusion in clinical PET imaging.

Coronary artery disease increases risk of cognitive decline and stroke and is associated with white matter alterations. However, the biological basis of these changes remains unclear. Myelin content and iron deposition are crucial measures of white matter health and can be measured with quantitative MRI. This study investigated whether myelin and iron alterations occur in coronary artery disease, and their relationship with cognition. In this cross-sectional study, 46 individuals with coronary artery disease and 40 healthy controls aged > 50 years, with normal cognition underwent 3T MRI and cognitive assessments. Quantitative MRI metrics (susceptibility, magnetization transfer saturation, R2* and R1 relaxation rates) were calculated in the border zones between adjacent arterial territories (watershed regions) and in the areas outside these borders (non-watershed regions). Relative to controls, the coronary artery disease group showed lower myelin and higher iron content, as measured by lower magnetization transfer saturation and R1, and higher susceptibility specifically in watershed regions. Importantly, these microstructural alterations were associated with poorer cognitive performance in the coronary artery disease group with lower magnetization transfer and R1related to poorer global cognition and with higher magnetic susceptibility with poorer verbal memory. These findings suggest that coronary artery disease is associated with demyelination and iron deposition in white matter, most prominently in watershed regions, which are known for their susceptibility to stroke. The association of these microstructural alterations with cognition highlights the role of white matter as a key vulnerable region and a promising focus for future mechanistic and therapeutic studies.

With few exceptions, pathological progression in ischemic stroke is presumed to occur uniformly within the ischemic core region. These exceptions include edema formation, brain tissue [Na+] increase, and the qualitative visually-observed decrease of brain tissue [K+], [K+]br, all of which occur in peripheral regions of the ischemic core. We hypothesize that [K+]br within these peripheral regions are heterogeneous (with lower [K+]br in the peripheral compared to the central ischemic core) and are not associated with neuronal degradation. Permanent focal ischemia in 13 rats was produced for 2.5-5 h. Brain sections were quantitatively stained for K+ to assess [K+]br variations between the peripheral and central ischemic core. Regions within the cortical ribbon were used to explore differing rates of K+-depletion expressed as the slopes of [K+]br vs. time relations. Adjacent sections were observed for reflective change and stained for microtubule-associated protein 2 (MAP2) to identify the ischemic region and to relate neuronal pathology to [K+]br variations. The mean value of normal cortex (NC) [K+]br was 96 mEq/kg and of K+-depletion in all ischemic regions over time was 12.2 mEq/kg/h, consistent with measurements from other studies. Exaggerated K+-depletion occurred in 56% of the peripheral ischemic core regions classed as depleted peripheral ischemic core (ICp-DP) regions. These were clearly separated (p<0.001) from the non-depleted peripheral ischemic core (ICp-ND) regions. The normal cortex (NC) regions show stability of [K+]br with a slope near zero. However, the 13.6 mEq/kg/h slopes of the central ischemic core (ICc) and ICp-ND regions were similar (p=0.99) and showed a significant decrease over time. The 6.2 mEq/kg/h slope of the ICp-DP regions was significantly different from that of the ICc (p=0.010) and the ICp-ND (p=0.0071). This lower slope of the ICp-DP curve 2.5 h after stroke onset is due to the accelerated K+-efflux from 0 to 2.5 h, as its value at stroke onset must be [~]100 mEq/kg. However, these differential K+ losses were not reflected in the homogeneous peripheral ischemic core MAP2 immunoreactivity losses. Unlike [K+]br, there was no difference between the MAP2 immunoreactivity in K+-depleted and non-K+-depleted peripheral ischemic core regions (ICp-ND vs ICp-DP, ICp-ND vs ICp-DP, unpaired t-test, p=0.83, p=0.16, respectively). While confirming previous results of quantitative regional losses of [K+]br in the ischemic core, we show that K+ dynamics within the peripheral and the central ischemic core are heterogeneous and not related to MAP2-assessed neuronal structural integrity: the K+-depleted regions in the peripheral ischemic core regions are presumably closer to glymphatic system and other K+-efflux pathways. Such differing K+ dynamics at the edge of the ischemic core in the hyper-acute period in first hours after ischemic onset possibly relate to the spreading depolarization-mediated expansion of the infarct during the period of secondary brain injury. Peripheral ischemic core regions with less K+ might limit spreading depolarization initiation and propagation if there is insufficient K+ for depolarization to occur and make restoration of parenchymal membrane potential improbable even if the functionality of the Na+,K+-ATPase is restored. Further study of differing K+-dynamics within the ischemic core might lead to a better understanding of ischemic stroke pathophysiology.

