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Gao M, Wang X, Su S, Feng W, Lai Y, Huang K, Cao D, Wang Q. Meningeal lymphatic vessel crosstalk with central nervous system immune cells in aging and neurodegenerative diseases. Neural Regen Res 2025; 20:763-778. [PMID: 38886941 DOI: 10.4103/nrr.nrr-d-23-01595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/22/2023] [Indexed: 06/20/2024] Open
Abstract
Meningeal lymphatic vessels form a relationship between the nervous system and periphery, which is relevant in both health and disease. Meningeal lymphatic vessels not only play a key role in the drainage of brain metabolites but also contribute to antigen delivery and immune cell activation. The advent of novel genomic technologies has enabled rapid progress in the characterization of myeloid and lymphoid cells and their interactions with meningeal lymphatic vessels within the central nervous system. In this review, we provide an overview of the multifaceted roles of meningeal lymphatic vessels within the context of the central nervous system immune network, highlighting recent discoveries on the immunological niche provided by meningeal lymphatic vessels. Furthermore, we delve into the mechanisms of crosstalk between meningeal lymphatic vessels and immune cells in the central nervous system under both homeostatic conditions and neurodegenerative diseases, discussing how these interactions shape the pathological outcomes. Regulation of meningeal lymphatic vessel function and structure can influence lymphatic drainage, cerebrospinal fluid-borne immune modulators, and immune cell populations in aging and neurodegenerative disorders, thereby playing a key role in shaping meningeal and brain parenchyma immunity.
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Affiliation(s)
- Minghuang Gao
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xinyue Wang
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Shijie Su
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Weicheng Feng
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yaona Lai
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Kongli Huang
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Dandan Cao
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Qi Wang
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
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Jaja PT, Yuri Y, Sufianov A. Early clinico-radiological outcomes following neuroendoscopic cysto-cisternostomy for middle cranial fossa arachnoid cysts: a prospective cohort study with illustrative cases. Childs Nerv Syst 2024:10.1007/s00381-024-06596-1. [PMID: 39269464 DOI: 10.1007/s00381-024-06596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The dysmorphogenetic arachnoid cysts' pathomechanism is most favoured, and about 50% occur as middle cranial fossa cysts (MCFAC). Still being rare, management options are yet evolving. We described the clinico-radiological features, management and early outcomes of participants with MCFAC in our service. METHODS This prospective cohort study involved 29 pediatric participants recruited (from electronic health records, using ICD G93.0 D016080 for arachnoid cysts) between 01/01/2023 and 31/06/2023, following informed consent according to the ethical approval. All participants had neuro-imaging confirmed MCFAC. Baseline and follow-up data were retrieved and analyzed using summary (mean, standard deviation) and inferential (ANOVA, t-test) statistics. RESULTS They were averagely aged 6.2 ± 4.48 years and were mostly males (89.7%). 24.1% were asymptomatic. The commonest symptoms (n = 38) were headaches (23.7%), developmental delays (15.8%), eye complaints (15.8%) and cephalomegaly (7.9%). They were predominantly left-sided (89.7%). Galassi (G) 3 lesions were less (24.1%), with G2 and G1 lesions evenly sharing the rest. The average cyst volume was 58.4 ± 80.83cm3; there were significant differences (F = 4.682; p = 0.018) between the average volumes for G1 (14.4 ± 22.42cm3), G2 (61.7 ± 89.92cm3) and G3 (122.5 ± 94.37cm3) lesions. 44.8% of the participants had rigid-endoscopic cysto-cisternotomy (all between the ICA and oculomotor nerve into the interpeduncular cistern, using ventriculostomy forceps); including all G3, 50% of G2 and no G1 (had serial clinico-radiological observation) lesion. The average pre- (117.42cm3) and post-operative (53.48cm3) cyst volumes showed significant (t = - 2.797, p = 0.021) reductions. CONCLUSION Middle cranial fossa arachnoid cysts occur predominantly amongst males, in middle childhood and left-sided. The treatment-related patient series are largely symptomatic, unlike the largely asymptomatic, screening-related series. Higher Galassi grade lesions presented with progressively, significantly larger cyst volumes and higher likelihoods of surgery. The average post-operative cyst volume at follow-up averagely showed almost 60% reduction from the pre-operative. All participants reported clinical remission.
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Affiliation(s)
- Promise Tamunoipiriala Jaja
- Department of Neurosurgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
- Directorate of Medical and Dental Services, Rivers State Hospitals' Management Board, Port Harcourt, Nigeria.
