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Roberts KF, Elbert DL, Kasten TP, Patterson BW, Sigurdson WC, Connors RE, Ovod V, Munsell LY, Mawuenyega KG, Miller-Thomas MM, Moran CJ, Cross DT, Derdeyn CP, Bateman RJ. Amyloid-β efflux from the central nervous system into the plasma. Ann Neurol 2014; 76:837-44. [PMID: 25205593 PMCID: PMC4355962 DOI: 10.1002/ana.24270] [Citation(s) in RCA: 186] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this study was to measure the flux of amyloid-β (Aβ) across the human cerebral capillary bed to determine whether transport into the blood is a significant mechanism of clearance for Aβ produced in the central nervous system (CNS). METHODS Time-matched blood samples were simultaneously collected from a cerebral vein (including the sigmoid sinus, inferior petrosal sinus, and the internal jugular vein), femoral vein, and radial artery of patients undergoing inferior petrosal sinus sampling. For each plasma sample, Aβ concentration was assessed by 3 assays, and the venous to arterial Aβ concentration ratios were determined. RESULTS Aβ concentration was increased by ∼7.5% in venous blood leaving the CNS capillary bed compared to arterial blood, indicating efflux from the CNS into the peripheral blood (p < 0.0001). There was no difference in peripheral venous Aβ concentration compared to arterial blood concentration. INTERPRETATION Our results are consistent with clearance of CNS-derived Aβ into the venous blood supply with no increase from a peripheral capillary bed. Modeling these results suggests that direct transport of Aβ across the blood-brain barrier accounts for ∼25% of Aβ clearance, and reabsorption of cerebrospinal fluid Aβ accounts for ∼25% of the total CNS Aβ clearance in humans. Ann Neurol 2014;76:837-844.
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Affiliation(s)
- Kaleigh Filisa Roberts
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Donald L. Elbert
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Tom P. Kasten
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Bruce W. Patterson
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Wendy C. Sigurdson
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rose E. Connors
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Vitaliy Ovod
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ling Y. Munsell
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kwasi G. Mawuenyega
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Christopher J. Moran
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Dewitte T. Cross
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Colin P. Derdeyn
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Randall J. Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Knight Alzheimer’s Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
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Hart SE, Connors RE. Resourcing decision model for military hospitals. Mil Med 1996; 161:552-6. [PMID: 8840797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
As military medicine continues its adoption of managed care economic principles, the leadership of our military treatment facilities (MTFs) need a clear and simple rationale for making resource allocation decisions. The leadership body of an MTF needs to be cognizant of the role of readiness when making such decisions. This article provides a simple resourcing decision model that includes "readiness" as a decision-making factor.
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Affiliation(s)
- S E Hart
- Naval Hospital, Marine Corps Air Ground Combat Center, Twentynine Palms, CA 92278-8250, USA.
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