Endothelial Piezo1 Hyperactivity Drives Neurovascular Dysfunction in Hypertension

BACKGROUND: Hypertension is a major driver of neurovascular dysfunction and cognitive decline, yet the molecular mechanisms linking elevated arterial pressure to impaired cerebral blood flow remain poorly defined. Piezo1, a mechanosensitive cation channel enriched in the brain endothelium, is a candidate mediator of cerebral blood flow deficits during hypertension. METHODS: Using 2 distinct mouse models of hypertension—BPH/2J mice (genetically hypertensive strain) and angiotensin II–infused C57BL/6J mice—we assessed brain endothelial Piezo1 activity using patch-clamp electrophysiology. Endothelial-specific Piezo1 deletion models were used to evaluate the role of the channel in hypertension-associated cerebrovascular impairment. Cerebral blood flow responses were measured in vivo by laser speckle contrast imaging, and super-resolution nanoscopy was used to quantify Piezo1 nanoscale organization. Behavioral testing was used to assess cognition. RESULTS: Genetic manipulation of endothelial Piezo1 had minimal impact on baseline blood pressure. However, cerebral endothelial Piezo1 activity was markedly elevated in different hypertension models. Deletion of endothelial Piezo1 protected against hypertension-induced cerebrovascular deficits, including impaired vasomotion, reduced functional hyperemia, and blunted CO 2 -evoked hyperemia. Super-resolution imaging revealed that hypertension increased Piezo1 clustering, consistent with electrophysiological findings of enhanced channel coupling and open probability. Mechanistically, Piezo1 hyperactivity was PKC (protein kinase C)–dependent, and the PKC-Piezo1 spatial association was enhanced during hypertension. Importantly, PKC inhibition normalized brain endothelial Piezo1 activity, restored cerebral blood flow responses, and rescued cognitive performance. CONCLUSIONS: Hypertension increased the gain of Piezo1 function in brain endothelial cells, promoting dysfunctional neurovascular signaling and cognitive impairment. Targeting Piezo1 or PKC signaling selectively restored cerebrovascular regulation. This work identifies a mechanosensitive pathway that could be leveraged to protect the hypertensive brain.