- Department of Paediatric Neurosurgery, Federal Centre of Neurosurgery, Tyumen, Russian Federation.
| | - Yakimov Yuri
- Department of Neurosurgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Department of Paediatric Neurosurgery, Federal Centre of Neurosurgery, Tyumen, Russian Federation
| | - Albert Sufianov
- Department of Neurosurgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Department of Paediatric Neurosurgery, Federal Centre of Neurosurgery, Tyumen, Russian Federation
- Department of Neurosurgery, People's Friendship University, Moscow, Russian Federation
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Wu CH, Chang FC, Wang YF, Lirng JF, Wu HM, Pan LLH, Wang SJ, Chen SP. Impaired Glymphatic and Meningeal Lymphatic Functions in Patients with Chronic Migraine. Ann Neurol 2024; 95:583-595. [PMID: 38055324 DOI: 10.1002/ana.26842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study was undertaken to investigate migraine glymphatic and meningeal lymphatic vessel (mLV) functions. METHODS Migraine patients and healthy controls (HCs) were prospectively recruited between 2020 and 2023. Diffusion tensor image analysis along the perivascular space (DTI-ALPS) index for glymphatics and dynamic contrast-enhanced magnetic resonance imaging parameters (time to peak [TTP]/enhancement integral [EI]/mean time to enhance [MTE]) for para-superior sagittal (paraSSS)-mLV or paratransverse sinus (paraTS)-mLV in episodic migraine (EM), chronic migraine (CM), and CM with and without medication-overuse headache (MOH) were analyzed. DTI-ALPS correlations with clinical parameters (migraine severity [numeric rating scale]/disability [Migraine Disability Assessment (MIDAS)]/bodily pain [Widespread Pain Index]/sleep quality [Pittsburgh Sleep Quality Index (PSQI)]) were examined. RESULTS In total, 175 subjects (112 migraine + 63 HCs) were investigated. DTI-ALPS values were lower in CM (median [interquartile range] = 0.64 [0.12]) than in EM (0.71 [0.13], p = 0.005) and HCs (0.71 [0.09], p = 0.004). CM with MOH (0.63 [0.07]) had lower DTI-ALPS values than CM without MOH (0.73 [0.12], p < 0.001). Furthermore, CM had longer TTP (paraSSS-mLV: 55.8 [12.9] vs 40.0 [7.6], p < 0.001; paraTS-mLV: 51.2 [8.1] vs 44.0 [3.3], p = 0.002), EI (paraSSS-mLV: 45.5 [42.0] vs 16.1 [9.2], p < 0.001), and MTE (paraSSS-mLV: 253.7 [6.7] vs 248.4 [13.8], p < 0.001; paraTS-mLV: 252.0 [6.2] vs 249.7 [1.2], p < 0.001) than EM patients. The MIDAS (p = 0.002) and PSQI (p = 0.002) were negatively correlated with DTI-ALPS index after Bonferroni corrections (p < q = 0.01). INTERPRETATION CM patients, particularly those with MOH, have glymphatic and meningeal lymphatic dysfunctions, which are highly clinically relevant and may implicate pathogenesis for migraine chronification. ANN NEUROL 2024;95:583-595.
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Grants
- MOHW 108-TDU-B-211-133001 Ministry of Health and Welfare, Taiwan
- MOHW107-TDU-B-211-123001 Ministry of Health and Welfare, Taiwan
- MOHW112-TDU-B-211-144001 Ministry of Health and Welfare, Taiwan
- N/A Professor Tsuen CHANG's Scholarship Program from Medical Scholarship Foundation In Memory Of Professor Albert Ly-Young Shen
- V109B-009 Taipei Veterans General Hospital
- V110C-102 Taipei Veterans General Hospital
- V111B-032 Taipei Veterans General Hospital
- V112B-007 Taipei Veterans General Hospital
- V112C-053 Taipei Veterans General Hospital
- V112C-059 Taipei Veterans General Hospital
- V112C-113 Taipei Veterans General Hospital
- V112D67-001-MY3-1 Taipei Veterans General Hospital
- V112D67-002-MY3-1 Taipei Veterans General Hospital
- V112E-004-1 Taipei Veterans General Hospital
- VGH-111-C-158 Taipei Veterans General Hospital
- The Brain Research Center, National Yang Ming Chiao Tung University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan
- 110-2314-B-075-005 The National Science and Technology Council, Taiwan
- 110-2314-B-075-032 The National Science and Technology Council, Taiwan
- 110-2321-B-010-005- The National Science and Technology Council, Taiwan
- 110-2326-B-A49A-501-MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-075 -086-MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-075-025 -MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-A49-069-MY3 The National Science and Technology Council, Taiwan
- 111-2321-B-A49-004 The National Science and Technology Council, Taiwan
- 111-2321-B-A49-011 The National Science and Technology Council, Taiwan
- 112-2314-B-075-066- The National Science and Technology Council, Taiwan
- 112-2314-B-A49-037 -MY3 The National Science and Technology Council, Taiwan
- 112-2321-B-075-007 The National Science and Technology Council, Taiwan
- NSTC 108-2314-B-010-022 -MY3 The National Science and Technology Council, Taiwan
- 109V1-5-2 Veterans General Hospitals and University System of Taiwan Joint Research Program
- 110-G1-5-2 Veterans General Hospitals and University System of Taiwan Joint Research Program
- VGHUST-112-G1-2-1 Veterans General Hospitals and University System of Taiwan Joint Research Program
- Vivian W. Yen Neurological Foundation
- CI-109-3 Yen Tjing Ling Medical Foundation
- CI-111-2 Yen Tjing Ling Medical Foundation
- CI-112-2 Yen Tjing Ling Medical Foundation
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Peters ME, Lyketsos CG. The glymphatic system's role in traumatic brain injury-related neurodegeneration. Mol Psychiatry 2023; 28:2707-2715. [PMID: 37185960 DOI: 10.1038/s41380-023-02070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
