Wang Ying-Jie, Sun Yan-Rong, Pei Yan-Hong, Ma Hao-Wen, Mu Ya-Kun, Qin Li-Hua, Yan Jun-Hao
Department of Anatomy and Histology, School of Basic Medical Sciences, Peking University, Beijing, China.
Neural Regen Res. 2023 Mar;18(3):485-491. doi: 10.4103/1673-5374.346484.
Recent studies have proposed three lymphatic drainage systems in the brain, that is, the glymphatic system, the intramural periarterial drainage pathway, and meningeal lymphatic vessels, whose roles in various neurological diseases have been widely explored. The glymphatic system is a fluid drainage and waste clearance pathway that utilizes perivascular space and aquaporin-4 protein located in the astrocyte endfeet to provide a space for exchange of cerebrospinal fluid and interstitial fluid. The intramural periarterial drainage pathway drives the flow of interstitial fluid through the capillary basement membrane and the arterial tunica media. Meningeal lymphatic vessels within the dura mater are involved in the removal of cerebral macromolecules and immune responses. After ischemic stroke, impairment of these systems could lead to cerebral edema, accumulation of toxic factors, and activation of neuroinflammation, while restoration of their normal functions can improve neurological outcomes. In this review, we summarize the basic concepts of these drainage systems, including drainage routes, physiological functions, regulatory mechanisms, and detection technologies. We also focus on the roles of lymphatic drainage systems in brain injury after ischemic stroke, as well as recent advances in therapeutic strategies targeting these drainage systems. These findings provide information for potential novel strategies for treatment of stroke.
最近的研究提出了大脑中的三种淋巴引流系统，即类淋巴系统、壁内动脉周围引流途径和脑膜淋巴管，它们在各种神经系统疾病中的作用已得到广泛探索。类淋巴系统是一种液体引流和废物清除途径，它利用血管周围间隙和位于星形胶质细胞终足的水通道蛋白-4来为脑脊液和组织液的交换提供空间。壁内动脉周围引流途径促使组织液通过毛细血管基底膜和动脉中膜流动。硬脑膜内的脑膜淋巴管参与脑大分子物质的清除和免疫反应。缺血性中风后，这些系统的损伤可导致脑水肿、毒性因子积累和神经炎症激活，而恢复其正常功能可改善神经功能结局。在这篇综述中，我们总结了这些引流系统的基本概念，包括引流途径、生理功能、调节机制和检测技术。我们还重点关注淋巴引流系统在缺血性中风后脑损伤中的作用，以及针对这些引流系统的治疗策略的最新进展。这些发现为中风治疗的潜在新策略提供了信息。
