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Mokbel AY, Burns MP, Main BS. The contribution of the meningeal immune interface to neuroinflammation in traumatic brain injury. J Neuroinflammation 2024; 21:135. [PMID: 38802931 PMCID: PMC11131220 DOI: 10.1186/s12974-024-03122-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide, particularly among the elderly, yet our mechanistic understanding of what renders the post-traumatic brain vulnerable to poor outcomes, and susceptible to neurological disease, is incomplete. It is well established that dysregulated and sustained immune responses elicit negative consequences after TBI; however, our understanding of the neuroimmune interface that facilitates crosstalk between central and peripheral immune reservoirs is in its infancy. The meninges serve as the interface between the brain and the immune system, facilitating important bi-directional roles in both healthy and disease settings. It has been previously shown that disruption of this system exacerbates neuroinflammation in age-related neurodegenerative disorders such as Alzheimer's disease; however, we have an incomplete understanding of how the meningeal compartment influences immune responses after TBI. In this manuscript, we will offer a detailed overview of the holistic nature of neuroinflammatory responses in TBI, including hallmark features observed across clinical and animal models. We will highlight the structure and function of the meningeal lymphatic system, including its role in immuno-surveillance and immune responses within the meninges and the brain. We will provide a comprehensive update on our current knowledge of meningeal-derived responses across the spectrum of TBI, and identify new avenues for neuroimmune modulation within the neurotrauma field.
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Affiliation(s)
- Alaa Y Mokbel
- Department of Neuroscience, Georgetown University Medical Center, New Research Building-EG11, 3970 Reservoir Rd, NW, Washington, DC, 20057, USA
| | - Mark P Burns
- Department of Neuroscience, Georgetown University Medical Center, New Research Building-EG11, 3970 Reservoir Rd, NW, Washington, DC, 20057, USA
| | - Bevan S Main
- Department of Neuroscience, Georgetown University Medical Center, New Research Building-EG11, 3970 Reservoir Rd, NW, Washington, DC, 20057, USA.
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Peng T, Xie Y, Liu F, Lian Y, Xie Y, Ma Y, Wang C, Xie N. The cerebral lymphatic drainage system and its implications in epilepsy. J Neurosci Res 2024; 102:e25267. [PMID: 38284855 DOI: 10.1002/jnr.25267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 01/30/2024]
Abstract
The central nervous system has long been thought to lack a clearance system similar to the peripheral lymphatic system. Therefore, the clearance of metabolic waste in the central nervous system has been a subject of great interest in neuroscience. Recently, the cerebral lymphatic drainage system, including the parenchymal clearance system and the meningeal lymphatic network, has attracted considerable attention. It has been extensively studied in various neurological disorders. Solute accumulation and neuroinflammation after epilepsy impair the blood-brain barrier, affecting the exchange and clearance between cerebrospinal fluid and interstitial fluid. Restoring their normal function may improve the prognosis of epilepsy. However, few studies have focused on providing a comprehensive overview of the brain clearance system and its significance in epilepsy. Therefore, this review addressed the structural composition, functions, and methods used to assess the cerebral lymphatic system, as well as the neglected association with epilepsy, and provided a theoretical basis for therapeutic approaches in epilepsy.
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Affiliation(s)
- Tingting Peng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, P.R. China
| | - Yinyin Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, P.R. China
| | - Fengxia Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yi Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Yunqing Ma
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Cui Wang
- Key Clinical Laboratory of Henan Province, Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Nanchang Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
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3
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Sennfält S, Thrippleton MJ, Stringer M, Reyes CA, Chappell F, Doubal F, Garcia DJ, Zhang J, Cheng Y, Wardlaw J. Visualising and semi-quantitatively measuring brain fluid pathways, including meningeal lymphatics, in humans using widely available MRI techniques. J Cereb Blood Flow Metab 2023; 43:1779-1795. [PMID: 37254892 PMCID: PMC10581238 DOI: 10.1177/0271678x231179555] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Abstract
Brain fluid dynamics remains poorly understood with central issues unresolved. In this study, we first review the literature regarding points of controversy, then pilot study if conventional MRI techniques can assess brain fluid outflow pathways and explore potential associations with small vessel disease (SVD). We assessed 19 subjects participating in the Mild Stroke Study 3 who had FLAIR imaging before and 20-30 minutes after intravenous Gadolinium (Gd)-based contrast. Signal intensity (SI) change was assessed semi-quantitatively by placing regions of interest, and qualitatively by a visual scoring system, along dorsal and basal fluid outflow routes. Following i.v. Gd, SI increased substantially along the anterior, middle, and posterior superior sagittal sinus (SSS) (82%, 104%, and 119%, respectively), at basal areas (cribriform plate, 67%; jugular foramina, 72%), and in narrow channels surrounding superficial cortical veins separated from surrounding cerebrospinal fluid (CSF) (96%) (all p < 0.001). The SI increase was associated with higher intraparenchymal perivascular spaces (PVS) scores (Std. Beta 0.71, p = 0.01). Our findings suggests that interstitial fluid drainage is visible on conventional MRI and drains from brain parenchyma via cortical perivenous spaces to dural meningeal lymphatics along the SSS remaining separate from the CSF. An association with parenchymal PVS requires further research, now feasible in humans.