In at least some individuals who suffer a traumatic brain injury (TBI), there exists a risk of future neurodegenerative illness. This review focuses on the association between the brain-based paravascular drainage pathway known as the "glymphatic system" and TBI-related neurodegeneration. The glymphatic system is composed of cerebrospinal fluid (CSF) flowing into the brain parenchyma along paravascular spaces surrounding penetrating arterioles where it mixes with interstitial fluid (ISF) before being cleared along paravenous drainage pathways. Aquaporin-4 (AQP4) water channels on astrocytic end-feet appear essential for the functioning of this system. The current literature linking glymphatic system disruption and TBI-related neurodegeneration is largely based on murine models with existing human research focused on the need for biomarkers of glymphatic system function (e.g., neuroimaging modalities). Key findings from the existing literature include evidence of glymphatic system flow disruption following TBI, mechanisms of this decreased flow (i.e., AQP4 depolarization), and evidence of protein accumulation and deposition (e.g., amyloid β, tau). The same studies suggest that glymphatic dysfunction leads to subsequent neurodegeneration, cognitive decline, and/or behavioral change although replication in humans is needed. Identified emerging topics from the literature are as follows: link between TBI, sleep, and glymphatic system dysfunction; influence of glymphatic system disruption on TBI biomarkers; and development of novel treatments for glymphatic system disruption following TBI. Although a burgeoning field, more research is needed to elucidate the role of glymphatic system disruption in TBI-related neurodegeneration.
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Affiliation(s)
- Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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Mee-Inta O, Hsieh CF, Chen DQ, Fan CH, Chiang YY, Liu CC, Sze CI, Gean PW, Wu PC, Yang MS, Huang PS, Chieh Wu P, Kuo YM, Huang CC. High-frequency ultrasound imaging for monitoring the function of meningeal lymphatic system in mice. ULTRASONICS 2023; 131:106949. [PMID: 36773481 DOI: 10.1016/j.ultras.2023.106949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
The meningeal lymphatic system drains the cerebrospinal fluid from the subarachnoid space to the cervical lymphatic system, primarily to the deep cervical lymph nodes. Perturbations of the meningeal lymphatic system have been linked to various neurologic disorders. A method to specifically monitor the flow of meningeal lymphatic system in real time is unavailable. In the present study, we adopted the high-frequency ultrasound (HFUS) with 1,1'diocatadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI)-loaded microbubble and FePt@PLGA nanoparticle contrast agents to evaluate the flow of the meningeal lymphatic system in 2-month-old mice. Statistical analysis was performed to identify changes of HFUS signals among the microbubbles, FePt@PLGA nanoparticles, and saline control groups. Approximately 15 min from the start of intracerebroventricular injection of contrast agents, their signals were evident at the deep cervical lymph nodes and lasted for at least 60 min. These signals were validated on the basis of the presence of DiI and Fe signals in the deep cervical lymph nodes. Ligation of afferent lymphatic vessels to the deep cervical lymph nodes eliminated the HFUS signals. Moreover, ablation of lymphatic vessels near the confluence of sinuses decreased the HFUS signals in the deep cervical lymph nodes. Glioma-bearing mice that exhibited reduced lymphatic vessel immunostaining signals near the confluence of sinuses had lowered HFUS signals in the deep cervical lymph nodes within 60 min. The proposed method provides a minimally invasive approach to monitor the qualities of the meningeal lymphatic system in real time as well as the progression of the meningeal lymphatic system in various brain disease animal models.
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Affiliation(s)
- Onanong Mee-Inta
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Fang Hsieh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - De-Quan Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hsiang Fan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Yi Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chan-Chuan Liu
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Chun-I Sze
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Wu Gean
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ching Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan; Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan, Taiwan; Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan
| | - Mon-Shieh Yang
- College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Po-Sheng Huang
- Department of Photonics, National Cheng Kung University, Tainan, Taiwan
| | - Pin Chieh Wu
- Department of Photonics, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Min Kuo
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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Semyachkina-Glushkovskaya O, Bragin D, Fedosov I, Blokhina I, Khorovodov A, Terskov A, Shirokov A, Dubrovsky A, Vinnik V, Evsukova A, Elovenko D, Adushkina V, Tzoy M, Dmitrenko A, Krupnova V, Manzhaeva M, Agranovich I, Saranceva E, Iskra T, Lykova E, Sokolovski S, Rafailov E, Kurths J. Mechanisms of Photostimulation of Brain's Waste Disposal System: The Role of Singlet Oxygen. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1438:45-50. [PMID: 37845438 PMCID: PMC11349324 DOI: 10.1007/978-3-031-42003-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
There is strong evidence that augmentation of the brain's waste disposal system via stimulation of the meningeal lymphatics might be a promising therapeutic target for preventing neurological diseases. In our previous studies, we demonstrated activation of the brain's waste disposal system using transcranial photostimulation (PS) with a laser 1267 nm, which stimulates the direct generation of singlet oxygen in the brain tissues. Here we investigate the mechanisms underlying this phenomenon. Our results clearly demonstrate that PS-mediated stimulation of the brain's waste disposal system is accompanied by activation of lymphatic contractility associated with subsequent intracellular production of the reactive oxygen species and the nitric oxide underlying lymphatic relaxation. Thus, PS stimulates the brain's waste disposal system by influencing the mechanisms of regulation of lymphatic pumping.
