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Endothelial PROX1 induces blood-brain barrier disruption in the central nervous system
Sara González-Hernández, Ryo Sato, Yuya Sato, Chang Liu, Wenling Li, Zulfeqhar A. Syed, Chengyu Liu, Sadhana Jackson, Yoshiaki Kubota, Yoh-suke Mukouyama
Sara González-Hernández, Ryo Sato, Yuya Sato, Chang Liu, Wenling Li, Zulfeqhar A. Syed, Chengyu Liu, Sadhana Jackson, Yoshiaki Kubota, Yoh-suke Mukouyama
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Research Article Neuroscience Vascular biology

Endothelial PROX1 induces blood-brain barrier disruption in the central nervous system

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Abstract

The central nervous system (CNS) parenchyma has conventionally been believed to lack lymphatic vasculature, likely owing to a non-permissive microenvironment that hinders the formation and growth of lymphatic endothelial cells (LECs). Recent findings of ectopic expression of LEC markers including prospero homeobox 1 (PROX1), a master regulator of lymphatic differentiation, and the vascular permeability marker plasmalemma vesicle–associated protein (PLVAP) in certain glioblastomas (GBM) and brain arteriovenous malformations have prompted investigation into their roles in cerebrovascular malformations, tumor environments, and blood-brain barrier (BBB) abnormalities. To explore the relationship between ectopic LEC properties and BBB disruption, we used endothelial cell–specific Prox1 overexpression mutants. When induced during embryonic stages of BBB formation, endothelial Prox1 expression induces hybrid blood-lymphatic phenotypes in the developing CNS vasculature. This effect is not observed when Prox1 is overexpressed during postnatal BBB maturation. Ectopic Prox1 expression leads to significant vascular malformations and enhanced vascular leakage, resulting in BBB disruption when induced during both embryonic and postnatal stages. Mechanistically, PROX1 downregulates critical BBB-associated genes, including β-catenin and claudin-5, which are essential for BBB development and maintenance. These findings suggest that PROX1 compromises BBB integrity by negatively regulating BBB-associated gene expression and Wnt/β-catenin signaling.

Authors

Sara González-Hernández, Ryo Sato, Yuya Sato, Chang Liu, Wenling Li, Zulfeqhar A. Syed, Chengyu Liu, Sadhana Jackson, Yoshiaki Kubota, Yoh-suke Mukouyama

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Figure 14

PROX1-mediated BBB disruption.

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PROX1-mediated BBB disruption.
Schematic model showing that in homeostat...
Schematic model showing that in homeostatic brain ECs (left), absence of Prox1 allows Cldn5 and Ctnnb1 expression, promoting TJs and Mfsd2a-dependent suppression of transcytosis, thereby maintaining BBB integrity. In contrast, aberrant Prox1 expression in brain ECs (right) represses Cldn5 and Ctnnb1, reducing TJs and increasing transcytosis, leading to BBB breakdown. Created in BioRender (Gonzalez S, 2025, https://BioRender.com/kdo2upo).

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