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Affiliation(s)
- Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Michael Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Francesca Chappell
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Daniela J Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Junfang Zhang
- Department of Neurology, Shanghai General Hospital and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yajun Cheng
- Department of Neurology, West China Hospital and Sichuan University, Chengdu, China
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
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Laaker C, Baenen C, Kovács KG, Sandor M, Fabry Z. Immune cells as messengers from the CNS to the periphery: the role of the meningeal lymphatic system in immune cell migration from the CNS. Front Immunol 2023; 14:1233908. [PMID: 37662908 PMCID: PMC10471710 DOI: 10.3389/fimmu.2023.1233908] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
In recent decades there has been a large focus on understanding the mechanisms of peripheral immune cell infiltration into the central nervous system (CNS) in neuroinflammatory diseases. This intense research led to several immunomodulatory therapies to attempt to regulate immune cell infiltration at the blood brain barrier (BBB), the choroid plexus (ChP) epithelium, and the glial barrier. The fate of these infiltrating immune cells depends on both the neuroinflammatory environment and their type-specific interactions with innate cells of the CNS. Although the fate of the majority of tissue infiltrating immune cells is death, a percentage of these cells could become tissue resident immune cells. Additionally, key populations of immune cells can possess the ability to "drain" out of the CNS and act as messengers reporting signals from the CNS toward peripheral lymphatics. Recent data supports that the meningeal lymphatic system is involved not just in fluid homeostatic functions in the CNS but also in facilitating immune cell migration, most notably dendritic cell migration from the CNS to the meningeal borders and to the draining cervical lymph nodes. Similar to the peripheral sites, draining immune cells from the CNS during neuroinflammation have the potential to coordinate immunity in the lymph nodes and thus influence disease. Here in this review, we will evaluate evidence of immune cell drainage from the brain via the meningeal lymphatics and establish the importance of this in animal models and humans. We will discuss how targeting immune cells at sites like the meningeal lymphatics could provide a new mechanism to better provide treatment for a variety of neurological conditions.
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Affiliation(s)
- Collin Laaker
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI, United States
| | - Cameron Baenen
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Kristóf G. Kovács
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Matyas Sandor
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, United States
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Qi Y, Xiong W, Chen Q, Ye Z, Jiang C, He Y, Ye Q. New trends in brain tumor immunity with the opportunities of lymph nodes targeted drug delivery. J Nanobiotechnology 2023; 21:254. [PMID: 37542241 PMCID: PMC10401854 DOI: 10.1186/s12951-023-02011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/17/2023] [Indexed: 08/06/2023] Open
Abstract
Lymph nodes targeted drug delivery is an attractive approach to improve cancer immunotherapy outcomes. Currently, the depth of understanding of afferent and efferent arms in brain immunity reveals the potential clinical applications of lymph node targeted drug delivery in brain tumors, e.g., glioblastoma. In this work, we systematically reviewed the microenvironment of glioblastoma and its structure as a basis for potential immunotherapy, including the glial-lymphatic pathway for substance exchange, the lymphatic drainage pathway from meningeal lymphatic vessels to deep cervical lymph nodes that communicate intra- and extracranial immunity, and the interaction between the blood-brain barrier and effector T cells. Furthermore, the carriers designed for lymph nodes targeted drug delivery were comprehensively summarized. The challenges and opportunities in developing a lymph nodes targeted delivery strategy for glioblastoma using nanotechnology are included at the end.
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Affiliation(s)
- Yangzhi Qi
- Center of Regenerative Medicine, Department of Stomatology, Renmin Hospital of Wuhan University, Gaoxin 6th Road, Jiangxia, Wuhan, 430000, Hubei, People's Republic of China
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Wei Xiong
- Center of Regenerative Medicine, Department of Stomatology, Renmin Hospital of Wuhan University, Gaoxin 6th Road, Jiangxia, Wuhan, 430000, Hubei, People's Republic of China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Zhifei Ye
- Clinical Research Center, The Second Linhai Renmin Hospital, Linhai, 317000, Zhejiang, China
| | - Cailei Jiang
- Institute of Translational and Regenerative Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430040, Hubei, China
| | - Yan He
- Center of Regenerative Medicine, Department of Stomatology, Renmin Hospital of Wuhan University, Gaoxin 6th Road, Jiangxia, Wuhan, 430000, Hubei, People's Republic of China.
- Institute of Translational and Regenerative Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430040, Hubei, China.
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Qingsong Ye
- Center of Regenerative Medicine, Department of Stomatology, Renmin Hospital of Wuhan University, Gaoxin 6th Road, Jiangxia, Wuhan, 430000, Hubei, People's Republic of China.
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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Park CJ, Kim SY, Kim JH, Son NH, Park JY, Jeong YH, Kim HJ, Park J, Kim WJ. Evaluation of glymphatic system activity using diffusion tensor image analysis along the perivascular space and amyloid PET in older adults with objectively normal cognition: a preliminary study. Front Aging Neurosci 2023; 15:1221667. [PMID: 37577357 PMCID: PMC10413261 DOI: 10.3389/fnagi.2023.1221667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives Diffusion tensor image analysis along the perivascular space (DTI-ALPS) is a recently introduced method for the assessment of the glymphatic system without the need for contrast injection. The purpose of our study was to assess the glymphatic system in cognitively normal older adults with or without subjective cognitive decline (SCD) using DTI-ALPS, and correlating with amyloid PET. Design and participants To evaluate the glymphatic system in cognitively normal older adults using DTI-ALPS, we built a prospective cohort including a total of 123 objectively cognitively normal older adults with or without SCD. The ALPS index was calculated from DTI MRI and was assessed by correlating it with standardized uptake value ratios (SUVRs) from amyloid PET and clinically relevant variables. The study subjects were also divided into amyloid "positive" and "negative" groups based on the result of amyloid PET, and the ALPS indices between those two groups were compared. Results The ALPS index was not significantly different between the normal and SCD groups (P = 0.897). The mean ALPS index from the amyloid positive and amyloid negative group was 1.31 and 1.35, respectively, which showed no significant difference (P = 0.308). Among the SUVRs from variable cortices, that of the paracentral cortex was negatively correlated with the ALPS index (r = -0.218, P = 0.016). Multivariate linear regression revealed that older age (coefficient, -0.007) and higher SUVR from the paracentral cortex (coefficient, -0.101) were two independent variables with a significant association with a lower ALPS index (P = 0.015 and 0.045, respectively). Conclusion DTI-ALPS may not be useful for evaluation of the glymphatic system in subjects with SCD. Older age was significantly associated with lower ALPS index. Greater amyloid deposition in the paracentral cortex was significantly associated with lower glymphatic activity in cognitively normal older adults. These results should be validated in future studies on the relationships between ALPS index and other fundamental compartments in glymphatic system, such as perivenous space and the meningeal lymphatic vessels.