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Affiliation(s)
| | - Denis Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM, USA.
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Ivan Fedosov
- Department of Biology, Saratov State University, Saratov, Russia
| | - Inna Blokhina
- Department of Biology, Saratov State University, Saratov, Russia
| | | | - Andrey Terskov
- Department of Biology, Saratov State University, Saratov, Russia
| | - Alexander Shirokov
- Department of Biology, Saratov State University, Saratov, Russia
- Institute of Biochemistry and Physiology of Plants and Microorganisms, Russian Academy of Sciences, Saratov, Russia
| | | | - Valeria Vinnik
- Department of Biology, Saratov State University, Saratov, Russia
| | - Arina Evsukova
- Department of Biology, Saratov State University, Saratov, Russia
| | - Daria Elovenko
- Department of Biology, Saratov State University, Saratov, Russia
| | | | - Maria Tzoy
- Department of Biology, Saratov State University, Saratov, Russia
| | | | - Valeria Krupnova
- Department of Biology, Saratov State University, Saratov, Russia
| | - Maria Manzhaeva
- Department of Biology, Saratov State University, Saratov, Russia
| | - Ilana Agranovich
- Department of Biology, Saratov State University, Saratov, Russia
| | - Elena Saranceva
- Department of Biology, Saratov State University, Saratov, Russia
| | - Tatyana Iskra
- Department of Biology, Saratov State University, Saratov, Russia
| | - Ekaterina Lykova
- Department of Biology, Saratov State University, Saratov, Russia
| | - Sergey Sokolovski
- Optoelectronics and Biomedical Photonics Group, AIPT, Aston University, Birmingham, UK
| | - Edik Rafailov
- Optoelectronics and Biomedical Photonics Group, AIPT, Aston University, Birmingham, UK
| | - Jürgen Kurths
- Physics Department, Humboldt University, Berlin, Germany
- Department of Biology, Saratov State University, Saratov, Russia
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
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7
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Pappolla MA, Carare RO, Poeggeler B, Wisniewski T, Sambamurti K. The Lymphatic System in Neurological Disease and Alzheimer's Disease. A Brief Editorial. Curr Alzheimer Res 2022; 19:689-693. [PMID: 36306458 DOI: 10.2174/1567205020666221028111517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Miguel A Pappolla
- Department of Neurology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Burkhand Poeggeler
- Johann-Friedrich-Blumenbach- Institute for Zoology and Anthropology, Faculty of Biology and Psychology, Georg-August-University of Göttingen, Am Türmchen 3, Gütersloh 33332, Germany
| | - Thomas Wisniewski
- New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kumar Sambamurti
- Department of Neurosciences, The Medical University of South Carolina, Charleston, SC 29425, USA
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8
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Alajangi HK, Kaur M, Sharma A, Rana S, Thakur S, Chatterjee M, Singla N, Jaiswal PK, Singh G, Barnwal RP. Blood-brain barrier: emerging trends on transport models and new-age strategies for therapeutics intervention against neurological disorders. Mol Brain 2022; 15:49. [PMID: 35650613 PMCID: PMC9158215 DOI: 10.1186/s13041-022-00937-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/24/2022] [Indexed: 12/12/2022] Open
Abstract
The integrity of the blood–brain barrier (BBB) is essential for normal central nervous system (CNS) functioning. Considering the significance of BBB in maintaining homeostasis and the neural environment, we aim to provide an overview of significant aspects of BBB. Worldwide, the treatment of neurological diseases caused by BBB disruption has been a major challenge. BBB also restricts entry of neuro-therapeutic drugs and hinders treatment modalities. Hence, currently nanotechnology-based approaches are being explored on large scale as alternatives to conventional methodologies. It is necessary to investigate the in-depth characteristic features of BBB to facilitate the discovery of novel drugs that can successfully cross the barrier and target the disease effectively. It is imperative to discover novel strategies to treat life-threatening CNS diseases in humans. Therefore, insights regarding building blocks of BBB, activation of immune response on breach of this barrier, and various autoimmune neurological disorders caused due to BBB dysfunction are discussed. Further, special emphasis is given on delineating BBB disruption leading to CNS disorders. Moreover, various mechanisms of transport pathways across BBB, several novel strategies, and alternative routes by which drugs can be properly delivered into CNS are also discussed.
