Endothelial KLF4 depletion drives age-related neurovascular dysfunction and neuropsychiatric impairment

M Matasha Dhar (Department of Psychiatry, School of Medicine, Case Western Reserve University) E Edwin Vázquez-Rosa (Department of Psychiatry, Case Western Reserve University) K Kalyani Chaubey (Department of Psychiatry, Case Western Reserve University) E Emiko Miller (Department of Psychiatry, Case Western Reserve University) S Sofia G. Corella (Department of Psychiatry, Case Western Reserve University) S Suwarna Chakraborty (Department of Physiology, Pharmacology, & Therapeutics, Johns Hopkins University School of Medicine) S Sunil Jamuna Tripathi (Department of Physiology, Pharmacology, & Therapeutics, Johns Hopkins University School of Medicine) T Tapatee Das (Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University) X Xudong Liao (Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University) M Mohamed Alkassem Alosman (Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University) H Hua Fang (Discovery and Development Sciences) Y Yeojung Koh (Department of Psychiatry, School of Medicine, Case Western Reserve University) P Preethy S. Sridharan (Department of Psychiatry, School of Medicine, Case Western Reserve University) K Kathryn Franke (Department of Psychiatry, School of Medicine, Case Western Reserve University) C Coral J. Cintrón-Pérez (Department of Psychiatry, School of Medicine, Case Western Reserve University) A Adrian A. Cintrón-Pérez (Department of Psychiatry, Case Western Reserve University) T Taylor Tomco (Department of Psychiatry, Case Western Reserve University) V Vidya Indrakumar (Department of Psychiatry, School of Medicine, Case Western Reserve University) P Phoebe J. Rubin (Department of Psychiatry, Case Western Reserve University) J Justin G. Pieper (Department of Psychiatry, Case Western Reserve University) L Luke A. Ashiku (Department of Psychiatry, Case Western Reserve University) M Min-Kyoo Shin (Department of Psychiatry, School of Medicine, Case Western Reserve University) X Xinmiao Tang (Yueyang Hospital, Shanghai University of Traditional Chinese Medicine) R Roshan Padmanabhan (Trailhead Biosystems Inc.) H Hariprakash Haragopal (Department of Biomedical Sciences, Northeast Ohio Medical University) M Margaret E. Flanagan (Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University) R Rajan Jain (Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Penn Epigenetics Institute, Perelman School of Medicine, University of Pennsylvania) B Bradley D. Winters (Department of Biomedical Sciences, Northeast Ohio Medical University) B Brigid M. Wilson (Geriatric Psychiatry, Geriatric Research Education and Clinical Center, Louis Stokes VA Medical Center) B Bindu D. Paul (Department of Physiology, Pharmacology, & Therapeutics, Johns Hopkins University School of Medicine) M Mukesh K. Jain (Department of Molecular Biology, Cell Biology and Biochemistry, The Warren Alpert Medical School, Brown University) A Andrew A. Pieper (Department of Psychiatry, Case Western Reserve University)

Abstract

Deterioration of the blood–brain barrier (BBB), including impaired neurovascular uncoupling, contributes to cognitive decline in aging. The BBB is formed principally by brain microvascular endothelial cells (ECs), and ECs throughout the body are enriched for the transcription factor Krüppel-like factor 4 (KLF4). Because KLF4 levels in ECs decrease with age, we tested whether that decline contributes to aging-related BBB deterioration, neurovascular dysfunction, and cognitive impairment. Using EC-specific Klf4 knockout mice (EC-K4KO), we show that loss of EC KLF4 accelerates multiple age-related brain pathologies. Indeed, middle-aged EC-K4KO mice display pathological features that are not normally observed until advanced age, including marked BBB leakage, impaired neurovascular coupling, loss of microvessels, increased oxidative damage, neuroinflammation, neurodegeneration, anxiety-like behavior, and cognitive deficits. Single-cell RNA sequencing of brain vasculature reveals dysregulation of immune response and barrier-related genes in ECs lacking KLF4, indicating that KLF4 maintains brain endothelial homeostasis by constraining proinflammatory and senescence programs at the chromatin level. Together, these results identify loss of EC KLF4 as a key driver of neurovascular decline and age-associated cognitive dysfunction.

Article Details

Volume / Issue Vol. 123, Issue 25
Published June 23, 2026
ISSN 0027-8424
Publisher National Academy of Sciences

Authors (32)

M

Matasha Dhar

Department of Psychiatry, School of Medicine, Case Western Reserve University

E

Edwin Vázquez-Rosa

Department of Psychiatry, Case Western Reserve University

K

Kalyani Chaubey

Department of Psychiatry, Case Western Reserve University

E

Emiko Miller

Department of Psychiatry, Case Western Reserve University

S

Sofia G. Corella

Department of Psychiatry, Case Western Reserve University

S

Suwarna Chakraborty

Department of Physiology, Pharmacology, & Therapeutics, Johns Hopkins University School of Medicine

S

Sunil Jamuna Tripathi

Department of Physiology, Pharmacology, & Therapeutics, Johns Hopkins University School of Medicine

T

Tapatee Das

Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University

X

Xudong Liao

Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University

M

Mohamed Alkassem Alosman

Department of Molecular Biology, Cell Biology and Biochemistry, Division of Biology and Medicine, Brown University

H

Hua Fang

Discovery and Development Sciences

Y

Yeojung Koh

Department of Psychiatry, School of Medicine, Case Western Reserve University

P

Preethy S. Sridharan

Department of Psychiatry, School of Medicine, Case Western Reserve University

K

Kathryn Franke

Department of Psychiatry, School of Medicine, Case Western Reserve University

C

Coral J. Cintrón-Pérez

Department of Psychiatry, School of Medicine, Case Western Reserve University

A

Adrian A. Cintrón-Pérez

Department of Psychiatry, Case Western Reserve University

T

Taylor Tomco

Department of Psychiatry, Case Western Reserve University

V

Vidya Indrakumar

Department of Psychiatry, School of Medicine, Case Western Reserve University

P

Phoebe J. Rubin

Department of Psychiatry, Case Western Reserve University

J

Justin G. Pieper

Department of Psychiatry, Case Western Reserve University

L

Luke A. Ashiku

Department of Psychiatry, Case Western Reserve University

M

Min-Kyoo Shin

Department of Psychiatry, School of Medicine, Case Western Reserve University

X

Xinmiao Tang

Yueyang Hospital, Shanghai University of Traditional Chinese Medicine

R

Roshan Padmanabhan

Trailhead Biosystems Inc.

H

Hariprakash Haragopal

Department of Biomedical Sciences, Northeast Ohio Medical University

M

Margaret E. Flanagan

Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Northwestern University

R

Rajan Jain

Departments of Medicine and Cell and Developmental Biology, Penn Cardiovascular Institute, Penn Epigenetics Institute, Perelman School of Medicine, University of Pennsylvania

B

Bradley D. Winters

Department of Biomedical Sciences, Northeast Ohio Medical University

B

Brigid M. Wilson

Geriatric Psychiatry, Geriatric Research Education and Clinical Center, Louis Stokes VA Medical Center

B

Bindu D. Paul

Department of Physiology, Pharmacology, & Therapeutics, Johns Hopkins University School of Medicine

M

Mukesh K. Jain

Department of Molecular Biology, Cell Biology and Biochemistry, The Warren Alpert Medical School, Brown University

A

Andrew A. Pieper

Department of Psychiatry, Case Western Reserve University