Intracerebral haemorrhage (ICH) is a severe form of stroke with high morbidity and mortality rates. For survivors, acute haematoma expansion strongly determines neurological outcome. Although blood pressure reduction is widely investigated as a strategy to limit haematoma growth, the haemodynamic mechanisms regulating haemorrhage development remain poorly understood. Zebrafish provide a tractable in vivo model to study cerebrovascular biology and spontaneous ICH, yet the contribution of vascular regulation to haemorrhage onset and expansion has not been explored in this species. Here, we investigated whether pharmacological modulation of vascular dilation influences ICH development in zebrafish larvae. We first characterised vascular changes during the developmental window in which spontaneous ICH occurs and observed increased heart rate and progressive reductions in arterial diameter between 2 and 3 days post-fertilisation, suggesting increased vascular resistance. We then tested whether vasoconstriction promotes haemorrhage using angiotensin II, which induced systemic and cerebrovascular vasoconstriction but did not increase ICH incidence or haematoma size in two independent ICH models. In contrast, pharmacological vasodilation using sodium nitroprusside or isoproterenol significantly reduced haematoma size in a high-incidence model of atorvastatin-induced ICH. Live imaging of cerebral blood flow revealed that vasodilation was associated with the confinement of red blood cells around affected vessels rather than dispersing into the brain ventricles. Together, these findings indicate that vascular dilation modulates haemorrhage progression in zebrafish ICH and establish this model as a platform to investigate haemodynamic mechanisms regulating haematoma expansion.

BackgroundIntracranial steno-occlusive disease (SOD) assessment benefits from hemodynamic imaging, but comprehensive evaluation often relies on contrast- or radiation-based techniques. Arterial spin labeling (ASL) provides a non-invasive alternative for quantifying tissue-level perfusion and cerebrovascular reactivity, yet does not capture upstream arterial flow dynamics. As a result, non-invasive assessment of macrovascular hemodynamics for SOD remains limited. This study evaluates whether quantitative 4D-MRA provides complementary arterial information beyond established ASL-derived metrics. MethodsTwelve SOD patients (7 women; age 42.3{+/-}25.8 years) underwent multi-delay ASL and 4D-MRA before and after acetazolamide. Cerebrovascular reactivity (CVR), arterial transit time (ATT), macrovascular ATT (mATT), and labeled blood volume (LBV) were quantified. Associations and vasodilatory responses were assessed using linear mixed-effects models. ResultsAt baseline, mATT correlated with ATT ({beta}=0.66{+/-}0.08, p<0.001). Both decreased following acetazolamide (mATT: 1.07{+/-}0.03s to 1.01{+/-}0.03s, p=0.029; ATT: 1.63{+/-}0.07s to 1.40{+/-}0.07s, p<0.001). However, changes in mATT and ATT were not associated with CVR. In contrast, CVR was positively associated with {Delta}LBV ({beta}=8.84, SE=2.43, p=0.01). Case analyses further demonstrated artery-level delayed inflow and vascular steal. ConclusionQuantitative 4D-MRA provides complementary macrovascular information to ASL in SOD. {Delta}LBV more consistently reflects cerebrovascular reactivity than transit-based metrics and is sensitive to artery-level delayed inflow and vascular steal. The local Medical Ethical Review Committee declared that the Medical Research Involving Human Subjects Act (WMO) did not apply (internal trial nr. 21-406).

