3D Vessels-on-Chip using isogenic hiPSC-derived VSMCs reveal NOTCH3-driven alterations in brain small vessel disease.

cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary brain small vessel disease caused by pathogenic variants in the NOTCH3 gene, leading to NOTCH3 protein accumulation and degeneration of vascular smooth muscle cells (VSMCs). Here, we developed a CADASIL 3D Vessel-on-Chip model using either primary brain VSMCs or human induced pluripotent stem cell (hiPSC)-derived VSMCs from CADASIL patients and isogenic controls. In 3D co-culture with hiPSC-derived endothelial cells, both primary and hiPSC-derived CADASIL VSMCs exhibited disease-relevant morphological abnormalities, increased NOTCH3 and contractile protein levels, and altered intracellular Ca2+ dynamics that were not observed under conventional 2D culture. PDGFRβ, a downstream NOTCH3 target, was upregulated and correlated with NOTCH3 protein levels in both 3D models and CADASIL patient brain tissue. Pharmacological inhibition of NOTCH3 cleavage reduced NOTCH3 protein levels and rescued CADASIL VSMC phenotypic abnormalities. In conclusion, this 3D Vessel-on-Chip model robustly shows CADASIL pathology-relevant readouts and provides a platform for mechanistic studies and therapeutic testing.