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Affiliation(s)
- Chae Jung Park
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Sang-Young Kim
- MR Clinical Science, Philips Healthcare Korea, Seoul, Republic of Korea
| | - Jun Hwee Kim
- Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Jin Young Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Yong Hyu Jeong
- Department of Nuclear Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Hyun Jeong Kim
- Department of Nuclear Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Jaesub Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Woo Jung Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
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Patel LD, Raghavan P, Tang S, Choi S, Harrison DM. Imaging of the meningeal lymphatic network in healthy adults: A 7T MRI study. J Neuroradiol 2023; 50:369-376. [PMID: 36918053 PMCID: PMC10981496 DOI: 10.1016/j.neurad.2023.03.002] [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: 02/09/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND AND PURPOSE Meningeal lymphatic vessels (MLVs) along the dural venous sinuses are suspected to be important in connecting the glymphatic and peripheral lymphatic system. Understanding the topography of MLVs may clarify the role of the glymphatic system in neurological diseases. The aim of this analysis was to use high resolution pre- and post-contrast FLAIR 7T MRI to identify and characterize the morphology of MLV in a cohort of healthy volunteers. MATERIALS AND METHODS MRI examinations of seventeen healthy volunteers enrolled as controls in a larger 7T MRI study were reviewed. Pre- and post-contrast 3-D FLAIR subtractions and MP2RAGE sequences were spatially normalized and reviewed for signal intensity and enhancement patterns within putative MLVs along pre-determined dural and venous structures. Frequency of occurrence of MLVs at the above-described locations and patterns of their enhancement were analyzed. RESULTS Putative MLVs are commonly located along the superior sagittal sinus (SSS) and cortical veins. A "fixed enhancement" signal pattern was more frequent at these locations (p<.05). The morphology of MLVs along the SSS qualitatively changes in an antero-posterior direction. Lack of signal was more frequent along the straight and transverse sinuses (p<.05). CONCLUSION Putative MLVs in healthy individuals are concentrated along the SSS and cortical veins. FLAIR signal and enhancement characteristics suggest these structures may transport proteinaceous fluid. Pathways connecting MLVs to cervical lymph nodes however remain unclear.
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Affiliation(s)
- Lakir D Patel
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA.
| | - Prashant Raghavan
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA.
| | - Shiyu Tang
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA; University of Maryland School of Medicine, Center for Advanced Imaging Research (CAIR), Baltimore, Maryland, USA.
| | - Seongjin Choi
- University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA.
| | - Daniel M Harrison
- University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA; Baltimore VA Medical Center, Baltimore, Maryland, USA.
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Kim JH, Yoo RE, Choi SH, Park SH. Non-invasive flow mapping of parasagittal meningeal lymphatics using 2D interslice flow saturation MRI. Fluids Barriers CNS 2023; 20:37. [PMID: 37237402 DOI: 10.1186/s12987-023-00446-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/21/2023] [Indexed: 05/28/2023] Open
Abstract
The clearance pathways of brain waste products in humans are still under debate in part due to the lack of noninvasive imaging techniques for meningeal lymphatic vessels (mLVs). In this study, we propose a new noninvasive mLVs imaging technique based on an inter-slice blood perfusion MRI called alternate ascending/descending directional navigation (ALADDIN). ALADDIN with inversion recovery (IR) at single inversion time of 2300 ms (single-TI IR-ALADDIN) clearly demonstrated parasagittal mLVs around the human superior sagittal sinus (SSS) with better detectability and specificity than the previously suggested noninvasive imaging techniques. While in many studies it has been difficult to detect mLVs and confirm their signal source noninvasively, the detection of mLVs in this study was confirmed by their posterior to anterior flow direction and their velocities and morphological features, which were consistent with those from the literature. In addition, IR-ALADDIN was compared with contrast-enhanced black blood imaging to confirm the detection of mLVs and its similarity. For the quantification of flow velocity of mLVs, IR-ALADDIN was performed at three inversion times of 2000, 2300, and 2600 ms (three-TI IR-ALADDIN) for both a flow phantom and humans. For this preliminary result, the flow velocity of the dorsal mLVs in humans ranged between 2.2 and 2.7 mm/s. Overall, (i) the single-TI IR-ALADDIN can be used as a novel non-invasive method to visualize mLVs in the whole brain with scan time of ~ 17 min and (ii) the multi-TI IR-ALADDIN can be used as a way to quantify the flow velocity of mLVs with a scan time of ~ 10 min (or shorter) in a limited coverage. Accordingly, the suggested approach can be applied to noninvasively studying meningeal lymphatic flows in general and also understanding the clearance pathways of waste production through mLVs in humans, which warrants further investigation.
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Affiliation(s)
- Jun-Hee Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Sung-Hong Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea.
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Lee MK, Cho SJ, Bae YJ, Kim JM. MRI-Based Demonstration of the Normal Glymphatic System in a Human Population: A Systematic Review. Front Neurol 2022; 13:827398. [PMID: 35693018 PMCID: PMC9174517 DOI: 10.3389/fneur.2022.827398] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background The glymphatic system has been described as one that facilitates the exchange between the cerebrospinal fluid (CSF) and interstitial fluid, and many recent studies have demonstrated glymphatic flow based on magnetic resonance imaging (MRI). We aim to systematically review the studies demonstrating a normal glymphatic flow in a human population using MRI and to propose a detailed glymphatic imaging protocol. Methods We searched the MEDLINE and EMBASE databases to identify studies with human participants involving MRI-based demonstrations of the normal glymphatic flow. We extracted data on the imaging sequence, imaging protocol, and the targeted anatomical structures on each study. Results According to contrast-enhanced MRI studies, peak enhancement was sequentially detected first in the CSF space, followed by the brain parenchyma, the meningeal lymphatic vessel (MLV), and, finally, the cervical lymph nodes, corresponding with glymphatic flow and explaining the drainage into the MLV. Non-contrast flow-sensitive MRI studies revealed similar glymphatic inflow from the CSF space to the brain parenchyma and efflux of exchanged fluid from the brain parenchyma to the MLV. Conclusion We may recommend T1-weighted contrast-enhanced MRI for visualizing glymphatic flow. Our result can increase understanding of the glymphatic system and may lay the groundwork for establishing central nervous system fluid dynamic theories and developing standardized imaging protocols.