Cerebral small vessel disease (cSVD) is a leading cause of stroke and vascular cognitive impairment, yet the cellular mechanisms underlying microvascular dysfunction in human disease remain incompletely understood. In particular, the relationship between pericyte alterations and endothelial activation, two key features of blood-brain barrier dysfunction, remains unresolved. Here, we performed a quantitative single-vessel analysis of the human cortical microvasculature across increasing cSVD severity and ageing. Using multiplex immunohistochemistry combined with spectral unmixing and automated image analysis, we analysed 11,409 microvascular fragments from post-mortem brain tissue derived from 20 cases. Endothelial cells, pericytes, and endothelial activation were assessed using PECAM-1, PDGFR{beta}, and VCAM-1, respectively. Microvascular density and diameter differed between cortical grey matter and the underlying white matter, with white matter vessels being less dense and wider in controls. While vessel diameter remained stable across disease stages, microvascular density increased with cSVD severity and age in the white matter. At the molecular level, PDGFR{beta} signal decreased markedly with increasing cSVD severity, consistent with progressive pericyte loss. This reduction was observed in both grey and white matter and correlated with disease severity and age. Notably, intermediate disease groups displayed marked heterogeneity, with vessels exhibiting either preserved or near-complete pericyte coverage, suggesting a potentially bimodal transition. In parallel, endothelial markers PECAM-1 and VCAM-1 increased significantly with disease severity, reflecting endothelial activation. Unsupervised Gaussian mixture clustering of marker expression identified three vascular states characterised by (i) preserved pericytes with low endothelial activation, (ii) marked pericyte loss without endothelial activation, and (iii) combined pericyte depletion and endothelial activation. These clusters broadly aligned with clinical severity but revealed intermediate states not captured by post-mortem diagnosis alone. Together, these findings suggest that pericyte loss and endothelial activation are partially dissociated processes that occur in a sequential progression in human cSVD, supporting pericyte dysfunction as an early event and highlighting it as a potential therapeutic target in microvascular disease.

BackgroundPeripheral microvascular abnormalities may reflect systemic microvascular dysfunction relevant to cerebral small vessel disease (cSVD), yet their relationship to individual neuroimaging markers and overall cSVD burden remains unclear. We evaluated whether abnormalities in nailfold capillaroscopy (NFC) are associated with specific cSVD markers and with the total cSVD score in a population-based cohort. MethodsAtahualpa residents aged [&ge;]60 years underwent NFC and brain MRI. Capillary tortuosities, dilatations, density, and megacapillaries were quantified using automated software with expert validation. Neuroimaging markers included white matter hyperintensities (WMH), lacunes, deep cerebral microbleeds (CMB), and enlarged basal ganglia perivascular spaces (BG-PVS). Logistic regression models assessed associations between NFC abnormalities and cSVD markers. Poisson regression was used to model the total cSVD score. All models were adjusted for demographics, educational attainment, and cardiovascular risk factors. ResultsAmong 289 participants (mean age 71.3 {+/-} 7.5 years; 51% women), lower capillary density was independently associated with CMB (OR: 0.70; 95% C.I.: 0.51-0.96) and lacunes (OR: 0.67; 95% C.I.: 0.50-0.91), with a borderline association for WMH (p=0.062). Megacapillaries were independently associated with moderate-to-severe WMH (OR: 5.01; 95% C.I.: 1.42-17.68). Tortuosities and dilatations showed no significant associations. Higher capillary density was inversely associated with the total cSVD score ({beta}: -0.179; 95% C.I.: -0.283 to -0.075). ConclusionsReduced capillary density and megacapillaries track with the burden of cSVD. NFC may provide a noninvasive window into cerebral microvascular health and could inform risk stratification for cSVD progression and related outcomes.

IntroductionCoronary artery disease (CAD) increases the risk of cerebrovascular events, yet early brain injury in this population remains poorly characterized. White matter hyperintensities (WMHs), a biomarker of cerebrovascular lesions, are prevalent in CAD and are linked to risk of stroke. Beyond total burden, spatial distribution of WMHs carries pathological significance and is critical for understanding CAD-related injury. While clinical outcomes including coronary revascularization procedure and myocardial infarction influence CAD prognosis, their impact on WMH burden remains unclear. MethodsThis study investigated regional WMH burden in CAD and its relationship with clinical characteristics. 82 adults over 50 years participated, including 44 individuals with CAD and 38 controls. WMHs were segmented from fluid attenuated inversion recovery and T1-weighted MRI and categorized as total, periventricular, deep, and superficial regions. History of myocardial infarction and coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)), was obtained from medical files. ResultsIndividuals with CAD exhibited higher total, periventricular, and deep WMH volumes than controls. Participants who underwent CABG had higher superficial WMH volumes than those with PCI, suggesting greater disease severity influences WMH burden. ConclusionCAD is characterized by a distinct pattern of cerebrovascular vulnerability, with revascularization procedures influencing WMH burden