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Affiliation(s)
- Hema Kumari Alajangi
- Department of Biophysics, Panjab University, Chandigarh, 160014, India.,University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Mandeep Kaur
- Department of Biophysics, Panjab University, Chandigarh, 160014, India
| | - Akanksha Sharma
- Department of Biophysics, Panjab University, Chandigarh, 160014, India.,University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India
| | - Sumedh Rana
- Department of Biophysics, Panjab University, Chandigarh, 160014, India
| | - Shipali Thakur
- Department of Biophysics, Panjab University, Chandigarh, 160014, India
| | - Mary Chatterjee
- Department of Biotechnology, UIET, Panjab University, Chandigarh, 160014, India
| | - Neha Singla
- Department of Biophysics, Panjab University, Chandigarh, 160014, India
| | - Pradeep Kumar Jaiswal
- Department of Biochemistry and Biophysics, Texas A&M University, College Station, TX, 77843, USA.
| | - Gurpal Singh
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, 160014, India.
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Maloveská M, Humeník F, Vikartovská Z, Hudáková N, Almášiová V, Krešáková L, Čížková D. Brain Fluid Channels for Metabolite Removal. Physiol Res 2022; 71:199-208. [DOI: 10.33549/physiolres.934802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The adult human brain represents only 2 % of the body's total weight, however it is one of the most metabolically active organs in the mammalian body. Its high metabolic activity necessitates an efficacious waste clearance system. Besides the blood, there are two fluids closely linked to the brain and spinal cord drainage system: interstitial fluid (ISF) and cerebrospinal fluid (CSF). The aim of this review is to summarize the latest research clarifying the channels of metabolite removal by fluids from brain tissue, subarachnoid space (SAS) and brain dura (BD). Special attention is focused on lymphatic vascular structures in the brain dura, their localizations within the meninges, morphological properties and topographic anatomy. The review ends with an account of the consequences of brain lymphatic drainage failure. Knowledge of the physiological state of the clearance system is crucial in order to understand the changes related to impaired brain drainage.
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Affiliation(s)
| | | | | | | | | | | | - D Čížková
- Centre of Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy in Kosice, Slovak Republic.
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10
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Klostranec JM, Vucevic D, Bhatia KD, Kortman HGJ, Krings T, Murphy KP, terBrugge KG, Mikulis DJ. Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part II-Imaging Techniques and Clinical Applications. Radiology 2021; 301:516-532. [PMID: 34698564 DOI: 10.1148/radiol.2021204088] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The glymphatic system is a recently discovered network unique to the central nervous system that allows for dynamic exchange of interstitial fluid (ISF) and cerebrospinal fluid (CSF). As detailed in part I, ISF and CSF transport along paravascular channels of the penetrating arteries and possibly veins allow essential clearance of neurotoxic solutes from the interstitium to the CSF efflux pathways. Imaging tests to investigate this neurophysiologic function, although challenging, are being developed and are reviewed herein. These include direct visualization of CSF transport using postcontrast imaging techniques following intravenous or intrathecal administration of contrast material and indirect glymphatic assessment with detection of enlarged perivascular spaces. Application of MRI techniques, including intravoxel incoherent motion, diffusion tensor imaging, and chemical exchange saturation transfer, is also discussed, as are methods for imaging dural lymphatic channels involved with CSF efflux. Subsequently, glymphatic function is considered in the context of proteinopathies associated with neurodegenerative diseases and traumatic brain injury, cytotoxic edema following acute ischemic stroke, and chronic hydrocephalus after subarachnoid hemorrhage. These examples highlight the substantial role of the glymphatic system in neurophysiology and the development of certain neuropathologic abnormalities, stressing the importance of its consideration when interpreting neuroimaging investigations. © RSNA, 2021.
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Affiliation(s)
- Jesse M Klostranec
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Diana Vucevic
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kartik D Bhatia
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Hans G J Kortman
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Timo Krings
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kieran P Murphy
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Karel G terBrugge
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - David J Mikulis
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
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11
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Klostranec JM, Vucevic D, Bhatia KD, Kortman HGJ, Krings T, Murphy KP, terBrugge KG, Mikulis DJ. Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part I-Anatomy and Physiology. Radiology 2021; 301:502-514. [PMID: 34665028 DOI: 10.1148/radiol.2021202043] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Normal physiologic function of organs requires a circulation of interstitial fluid to deliver nutrients and clear cellular waste products. Lymphatic vessels serve as collectors of this fluid in most organs; however, these vessels are absent in the central nervous system. How the central nervous system maintains tight control of extracellular conditions has been a fundamental question in neuroscience until recent discovery of the glial-lymphatic, or glymphatic, system was made this past decade. Networks of paravascular channels surrounding pial and parenchymal arteries and veins were found that extend into the walls of capillaries to allow fluid transport and exchange between the interstitial and cerebrospinal fluid spaces. The currently understood anatomy and physiology of the glymphatic system is reviewed, with the paravascular space presented as an intrinsic component of healthy pial and parenchymal cerebral blood vessels. Glymphatic system behavior in animal models of health and disease, and its enhanced function during sleep, are discussed. The evolving understanding of glymphatic system characteristics is then used to provide a current interpretation of its physiology that can be helpful for radiologists when interpreting neuroimaging investigations.