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Affiliation(s)
- Min Kyoung Lee
- Department of Radiology, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Soeul, South Korea
| | - Se Jin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- *Correspondence: Yun Jung Bae
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- Jong-Min Kim
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Li AM, Chen L, Liu H, Li Y, Duan W, Xu J. Age-dependent cerebrospinal fluid-tissue water exchange detected by magnetization transfer indirect spin labeling MRI. Magn Reson Med 2022; 87:2287-2298. [PMID: 34958518 PMCID: PMC8847338 DOI: 10.1002/mrm.29137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE A non-invasive magnetization transfer indirect spin labeling (MISL) MRI method is developed to quantify the water exchange between cerebrospinal fluid (CSF) and other tissues in the brain and to examine the age-dependence of water exchange. METHOD In the pulsed MISL, we implemented a short selective pulse followed by a post-labeling delay before an MRI acquisition with a long echo time; in the continuous MISL, a train of saturation pulses was applied. MISL signal (∆Z) was obtained by the subtraction of the label MRI at -3.5 ppm from the control MRI at 200 ppm. CSF was extracted from the mouse ventricles for the MISL optimization and validation. Comparison between wild type (WT) and aquaporin-4 knockout (AQP4-/- ) mice was performed to examine the contributions of CSF water exchange, whereas its age-dependence was investigated by comparing the adult and young WT mice. RESULTS The pulsed MISL method observed that the MISL signal reached the maximum at 1.5 s. The continuous MISL method showed the highest MISL signal in the fourth ventricle (∆Z = 13.5% ± 1.4%), whereas the third ventricle and the lateral ventricles had similar MISL ∆Z values (∆Z = 12.0% ± 1.8%). Additionally, significantly lower ∆Z (9.3%-18.7% reduction) was found in all ventricles for the adult mice than those of the young mice (p < 0.02). For the AQP4-/- mice, the ∆Z values were 5.9%-8.3% smaller than those of the age-matched WT mice in the lateral and fourth ventricles, but were not significant. CONCLUSION The MISL method has a great potential to study CSF water exchange with the surrounding tissues in brain.
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Affiliation(s)
- Anna M. Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD 21205, USA
| | - Lin Chen
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD 21205, USA
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, School of Electronic Science and Engineering, National Model Microelectronics College, Xiamen University, Xiamen, China
| | - Hongshuai Liu
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Yuguo Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD 21205, USA
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Wenzhen Duan
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jiadi Xu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD 21205, USA
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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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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12
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Li AM, Xu J. Cerebrospinal fluid-tissue exchange revealed by phase alternate labeling with null recovery MRI. Magn Reson Med 2022; 87:1207-1217. [PMID: 34799860 PMCID: PMC8794537 DOI: 10.1002/mrm.29092] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/09/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE To develop phase alternate labeling with null recovery (PALAN) MRI methods for the quantification of the water exchange between cerebrospinal fluid (CSF) and other surrounding tissues in the brain. METHOD In both T1 -PALAN and apparent diffusion coefficient (ADC)-PALAN MRI methods, the cerebrospinal fluid signal was nulled, whereas the partial recovery of other tissues with shorter T1 (T1 -PALAN) or lower ADC values (ADC-PALAN) was labeled by alternating the phase of pulses. The water exchange was extracted from the difference between the recovery curves of CSF with and without labeling. RESULTS Both T1 -PALAN and ADC-PALAN observed a rapid occurrence of CSF water exchange with the surrounding tissues at 67 ± 56 ms and 13 ± 2 ms transit times, respectively. The T1 and ADC-PALAN signal peaked at 1.5 s. The CSF water exchange was 1153 ± 270 mL/100 mL/min with T1 -PALAN in the third and lateral ventricles, which was higher than 891 ± 60 mL/100 mL/min obtained by ADC-PALAN. T1 -PALAN ∆S values for the rostral and caudal ventricles are 0.015 ± 0.013 and 0.034 ± 0.01 (p = 0.022, n = 5), whereas similar ΔS values in both rostral and caudal lateral ventricles were observed by ADC-PALAN (3.9 ± 1.9 × 10-3 vs 4.4 ± 1.4 × 10-3 ; p = 0.66 and n = 5). CONCLUSION The PALAN methods are suitable tools to study CSF water exchange across different compartments in the brain.
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Affiliation(s)
- Anna M. Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
| | - Jiadi Xu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA,Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Corresponding Author: Jiadi Xu, Ph.D., Kennedy Krieger Institute, The Johns Hopkins University School of Medicine, 707 N. Broadway, Baltimore, MD, 21205, , Tel: 443-923-9572, Fax: 443-923-9505
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13
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Albayram MS, Smith G, Tufan F, Tuna IS, Bostancıklıoğlu M, Zile M, Albayram O. Non-invasive MR imaging of human brain lymphatic networks with connections to cervical lymph nodes. Nat Commun 2022; 13:203. [PMID: 35017525 PMCID: PMC8752739 DOI: 10.1038/s41467-021-27887-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Meningeal lymphatic vessels have been described in animal studies, but limited comparable data is available in human studies. Here we show dural lymphatic structures along the dural venous sinuses in dorsal regions and along cranial nerves in the ventral regions in the human brain. 3D T2-Fluid Attenuated Inversion Recovery magnetic resonance imaging relies on internal signals of protein rich lymphatic fluid rather than contrast media and is used in the present study to visualize the major human dural lymphatic structures. Moreover we detect direct connections between lymphatic fluid channels along the cranial nerves and vascular structures and the cervical lymph nodes. We also identify age-related cervical lymph node atrophy and thickening of lymphatics channels in both dorsal and ventral regions, findings which reflect the reduced lymphatic output of the aged brain.