Stroke is a leading cause of mortality and morbidity worldwide. MRI-visible perivascular spaces (PVS) are an emerging marker of cerebral small vessel disease and may have prognostic value in stroke. We investigated longitudinal changes in PVS volume and cluster count following ischaemic stroke. PVS volumes and cluster counts were compared between stroke survivors (n=124; 39 women; median [Q1, Q3] age=70 [62, 76] years) and healthy controls (n=39; 15 women; median age=69 [66, 72.5] years). MRI scans were acquired at 3 months, 12 months, and 36 months post-stroke. PVS were automatically segmented from T1-weighted MRI using a validated deep learning algorithm (nnU-Net). Generalised linear mixed-effects models were used to assess group differences and longitudinal changes in PVS, adjusting for baseline age, sex, total intracranial volume, and BMI. At the 12-month timepoint, no significant differences in PVS metrics were observed between stroke and control groups. However, at the 36-month timepoint we observed a significant brain-wide reduction in PVS volume (exp({beta})=0.93, 95%CI [0.87, 1], p=0.035) and cluster count (exp({beta})=0.92, 95%CI [0.85, 0.99], p=0.003) in the stroke group compared to control. Regionally, by 36 months, stroke patients demonstrated significant PVS reductions relative to controls in the frontal (PVS volume: exp({beta})=0.93, 95%CI [0.82, 0.99], p=0.032; PVS cluster counts: exp({beta})=0.91, 95%CI [0.83, 1], p=0.037) and parietal lobes (PVS volume: exp({beta})=0.93, 95%CI [0.85, 1.01], p=0.10; PVS cluster counts: exp({beta})=0.84, 95%CI [0.68, 1.08], p<0.001). These findings suggest that ischaemic stroke is associated with dynamic and regional changes in PVS volume and counts.

Objective: Cranial artery stenosis and dilatation are distinct large artery phenotypes that often coexist with cerebral small vessel disease (cSVD), yet their downstream microvascular functional correlates remain unclear. Methods: In the prospective Mild Stroke Study 3, we recruited patients with lacunar or mild non-lacunar stroke. At baseline, large artery stenosis (LAS), basilar artery dolichoectasia (BADE), and intracranial arterial diameters were assessed. Multimodal MRI quantified cerebrovascular reactivity (CVR), blood-brain barrier (BBB) permeability, plasma volume fraction, and intracranial pulsatility. cSVD markers were evaluated at baseline and 1 year. Associations between large artery phenotypes and vascular function were examined with multivariable regression. Mediation analyses tested whether vascular dysfunction linked large artery pathology to cSVD progression. Results: Among 224 participants (mean age 66.0, SD 11.2 years; 66.5% men), BADE (n=36, 16.1%) was independently associated with lower CVR in normal-appearing white matter (NAWM; {beta} -0.01, 95% CI -0.016 to -0.004, P=0.003). Larger mean intracranial arterial diameter was associated with lower CVR in NAWM and white matter hyperintensities (WMH), while showing a U-shaped association with BBB permeability. LAS (n=46, 20.5%) was unrelated to CVR, BBB permeability, or pulsatility, but was associated with higher plasma volume in WMH. CVR in NAWM partially mediated the association between BADE and both baseline cSVD burden and 1-year progression. Interpretation: Large artery dilatation may serve as a macroscopic signal of small-vessel dysfunction, being associated with lower CVR and altered BBB permeability. Reduced CVR in NAWM partially mediated the impact of dolichoectasia on cSVD progression and may represent a potential therapeutic target.

