Loss of angiopoietin-2 leads to region-specific brain malformations and blood-brain barrier leakage.

Angiopoietin-2 (ANGPT2) is known to destabilize vascular barriers in most peripheral organs; however, its role in the brain vasculature remains poorly understood. To investigate its physiological function within the brain vasculature, we analyzed constitutive Angpt2-knockout mice in adulthood. We showed that loss of ANGPT2 leads to region-specific vascular malformations and blood-brain barrier (BBB) dysfunction, resulting in differential permeability to 1 kDa and 70 kDa fluorescent tracers. Notably, overt vascular malformations appeared only in select brain regions that allowed leakage of both tracers. These malformations were characterized by dilated, intertwined, and sprouting endothelial cells, surrounded by reactive perivascular cells, along with high levels of astrocyte- and neuron-derived vascular endothelial growth factor A (VEGFA) and elevated expression of the vascular receptors VEGF receptor 2 (KDR) and neuropilin-1 (NRP1). Other cortical areas without obvious malformations exhibited significant leakage of the 1 kDa tracer. We also demonstrated that different cell types took up the tracers after passing the BBB. Our findings identified ANGPT2 as an important factor involved in the regulation of cerebrovascular architecture, barrier integrity, and endothelial-parenchymal interactions, and uncovered surprising differences in the leakage patterns and cellular uptake of two widely used BBB tracers.