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Affiliation(s)
- Mehmet Sait Albayram
- Department of Radiology, University of Florida, College of Medicine, Gainesville, FL, 32610, USA.
| | - Garrett Smith
- Department of Radiology, University of Florida, College of Medicine, Gainesville, FL, 32610, USA
| | - Fatih Tufan
- Geriatrician (PP), Silivrikapi Mh. Hisaralti Cd, Istanbul, 34093, Turkey
| | - Ibrahim Sacit Tuna
- Department of Radiology, University of Florida, College of Medicine, Gainesville, FL, 32610, USA
| | | | - Michael Zile
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
- Division of Cardiology, Department of Medicine, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, 29425, USA
| | - Onder Albayram
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, 29425, USA
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14
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Mehta NH, Sherbansky J, Kamer AR, Carare RO, Butler T, Rusinek H, Chiang GC, Li Y, Strauss S, Saint-Louis LA, Theise ND, Suss RA, Blennow K, Kaplitt M, de Leon MJ. The Brain-Nose Interface: A Potential Cerebrospinal Fluid Clearance Site in Humans. Front Physiol 2022; 12:769948. [PMID: 35058794 PMCID: PMC8764168 DOI: 10.3389/fphys.2021.769948] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
The human brain functions at the center of a network of systems aimed at providing a structural and immunological layer of protection. The cerebrospinal fluid (CSF) maintains a physiological homeostasis that is of paramount importance to proper neurological activity. CSF is largely produced in the choroid plexus where it is continuous with the brain extracellular fluid and circulates through the ventricles. CSF movement through the central nervous system has been extensively explored. Across numerous animal species, the involvement of various drainage pathways in CSF, including arachnoid granulations, cranial nerves, perivascular pathways, and meningeal lymphatics, has been studied. Among these, there is a proposed CSF clearance route spanning the olfactory nerve and exiting the brain at the cribriform plate and entering lymphatics. While this pathway has been demonstrated in multiple animal species, evidence of a similar CSF egress mechanism involving the nasal cavity in humans remains poorly consolidated. This review will synthesize contemporary evidence surrounding CSF clearance at the nose-brain interface, examining across species this anatomical pathway, and its possible significance to human neurodegenerative disease. Our discussion of a bidirectional nasal pathway includes examination of the immune surveillance in the olfactory region protecting the brain. Overall, we expect that an expanded discussion of the brain-nose pathway and interactions with the environment will contribute to an improved understanding of neurodegenerative and infectious diseases, and potentially to novel prevention and treatment considerations.
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Affiliation(s)
- Neel H. Mehta
- Undergraduate Department of Biology, Cornell University, Ithaca, NY, United States
| | | | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, NYU College of Dentistry, New York, NY, United States
| | - Roxana O. Carare
- Department of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tracy Butler
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY, United States
| | - Henry Rusinek
- Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Gloria C. Chiang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Yi Li
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY, United States
| | - Sara Strauss
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - L. A. Saint-Louis
- Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Neil D. Theise
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, United States
| | - Richard A. Suss
- Division of Neuroradiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kaj Blennow
- Clinical Neurochemistry Lab, Inst. of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Michael Kaplitt
- Laboratory of Molecular Neurosurgery, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Mony J. de Leon
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY, United States
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15
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Kaur J, Fahmy LM, Davoodi-Bojd E, Zhang L, Ding G, Hu J, Zhang Z, Chopp M, Jiang Q. Waste Clearance in the Brain. Front Neuroanat 2021; 15:665803. [PMID: 34305538 PMCID: PMC8292771 DOI: 10.3389/fnana.2021.665803] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022] Open
Abstract
Waste clearance (WC) is an essential process for brain homeostasis, which is required for the proper and healthy functioning of all cerebrovascular and parenchymal brain cells. This review features our current understanding of brain WC, both within and external to the brain parenchyma. We describe the interplay of the blood-brain barrier (BBB), interstitial fluid (ISF), and perivascular spaces within the brain parenchyma for brain WC directly into the blood and/or cerebrospinal fluid (CSF). We also discuss the relevant role of the CSF and its exit routes in mediating WC. Recent discoveries of the glymphatic system and meningeal lymphatic vessels, and their relevance to brain WC are highlighted. Controversies related to brain WC research and potential future directions are presented.
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Affiliation(s)
- Jasleen Kaur
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
- Department of Physics, Oakland University, Rochester, MI, United States
| | - Lara M. Fahmy
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Esmaeil Davoodi-Bojd
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
- Department of Radiology, Henry Ford Health System, Detroit, MI, United States
| | - Li Zhang
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
| | - Guangliang Ding
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, United States
| | - Zhenggang Zhang
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
- Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Michael Chopp
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
- Department of Physics, Oakland University, Rochester, MI, United States
| | - Quan Jiang
- Department of Neurology, Henry Ford Health System, Detroit, MI, United States
- Department of Physics, Oakland University, Rochester, MI, United States
- Department of Neurology, Wayne State University, Detroit, MI, United States
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16
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Hsu M, Laaker C, Sandor M, Fabry Z. Neuroinflammation-Driven Lymphangiogenesis in CNS Diseases. Front Cell Neurosci 2021; 15:683676. [PMID: 34248503 PMCID: PMC8261156 DOI: 10.3389/fncel.2021.683676] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
The central nervous system (CNS) undergoes immunosurveillance despite the lack of conventional antigen presenting cells and lymphatic vessels in the CNS parenchyma. Additionally, the CNS is bathed in a cerebrospinal fluid (CSF). CSF is continuously produced, and consequently must continuously clear to maintain fluid homeostasis despite the lack of conventional lymphatics. During neuroinflammation, there is often an accumulation of fluid, antigens, and immune cells to affected areas of the brain parenchyma. Failure to effectively drain these factors may result in edema, prolonged immune response, and adverse clinical outcome as observed in conditions including traumatic brain injury, ischemic and hypoxic brain injury, CNS infection, multiple sclerosis (MS), and brain cancer. Consequently, there has been renewed interest surrounding the expansion of lymphatic vessels adjacent to the CNS which are now thought to be central in regulating the drainage of fluid, cells, and waste out of the CNS. These lymphatic vessels, found at the cribriform plate, dorsal dural meninges, base of the brain, and around the spinal cord have each been implicated to have important roles in various CNS diseases. In this review, we discuss the contribution of meningeal lymphatics to these processes during both steady-state conditions and neuroinflammation, as well as discuss some of the many still unknown aspects regarding the role of meningeal lymphatics in neuroinflammation. Specifically, we focus on the observed phenomenon of lymphangiogenesis by a subset of meningeal lymphatics near the cribriform plate during neuroinflammation, and discuss their potential roles in immunosurveillance, fluid clearance, and access to the CSF and CNS compartments. We propose that manipulating CNS lymphatics may be a new therapeutic way to treat CNS infections, stroke, and autoimmunity.
