lunes, 22 de enero de 2018

Sistema glimfático cerebral / The brain glymphatic system

Enero 21, 2018. No. 2970
El sistema glimfático cerebral fue descrito por Maiken Nedergaard, y nombrado así por la participación de la neuroglia. Los descubrimientos han demostrado que es una vía peri vascular de eliminación de productos metabólicos del cerebro (función pseudolinfática) en el cual los astrocitos juegan un papel vital. Se le ha relacionado con la fisiología cerebral y algunas enfermedades del SNC y la posibilidad de manipularlo con efectos terapéuticos que sin duda pronto estaremos utilizando en clínica.
Hoy y mañana enviaremos información disponible con acceso abierto sobre este interesante tópico.
The glymphatic system was described by Maiken Nedergaard, and named for the participation of the neuroglia. The discoveries have shown that it is a peri-vascular pathway for the elimination of metabolic products from the brain (pseudolymphatic function), in which astrocytes play a vital role. It has been related to brain physiology and some CNS diseases, and the possibility of manipulating it with therapeutic effects that we will soon be using in the clinic.
Today and tomorrow we will send information available with open access on this interesting topic.
¿Hay un sistema linfático cerebral?
Is there a cerebral lymphatic system?
Stroke. 2013 Jun;44(6 Suppl 1):S93-5. doi: 10.1161/STROKEAHA.112.678698.
El camino paravascular para la eliminación de desechos cerebrales: comprensión actual, importancia y controversia.
The Paravascular Pathway for Brain Waste Clearance: Current Understanding, Significance and Controversy.
Front Neuroanat. 2017 Nov 7;11:101. doi: 10.3389/fnana.2017.00101. eCollection 2017.
Abstract
The paravascular pathway, also known as the "glymphatic" pathway, is a recently described system for waste clearance in the brain. According to this model, cerebrospinal fluid (CSF) enters the paravascular spaces surrounding penetrating arteries of the brain, mixes with interstitial fluid (ISF) and solutes in the parenchyma, and exits along paravascular spaces of draining veins. Studies have shown that metabolic waste products and solutes, including proteins involved in the pathogenesis of neurodegenerative diseases such as amyloid-beta, may be cleared by this pathway. Consequently, a growing body of research has begun to explore the association between glymphatic dysfunction and various disease states. However, significant controversy exists in the literature regarding both the direction of waste clearance as well as the anatomical space in which the waste-fluid mixture is contained. Some studies have found no evidence of interstitial solute clearance along the paravascular space of veins. Rather, they demonstrate a perivascular pathway in which waste is cleared from the brain along an anatomically distinct perivascular space in a direction opposite to that of paravascular flow. Although possible explanations have been offered, none have been able to fully reconcile the discrepancies in the literature, and many questions remain. Given the therapeutic potential that a comprehensive understanding of brain waste clearance pathways might offer, further research and clarification is highly warranted.
KEYWORDS: amyloid-beta; brain waste clearance; glymphatic system; paravascular pathway; perivascular pathway
Comprendiendo las funciones y relaciones del sistema glimfático y linfático meníngeo.
Understanding the functions and relationships of the glymphatic system and meningeal lymphatics.
J Clin Invest. 2017 Sep 1;127(9):3210-3219. doi: 10.1172/JCI90603. Epub 2017 Sep 1.
Abstract
Recent discoveries of the glymphatic system and of meningeal lymphatic vessels have generated a lot of excitement, along with some degree of skepticism. Here, we summarize the state of the field and point out the gaps of knowledge that should be filled through further research. We discuss the glymphatic system as a system that allows CNS perfusion by the cerebrospinal fluid (CSF) and interstitial fluid (ISF). We also describe the recently characterized meningeal lymphatic vessels and their role in drainage of the brain ISF, CSF, CNS-derived molecules, and immune cells from the CNS and meninges to the peripheral (CNS-draining) lymph nodes. We speculate on the relationship between the two systems and their malfunction that may underlie some neurological diseases. Although much remains to be investigated, these new discoveries have changed our understanding of mechanisms underlying CNS immune privilege and CNS drainage. Future studies should explore the communications between the glymphatic system and meningeal lymphatics in CNS disorders and develop new therapeutic modalities targeting these systems.
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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