BackgroundMoyamoya disease (MMD) is a progressive cerebrovascular disorder characterized by steno-occlusive lesions and intimal hyperplasia. Although vascular smooth muscle cell (VSMC) phenotypic switching is implicated in its pathogenesis, the precise spatial interplay between extracellular matrix (ECM) remodeling and local metabolic alterations within the distinct vascular microenvironments remains unknown. MethodsSuperficial temporal artery (STA) samples from patients with MMD and controls were analyzed by histology, immunofluorescence, spatial transcriptomics, spatial proteomics, and spatial metabolomics. Single cell RNA sequencing was used to profile the cellular landscape of STA tissues. To functionally validate the identified pathway, human brain vascular smooth muscle cells (HBVSMCs) were stimulated with fibronectin 1 (FN1), and patient derived induced pluripotent stem cell smooth muscle cells (iPSC-SMCs) were generated for migration and protein expression assays following ITGA5 silencing or focal adhesion kinase (FAK) inhibition. ResultsMMD STA samples exhibited marked intimal hyperplasia with medial thinning and intimal accumulation of -SMA positive cells. Spatial transcriptomic and proteomic analyses identified an intimal remodeling program characterized by increased FN1, EFEMP1, fibronectin, ITGA5, and FAK, together with reduced MYH11. FN1 stimulation promoted smooth muscle cell migration, ECM associated protein expression, and FAK phosphorylation, whereas ITGA5 knockdown or FAK inhibition attenuated these effects. Patient derived MMD iPSC-SMCs showed similar abnormalities, including enhanced migration, increased FAK activation, reduced contractile markers, and increased ECM associated proteins. Spatial metabolomics and integrated multi-omics analyses further revealed that these changes were coupled to a metabolically depleted intimal niche enriched for reduced acyl-CoA related metabolites. ConclusionsIntegrated spatial multi-omics identifies coupled ECM remodeling and metabolic alteration in the hyperplastic intima of MMD. Within this context, the FN1-ITGA5-FAK axis emerges as a plausible mediator of smooth muscle remodeling that warrants further validation. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=165 SRC="FIGDIR/small/721225v1_ufig1.gif" ALT="Figure 1"> View larger version (90K): org.highwire.dtl.DTLVardef@3f6e19org.highwire.dtl.DTLVardef@554d49org.highwire.dtl.DTLVardef@451dd9org.highwire.dtl.DTLVardef@1aac1e9_HPS_FORMAT_FIGEXP M_FIG C_FIG

A prominent radiological manifestation of cerebral amyloid angiopathy (CAA) is enlargement of perivascular spaces (EPVS), which is suggested to result from fluid stagnation due to impaired perivascular clearance. Here, we report a novel observation of hypointense rims in cerebral white matter surrounding EPVS near haemorrhages on in vivo 7T Gradient Echo MRI. We hypothesised that the observed black rim pattern denotes iron accumulation that may be caused by incomplete clearance following bleeding. We investigated the occurrence and localisation of this marker on in vivo and ex vivo MRI and examined its histopathological correlates. From MRI data of the prospective longitudinal natural history study of hereditary Dutch-type CAA (D-CAA) at Leiden University Medical Centre, we selected the first 20 consecutive patients who underwent 7T imaging and assessed the presence of black rims on MRI. Post-mortem material was available from one donor with black rims on in vivo scans. Formalin-fixed coronal brain slabs were scanned at 7T MRI, including a high-resolution T2*-weighted sequence. Guided by ex vivo MRI, tissue blocks from representative areas with black rims were sampled for histopathological analysis. Serial sections were stained for iron, calcium, myelin, and general tissue morphology. On in vivo 7T MRI, 9 out of 20 participants exhibited one or several black rims, all located close to a haemorrhage. In the D-CAA donor, ex vivo MRI signal loss matched the in vivo contrast changes. Thirty-six vessels with ex vivo-observed black rims were retrieved and histopathologically examined, showing iron accumulation surrounding perivascular spaces, but the pattern and severity of iron deposition varied. Across groups, vessels displayed microvascular degeneration, including hyaline vessel wall thickening, adventitial fibrosis, and perivascular inflammation. We identified black rims on in vivo 7T MRI and confirmed their correspondence on ex vivo imaging. Iron deposition was determined as the underlying correlate of black rims, but the histopathology appears heterogeneous. The preferential deposition of iron around EPVS may indicate incomplete clearance of iron-positive blood-breakdown products after bleeding. The varied pattern of iron accumulation and microvascular alterations may reflect different pathophysiological mechanisms related to the formation and maintenance of black rims in D-CAA.