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Affiliation(s)
- Martin Hsu
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI, United States
| | - Collin Laaker
- Neuroscience Training Program, University of Wisconsin Madison, Madison, WI, United States
| | - Matyas Sandor
- Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, Madison, WI, United States
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, University of Wisconsin Madison, Madison, WI, United States
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17
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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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18
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Neuroimmune cleanup crews in brain injury. Trends Immunol 2021; 42:480-494. [PMID: 33941486 DOI: 10.1016/j.it.2021.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability. Mounting evidence indicates that the immune system is critically involved in TBI pathogenesis, where it is deployed to dispose of neurotoxic material generated from head trauma and to instruct the wound healing process. However, the immune response to brain damage must be carefully held in check as aberrant regulation of immune signaling can lead to deleterious neuroinflammation, brain pathology, and neurological dysfunction. Efficient clearance of neurotoxic material by microglia (the brain's resident phagocytes) and the glymphatic-meningeal lymphatic drainage system are paramount to keeping the immune system in balance following head trauma. In this review, we highlight emerging evidence that defines pivotal roles for microglia and the recently discovered glymphatic-meningeal lymphatic system in TBI pathogenesis.
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19
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Nycz B, Mandera M. The features of the glymphatic system. Auton Neurosci 2021; 232:102774. [PMID: 33610009 DOI: 10.1016/j.autneu.2021.102774] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
The glymphatic system creates a network of perivascular channels. It is made of astroglia cells, whose perikaryon extensions strongly express aquaporin-4 water channels (AQP4). The pathways of the glymphatic system ensure the transport of nutrients, including glucose, lipids, amino acids, neurotransmitters, antigens, and immune cells, as well as exchange of information via afferent and efferent immune pathways. Within the glymphatic system, convective exchange of cerebrospinal fluid (CSF) and interstitial fluid (ISF) components takes place, through aquaporin-4 water channels that facilitate fluid exchange. The proper functioning of the glymphatic system allows elimination and reabsorption of solutes, metabolites, pursuit of water and ionic balance, transport of lipid signaling molecules, regulation of intracranial pressure, cerebrospinal fluid pressure, and interstitial fluid pressure. The functions of the glymphatic system are primarily affected by the influence of the sympathetic and parasympathetic innervation, sleep and wakefulness cycle, the aging process, genetic factors, and body posture. Now, the glymphatic system shows weak activity during wakefulness, while its activity increases dramatically during sleep and the state of anesthesia. Changes occurring with age begin a number of factors that impair the function of the glymphatic system pathways. Dysfunction of the glymphatic pathways causes the aggregation of incorrectly formed proteins that underlie the development of neurodegenerative diseases. Harmful protein aggregates cause prolonged inflammation. All pathologies occurring within the central nervous system (CNS), both neurodegenerative diseases and injuries, disrupt the drainage of glymphatic pathways, which are important efflux of interstitial substances and byproducts of CNS metabolism.
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Affiliation(s)
- Blanka Nycz
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Medyków 16 Street, 40-752 Katowice, Poland.
| | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Medyków 16 Street, 40-752 Katowice, Poland.
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20
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Proulx ST. Cerebrospinal fluid outflow: a review of the historical and contemporary evidence for arachnoid villi, perineural routes, and dural lymphatics. Cell Mol Life Sci 2021; 78:2429-2457. [PMID: 33427948 PMCID: PMC8004496 DOI: 10.1007/s00018-020-03706-5] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 12/19/2022]
Abstract
Cerebrospinal fluid (CSF) is produced by the choroid plexuses within the ventricles of the brain and circulates through the subarachnoid space of the skull and spinal column to provide buoyancy to and maintain fluid homeostasis of the brain and spinal cord. The question of how CSF drains from the subarachnoid space has long puzzled scientists and clinicians. For many decades, it was believed that arachnoid villi or granulations, outcroppings of arachnoid tissue that project into the dural venous sinuses, served as the major outflow route. However, this concept has been increasingly challenged in recent years, as physiological and imaging evidence from several species has accumulated showing that tracers injected into the CSF can instead be found within lymphatic vessels draining from the cranium and spine. With the recent high-profile rediscovery of meningeal lymphatic vessels located in the dura mater, another debate has emerged regarding the exact anatomical pathway(s) for CSF to reach the lymphatic system, with one side favoring direct efflux to the dural lymphatic vessels within the skull and spinal column and another side advocating for pathways along exiting cranial and spinal nerves. In this review, a summary of the historical and contemporary evidence for the different outflow pathways will be presented, allowing the reader to gain further perspective on the recent advances in the field. An improved understanding of this fundamental physiological process may lead to novel therapeutic approaches for a wide range of neurological conditions, including hydrocephalus, neurodegeneration and multiple sclerosis.
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Affiliation(s)
- Steven T Proulx
- Theodor Kocher Institute, University of Bern, Bern, Switzerland.
