The blood-brain barrier is a tightly controlled interface between the blood and brain that determines what goes into and comes out of the brain. Anatomically, endothelial cells compose the blood-brain barrier and forms a complex, continuous capillary network. Physiologically, this capillary network supplies the brain with oxygen and nutrients while simultaneously disposing of carbon dioxide and metabolic waste products. Importantly, evidence supports that the changes to the barrier contribute to numerous pathologies, including Alzheimer's disease, epilepsy, and stroke1,2,3,4,5,6,7. Brain endothelial cells also serve as a barrier to treatment by blocking drug uptake into the brain, e.g., chemotherapy of glioblastoma multiforme following tumor resection8,9,10. In this regard, isolated human brain capillaries represent a unique ex vivo blood-brain barrier model that closely resembles barrier properties in vivo, which allows for the study of barrier function and dysfunction in health and disease. In this article, we provide a protocol to isolate brain capillaries from human brain at a consistently high capillary quality and yield to study the blood-brain barrier.
In 1969, Siakotos et al.11 were the first to report the isolation of brain capillaries from bovine and human brain tissue using density gradient centrifugation and glass bead column separation. Later, Goldstein et al.12 improved this method by adding multiple filtration steps to decrease the amount of tissue needed to study brain capillaries isolated from rats, while maintaining the metabolic activity of glucose transport. Since then, researchers optimized the capillary isolation procedure numerous times, improving the method and brain capillary model with each iteration13,14,15. For example, Pardridge et al.16 isolated bovine capillaries using enzymatic digestion rather than mechanical homogenization, and then subsequently passed a capillary suspension through a 210 µm mesh filter and a glass bead column. These modifications improved the trypan blue exclusion stain of isolated brain capillaries, and thus, increased endothelial cell viability. In the early 1990s, Dallaire et al.17 isolated bovine and rat capillaries that were clear of neuronal contamination and maintained metabolic activity of γ-glutamyl transpeptidase (γ-GTase) and alkaline phosphatase. In 2000, Miller et al.18, used isolated rat and porcine brain capillaries in combination with confocal microscopy to show the accumulation of transport substrates into the lumen of capillaries. Subsequently, our laboratory has continued to optimize the brain capillary isolation procedure and we have established transport assays to determine P-glycoprotein (P-gp)19,20,21, breast cancer resistance protein (BCRP)22,23, and multi-drug resistance protein 2 (Mrp2)24 transport activity. In 2004, we published two reports where we used isolated rat brain capillaries to investigate various signaling pathways. In Hartz et al.21, we found that the peptide endothelin-1 rapidly and reversibly reduced P-gp transport function in brain capillaries by acting through the endothelin receptor B (ETB) receptor, nitric oxide synthase (NOS), and protein kinase C (PKC). In Bauer et al.19, we demonstrated expression of the nuclear receptor pregnane X receptor (PXR) and showed PXR-modulation of P-gp expression and transport function in brain capillaries. In experiments with transgenic humanized PXR mice, we expanded this line of research and showed in vivo tightening of the barrier by upregulating P-gp through hPXR activation25. In 2010, Hartz et al.26 used this approach to restore P-gp protein expression and transport activity in transgenic human amyloid precursor protein (hAPP) mice that overexpress hAPP. Moreover, restoring P-gp in hAPP mice significantly reduced amyloid beta (Aβ)40and Aβ42brain levels.
In addition to studying signaling pathways, isolated brain capillaries can be used to determine changes in capillary permeability which we refer to as capillary leakage. In particular, the Texas Red leakage assay is used to assess leakage of the fluorescent dye Texas Red from the capillary lumen over time and these data are then used to analyze leakage rates. Increased capillary leakage rates compared to those from control capillaries indicate changes in the physical integrity of the blood-brain barrier2. This is valuable because there are numerous disease states associated with barrier disruption, e.g., epilepsy, multiple sclerosis, Alzheimer's disease, and traumatic brain injury27,28,29,30. Other groups have also utilized isolated capillaries to discern signaling pathways that regulate protein expression and transport activity of proteins31,32,33,34,35,36,37. Finally, we have continued to optimize this method for the isolation of human brain capillaries and, recently, we showed increased P-gp expression at the human blood-brain barrier in patients with epilepsy compared to seizure-free control individuals38. Taken together, these developments demonstrate that isolated brain capillaries can serve as a versatile model to study barrier function.