Ischemic stroke triggers a cascade of molecular and cellular processes leading to fibrotic scar formation, entailing activation of brain platelet-derived growth factor receptor (PDGFR){beta}+ cells. Kruppel-like factor (KLF)4 plays an important role in regulating the activation of peripheral PDGFR{beta}+ perivascular cells in response to hypoxia/ischemia. Herein, we aimed to characterize the spatiotemporal responses of brain PDGFR{beta}+ cells while assessing the contribution of KLF4. This was achieved using transgenic mice that enable tracking or conditionally depleting KLF4 in PDGFR{beta}+ cells, which were subjected to experimental ischemic stroke. Next, we employed point pattern analysis (PPA) and topological data analysis (TDA) to quantitatively characterize cell phenotypic changes and spatial distribution over injury progression after ischemic stroke. We show that brain PDGFR{beta}+ cells rapidly become reactive and early localize to regions prone to irreversible damage. We report the emergence of parenchymal PDGFR{beta}+ cells, which cannot be causally linked to proliferation or vascular detachment. Moreover, our analysis reveals that KLF4 is barely expressed in brain PDGFR{beta}+ cells under normal conditions, and that its expression is slightly induced in reactive cells in the injured brain. Notably, specific attenuation of KLF4 induced expression in PDGFR{beta}+ cells does not affect cell reactivity and spatiotemporal distribution, nor scar formation and injury severity. These observations suggest that in contrast with the periphery, KLF4 is not implicated in regulating the responses of brain PDGFR{beta}+ cells. Our results indicate that the reactivity of brain PDGFR{beta}+ cells after stroke is spatiotemporally diverse, evolve over injury progression, and is distinct from peripheral perivascular cells. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=65 SRC="FIGDIR/small/712632v1_ufig1.gif" ALT="Figure 1"> View larger version (26K): org.highwire.dtl.DTLVardef@1149c62org.highwire.dtl.DTLVardef@26edaaorg.highwire.dtl.DTLVardef@1bd3d35org.highwire.dtl.DTLVardef@fd8030_HPS_FORMAT_FIGEXP M_FIG C_FIG

IntroductionNeuroinflammation is increasingly implicated in age-related cognitive decline, neurodegeneration and neuropsychiatric disorders. During systemic inflammation, microglia are rapidly activated, simultaneously changing their shape and releasing cytokines that perturb neuronal function. This change in glial morphology alters their intracellular diffusion properties and provides a potentially measurable signature of their activation state. Diffusion-weighted magnetic resonance spectroscopy (dMRS) shows promise in detecting these changes. Here, we combined IFN-{beta} challenge with dMRS to assess changes in metabolite diffusion in healthy young and older adults. We hypothesised that IFN-{beta} would increase diffusion of choline-containing compounds (tCho) but not N-acetylaspartate + N-acetylaspartylglutamate (tNAA), age would be associated with an increase in tCho diffusion and concentration, lower tNAA concentration and increased effects of IFN-{beta}. MethodsWe recruited 15 young (mean 25.2 {+/-} 5.1 years, 6 male) and 15 older (mean 62.6 {+/-} 4.1 years, 5 male) healthy volunteers, each tested twice, once after IFN-{beta} and once after placebo. Physiological and behavioural responses were recorded hourly, and blood samples taken at baseline, 4 and 6.5 hours post-injection. dMRS occurred at [~]4.5 hours at 3T, using a semi-LASER sequence with four diffusion weightings (b = 0 and 3 x 3500 s/mm{superscript 2}), in 4.5 cm3 VOIs in the left thalamus and corona radiata. Apparent Diffusion Coefficients (ADCs) of tCho, tNAA and creatine+phosphocreatine (tCr) were calculated from averaged spectra using custom MATLAB software. ResultsIFN-{beta} administration produced a significant increase in thalamic tCho diffusivity compared with placebo (t(28) = -2.15, p = 0.040), with no change in tNAA or tCr ADC, or tCho concentrations. IFN-{beta}-related increases in tCho ADC positively correlated with increases in circulating IL-6 (R{superscript 2} = 0.14, p = 0.040). Age-related effects were also evident during the placebo condition, with older participants showing lower thalamic tNAA diffusivity (t(27) = 2.86, p = 0.008), lower tNAA/tCr in both grey and white matter (grey: t(27) = 2.49, p = 0.023; white: t(27) = 2.94, p = 0.007), and higher white-matter tCho/tCr (t(27) = -2.23, p = 0.034). ConclusiondMRS detected IFN-{beta}-induced increases in thalamic tCho diffusivity corresponding with peripheral inflammation, supporting its sensitivity to acute inflammation-induced changes in glial morphology. Age-related differences in tNAA diffusion and concentrations further highlight metabolite-specific ageing effects. HighlightsO_LIdMRS detects increased thalamic total choline diffusivity following IFN-{beta}-induced inflammation. C_LIO_LIIFN-{beta}-related changes in total choline diffusivity are associated with peripheral IL-6 responses. C_LIO_LIAgeing is linked to reduced NAA diffusion and higher white-matter tCho/tCr C_LIO_LIdMRS is sensitive to inflammation- and age-related neurochemical changes in vivo. C_LI

