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The human BBB is a unique boundary of brain tissue, separating the brain from the blood. It strictly regulates the passage of larger and hydrophilic molecules, blocks paracellular diffusion, and maintains brain homeostasis. It also protects the brain from plasma fluctuations, toxins, microbes, and guides inflammatory cells as part of the central nervous system (CNS) immunity. Since its discovery a century ago1, many studies have been carried out to understand the structure and function of the BBB. The complex interactions of cells, proteins, and signals from brain and blood demand still further investigation and models.
The human BBB is composed of three cell types: brain microvascular endothelial cells (BMECs), pericytes, and astrocytes2,3. The BMECs differ from the majority of the endothelial cells in the body in that they possess a high number of tight junctions and adherens junctions4, low pinocytotic activity2,5, and a continuous basement membrane6,7 to block paracellular diffusion. Small lipophilic molecules can diffuse and pass the BBB following their concentration gradient; larger and hydrophilic molecules enter or leave the brain only through polarized expressed selective transport systems8. This regulation results in a high transendothelial electrical resistance (TEER) of 1,500-2,000 Ω·cm2 that is inversely correlated to permeability9,10. Although BMECs build a tight barrier, they can react to local and peripheral signals11,12. There is a close interaction between BMECs and astrocytes13; the astrocyte end-feet build a layer around the vessels and induce the formation of tight junctions13,14. They are involved in BBB maturation with different factors, including transforming growth factor-β (TGF-β)15,16. In addition, pericytes play a key role in the regulation of angiogenesis17 and preventing apoptosis of the endothelium in cellular differentiation18 (Figure 1). They are embedded in the basement membrane and provide structural stability of the vessel wall19.

Figure 1: Schematic structure of the blood-brain barrier. The unique structure of the human BBB is composed of three different cell types. The microvessel lumen is surrounded by endothelial cells, which are enriched in tight junctions, and are not fenestrated. They are embedded in the basement membrane, like the pericytes. These cells are important for structural stability of the vessel wall and play a role in the development of the BBB next to the astrocytes. Their end-feet build a close layer around the vessel and support the building of tight junctions. All components of the BBB are important for physiological functionality. Please click here to view a larger version of this figure.
Many different pathologies are related to the collapse of the BBB (e.g., septic encephalopathy). The affected patients have increased protein levels in the cerebrospinal fluid20, and the brain parenchyma in affected rodents shows an increased uptake of marked colloidal iron oxide and amino acids21,22. These results point towards an increased permeability of the BBB that occurs alongside an increased pinocytosis in BMECs21 and endothelial activation23. Another associated pathology related to an altered BBB is meningitis, a medical emergency and a complex inflammation accompanied with cerebral edema that can lead to neuronal cell death. The primary entry site of circulating bacteria is supposed to be the microvessels24; however, the BBB prevents the entry of bacteria. The permeability of the BBB is not always linked to an increase in experimental hematogenous meningitis25 and the mechanisms can be multifactorial. Coincidence of sepsis with postoperative delirium (POD)26 and the association with preoperative infections27,28 indicates the need for a BBB model that enables the direct exposure to bacteria to get a better understanding into bacterial pathogenesis.
There are many gaps in understanding and quantifying the microbial traversal through the BBB. Therefore, we developed a model that allows a convenient testing of different factors and conditions with a direct correlation between bacterial traversal and influences on the permeability of the BBB. Previous work focused on the paracellular permeability and included TEER measurement and tracer flux. In addition, macromolecule transport was analyzed by conjugated molecules or antibodies, whereby different models using only endothelial cells or combinations with astrocytes and pericytes were developed. Due to the difficulty in obtaining human tissue on a regular basis, many animal-based models are used. Brain endothelial cells of bovine and porcine origin form tight monolayers with a high TEER that form well-shaped apical-basal polarity and are suited for investigations of small molecule transport through the BBB. The proteins differ in sequence from their human homologues29,30, making investigation of therapeutic antibodies difficult. For this reason, murine or human culture models may be preferable. Mouse or rats as sample sources have the advantage of being obtained from well characterized species but yield few cells for study purposes. This can be circumvented by the use of immortalized mouse brain endothelioma (END) cell lines bEND.3, bEND.5 or cEND31,32,33.
Primary cultured cells from human tissue are difficult to obtain and to handle on a regular basis. Therefore, most human cellular models used in research investigating the human BBB are immortalized endothelial cell lines. A published cell line is human cerebral microvascular endothelial cell line hCMEC/D3, which is well suited for studying drug uptake and is easy to handle. The cells build a monolayer and express the characteristic tight junction proteins of the BBB34, whereas the expression level of claudin-5 is reported to be lower than in intact microvessels35 and many specific transporters have been detected at transcript level36 as well as in proteomic studies34. A relatively low TEER in the range of 30-50 Ω·cm2 is still a challenge37. Another source for brain endothelial cells are human pluripotent stem cells (hPSCs)38 and human cord blood-derived stem cells of circulating endothelial progenitor and hematopoietic lineages39,40. Both protocols of differentiation result in tight cell monolayers and high TEER values (e.g., 1,450 Ω·cm2 in co-cultures)38. These stem cell models require extreme care for cultivation, yet offer the opportunity to study the influence of regulating hormones41 or diseases with genetic backgrounds42 on BBB development.
In this study, we established an immortalized transfected human brain microvascular endothelial cell line, THBMEC43, to mimic the BBB and to study bacterial traversal. Cells are seeded on a filter and grown to 100% confluency in this cell culture model. Bacteria are inoculated in the upper part of the cell culture chamber. We use Escherichia coli (E. coli) in our sample study because of the high incidence of E. coli meningitis44. It has been shown that the lowest permeability of cell monolayer occurs between day 13 and day 15 after seeding45. Therefore, treatment of the THBMEC monolayer is performed after this time and bacteria are inoculated afterwards in the medium on the apical surface of the monolayer. After an incubation time, bacteria that were able to cross the barrier are quantified via plating medium with the bacteria on agar plates and counting the colonies. An increased number of colonies correlates with higher bacterial traversal through the BBB. The TEER is about 70 Ω·cm2 46. However, it is not necessary to measure the TEER in the described method. Although it is a well-established value for the permeability of the BBB, it seems to have no impact on the traversal of bacteria through the BBB. Untreated cells serve as a control of tightness in our model. It has been shown in previous work that the cells are able to react to proinflammatory cytokines and express typical tight junction proteins47. This allows for compound screening and validation of a larger set of transporter substrates and receptors.