Abstract
Achieving widespread delivery of pharmacological agents beyond the blood-brain barrier (BBB) remains a formidable challenge in preclinical and clinical research. Here we quantitatively evaluate and compare three strategies for brain-wide delivery that employ transient BBB disruption or infusion via the cerebrospinal fluid (CSF) in rats. Using molecular magnetic resonance imaging (MRI) techniques, we find that the three techniques produce spatially differentiated labeling patterns, with the most homogeneous delivery produced either using chemically mediated or unfocused ultrasound-based BBB manipulation methods. Contrast enhancement distributions are similar following chemical and ultrasound procedures, but differ notably from the results of intra-CSF infusion. Delivery efficiency using the two BBB disruption methods also correlates inversely with a marker of tight junction density, suggesting that common factors determine susceptibility to these techniques. Our study thus documents the spatial variation of BBB properties across the brain while offering guidance about brain-wide application of molecular technologies in neuroscience and neuromedicine.
Data availability
Processed data are presented in the text, figures, and Supplementary Information. Numerical source data used to generate graphs in this study are provided as an accompanying Supplementary Data file. Raw data for key experiments have been deposited with the Dryad repository at https://doi.org/10.5061/dryad.tqjq2bwb7.
References
Abbott, N. J., Patabendige, A. A., Dolman, D. E., Yusof, S. R. & Begley, D. J. Structure and function of the blood-brain barrier. Neurobiol. Dis. 37, 13–25 (2010).
Neuwelt, E. A. et al. Engaging neuroscience to advance translational research in brain barrier biology. Nat. Rev. Neurosci. 12, 169–182 (2011).
Terstappen, G. C., Meyer, A. H., Bell, R. D. & Zhang, W. Strategies for delivering therapeutics across the blood-brain barrier. Nat. Rev. Drug Discov. 20, 362–383 (2021).
Pardridge, W. M. Treatment of Alzheimer’s disease and blood-brain barrier drug delivery. Pharmaceuticals 13, 394 (2020).
Goulatis, L. I. & Shusta, E. V. Protein engineering approaches for regulating blood-brain barrier transcytosis. Curr. Opin. Struct. Biol. 45, 109–115 (2017).
Pulgar, V. M. Transcytosis to cross the blood brain barrier, new advancements and challenges. Front. Neurosci. 12, 1019 (2018).
Grimm, H. P. et al. Delivery of the Brainshuttle amyloid-beta antibody fusion trontinemab to non-human primate brain and projected efficacious dose regimens in humans. MAbs 15, 2261509 (2023).
Barker, S. J. et al. Targeting the transferrin receptor to transport antisense oligonucleotides across the mammalian blood-brain barrier. Sci. Transl. Med. 16, eadi2245 (2024).
Huang, Q. et al. An AAV capsid reprogrammed to bind human transferrin receptor mediates brain-wide gene delivery. Science 384, 1220–1227 (2024).
Khoury, N. et al. Fc-engineered large molecules targeting blood-brain barrier transferrin receptor and CD98hc have distinct central nervous system and peripheral biodistribution. Nat. Commun. 16, 1822 (2025).
Sadekar, S. S. et al. Translational approaches for brain delivery of biologics via cerebrospinal fluid. Clin. Pharmacol. Ther. 111, 826–834 (2022).
Iliff, J. J. et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid beta. Sci. Transl. Med. 4, 147ra111 (2012).
Iliff, J. J. et al. Brain-wide pathway for waste clearance captured by contrast-enhanced MRI. J. Clin. Invest. 123, 1299–1309 (2013).
Jessen, N. A., Munk, A. S., Lundgaard, I. & Nedergaard, M. The glymphatic system: a beginner’s guide. Neurochem. Res. 40, 2583–2599 (2015).
Abbott, N. J., Pizzo, M. E., Preston, J. E., Janigro, D. & Thorne, R. G. The role of brain barriers in fluid movement in the CNS: is there a ‘glymphatic’ system? Acta Neuropathol. 135, 387–407 (2018).
Wolak, D. J. & Thorne, R. G. Diffusion of macromolecules in the brain: implications for drug delivery. Mol. Pharm. 10, 1492–1504 (2013).
