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Lymphatic Vessels Found in the Brain—Osteopathic Considerations

  • Hollis H. King
Published/Copyright: October 1, 2015
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 115 Issue 10

Aspelund A, Antila S, Proulx ST, et al. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules [published online June 15, 2015]. J Exp Med. 2015;212(7):991-999. doi:10.1084/jem.20142290.

Louveau A, Smirnov I, Keyes TJ, et al. Structural and functional features of central nervous system lymphatic vessels [published online June 1, 2015]. Nature. 2015;523(7560):337-341. doi:10.1038/nature14432.

In previous editions of The Somatic Connection,1,2 we have reviewed basic science research illuminating osteopathic medical practice, particularly brain functions potentially affected by osteopathic manipulative treatment (OMT). In the October 2012 column,1 research on cerebrospinal fluid (CSF) drainage into the venous drainage system, now popularly termed the glymphatic system, was reviewed. The May 2014 column2 reviewed research elaborating how glymphatic system activity is enhanced during sleep and facilitates the cleansing of the brain. These reviews suggest the possible application of osteopathic cranial manipulative medicine procedures as possibly having effects on CSF functions.

Researchers at both the University of Virginia in Charleston and the University of Helskinki in Finland independently and concurrently found lymphatic vessels in the brain, which reverses decades-long basic science opinion that the brain was devoid of any lymphatics. These discoveries bring the lymphatic system into the same conversation as CSF with regard to intracranial fluid flow dynamics.

Both studies used lymphatic endothelial cell markers to identify lymphatic vessels in the dural membranes in and around the brain. Previous research found that CSF drained into the venous circulation through arachnoid granulations,3,4 and another study5 found that CSF is also drained into extracranial lymphatic and lymph nodes. However, the mechanism of how CSF entered the extracranial lymphatic vessel and nodes was unclear. The reviewed studies offer a clear explanation as to how CSF enters the lymphatic system and how cerebral interstitial fluid is cleared of waste products. Experts previously thought that the blood-brain barrier would limit clearance macromolecules such as amyloid β and other waste products of cellular metabolism. Both studies suggest that the adjacent dural lymphatic network may be the mechanism for clearance of these larger molecules, some of which have been associated with Alzheimer disease.

Although there is still a need to demonstrate the impact of OMT on intracranial fluid dynamics, the scientific basis for the impact of OMT, including osteopathic cranial manipulative medicine, has now been laid out. Such OMT procedures as anterior cervical lymphatic drainage facilitation could affect intracranial fluid dynamics based on these new data. If we add in the immune system impact via the cranial lymphatic flow, brain-immune system interaction should also be examined.

University of California, San Diego School of Medicine

References

1. King HH. New technology sheds light on CSF flow through the brain [The Somatic Connection].J Am Osteopath Assoc.2012;112(10):658.Search in Google Scholar

2. King HH ,MadafferNC. Mechanical changes of the brain during sleep clear metabolites and provide key mechanism for Sutherland’s cranial respiratory impulse [The Somatic Connection].J Am Osteopath Assoc.2014;114(5):407-408. doi:10.7556/jaoa.2014.084.10.7556/jaoa.2014.084Search in Google Scholar

3. Iliff JJ ,WangM,LiaoY,et al.. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β.Sci Transl Med.2012;4(147):147ra111. doi:10.1126/scitranslmed.3003748.10.1126/scitranslmed.3003748Search in Google Scholar PubMed PubMed Central

4. Xie L ,KangH,XuQ,et al.. Sleep drives metabolite clearance from the adult brain.Science.2013;342(6156):373-377. doi:10.1126/science.1241224.10.1126/science.1241224Search in Google Scholar PubMed PubMed Central

5. Koh L ,ZakharovA,JohnstonM. Integration of the subarachnoid space and lymphatics: is it time to embrace a new concept of cerebrospinal fluid absorption? Cerebrosponal Fluid Res. 2005;2:6. doi:10.1186/1743-8454-2-6.10.1186/1743-8454-2-6Search in Google Scholar PubMed PubMed Central

Published Online: 2015-10-01
Published in Print: 2015-10-01

© 2015 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2015.126
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Effects of Stem Cell Treatment in Human Patients With Peyronie Disease
  3. IN MY VIEW
  4. Interstate Medical Licensure Compact: Pernicious Myths and Inescapable Facts
  5. ORIGINAL CONTRIBUTION
  6. Accuracy and Adequacy of Computed Tomography–Guided Lung Biopsies: Experience From a Community Hospital
  7. Quantification of Motion Palpation
  8. REVIEW
  9. Non–Vitamin K Antagonist Oral Anticoagulants: The Clinician’s New Challenge
  10. CASE REPORT
  11. Peroneus Longus Rupture at Its Origin Managed With Platelet Rich Plasma
  12. THE SOMATIC CONNECTION
  13. 2b or not 2b: The State of the Evidence for Myofascial Release
  14. Lymphatic Vessels Found in the Brain—Osteopathic Considerations
  15. Osteopathic Manipulative Therapy Efficacious for Patients With Chronic Migraines
  16. Ultrasound Measurement of Vertebral Artery Blood Flow Before and After High-Velocity, Low-Amplitude Thrust Therapy
  17. Osteopathic Manipulative Therapy Shows Promise for Improving Postdiskectomy Recovery
  18. Bodywork Shown to Reduce the Symptoms of Chronic Constipation and Improve Quality of Life
  19. CLINICAL IMAGES
  20. Extensive Case of Subcutaneous Emphysema
  21. IN YOUR WORDS
  22. Filling an Open Spot
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