Single-cell transcriptome sequencing for opening the blood-brain barrier through specific mode electroacupuncture stimulation

Reviewer #1 (Public review):

Summary:

The work from this paper successfully mapped transcriptional landscape and identified EA-responsive cell types (endothelial, microglia). Data suggest EA modulates BBB via immune pathways and cell communication. However, claims of "BBB opening" are not directly proven (no permeability data).

Strengths:

First scRNA-seq atlas of EA effects on BBB, revealing 23 cell clusters and 8 cell types. High cell throughput (98,338 cells), doublet removal, and robust clustering (Seurat, SingleR). Comprehensive bioinformatics (GO/KEGG, CellPhoneDB for ligand-receptor interactions). Raw data were deposited in GEO (GSE272895) and can be accessed.

Weaknesses:

(1) No in vivo/in vitro assays confirm BBB permeability changes (e.g., Evans blue leakage, TEER).

(2) Only male rats were used, ignoring sex-specific BBB differences.

(3) Pericytes and neurons, critical for the BBB, were not captured, likely due to dissociation artifacts.

(4) Protein-level validation (Western blot, IHC) absent for key genes (e.g., LY6E, HSP90).

(5) Fixed stimulation protocol (2/100 Hz, 40 min); no dose-response or temporal analysis.

Reviewer #2 (Public review):

Summary:

This study uses single-cell RNA sequencing to explore how electroacupuncture (EA) stimulation alters the brain's cellular and molecular landscape after blood-brain barrier (BBB) opening. The authors aim to identify changes in gene expression and signaling pathways across brain cell types in response to EA stimulation using single-cell RNA sequencing. This direction holds promise for understanding the consequences of noninvasive methods of BBB opening for therapeutic drug delivery across the BBB.

Strengths:

(1) The study addresses an emerging and potentially important application of noninvasive stimulation methods to manipulate BBB permeability.

(2) The dataset provides broad transcriptional profiling across multiple brain cell types using single-cell resolution, which could serve as a valuable community resource.

(3) Analyses of receptor-ligand signaling and cell-cell communication are included and have the potential to offer mechanistic insight into BBB regulation.

Weaknesses:

(1) The work falls short in its current form. The experimental design lacks a clear justification, and readers are not provided with sufficient background information on the extent, timing, or regional specificity of BBB opening in this EA model. These details, established in prior work, are critical to understanding the rationale behind the current transcriptomic analyses.

(2) Further, the results are often presented with minimal context or interpretation. There is no model of intercellular or molecular coordination to explain the BBB-opening process, despite the stated goal of identifying such mechanisms. The statement that EA induces a "unique frontal cortex-specific transcriptome signature" is not supported, as no data from other brain regions are presented. Biological interpretation is at times unclear or inaccurate - for instance, attributing astrocyte migration effects to endothelial cell clusters or suggesting microglial tight junction changes without connecting them meaningfully to endothelial function.

(3) The study does include analyses of receptor-ligand signaling and cell-cell communication, which could be among its most biologically rich outputs. However, these are relegated to supplementary material and not shown in the leading figures. This choice limits the utility of the manuscript as a hypothesis-generating resource.

(4) Overall, while the dataset may be of interest to BBB researchers and those developing technologies for drug delivery across the BBB, the manuscript in its current form does not yet fulfill its interpretive goals. A more integrated and biologically grounded analysis would be beneficial.