Nicholson, C. & Hrabetova, S. Brain extracellular space: the final frontier of neuroscience. Biophys. J. 113, 2133–2142 (2017).
Szablowski, J. O., Bar-Zion, A. & Shapiro, M. G. Achieving spatial and molecular specificity with ultrasound-targeted biomolecular nanotherapeutics. Acc. Chem. Res. 52, 2427–2434 (2019).
McMahon, D., O’Reilly, M. A. & Hynynen, K. Therapeutic agent delivery across the blood-brain barrier using focused ultrasound. Annu. Rev. Biomed. Eng. 23, 89–113 (2021).
Howles, G. P. et al. Contrast-enhanced in vivo magnetic resonance microscopy of the mouse brain enabled by noninvasive opening of the blood-brain barrier with ultrasound. Magn. Reson. Med. 64, 995–1004 (2010).
McDannold, N., Zhang, Y. & Vykhodtseva, N. Blood-brain barrier disruption and vascular damage induced by ultrasound bursts combined with microbubbles can be influenced by choice of anesthesia protocol. Ultrasound Med. Biol. 37, 1259–1270 (2011).
Beccaria, K. et al. Opening of the blood-brain barrier with an unfocused ultrasound device in rabbits. J. Neurosurg. 119, 887–898 (2013).
Bakay, L., Ballantine, H. T. Jr., Hueter, T. F. & Sosa, D. Ultrasonically produced changes in the blood-brain barrier. AMA Arch. Neurol. Psychiatry 76, 457–467 (1956).
Hynynen, K., McDannold, N., Vykhodtseva, N. & Jolesz, F. A. Noninvasive MR imaging-guided focal opening of the blood-brain barrier in rabbits. Radiology 220, 640–646 (2001).
Lipsman, N. et al. Blood-brain barrier opening in Alzheimer’s disease using MR-guided focused ultrasound. Nat. Commun. 9, 2336 (2018).
Gasca-Salas, C. et al. Blood-brain barrier opening with focused ultrasound in Parkinson’s disease dementia. Nat. Commun. 12, 779 (2021).
Rezai, A. R. et al. Ultrasound blood-brain barrier opening and Aducanumab in Alzheimer’s disease. New Engl. J. Med. 390, 55–62 (2024).
Wu, C. C. et al. Blood-brain barrier opening with neuronavigation-guided focused ultrasound in pediatric patients with diffuse midline glioma. Sci. Transl. Med. 17, eadq6645 (2025).
Bhunia, S. et al. Drug delivery to the brain: recent advances and unmet challenges. Pharmaceutics 15, 2658 (2023).
On, N. H., Savant, S., Toews, M. & Miller, D. W. Rapid and reversible enhancement of blood-brain barrier permeability using lysophosphatidic acid. J. Cereb. Blood Flow Metab. 33, 1944–1954 (2013).
Sun, Z. et al. Biodistribution of negatively charged iron oxide nanoparticles (IONPs) in mice and enhanced brain delivery using lysophosphatidic acid (LPA). Nanomedicine 12, 1775–1784 (2016).
Doolittle, N. D., Muldoon, L. L., Culp, A. Y. & Neuwelt, E. A. Delivery of chemotherapeutics across the blood-brain barrier: challenges and advances. Adv. Pharmacol. 71, 203–243 (2014).
Tweedle, M. F. Physicochemical properties of gadoteridol and other magnetic resonance contrast agents. Invest. Radiol. 27, S2–S6 (1992).
Probst, R. J. et al. Gender differences in the blood volume of conscious Sprague-Dawley rats. J. Am. Assoc. Lab. Anim. Sci. 45, 49–52 (2006).
Westerhout, J., Ploeger, B., Smeets, J., Danhof, M. & de Lange, E. C. Physiologically based pharmacokinetic modeling to investigate regional brain distribution kinetics in rats. AAPS J. 14, 543–553 (2012).
Yang, L. et al. Evaluating glymphatic pathway function utilizing clinically relevant intrathecal infusion of CSF tracer. J. Transl. Med. 11, 107 (2013).
Szomolanyi, P. et al. Comparison of the relaxivities of macrocyclic gadolinium-based contrast agents in human plasma at 1.5, 3, and 7 T, and blood at 3 T. Invest. Radiol. 54, 559–564 (2019).