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21
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Park M, Kim JW, Ahn SJ, Cha YJ, Suh SH. Aging Is Positively Associated with Peri-Sinus Lymphatic Space Volume: Assessment Using 3T Black-Blood MRI. J Clin Med 2020; 9:jcm9103353. [PMID: 33086702 PMCID: PMC7590154 DOI: 10.3390/jcm9103353] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Aging is a major risk factor for many neurological disorders and is associated with dural lymphatic dysfunction. We sought to evaluate the association of aging with the volume of the peri-sinus lymphatic space using contrast-enhanced 3T T1-weighted black-blood magnetic resonance imaging (MRI). METHODS In this retrospective study, 165 presumed neurologically normal subjects underwent brain MRIs for cancer staging between April and November 2018. The parasagittal peri-sinus lymphatic space was evaluated using contrast-enhanced 3D T1-weighted black-blood MRIs, and volumes were measured with semiautomatic method. We compared the volumes of normalized peri-sinus lymphatic spaces between the elderly (≥65 years, n = 72) and non-elderly (n = 93) groups and performed multivariate logistic regression analyses to assess if aging is independently associated with the volume of normalized peri-sinus lymphatic spaces. RESULTS The normalized peri-sinus lymphatic space volume was significantly higher in the elderly than in the non-elderly (mean, 3323 ± 758.7 mL vs. 2968.7 ± 764.3 mL, p = 0.047). After adjusting the intracranial volume, age age was the strongest factor independently associated with peri-sinus lymphatic space volume (β coefficient, 28.4 (5.7-51.2), p = 0.015) followed by male sex (β coefficient, 672.4 (113.5-1230.8), p = 0.019). CONCLUSIONS We found that the peri-sinus dural lymphatic space volume was higher in the elderly group than in the non-elderly group, and the increased peri-sinus lymphatic space was independently associated with aging. These findings indicate that the peri-sinus lymphatic space may be related with the aging process and lymphatic system dysfunction as well.
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Affiliation(s)
- Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.P.); (J.W.K.); (S.H.S.)
| | - Jin Woo Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.P.); (J.W.K.); (S.H.S.)
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.P.); (J.W.K.); (S.H.S.)
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.P.); (J.W.K.); (S.H.S.)
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22
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Bolte AC, Dutta AB, Hurt ME, Smirnov I, Kovacs MA, McKee CA, Ennerfelt HE, Shapiro D, Nguyen BH, Frost EL, Lammert CR, Kipnis J, Lukens JR. Meningeal lymphatic dysfunction exacerbates traumatic brain injury pathogenesis. Nat Commun 2020; 11:4524. [PMID: 32913280 PMCID: PMC7483525 DOI: 10.1038/s41467-020-18113-4] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 08/06/2020] [Indexed: 01/12/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading global cause of death and disability. Here we demonstrate in an experimental mouse model of TBI that mild forms of brain trauma cause severe deficits in meningeal lymphatic drainage that begin within hours and last out to at least one month post-injury. To investigate a mechanism underlying impaired lymphatic function in TBI, we examined how increased intracranial pressure (ICP) influences the meningeal lymphatics. We demonstrate that increased ICP can contribute to meningeal lymphatic dysfunction. Moreover, we show that pre-existing lymphatic dysfunction before TBI leads to increased neuroinflammation and negative cognitive outcomes. Finally, we report that rejuvenation of meningeal lymphatic drainage function in aged mice can ameliorate TBI-induced gliosis. These findings provide insights into both the causes and consequences of meningeal lymphatic dysfunction in TBI and suggest that therapeutics targeting the meningeal lymphatic system may offer strategies to treat TBI.
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Affiliation(s)
- Ashley C Bolte
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, VA, 22908, USA
- Medical Scientist Training Program, University of Virginia, Charlottesville, VA, 22908, USA
- Immunology Training Program, University of Virginia, Charlottesville, VA, 22908, USA
| | - Arun B Dutta
- Medical Scientist Training Program, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, 22908, USA
| | - Mariah E Hurt
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
| | - Igor Smirnov
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
| | - Michael A Kovacs
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Microbiology, Immunology and Cancer Biology, University of Virginia, Charlottesville, VA, 22908, USA
- Medical Scientist Training Program, University of Virginia, Charlottesville, VA, 22908, USA
- Immunology Training Program, University of Virginia, Charlottesville, VA, 22908, USA
| | - Celia A McKee
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
| | - Hannah E Ennerfelt
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA, 22908, USA
| | - Daniel Shapiro
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
| | - Bao H Nguyen
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, VA, 22908, USA
| | - Elizabeth L Frost
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
| | - Catherine R Lammert
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA, 22908, USA
| | - Jonathan Kipnis
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA, 22908, USA
| | - John R Lukens
- Center for Brain Immunology and Glia (BIG), Department of Neuroscience, University of Virginia, Charlottesville, VA, 22908, USA.
- Medical Scientist Training Program, University of Virginia, Charlottesville, VA, 22908, USA.
- Immunology Training Program, University of Virginia, Charlottesville, VA, 22908, USA.
- Neuroscience Graduate Program, University of Virginia, Charlottesville, VA, 22908, USA.
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23
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Brain Glymphatic/Lymphatic Imaging by MRI and PET. Nucl Med Mol Imaging 2020; 54:207-223. [PMID: 33088350 DOI: 10.1007/s13139-020-00665-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 01/19/2023] Open
Abstract
Since glymphatic was proposed and meningeal lymphatic was discovered, MRI and even PET were introduced to investigate brain parenchymal interstitial fluid (ISF), cerebrospinal fluid (CSF), and lymphatic outflow in rodents and humans. Previous findings by ex vivo fluorescent microscopic, and in vivo two-photon imaging in rodents were reproduced using intrathecal contrast (gadobutrol and the similar)-enhanced MRI in rodents and further in humans. On dynamic MRI of meningeal lymphatics, in contrast to rodents, humans use mainly dorsal meningeal lymphatic pathways of ISF-CSF-lymphatic efflux. In mice, ISF-CSF exchange was examined thoroughly using an intra-cistern injection of fluorescent tracers during sleep, aging, and neurodegeneration yielding many details. CSF to lymphatic efflux is across arachnoid barrier cells over the dorsal dura in rodents and in humans. Meningeal lymphatic efflux to cervical lymph nodes and systemic circulation is also well-delineated especially in humans onintrathecal contrast MRI. Sleep- or anesthesia-related changes of glymphatic-lymphatic flow and the coupling of ISF-CSF-lymphatic drainage are major confounders ininterpreting brain glymphatic/lymphatic outflow in rodents. PET imaging in humans should be interpreted based on human anatomy and physiology, different in some aspects, using MRI recently. Based on the summary in this review, we propose non-invasive and longer-term intrathecal SPECT/PET or MRI studies to unravel the roles of brain glymphatic/lymphatic in diseases.
