The choroid plexus links innate immunity to CSF dysregulation in hydrocephalus

SM Robert, BC Reeves, E Kiziltug, PQ Duy, JK Karimy… - Cell, 2023 - cell.com
Cell, 2023cell.com
The choroid plexus (ChP) is the blood-cerebrospinal fluid (CSF) barrier and the primary
source of CSF. Acquired hydrocephalus, caused by brain infection or hemorrhage, lacks
drug treatments due to obscure pathobiology. Our integrated, multi-omic investigation of post-
infectious hydrocephalus (PIH) and post-hemorrhagic hydrocephalus (PHH) models
revealed that lipopolysaccharide and blood breakdown products trigger highly similar TLR4-
dependent immune responses at the ChP-CSF interface. The resulting CSF" cytokine storm" …
Summary
The choroid plexus (ChP) is the blood-cerebrospinal fluid (CSF) barrier and the primary source of CSF. Acquired hydrocephalus, caused by brain infection or hemorrhage, lacks drug treatments due to obscure pathobiology. Our integrated, multi-omic investigation of post-infectious hydrocephalus (PIH) and post-hemorrhagic hydrocephalus (PHH) models revealed that lipopolysaccharide and blood breakdown products trigger highly similar TLR4-dependent immune responses at the ChP-CSF interface. The resulting CSF "cytokine storm", elicited from peripherally derived and border-associated ChP macrophages, causes increased CSF production from ChP epithelial cells via phospho-activation of the TNF-receptor-associated kinase SPAK, which serves as a regulatory scaffold of a multi-ion transporter protein complex. Genetic or pharmacological immunomodulation prevents PIH and PHH by antagonizing SPAK-dependent CSF hypersecretion. These results reveal the ChP as a dynamic, cellularly heterogeneous tissue with highly regulated immune-secretory capacity, expand our understanding of ChP immune-epithelial cell cross talk, and reframe PIH and PHH as related neuroimmune disorders vulnerable to small molecule pharmacotherapy.
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