Post-stroke endothelial cell plasticity: A transformational lineage from complete to partial EndoMT

The internationalization of vascular endothelial cells has been established to promote the development and progression of ischemic stroke. Research indicates that endothelial-mesenchymal transition (EndoMT) exists in an intermediate state, where some EndoMT can be reversibly converted into endothelial cells during the MEndT process, suggesting this phase could become a critical target for preventing further brain damage. Pathophysiological processes including TGF-β signaling pathways, nuclear transcription factors, and energy metabolism all contribute to EndoMT development. Single-cell sequencing not only confirms cellular heterogeneity in EndoMT formation but also reveals multiple intermediate cell phenotypes, providing theoretical foundations for novel intervention strategies. Additionally, EndoMT plays a pivotal role in the blood-brain barrier. This review will focus on detailing the intermediate states of EndoMT, key signaling pathways involved, and their critical roles in ischemic stroke development.