Cerebrospinal fluid flow modulates brain health
Lauren M. Hablitz, Maiken Nedergaard
Lauren M. Hablitz, Maiken Nedergaard
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Commentary

Cerebrospinal fluid flow modulates brain health

Abstract

Cerebrospinal fluid dynamics play an important role in maintaining brain health and clearing metabolic waste from the brain. In this issue of the JCI, Gursky et al. investigate how CSF distribution is affected when its primary efflux pathway — the deep cervical lymph nodes — is disrupted by cauterization. This timely study reveals compensatory fluid drainage routes from the skull, age-dependent adaptations in CSF homeostasis, and the emergence of neuroinflammation when an efflux pathway is occluded. The findings underscore the need to better understand the physiological mechanisms governing CSF clearance, how these pathways evolve with aging, and whether CSF influx and efflux exhibit region-specific dynamics shaped by neuroanatomy. Additionally, the study raises important questions about whether peripheral injury can influence central nervous system states. A more complete understanding of CSF flow regulation may offer new perspectives on the origins of neuropathology.

Authors

Lauren M. Hablitz, Maiken Nedergaard

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Figure 1

Rerouting of CSF drainage after cauterization of the deep cervical lymph nodes.

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Rerouting of CSF drainage after cauterization of the deep cervical lymph...
In healthy rats (left), cerebrospinal fluid (CSF) efflux pathways generally follow a carotid artery pathway (red) from the internal and external carotid arteries (iCA and eCA, respectively) toward the common carotid artery (CCA), accompanied by drainage by the lymphatic system (green), with accumulation in the deep and superficial cervical lymph nodes (dcLN and scLN, respectively). Following cauterization of the dcLN (dotted outlines), young rats (middle) exhibited a rerouting of efflux (highlighted in pink) towardsthe posterior facial veins (blue), in addition to existing carotid artery pathways. In middle-aged rats (right), efflux increased along the eCA, while no change was observed along the cervical veins. Omics analysis indicated elevated neuroinflammatory markers in both young and middle-aged rats following dcLN cauterization (depicted as darker brain color). Efflux of CSF contrast agent is depicted in pink.