Research ArticleNEUROPATHOLOGY

Reversal of endothelial dysfunction reduces white matter vulnerability in cerebral small vessel disease in rats

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Science Translational Medicine  04 Jul 2018:
Vol. 10, Issue 448, eaam9507
DOI: 10.1126/scitranslmed.aam9507

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Defeating dysfunction

Cerebral small vessel disease (SVD) affects arterioles in the brain, increasing risk of stroke and causing symptoms of dementia. To understand the link between vascular changes and white matter pathology, Rajani and colleagues studied a rat model of SVD. Vascular tight junctions were impaired in SVD, and dysfunctional endothelial cells prevented oligodendrocyte precursors from maturing into myelinating cells. SVD rats had a mutation in an ATPase, which was also found in SVD human brain tissue. Drugs that stabilized endothelial cells could reverse the white matter abnormalities in early-stage SVD in the rat model, suggesting a potential therapeutic approach.

Abstract

Dementia is a major social and economic problem for our aging population. One of the most common of dementia in the elderly is cerebral small vessel disease (SVD). Magnetic resonance scans of SVD patients typically show white matter abnormalities, but we do not understand the mechanistic pathological link between blood vessels and white matter myelin damage. Hypertension is suggested as the cause of sporadic SVD, but a recent alternative hypothesis invokes dysfunction of the blood-brain barrier as the primary cause. In a rat model of SVD, we show that endothelial cell (EC) dysfunction is the first change in development of the disease. Dysfunctional ECs secrete heat shock protein 90α, which blocks oligodendroglial differentiation, contributing to impaired myelination. Treatment with EC-stabilizing drugs reversed these EC and oligodendroglial pathologies in the rat model. EC and oligodendroglial dysfunction were also observed in humans with early, asymptomatic SVD pathology. We identified a loss-of-function mutation in ATPase11B, which caused the EC dysfunction in the rat SVD model, and a single-nucleotide polymorphism in ATPase11B that was associated with white matter abnormalities in humans with SVD. We show that EC dysfunction is a cause of SVD white matter vulnerability and provide a therapeutic strategy to treat and reverse SVD in the rat model, which may also be of relevance to human SVD.

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