25-hydroxycholesterol dysregulates brain endothelial cell function and exacerbates cerebral haemorrhage

Abstract

AbstractViral infection and hypocholesterolaemia are two independent risk factors for intracerebral haemorrhage (ICH), but the molecular mechanisms leading to vascular rupture via these risk factors remain unknown. We hypothesised that the enzyme cholesterol 25-hydroxylase (CH25H) and its metabolite 25-hydroxycholesterol (25HC), which modulates cholesterol metabolism during infection, may offer a mechanistic link between cholesterol dysregulation and infection during neurovascular dysfunction. We identified an upregulation of CH25H in infection-associated cerebral haemorrhage, in a SARS-CoV-2-induced zebrafish ICH model and foetal human SARS-CoV-2-associated cortical microbleeds. Using human brain endothelial cells and zebrafish ICH models, we show that 25HC promotes endothelial dysfunction and exacerbates brain bleeding. These effects involved cholesterol metabolism modulation, as cholesterol supplementation rescued these effects, while 25HC and statin treatments interacted to exacerbate dysfunction. We propose that the CH25H/25HC pathway represents an important component in the pathophysiology of brain vessel dysfunction associated with infection and cholesterol dysregulation in the context of ICH.