Various in vivo, ex vivo, and in vitro blood-brain barrier models have been used in basic research and industrial drug screening, mainly with the goal of testing drug delivery to the brain39,40,41,42,43,44. In addition to isolated ex vivo brain capillaries, current blood-brain barrier models include in silico models, in vitro cell culture of isolated brain capillary endothelial cells or immortalized cell lines from various species, in vitro culture of human pluripotent stem cells (hPSC) that differentiate into brain capillary endothelial cells, and microfluidic models on a chip.
In silico models are most commonly used in drug development for selecting drug candidates based on predicted absorption, distribution, metabolism, and excretion (ADME) properties. Methods such as quantitative structure-property relationship (QSPR) models and quantitative structure-activity relationship (QSAR) models are popular methods used in high-throughput screening of libraries to predict brain penetration of drug candidates45,46. These models are useful to screen molecules for barrier penetration properties.
Betz et al.47 established monolayers of cultured brain capillary endothelial cells as an in vitro blood-brain barrier model system. In vitro cell culture models using fresh tissue or immortalized endothelial cell lines such as human cerebral microvessel endothelial cells (hCMECs) can be another high-throughput screening tool for brain penetration or mechanistic studies. However, brain capillary endothelial cell culture models lack the physiologic shear stress of blood flow inside the capillary lumen, are limited in overall biologic complexity, and undergo changes in expression and localization of important barrier components such as tight junction proteins, surface receptors, transporters, enzymes, and ion channels48,49,50. Conversely, endothelial monolayers derived from hPSCs, have low sucrose permeability compared to hCMEC/D3 cultures and contain polarized expression of some blood-brain barrier transporters, adhesion molecules, and tight junctions51,52. However, these cells are also subject to changing properties in the culture, and the system must be validated for its recapitulation of in vivo barrier properties52.
Newer trends in blood-brain barrier research include utilizing 3D tissue culture systems to create artificial capillaries, using the organ-on-chip technology to generate microfluidic devices, or utilizing the hollow fiber technology53,54,55. Artificial capillaries, however, have significantly larger diameters (100–200 µm) than brain capillaries (3–7 µm). Hence, the shear forces in vitro do not fully resemble the in vivo situation. This is addressed in "blood-brain-barrier-on-a-chip" microfluidic devices, where artificial membranes form "blood" and "brain" compartments and fluids are pumped through these devices generating microfluidic shear forces. Similarly, co-cultures of endothelial cells in various combinations with astrocytes and vascular smooth muscle cells have also been used with the hollow fiber technology to recreate rheological parameters present under in vivo conditions56,57,58. However, it is unclear how well this model reflects other properties of the blood-brain barrier such as transport, metabolism, signaling, and others. These artificial capillary and chip models are suitable for high-throughput screening of drugs, but the cells used to generate these models are also subject to change during culture.
Frozen and fixed brain slices or primary brain capillary endothelial cell cultures are additional models that can be used tostudy the human microvasculature5,59,60,61. For example, immunohistochemistry of fixed brain tissue is used to determine protein localization and expression in healthy compared to diseased tissue.
In addition to tissue slices and the in vitro models described above, freshly isolated brain capillaries can be utilized to study blood-brain barrier function. Limitations of this isolated capillary model include the difficulty to obtain fresh human brain tissue, absence of astrocytes and neurons, and a relatively time-consuming isolation process. An advantage of the isolated brain capillary model is that this model closely resembles the in vivo situation and, therefore, can be used to characterize barrier function and dysfunction. Importantly, it can also be used to discern signaling mechanisms using a multitude of assays and molecular techniques3,19,62,63.
Our laboratory has access to both fresh and frozen human brain tissue through the Sanders-Brown Center on Aging (IRB #B15-2602-M)64. In this context, autopsies follow a standard protocol, brains are obtained in <4 h, and all procedures conform to NIH Biospecimen Best Practice Guidelines65. Given this unique access to human brain tissue, we established and optimized a protocol to isolate brain capillaries from human brain tissue that results in a high yield of intact, viable human brain capillaries. Two common endpoints of interest are to determine the protein expression and activity. In this regard, we and others have established various assays that can be used with isolated brain capillaries to study protein expression and activity levels. These assays include Western blotting, Simple Western assay, enzyme-linked immunosorbent assay (ELISA), reverse transcription polymerase chain reaction (RT-PCR), quantitative polymerase chain reaction (qPCR), zymography, transport activity assays, and capillary leakage assays. These assays allow researchers to study changes in barrier function in human pathologic conditions, determine pathways that govern protein expression and activity, and identify pharmacologic targets for the treatment of blood-brain barrier associated diseases.
Taken together, freshly isolated brain capillaries can serve as a robust and reproducible model of the blood-brain barrier. Especially, this model can be combined with many different assays to determine a wide array of endpoints to study barrier function.