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24
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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: 37] [Impact Index Per Article: 9.3] [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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25
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Hershenhouse KS, Shauly O, Gould DJ, Patel KM. Meningeal Lymphatics: A Review and Future Directions From a Clinical Perspective. Neurosci Insights 2019; 14:1179069519889027. [PMID: 32363346 PMCID: PMC7176397 DOI: 10.1177/1179069519889027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/07/2019] [Indexed: 12/25/2022] Open
Abstract
The recent discovery of lymphatic vessels in the meningeal layers calls into question the known mechanisms of fluid and macromolecule homeostasis and immunoregulation within the central nervous system. These meningeal lymphatic vessels and their potential role in the pathophysiology of neurological disease have become a rapidly expanding area of research, with the hopes that they may provide a novel therapeutic target in the treatment of many devastating conditions. This article reviews the current state of knowledge surrounding the anatomical structure of the vessels, their functions in fluid and solute transport and immune surveillance, as well as their studied developmental biology, relationship with the novel hypothesized “glymphatic” system, and implications in neurodegenerative disease in animal models. Furthermore, this review summarizes findings from the human studies conducted thus far regarding the presence, anatomy, and drainage patterns of meningeal lymphatic vessels and discusses, from a clinical perspective, advancements in both imaging technologies and interventional methodologies used to access ultrafine peripheral lymphatic vessels.
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Affiliation(s)
- Korri S Hershenhouse
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA, USA
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26
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He W, You J, Wan Q, Xiao K, Chen K, Lu Y, Li L, Tang Y, Deng Y, Yao Z, Yue J, Cao G. The anatomy and metabolome of the lymphatic system in the brain in health and disease. Brain Pathol 2019; 30:392-404. [PMID: 31747475 DOI: 10.1111/bpa.12805] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/10/2019] [Indexed: 12/18/2022] Open
Abstract
Recent studies have demonstrated that the brain is equipped with a lymphatic drainage system that is actively involved in parenchymal waste clearance, brain homeostasis and immune regulation. However, the exact anatomic drainage routes of brain lymph fluid (BLF) remain elusive, hampering the physiological study and clinical application of this system. In this study, we systematically dissected the anatomy of the BLF pathways in a rat model. Moreover, we developed a protocol to collect BLF from the afferent lymphatic vessels of deep cervical lymph nodes (dcLNs) and cerebrospinal fluid (CSF) from the fourth ventricle. Nuclear magnetic resonance spectroscopy showed that BLF contains more metabolites than CSF, suggesting that BLF might be a more sensitive indicator of brain dynamics under physiological and pathological conditions. Finally, we identified several metabolites as potential diagnostic biomarkers for glioma, Parkinson's disease and CNS infectious diseases. Together, these data may provide insight into the physiology of the lymphatic system in the brain and into the clinical diagnosis of CNS disorders.
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Affiliation(s)
- Wenbo He
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Jing You
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,Department of Biomedical Engineering, University of North Texas, Denton, TX
| | - Qianfen Wan
- Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Ke Xiao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Kening Chen
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Yuan Lu
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Liang Li
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA
| | - Yajie Tang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China
| | - Yunte Deng
- Department of Pathology, Hubei Cancer Hospital, Wuhan, 430079, China
| | - Zhaohui Yao
- Department of Geriatrics, Renmin Hospital of Wuhan University, Jiefang Road, Wuhan, China
| | - Junqiu Yue
- Department of Pathology, Hubei Cancer Hospital, Wuhan, 430079, China
| | - Gang Cao
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan, 430070, China.,College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, China.,Bio-Medical Center, Huazhong Agricultural University, Wuhan, 430070, China.,Cooperative Innovation Center for Sustainable Pig Production (CICSPP), Huazhong Agricultural University, Wuhan, 430070, China
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27
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Carson RE, Kuo PH. Brain-Dedicated Emission Tomography Systems: A Perspective on Requirements for Clinical Research and Clinical Needs in Brain Imaging. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019. [DOI: 10.1109/trpms.2019.2912129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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28
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Noé FM, Marchi N. Central nervous system lymphatic unit, immunity, and epilepsy: Is there a link? Epilepsia Open 2019; 4:30-39. [PMID: 30868113 PMCID: PMC6398113 DOI: 10.1002/epi4.12302] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/08/2018] [Accepted: 01/06/2019] [Indexed: 12/16/2022] Open
Abstract
The recent definition of a network of lymphatic vessels in the meninges surrounding the brain and the spinal cord has advanced our knowledge on the functional anatomy of fluid movement within the central nervous system (CNS). Meningeal lymphatic vessels along dural sinuses and main nerves contribute to cerebrospinal fluid (CSF) drainage, integrating the cerebrovascular and periventricular routes, and forming a circuit that we here define as the CNS-lymphatic unit. The latter unit is important for parenchymal waste clearance, brain homeostasis, and the regulation of immune or inflammatory processes within the brain. Disruption of fluid drain mechanisms may promote or sustain CNS disease, conceivably applicable to epilepsy where extracellular accumulation of macromolecules and metabolic by-products occur in the interstitial and perivascular spaces. Herein we address an emerging concept and propose a theoretical framework on: (a) how a defect of brain clearance of macromolecules could favor neuronal hyperexcitability and seizures, and (b) whether meningeal lymphatic vessel dysfunction contributes to the neuroimmune cross-talk in epileptic pathophysiology. We propose possible molecular interventions targeting meningeal lymphatic dysfunctions, a potential target for immune-mediated epilepsy.
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Affiliation(s)
- Francesco M. Noé
- Neuro‐Lymphatic GroupA.I. Virtanen Institute for Molecular SciencesUniversity of Eastern FinlandKuopioFinland
- Biology of Neuro‐Immune InteractionHiLife‐Neuroscience CenterHelsinki UniversityHelsinkiFinland
| | - Nicola Marchi
- Cerebrovascular Mechanisms of Brain DisordersDepartment of NeuroscienceInstitute of Functional Genomics (UMR5203 CNRS – U1191 INSERM)University of MontpellierMontpellierFrance
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29
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Blei F. Update December 2018. Lymphat Res Biol 2018. [DOI: 10.1089/lrb.2018.29054.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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