Paxinos, G. & Watson, C. The Rat Brain in Stereotaxic Coordinates, 7th edn (Academic Press, 2013).
Siso, S., Jeffrey, M. & Gonzalez, L. Sensory circumventricular organs in health and disease. Acta Neuropathol. 120, 689–705 (2010).
Sheikov, N., McDannold, N., Sharma, S. & Hynynen, K. Effect of focused ultrasound applied with an ultrasound contrast agent on the tight junctional integrity of the brain microvascular endothelium. Ultrasound Med. Biol. 34, 1093–1104 (2008).
Schulze, C., Smales, C., Rubin, L. L. & Staddon, J. M. Lysophosphatidic acid increases tight junction permeability in cultured brain endothelial cells. J. Neurochem. 68, 991–1000 (1997).
Pavlou, G. et al. Engineered 3D human neurovascular model of Alzheimer’s disease to study vascular dysfunction. Biomaterials 314, 122864 (2025).
Stanton, E. H. et al. Mapping of CSF transport using high spatiotemporal resolution dynamic contrast-enhanced MRI in mice: effect of anesthesia. Magn. Reson. Med. 85, 3326–3342 (2021).
O’Reilly, M. A. & Hynynen, K. Ultrasound enhanced drug delivery to the brain and central nervous system. Int. J. Hyperth. 28, 386–396 (2012).
Kovacs, Z. I. et al. Disrupting the blood-brain barrier by focused ultrasound induces sterile inflammation. Proc. Natl. Acad. Sci. USA 114, E75–E84 (2017).
McMahon, D. & Hynynen, K. Acute inflammatory response following increased blood-brain barrier permeability induced by focused ultrasound is dependent on microbubble dose. Theranostics 7, 3989–4000 (2017).
Choi, J. J., Wang, S., Tung, Y. S., Morrison, B. 3rd & Konofagou, E. E. Molecules of various pharmacologically-relevant sizes can cross the ultrasound-induced blood-brain barrier opening in vivo. Ultrasound Med. Biol. 36, 58–67 (2010).
Blanchette, M., Tremblay, L., Lepage, M. & Fortin, D. Impact of drug size on brain tumor and brain parenchyma delivery after a blood-brain barrier disruption. J. Cereb. Blood Flow Metab. 34, 820–826 (2014).
Wei, H. et al. Single-nanometer iron oxide nanoparticles as tissue-permeable MRI contrast agents. Proc. Natl. Acad. Sci. USA 118, e2102340118 (2021).
Acknowledgements
This research was funded by grants from the K. Lisa Yang Brain-Body Center and the NIH (U01 EB031641, R01 NS121073, R01 DA062195) to A.J. M.D., S.B. were partially funded by the MIT Neurobiological Engineering Training Program (NIH T32 EB019940), and S.B. was also funded by a J. Douglas Tan Postdoctoral Fellowship from the McGovern Institute for Brain Research. P.H. was supported by a Wellcome Trust-MIT Postdoctoral Fellowship (105932/Z/14/Z). A.W. was partially funded by the Advanced Multimodal Neuroimaging Training Program at the Massachusetts General Hospital (NIH R90 DA023427). G.G.G. was supported by a travel grant from the Universidad Francisco de Vitoria, and T.K. was funded by a JSPS Postdoctoral Fellowship for Research Abroad.
Author information
Authors and Affiliations
Contributions
M.D., S.B., and P.H. contributed equally. P.H. conceived the study. M.D., S.B., P.H., A.W., H.W., and G.G.G. performed experimental surgeries and imaging. M.D., T.K. performed histology. M.D., S.B. performed imaging analyses. X.W., R.D.K. developed and performed the microfluidic assay. M.D., A.J. wrote the paper with input from other authors. A.J. supervised the research.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Peer review
Peer review information
Communications Biology thanks Bilal Syed Nizami and the other anonymous reviewer(s) for their contribution to the peer review of this work. Primary handling editors: Adib Keikhosravi and Benjamin Bessieres. A peer review file is available.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Dawson, M., Bricault, S., Harvey, P. et al. Quantitative comparison of methods for widespread delivery of small molecules across the blood-brain barrier. Commun Biol (2026). https://doi.org/10.1038/s42003-026-09951-x
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s42003-026-09951-x