SUMMARY:The present study provides evidence that chronic intake of a high-fat diet induces a dramatic extravasation of immunoglobulins, indicating alterations in blood-brain barrier (BBB) functioning, in the brains of apolipoprotein E (apoE)-knockout mice, but not of C57Bl/6 control mice. Using sodium fluorescein as a marker for the permeability of the BBB, we found additional support for age-related disturbances of BBB function in apoE-knockout mice. Behavioral analysis of apoE-knockout mice compared with C57Bl/6 mice indicated that they were also less efficient in acquiring the spatial Morris water maze task. Furthermore, apoE-knockout mice are known to develop severe atherosclerosis, which is exacerbated with a high-fat diet. We therefore compared the apoE-knockout mice with the apoE3-Leiden transgenic mice, which are known to develop atherosclerosis. However, apoE3-Leiden mice that were kept on a high-fat, high-cholesterol diet and that developed atherosclerosis to an extent similar to the apoE-knockout mice, showed no signs of BBB disturbances. These results indicate for the first time that apoE plays an essential role in the maintenance of the integrity of the BBB during aging and that it protects the brain from neuropathology induced by a high-fat diet. We therefore hypothesize that the role of apoE in the maintenance of the integrity of the BBB may be the mechanism by which apoE affects the progression of neurodegeneration, as seen in Alzheimer's disease. (Lab Invest 2001, 81:953-960).A polipoprotein E (apoE) is synthesized in almost all cell types and throughout the body. Within the brain, astrocytes are the predominant source of apoE (Pitas et al, 1987). It is thought that apoE functions by mediating neuronal repair and/or remodeling during development and during regeneration after injury to the central nervous system by mediating the distribution of lipids, predominantly cholesterol and phospholipids (Nathan et al, 1994).Three common human isoforms of apoE exist: E2, E3, and E4. ApoE4 is now a well-established risk factor for the development of Alzheimer's disease (AD) (Corder et al, 1993;Saunders et al, 1993). ApoE4 has also been associated with other neurological diseases, including vascular dementia and a poor clinical outcome in patients after stroke and head injury (Nicoll et al, 1995;Slooter et al, 1997). The mechanism by which apoE4 affects the process of neurodegeneration, however, is largely unknown.Mice deficient in apoE display disturbances in learning and memory function as well as in long-term potentiation (Krugers et al, 1997;Krzywkowski et al, 1999;Oitzl et al, 1997;Veinbergs and Masliah, 1999). They display several neuropathologic alterations, including a loss of synapses with increasing age, cytoskeletal alterations (Masliah et al, 1995), and a reduced activity of choline acetyltransferase (Gordon et al, 1995). In addition, they show an impaired response to ischemic, traumatic, and excitotoxic lesions (Chen et al, 1997;Laskowitz et al, 1997). On the contrary, a few studies report neit...