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Affiliation(s)
- Jesse M Klostranec
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Diana Vucevic
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Kartik D Bhatia
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Hans G J Kortman
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Timo Krings
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Kieran P Murphy
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - Karel G terBrugge
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
| | - David J Mikulis
- From the Montreal Neurologic Institute and Hospital, Department of Diagnostic and Interventional Neuroradiology, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montreal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montreal, Montréal, Canada (J.M.K.); Department of Materials Science & Engineering, Faculty of Applied Science & Engineering, University of Toronto, Toronto, Canada (D.V.); Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.); and Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada (T.K., K.G.t.B.)
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Mills M, van Zanten M, Borri M, Mortimer PS, Gordon K, Ostergaard P, Howe FA. Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective. J Magn Reson Imaging 2021; 53:1766-1790. [PMID: 33625795 PMCID: PMC7611641 DOI: 10.1002/jmri.27542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Clinical examination and lymphoscintigraphy are the current standard for investigating lymphatic function. Magnetic resonance imaging (MRI) facilitates three-dimensional (3D), nonionizing imaging of the lymphatic vasculature, including functional assessments of lymphatic flow, and may improve diagnosis and treatment planning in disease states such as lymphedema. PURPOSE To summarize the role of MRI as a noninvasive technique to assess lymphatic drainage and highlight areas in need of further study. STUDY TYPE Systematic review. POPULATION In October 2019, a systematic literature search (PubMed) was performed to identify articles on magnetic resonance lymphangiography (MRL). FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions. ASSESSMENT Article quality assessment was conducted using a bespoke protocol, designed with heavy reliance on the National Institutes of Health quality assessment tool for case series studies and Downs and Blacks quality checklist for health care intervention studies. STATISTICAL TESTS The results of the original research articles are summarized. RESULTS From 612 identified articles, 43 articles were included and their protocols and results summarized. Field strength was 1.5 or 3.0 T in all studies, with 25/43 (58%) employing 3.0 T imaging. Most commonly, imaging of the peripheries, upper and lower limbs including the pelvis (32/43, 74%), and the trunk (10/43, 23%) is performed, including two studies covering both regions. Imaging protocols were heterogenous; however, T2 -weighted and contrast-enhanced T1 -weighted images are routinely acquired and demonstrate the lymphatic vasculature. Edema, vessel, quantity and morphology, and contrast uptake characteristics are commonly reported indicators of lymphatic dysfunction. DATA CONCLUSION MRL is uniquely placed to yield large field of view, qualitative and quantitative, 3D imaging of the lymphatic vasculature. Despite study heterogeneity, consensus is emerging regarding MRL protocol design. MRL has the potential to dramatically improve understanding of the lymphatics and detect disease, but further optimization, and research into the influence of study protocol differences, is required before this is fully realized. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Michael Mills
- Molecular and Clinical Sciences Research Institute, St George’s University, London, UK
| | - Malou van Zanten
- Molecular and Clinical Sciences Research Institute, St George’s University, London, UK
| | - Marco Borri
- Molecular and Clinical Sciences Research Institute, St George’s University, London, UK
- Department of Neuroradiology, King’s College Hospital, London, UK
| | - Peter S. Mortimer
- Molecular and Clinical Sciences Research Institute, St George’s University, London, UK
| | - Kristiana Gordon
- Lymphovascular Medicine, Dermatology Department, St George’s Hospital, London, UK
| | - Pia Ostergaard
- Molecular and Clinical Sciences Research Institute, St George’s University, London, UK
| | - Franklyn A. Howe
- Molecular and Clinical Sciences Research Institute, St George’s University, London, UK
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Cells with Many Talents: Lymphatic Endothelial Cells in the Brain Meninges. Cells 2021; 10:cells10040799. [PMID: 33918497 PMCID: PMC8067019 DOI: 10.3390/cells10040799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
The lymphatic system serves key functions in maintaining fluid homeostasis, the uptake of dietary fats in the small intestine, and the trafficking of immune cells. Almost all vascularized peripheral tissues and organs contain lymphatic vessels. The brain parenchyma, however, is considered immune privileged and devoid of lymphatic structures. This contrasts with the notion that the brain is metabolically extremely active, produces large amounts of waste and metabolites that need to be cleared, and is especially sensitive to edema formation. Recently, meningeal lymphatic vessels in mammals and zebrafish have been (re-)discovered, but how they contribute to fluid drainage is still not fully understood. Here, we discuss these meningeal vessel systems as well as a newly described cell population in the zebrafish and mouse meninges. These cells, termed brain lymphatic endothelial cells/Fluorescent Granular Perithelial cells/meningeal mural lymphatic endothelial cells in fish, and Leptomeningeal Lymphatic Endothelial Cells in mice, exhibit remarkable features. They have a typical lymphatic endothelial gene expression signature but do not form vessels and rather constitute a meshwork of single cells, covering the brain surface.
