Lymphatic Clearance of the Brain: Perivascular, Paravascular and Significance for Neurodegenerative Diseases.
Lymphatic Clearance of the Brain: Perivascular, Paravascular and Significance for Neurodegenerative Diseases.
复制标题
DOI：
10.1007/s10571-015-0273-8
复制
发表时间：
2016-03
影响因子：
4
通讯作者：
Carare RO
中科院分区：
文献类型：
--
作者：
Bakker EN;Bacskai BJ;Arbel-Ornath M;Aldea R;Bedussi B;Morris AW;Weller RO;Carare RO
与身体其他器官相比，大脑的淋巴清除途径有所不同，并且一直是激烈争论的话题。脑细胞外液，特别是间质液 (ISF) 和脑脊液 (CSF) 的引流，不仅对于容量调节很重要，而且对于清除β淀粉样蛋白 (Aβ) 等废物也很重要。脑脊液在临床医学中发挥着特殊作用，因为它可用于分析阿尔茨海默病的生物标志物。尽管缺乏蛛网膜下腔 (SAS) 和脑实质之间通讯的完整解剖学和生理学图像，但通常认为 Aβ 从大脑 ISF 清除到 CSF。最近的研究表明，大脑的清理主要发生在睡眠期间，血管周围和血管旁空间作为脑实质的引流通道具有特定的作用。然而，流动方向、所涉及的解剖结构和驱动力仍然难以捉摸，文献中的数据部分相互矛盾。阿尔茨海默病的神经胶质细胞中 Aβ 的存在表明 ISF 与 CSF 存在直接通讯。尽管如此，还有与 Aβ 血管周围引流失败相关的脑淀粉样血管病的病理学已得到充分描述。在此，我们回顾了脉管系统的作用以及血管病理学对大脑血管周围和血管旁清除途径的影响。关于 ISF 脑部引流可能途径的不同观点在病理意义的背景下进行了讨论。
The lymphatic clearance pathways of the brain are different compared to the other organs of the body and have been the subject of heated debates. Drainage of brain extracellular fluids, particularly interstitial fluid (ISF) and cerebrospinal fluid (CSF), is not only important for volume regulation, but also for removal of waste products such as amyloid beta (Aβ). CSF plays a special role in clinical medicine, as it is available for analysis of biomarkers for Alzheimer’s disease. Despite the lack of a complete anatomical and physiological picture of the communications between the subarachnoid space (SAS) and the brain parenchyma, it is often assumed that Aβ is cleared from the cerebral ISF into the CSF. Recent work suggests that clearance of the brain mainly occurs during sleep, with a specific role for peri- and para-vascular spaces as drainage pathways from the brain parenchyma. However, the direction of flow, the anatomical structures involved and the driving forces remain elusive, with partially conflicting data in literature. The presence of Aβ in the glia limitans in Alzheimer’s disease suggests a direct communication of ISF with CSF. Nonetheless, there is also the well-described pathology of cerebral amyloid angiopathy associated with the failure of perivascular drainage of Aβ. Herein, we review the role of the vasculature and the impact of vascular pathology on the peri- and para-vascular clearance pathways of the brain. The different views on the possible routes for ISF drainage of the brain are discussed in the context of pathological significance.