In brain-heart interactions, several pathways have been proposed to mediate feedback loops between systems. Among these, cerebrovascular dynamics operate at their interface. However, how cardiovascular control, ventilation mechanisms, and cerebral autoregulation interact is not well characterized, especially in ageing and post-stroke conditions, where perfusion can be compromised. In a cohort of 57 elderly participants, including 30 stroke survivors, we investigated the relationship between cardiac sympathetic activity and both, cerebral blood flow regulation and ventilatory status. Sympathetic reflexes, assessed via cardiac sympathetic index (CSI) during sit-to-stand transitions, were preserved across all participants, with marginal group differences between stroke and non-stroke populations. However, among individuals with constrained ventilation, indexed by reduced end-tidal CO2 at baseline, we identified a more elevated CSI following postural change, scaling with the degree of CO2 dysregulation. Furthermore, transcranial Doppler measurements revealed exaggerated changes in mean flow velocity (MFV) within the right middle cerebral artery in most participants. These MFV shifts significantly correlated with the magnitude of cardiac sympathetic change under orthostatic stress, suggesting that CSI can capture maladaptive cerebrovascular responses. Together, these findings highlight a distinct cardiac-cerebrovascular crosstalk in elderly individuals, revealing patterns consistent with compensatory or maladaptive sympathetic overactivation under conditions of impaired cerebrovascular control.

Disturbances of neurovascular coupling (NVC) contribute to metabolic derailment and neurological symptoms associated with epilepsy. While postictal arterial constriction can be alleviated by inhibitors of voltage gated calcium channels (VGCCs), less is known regarding seizure-associated electrical signals in higher-order capillaries and their role in determining pericyte tone during seizures. Here we investigated electrical signaling within the ex vivo neurovascular unit (NVU) derived from rat and human brain tissue. We focused on electrical signal transduction between pericytes and endothelial cells and the potential role of VGCCs in vasomotion. Using dye coupling and paired patch-clamp recordings, we showed that morphologically heterogeneous groups of mid-capillary pericytes build a functional syncytium with endothelial cells. Coupling was asymmetric, allowing for directed propagation of electrical signals. Regardless of their morphology, mid-capillary pericytes responded with depolarization and constriction to metabotropic receptor (GPCR) activation (by thromboxane, norepinephrine and UDP-glucose). However, depolarization via the patch pipette induced neither Ca2+-influx nor constriction, suggesting lack of contribution of VGCCs to vasomotion. On inducing epileptiform activity, A2a adenosine receptors and inwardly rectifying potassium channels hyperpolarized the capillary syncytium, followed by repeated depolarizations due to seizure-associated potassium increase in the parenchyma. Thus, while mid-capillary pericytes are contractile, their tone does not rely on their membrane potential and VGCCs. However, syncytial coupling allows for transmission of seizure-associated hyper- and depolarizing signals to upstream feeding arterioles. Significance statementElectro-metabolic signaling is a mechanism, which couples neuronal metabolic activity to local blood flow, by generation and conduction of hyperpolarizing electrical signals in the vasculature. Repeated seizures are followed by postictal hypoperfusion, suggesting disturbances in this signaling mechanism. Due to the inaccessibility of mid capillary pericytes, little is known about how seizure-associated electrical signals modulate local capillary tone. O_LIRat and human mid-capillary pericytes are contractile and actively regulate capillary diameter upon GPCR activation. C_LIO_LIWhile GPCR-induced vasoconstriction is associated with depolarization of the pericytes, depolarization via the patch pipette induces neither constriction nor intracellular Ca2+ increases. C_LIO_LIDespite differences in their morphology, mesh and thin strand pericytes participate in a common electrical syncytium along with the capillary endothelial cells both in rat and in human tissue. C_LIO_LISignal transmission at electrical synapses between pericyte-pericyte and pericyte-endothelial cell pairs is asymmetric, suggesting a preferred direction of propagation of electrical signals. C_LIO_LIActivation of A2a adenosine receptors and Kir channels mediate capillary hyperpolarization prior to the onset of seizures, which is followed by seizure-associated depolarization due to extracellular potassium accumulation. C_LI

