A study of intrathecal, cerebrospinal fluid-to-brain exchange

Novel CNS-directed drug delivery systems in Alzheimer's disease and other neurological disorders

Increasing knowledge of the neurochemical aspects of central nervous system function raises the possibility of treating Alzheimer's disease (AD) and other neurological diseases by the appropriate manipulation of neurotransmitters, neuromodulators, neurohormones or neurotrophic factors. Clinical application of this knowledge may, however, be inhibited by long standing problems with drug delivery to the central nervous system (CNS). Novel, CNS-directed, drug delivery systems might be used to overcome many of these problems. The problems encountered in drug delivery to the brain, present experience with the clinical use of some novel drug delivery systems and the advantages and disadvantages of these systems will be discussed.

Strategies for drug delivery through the blood-brain barrier

Strategies for drug delivery through the blood-brain barrier include neurosurgical-based, pharmacologic-based, and physiologic-based approaches. Neurosurgical-based techniques involve the implantation of intraventricular catheters that allow for chronic drug delivery. However, this approach is limited by the much faster rates of bulk flow of CSF through the ventricular compartments as compared to the slow rates of drug diffusion down into brain parenchyma. Pharmacologic-based strategies, e.g., synthesis of lipid soluble pro-drugs, or physiologic-based strategies, e.g., the development of chimeric nutrients or chimeric peptides allow for drug delivery through the brain capillary wall, i.e., the blood-brain barrier, and allow for drug delivery directly into brain parenchyma.

Effect of short-term ammonia inhalation on selected amino acids in rat brain

Increased brain and plasma glutamine after ammonia inhalation had an effect on the concentrations of selected amino acids in rats. Rats inhaled ammonia vapour of 25 and 300 p.p.m. for 5 days 6 hr daily. Brain glutamine increased from the control level, 10.9 +/- 2.6 (S.D.) mumol/g to 15.5 +/- 5.2 (S.D.) mumol/g (P less than 0.05) in 25 p.p.m. NH3 and to 15.3 +/- 1.1 (S.D.) mumol/g (P less than 0.01) in 300 p.p.m. NH3. The blood glutamine was also increased so that the brain/plasma ratio was not changed. A slight elevation in the brain threonine was found, from 0.6 +/- 0.1 (S.D.) mumol/g (controls) to 0.8 +/- 0.2 (S.D.) mumol/g in 25 p.p.m. and to 0.8 +/- 0.1 (S.D.) mumol/g in 300 p.p.m. NH3. The brain/plasma ratio of threonine was increased at the 300 p.p.m. level. The increasing brain threonine linearly correlated to the increased plasma glutamine the general correlation co-efficient being 0.59 according to a linear regression analysis. The effects on other amino acids, e.g., glycine, alanine, serine, aspartate, glutamate, were less clear. It seems that the elevated blood glutamine impaired the threonine export or augmented its uptake from the blood stream. Exposure to NH3 vapour by inhalation proved to be an alternative model to portocaval shunting or urease injections in the study of hyperammonemia in the brain.

The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study

The fine anatomy of the human spinal meninges was examined in five postmortem spinal cords taken within 12 hours after death from patients aged 15 months to 46 years. Specimens of spinal cord were viewed in transverse section and from the dorsal and ventral aspects by scanning electron microscopy. Transverse sections of spinal cord and meninges were also examined by light microscopy. The arachnoid mater was seen to be closely applied to the inner aspect of the dura. An intermediate fenestrated leptomeningeal layer was observed attached to the inner aspect of the arachnoid mater and was reflected ventrally to form a series of dorsal septa. As it arborized laterally over the surface of the cord to surround nerves and blood vessels, the intermediate layer became highly fenestrated but remained distinct from the pia and arachnoid mater. The pia mater appeared to form a continuous layer which was reflected off the surface of the cord to coat blood vessels within the subarachnoid space in a manner similar to that described in the leptomeninges over the human cerebral cortex. Each dentate ligament consisted of a collagenous core which was continuous with the subpial connective tissue and was attached at intervals to the dura; pia-arachnoid cells coated the surface of the dentate ligaments. The present study suggests that the fine anatomy of the human spinal meninges differs significantly from that described in other mammals.

Anatomical relationships of the pia mater to cerebral blood vessels in man

Using scanning and transmission electron microscopy and light microscopy, the authors studied the human pia mater and its relationship to the entry of blood vessels into the normal cerebral cortex. The purpose of this investigation was to examine the long-established concept that the subarachnoid space communicates directly with the perivascular spaces of the cerebral cortex. Brains obtained post mortem from subjects with recent subarachnoid hemorrhage (SAH) and purulent leptomeningitis were studied by light microscopy to determine the permeability of the pia mater to red blood cells and inflammatory cells. Scanning electron microscopy showed that the normal pia mater is a flat sheet of cells that is reflected from the surface of the brain to form the outer coating of the meningeal vessels in the subarachnoid space. Transmission electron microscopy confirmed that the cells of the pia mater are joined by junctional complexes and form a continuous sheet that separates the subarachnoid space on one side from the subpial and perivascular spaces on the other. Thus, neither the pia mater nor the subarachnoid space extends into the brain beside blood vessels as they enter the cerebral cortex. The perivascular spaces were, in fact, found to be confluent with the subpial space and not with the subarachnoid space. In cases of recent SAH, red blood cells did not enter the perivascular spaces from the subarachnoid space; neither did India ink injected post mortem into the subarachnoid space pass into the perivascular spaces. The results of these crude tracer studies suggest that the pia mater is an effective barrier to the passage of particulate matter. Histological examination of brains of patients who had died with purulent leptomeningitis showed that inflammatory cells were present in the cortical perivascular spaces and in the contiguous subpial spaces. The presence of a large number of inflammatory cells in the subarachnoid space suggests that inflammatory cells readily penetrate the pia mater that separates the perivascular spaces from the subarachnoid space. The permeability of the pia mater to small molecular weight substances is briefly discussed.