Title: Identifying the origin and mechanisms of pathological angiogenesis in neuroinflammatory diseases
Description: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS). Neuropathological studies in both human MS and the experimental autoimmune encephalomyelitis (EAE) animal model have shown that endothelial cell (EC) inflammation, associated with focal breakdown of the blood-brain barrier (BBB) and neo-angiogenesis, is prevalent in demyelinating plaques. Neo-angiogenesis and BBB damage contribute to leakage of serum components, infiltration of immune cells into the CNS, neuroinflammation, axonal demyelination, neuronal dysfunction, and disease progression. In Chapter 1, I introduce MS and its pathological hallmarks related to immune and vascular dysfunctions, the clinical course of MS progression, genetic and environmental influences, current treatments, and animal models. Next, I elaborate upon the pathways and processes involved in the development of a functioning CNS vascular system and the BBB. Finally, I discuss what is currently known about the contribution and the underlying mechanisms of neo-angiogenesis in MS and other diseases.

While an increase in vessel density has been documented for both MS and EAE lesions, the origin and pathways that drive formation of new, but leaky, blood vessels in EAE are poorly understood. In Chapter 3, I address these questions by performing single-cell RNA-sequencing (scRNA-seq) of 45309 ECs isolated from the spinal cord of control, acute and chronic MOG35-55 EAE mice. Based on expression patterns of blood vessel subtype-specific markers, I identified 23 distinct EC clusters with arterial, capillary, venule, and vein identities in either control or disease states. I performed differential gene expression and gene set enrichment analyses comparing control and disease EC clusters for each vascular subtype to identify which vessels exhibited gene expression profiles indicative of neo-angiogenesis in EAE. I found that molecular signatures of neo-angiogenesis are upregulated specifically in venous ECs during acute and, to a lesser extent, chronic EAE. Consistent with these data, EC proliferation is upregulated in veins in the EAE spinal cord.

RNA fluorescent in situ hybridization and immunofluorescence staining confirmed increased expression of key angiogenic markers Egfl7, Ecm1, Serpine1 and Emcn, and the tip cell marker Mcam, with a corresponding increase in vein density, in demyelinating white matter lesions of EAE spinal cords relative to controls. I also assessed changes in expression of some of these markers in human MS tissue and discovered upregulated expression of EGFL7 in cortical white matter lesions of MS patients, concomitant with increased vascular density. In Chapter 4, I examine the signaling pathways that may trigger pathogenic angiogenesis in EAE. I discovered that, in contrast to developmental angiogenesis, VEGF-A and TGF-β signaling may act as the driver of neo-angiogenesis in EAE. To test this hypothesis, I used a humanized VEGF-A blocking antibody, bevacizumab, to block VEGF signaling and found that this treatment ameliorated the MOG35-55 EAE neurological score by reducing expression of several angiogenic markers Egfl7, Ecm1, Serpine1, and Emcn, as confirmed by both in situ hybridization and computational analysis of scRNA-seq data.

Immune profiling of spleens and spinal cords by flow cytometry did not show changes in immune cell activation in bevacizumab-treated mice relative to IgG controls, indicating that the protective effects of VEGF blockade are not due to defects in the initiation of the immune response. Finally, in Chapter 5, I summarize the major findings of my dissertation and propose a model for the mechanisms by which neo-angiogenesis contributes to pathology in MS/EAE. I also present several future avenues of research that can be pursued to further our understanding of the molecular and cellular changes underlying pathogenic angiogenesis and its role in MS/EAE. While most current disease-modifying MS therapies aim to reduce inflammation and infiltration of immune cells into the CNS, these findings may lead to development of additional potential therapeutics that may reduce pathogenic neo-angiogenesis in order to alleviate long-term neurological deficits in MS. Additionally, since postcapillary venules and veins are the major sites of immune cell infiltration, BBB damage and neo-angiogenesis in EAE, the findings of this study suggest that development of treatment modalities that target venous ECs with anti-angiogenic compounds may be more effective in inhibiting the growth of pathogenic neovessels than therapies directed against the entire endothelium.