Cerebrospinal fluid turnover as a driver of brain clearance

Cerebrospinal fluid (CSF) has historically been considered to function as a sink for brain‐derived waste disposal. Recent work suggested that CSF interacts even more intensely with brain tissue than previously recognized, through perivascular spaces that penetrate the brain. Cardiac pulsations, vaso...

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Bibliographic Details
Published in:NMR in biomedicine 2024-07, Vol.37 (7), p.e5029-n/a
Main Authors: Smets, Nina G., Strijkers, Gustav J., Vinje, Vegard, Bakker, Erik N. T. P.
Format: Article
Language:English
Subjects:
Aging
Aging - physiology
Anesthesia
Animals
Brain
Brain - diagnostic imaging
Brain - metabolism
Cerebrospinal fluid
Cerebrospinal Fluid - metabolism
Clearances
glymphatic system
Humans
Hypertension
Magnetic Resonance Imaging
Metabolic Clearance Rate
MRI
perivascular spaces
Waste disposal
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Summary:Cerebrospinal fluid (CSF) has historically been considered to function as a sink for brain‐derived waste disposal. Recent work suggested that CSF interacts even more intensely with brain tissue than previously recognized, through perivascular spaces that penetrate the brain. Cardiac pulsations, vasomotion, and respiration have been suggested to drive CSF flow in these perivascular spaces, thereby enhancing waste clearance. However, the intrinsic role of CSF production in relation to its distribution volume (turnover) is not an explicit component of recent concepts on brain clearance. Here, we review the work on CSF turnover and volume, focusing on preclinical evidence. Herein, we highlight the use of MRI in establishing CSF‐related parameters. We describe the impact of sleep, effect of anesthesia, aging, and hypertension on CSF turnover, and how this relates to brain clearance. Evaluation of the available evidence suggests that CSF turnover is a major determinant in brain clearance. In addition, we propose that several putative drivers of brain clearance, but also conditions associated with impaired clearance, such as aging, may actually relate to altered CSF turnover. Several factors, such as sleep, aging, circadian rhythms, and hypertension, can impact CSF turnover, thereby affecting brain clearance. We propose CSF turnover as an important driver of brain clearance, and impaired clearance might be related to alterations in CSF turnover.
ISSN:0952-3480
1099-1492
DOI:10.1002/nbm.5029