Continuous positive airway pressure increases CSF flow and glymphatic transport

Ozturk, Burhan; Koundal, Sunil; Bizri, Ehab Al; Chen, Xinan; Gursky, Zachary H; Dai, Feng; Lim, Andrew; Heerdt, Paul M.; Kipnis, Jonathan; Tannenbaum, Allen; Lee, Hedok; Benveniste, Helene

doi:10.1172/jci.insight.170270

Cited by 13 publications

(3 citation statements)

References 76 publications

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“…46 It is possible that the daily drop in blood pressure during the sleep phase may promote glymphatic flow, partially by promoting arterial pulsatility. In fact, most circadian-controlled parameters of physiology that occur during sleep including lowered heart rate 153 and respiration rate 46,154 increase glymphatic function. The exact mechanisms of how these rhythms regulate glymphatics is unclear.…”

Section: Rhythms In Csf Pathways: the Glymphatic And Lymphatic Systemsmentioning

confidence: 99%

Circadian Mechanisms in Brain Fluid Biology

Vizcarra,

Fame,

Hablitz

2024

Circulation Research

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The brain is a complex organ, fundamentally changing across the day to perform basic functions like sleep, thought, and regulating whole-body physiology. This requires a complex symphony of nutrients, hormones, ions, neurotransmitters and more to be properly distributed across the brain to maintain homeostasis throughout 24 hours. These solutes are distributed both by the blood and by cerebrospinal fluid. Cerebrospinal fluid contents are distinct from the general circulation because of regulation at brain barriers including the choroid plexus, glymphatic system, and blood-brain barrier. In this review, we discuss the overlapping circadian (≈24-hour) rhythms in brain fluid biology and at the brain barriers. Our goal is for the reader to gain both a fundamental understanding of brain barriers alongside an understanding of the interactions between these fluids and the circadian timing system. Ultimately, this review will provide new insight into how alterations in these finely tuned clocks may lead to pathology.

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Section: Rhythms In Csf Pathways: the Glymphatic And Lymphatic Systemsmentioning

confidence: 99%

Circadian Mechanisms in Brain Fluid Biology

Vizcarra,

Fame,

Hablitz

2024

Circulation Research

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“…Respiration affects CSF motion in the human brain [ 74 ], but the impact on glymphatic function is not well studied. However, a study in spontaneously breathing rats showed that augmentation of respiratory function by continuous positive airway pressure promoted CSF as well as glymphatic transport [ 75 ]. As respiratory oscillations mostly affect the venous side of the circulation, this is an interesting subject for further study [ 74 ].…”

Section: Perivascular Brain Clearancementioning

confidence: 99%

Is CAA a perivascular brain clearance disease? A discussion of the evidence to date and outlook for future studies

van Veluw,

Benveniste,

Bakker

et al. 2024

Cell. Mol. Life Sci.

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The brain’s network of perivascular channels for clearance of excess fluids and waste plays a critical role in the pathogenesis of several neurodegenerative diseases including cerebral amyloid angiopathy (CAA). CAA is the main cause of hemorrhagic stroke in the elderly, the most common vascular comorbidity in Alzheimer’s disease and also implicated in adverse events related to anti-amyloid immunotherapy. Remarkably, the mechanisms governing perivascular clearance of soluble amyloid β—a key culprit in CAA—from the brain to draining lymphatics and systemic circulation remains poorly understood. This knowledge gap is critically important to bridge for understanding the pathophysiology of CAA and accelerate development of targeted therapeutics. The authors of this review recently converged their diverse expertise in the field of perivascular physiology to specifically address this problem within the framework of a Leducq Foundation Transatlantic Network of Excellence on Brain Clearance. This review discusses the overarching goal of the consortium and explores the evidence supporting or refuting the role of impaired perivascular clearance in the pathophysiology of CAA with a focus on translating observations from rodents to humans. We also discuss the anatomical features of perivascular channels as well as the biophysical characteristics of fluid and solute transport.

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“…Although numerous studies have confirmed the role of the GS, the relevant biophysical principles of CSF entry into the PVS have not been unified. Cerebral arterial pulsation is currently widely recognized and studied (Iliff et al., 2013; Mestre et al., 2018; Ozturk et al., 2023). Human magnetic resonance imaging (MRI) studies have shown that increased cerebral arterial pulsation promotes tracer entry into the PVS (Iliff et al., 2013).…”

Section: The Composition Of the Cerebral Lymphatic Drainage Systemmentioning

confidence: 99%

The cerebral lymphatic drainage system and its implications in epilepsy

Peng,

Xie,

Liu

et al. 2023

J of Neuroscience Research

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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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Continuous positive airway pressure increases CSF flow and glymphatic transport

Cited by 13 publications

References 76 publications

Circadian Mechanisms in Brain Fluid Biology

Circadian Mechanisms in Brain Fluid Biology

Is CAA a perivascular brain clearance disease? A discussion of the evidence to date and outlook for future studies

The cerebral lymphatic drainage system and its implications in epilepsy

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