Therapeutic modulation of the blood-brain barrier and ischemic stroke by a bioengineered FZD₄-selective WNT surrogate

Abstract Derangements of the blood-brain barrier (BBB) or blood-retinal barrier (BRB) occur in disorders ranging from stroke, cancer, diabetic retinopathy, and Alzheimer’s disease. The Norrin/FZD 4 /TSPAN12 pathway activates WNT/β-catenin signaling, which is essential for BBB and BRB function. However, systemic pharmacologic FZD 4 stimulation is hindered by obligate palmitoylation and insolubility of native WNTs and suboptimal properties of the FZD 4 -selective ligand Norrin. Here, we developed L6-F4-2, a non-lipidated, FZD 4 -specific surrogate with significantly improved sub-picomolar affinity versus native Norrin. In Norrin knockout ( Ndp KO ) mice, L6-F4-2 not only potently reversed neonatal retinal angiogenesis deficits, but also restored BRB and BBB function. In adult C57Bl/6J mice, post-stroke systemic delivery of L6-F4-2 strongly reduced BBB permeability, infarction, and edema, while improving neurologic score and capillary pericyte coverage. Our findings reveal systemic efficacy of a bioengineered FZD 4 -selective WNT surrogate during ischemic BBB dysfunction, with general applicability to adult CNS disorders characterized by an aberrant blood-brain barrier.