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Natale G, Limanaqi F, Busceti CL, Mastroiacovo F, Nicoletti F, Puglisi-Allegra S, Fornai F. Glymphatic System as a Gateway to Connect Neurodegeneration From Periphery to CNS. Front Neurosci 2021; 15:639140. [PMID: 33633540 PMCID: PMC7900543 DOI: 10.3389/fnins.2021.639140] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
The classic concept of the absence of lymphatic vessels in the central nervous system (CNS), suggesting the immune privilege of the brain in spite of its high metabolic rate, was predominant until recent times. On the other hand, this idea left questioned how cerebral interstitial fluid is cleared of waste products. It was generally thought that clearance depends on cerebrospinal fluid (CSF). Not long ago, an anatomically and functionally discrete paravascular space was revised to provide a pathway for the clearance of molecules drained within the interstitial space. According to this model, CSF enters the brain parenchyma along arterial paravascular spaces. Once mixed with interstitial fluid and solutes in a process mediated by aquaporin-4, CSF exits through the extracellular space along venous paravascular spaces, thus being removed from the brain. This process includes the participation of perivascular glial cells due to a sieving effect of their end-feet. Such draining space resembles the peripheral lymphatic system, therefore, the term "glymphatic" (glial-lymphatic) pathway has been coined. Specific studies focused on the potential role of the glymphatic pathway in healthy and pathological conditions, including neurodegenerative diseases. This mainly concerns Alzheimer's disease (AD), as well as hemorrhagic and ischemic neurovascular disorders; other acute degenerative processes, such as normal pressure hydrocephalus or traumatic brain injury are involved as well. Novel morphological and functional investigations also suggested alternative models to drain molecules through perivascular pathways, which enriched our insight of homeostatic processes within neural microenvironment. Under the light of these considerations, the present article aims to discuss recent findings and concepts on nervous lymphatic drainage and blood-brain barrier (BBB) in an attempt to understand how peripheral pathological conditions may be detrimental to the CNS, paving the way to neurodegeneration.
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Affiliation(s)
- Gianfranco Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Fiona Limanaqi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | | | | | | | - Francesco Fornai
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.,IRCCS Neuromed, Pozzilli, Italy
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Naganawa S, Ito R, Nakamichi R, Kawamura M, Taoka T, Yoshida T, Sone M. Relationship between Time-dependent Signal Changes in Parasagittal Perivenous Cysts and Leakage of Gadolinium-based Contrast Agents into the Subarachnoid Space. Magn Reson Med Sci 2021; 20:378-384. [PMID: 33441494 PMCID: PMC8922354 DOI: 10.2463/mrms.mp.2020-0138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose To investigate the association between signal changes over time in perivenous cystic structures near the superior sagittal sinus and leakage of a gadolinium-based contrast agent (GBCA) into the subarachnoid space in patients with suspected endolymphatic hydrops. Methods Fifty-one cystic structures in 27 cases were evaluated. The signal intensity of the cystic structures was measured on 3D real inversion recovery (3D-real IR) images obtained at pre-, and at 10 min, 4 hrs and 24 hrs post-intravenous administration (IV) of GBCA. Signal enhancement of the cystic structures from the pre-contrast images at each time point was compared in subjects with leakage (positive) versus those without leakage (negative) using an ANOVA. Fisher’s exact probability test was used to compare the maximum contrast-enhanced time point between positive and negative groups. We used 5% as a threshold to determine statistical significance. Results In leakage positive subjects, mean signal enhancement of the cysts was significantly greater at 4 and 24 hrs compared to 10 min. However, although there was a trend of an increase from 4 to 24 hrs, the difference was not significant. In the leakage negative group, mean signal enhancement of the cysts was significantly higher at 4 hrs compared to 10 min and 24 hrs. There was no significant difference between 10 min and 24 hrs. In the positive group, the maximum signal increase was found in 10/38 and 28/38 cysts at 4 and 24 hrs after IV-GBCA, respectively. In the leakage negative group, the maximum signal increase was found in 10/13 and 3/13 cysts at 4 and 24 hrs, respectively (P = 0.0019). Conclusion There was an association between signal changes over time after IV-GBCA in perivenous cystic structures and leakage of GBCA. Further research to clarify the impact of cystic structures on the function of the waste clearance system of the brain is warranted.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Rei Nakamichi
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Toshiaki Taoka
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine
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16
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Pedrini S, Chatterjee P, Hone E, Martins RN. High‐density lipoprotein‐related cholesterol metabolism in Alzheimer’s disease. J Neurochem 2020; 159:343-377. [DOI: 10.1111/jnc.15170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Steve Pedrini
- Sarich Neurosciences Research InstituteEdith Cowan University Nedlands WA Australia
| | - Pratishtha Chatterjee
- Sarich Neurosciences Research InstituteEdith Cowan University Nedlands WA Australia