BackgroundMoyamoya disease (MMD) is characterized by progressive arterial stenosis and abnormal collateral formation, but the spatial organization of vessel-wall abnormalities remains incompletely understood. MethodsWe combined Xenium in situ spatial transcriptomics and multiplex immunofluorescence in superficial temporal artery samples from patients with MMD and controls, and performed gain- and loss-of-function experiments in human brain microvascular endothelial cells (HBMECs). Western blotting, quantitative real-time polymerase chain reaction (qRT-PCR), tube-formation, Transwell migration, and cell scratch assays were used to assess signaling and endothelial phenotypes. ResultsMMD vascular tissue showed intimal hyperplasia, altered spatial cellular architecture, and enrichment of extracellular matrix- and proteoglycan-related programs, with upregulation of sulfatase 1 (SULF1). In HBMECs, SULF1 knockdown reduced, whereas SULF1 overexpression enhanced, vascular endothelial growth factor A165 (VEGF-A165)-induced vascular endothelial growth factor receptor 2 (VEGFR2), extracellular signal-regulated kinase 1/2 (ERK1/2), and protein kinase B (AKT) phosphorylation, migration, tube formation, and angiogenesis- and adhesion-related gene expression. Heparinase III attenuated the signaling effects associated with SULF1 overexpression. ConclusionThese findings suggest that SULF1-associated extracellular matrix alterations may contribute to local vessel-wall remodeling and enhanced endothelial responsiveness in MMD. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=199 SRC="FIGDIR/small/721514v1_ufig1.gif" ALT="Figure 1"> View larger version (81K): org.highwire.dtl.DTLVardef@143db87org.highwire.dtl.DTLVardef@1a9d9org.highwire.dtl.DTLVardef@1362215org.highwire.dtl.DTLVardef@f7c5a3_HPS_FORMAT_FIGEXP M_FIG C_FIG

The gliovascular unit (GVU), a specialized interface between the brain and the vascular system, assembles and matures after birth and establishes essential homeostatic functions, including blood-brain barrier integrity, metabolic exchanges, fluid drainage, neurovascular coupling, and immune surveillance. Here, we systematically compared the postnatal maturation of the cortical GVU in male vs. female mice. On P15, males exhibited a transiently greater vessel density and a higher level of aquaporin 4 expression in perivascular astrocyte processes. Females exhibited a higher density of perivascular macrophages expressing the lymphatic vessel endothelial hyaluronan receptor 1 (Lyve-1), along with earlier development of arterial vascular smooth muscle cells and greater cerebral blood flow. Transcriptomic profiling during the P5-P120 period revealed sex-specific developmental trajectories within the GVU, with the most prominent differences on P5. Taken as a whole, our results highlight pronounced sex-dependent differences in GVU assembly, GVU maturation, and the development of molecular programs that might influence brain physiology and vulnerability to neurodevelopmental disorders.

BackgroundWhite matter hyperintensities (WMH) are widely used to assess cerebral small vessel disease (SVD) but reflect late-stage injury. Diffusion MRI based biomarkers have been proposed to capture earlier SVD-related microstructural damage but their temporal progression relative to WMH and the risk factors associated with this progression have not been explored. MethodsWe analyzed longitudinal neuroimaging data from 2,047 participants from a population-based cohort study (aged 49-101 years, 47% female). Using multi-output nonlinear mixed-effects models, we characterized the temporal progression of WMH and four diffusion MRI based biomarkers: fractional anisotropy of the genu of the corpus callosum (Genu-FA), peak width of skeletonized mean diffusivity (PSMD), free water (FW), and Arteriolosclerosis-score (ARTS). Models incorporated participant-specific time shifts, correlations between biomarkers, and effects of risk factors (sex, education, APOE {varepsilon}4 status, and cardiometabolic conditions). ResultsARTS, Genu-FA, FW, and PSMD became abnormal in 50% of the study population 16, 12, 10, and 7 years before WMH, respectively. Global markers (ARTS, FW, PSMD, WMH) were correlated, indicating shared substrates of widespread white matter injury. Genu-FA, a vascular risk microstructural injury biomarker, was weakly coupled with WMH and had an earlier but more linear worsening across adulthood. Cardiometabolic conditions predicted earlier worsening of all biomarkers. Females showed earlier WMH, Genu-FA, and ARTS abnormalities whereas males exhibited earlier PSMD and FW abnormalities. ConclusionsDiffusion MRI based biomarkers capture microstructural injury at least a decade before appearance of WMH, revealing a prolonged phase of early SVD and highlighting their potential for SVD prevention.