- Department of Biomedical Sciences Faculty of Medicine, Health and Human Sciences Macquarie University Sydney NSW Australia
| | - Eugene Hone
- Sarich Neurosciences Research InstituteEdith Cowan University Nedlands WA Australia
| | - Ralph N. Martins
- Sarich Neurosciences Research InstituteEdith Cowan University Nedlands WA Australia
- Department of Biomedical Sciences Faculty of Medicine, Health and Human Sciences Macquarie University Sydney NSW Australia
- School of Psychiatry and Clinical Neurosciences University of Western Australia Nedlands WA Australia
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Rodriguez Alvarez M, Rodríguez Valencia LM, Seidman R, Acharya A, Espina N, Ravindran N, Mishan D, Mesa CJ, Espinoza LR, McFarlane IM. Rheumatoid meningitis and infection in absence of rheumatoid arthritis history: review of 31 cases. Clin Rheumatol 2020; 39:3833-3845. [PMID: 32519051 DOI: 10.1007/s10067-020-05221-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
A 62-year-old healthy male presents with leg weakness and fever. Imaging revealed leptomeningeal enhancement (LE). After cerebrospinal fluid (CSF) cultures were negative, he was discharged with a diagnosis of aseptic meningitis, but was readmitted due to worsening symptoms. Brain biopsy suggested rheumatoid leptomeningitis associated with elevated serum rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA). Following discharge, the New York State Department of Health (NYSDOH) reported a polymerase chain reaction (PCR) on CSF and brain DNA consistent with Naegleria fowleri (NF). After dramatic improvement on steroids, the patient declined antimicrobial treatment. Upon prednisone taper, symptoms recurred which responded to rituximab (RTX). This case highlights a possible association between rheumatoid leptomeningitis (RM) onset and infection, in a patient without a history of rheumatoid arthritis (RA). Our goal is to assess whether this association is present in 69 RM cases reported since 2000. We also describe diagnosis and treatment of 31 new cases (January 2017 to March 2020). We did not identify evidence of active/latent infection in patients with RM and previous RA; however, patients without RA history appeared to have a significantly higher rate. This finding could demonstrate the necessity of evaluating for infection in de novo RM cases without antecedent RA history. We also describe characteristic clinical patterns for each group. More studies are needed to corroborate these results and expand into a possible distinct natural history of RM in each group, which might have an impact upon the clinical outcome.
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Affiliation(s)
- Milena Rodriguez Alvarez
- Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA. .,School of Graduate Studies, SUNY-Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | | | - Roberta Seidman
- Department of Pathology, Stony Brook University Hospital, Stony Brook, NY, 11794, USA
| | - Ajita Acharya
- Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Noel Espina
- Department of Health, Wadsworth Center, New York State, Albany, NY, 12237, USA
| | - Nadish Ravindran
- Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Daniel Mishan
- School of Graduate Studies, SUNY-Downstate Medical Center, Brooklyn, NY, 11203, USA
| | - Christopher J Mesa
- Department of Internal Medicine, Division of Rheumatology, Louisiana State University Health Science Center New Orleans, New Orleans, LA, 70006, USA
| | - Luis R Espinoza
- Department of Internal Medicine, Division of Rheumatology, Louisiana State University Health Science Center New Orleans, New Orleans, LA, 70006, USA
| | - Isabel M McFarlane
- Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
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Naganawa S, Taoka T. The Glymphatic System: A Review of the Challenges in Visualizing its Structure and Function with MR Imaging. Magn Reson Med Sci 2020; 21:182-194. [PMID: 33250472 PMCID: PMC9199971 DOI: 10.2463/mrms.rev.2020-0122] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The central nervous system (CNS) was previously thought to be the only organ system lacking lymphatic vessels to remove waste products from the interstitial space. Recently, based on the results from animal experiments, the glymphatic system was hypothesized. In this hypothesis, cerebrospinal fluid (CSF) enters the periarterial spaces, enters the interstitial space of the brain parenchyma via aquaporin-4 (AQP4) channels in the astrocyte end feet, and then exits through the perivenous space, thereby clearing waste products. From the perivenous space, the interstitial fluid drains into the subarachnoid space and meningeal lymphatics of the parasagittal dura. It has been reported that the glymphatic system is particularly active during sleep. Impairment of glymphatic system function might be a cause of various neurodegenerative diseases such as Alzheimer’s disease, normal pressure hydrocephalus, glaucoma, and others. Meningeal lymphatics regulate immunity in the CNS. Many researchers have attempted to visualize the function and structure of the glymphatic system and meningeal lymphatics in vivo using MR imaging. In this review, we aim to summarize these in vivo MR imaging studies and discuss the significance, current limitations, and future directions. We also discuss the significance of the perivenous cyst formation along the superior sagittal sinus, which is recently discovered in the downstream of the glymphatic system.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Toshiaki Taoka
- Department of Radiology, Nagoya University Graduate School of Medicine
- Department of Innovative Biomedical Visualization (iBMV), Nagoya University Graduate School of Medicine
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