Hakan ERDOĞAN, Bilal KELTEN, Seyho Cem YÜCETAŞ, Nilgün ÇINAR, Alper KARAOĞLAN, Erol TAŞDEMİROĞLU

Beyinin Lenfatik Drenaj ve Protein Eliminasyon Yetmezliğine Bağlı Arteriyopatileri

Amaç: Vücuttaki birçok organda lenfatik drenaj, tanımlı lenfatik kanallardan bölgesel lenf nodlarına kadar olan uzanım boyunca çözünmüş maddeleri, antijenleri, antijen sunucu hücreleri ve yıkılmış doku parçalarını içerir. Santral Sinir Sistemi'nin SSS ise, konvansiyonel lenfatik sisteme ve lenfatik drenaja sahip olmadığı, immünolojik açıdan özel bir konuma sahip olduğu düşünülür. Beynin içinde konvansiyonel lenfatik yolaklar olmamasına karşın, fizyolojik çalışmalar insanda beyinden servikal lenf nodlarına kadar zengin ve immünolojik açıdan önemli bir lenfatik drenajın varlığını ortaya koymuştur. Metod: Beyin parankiminden sıvıların ve yıkılan parçaların anormal-artık proteinler perivasküler drenajındaki bozukluklar Protein Eliminasyon Yetmezliği Arteriyopatileri PEYA olarak isimlendirilmektedir. Bu tip bozukluklarda meydana gelen protein birikimleri, Serebral Amiloid Anjiyopati SAA , Alzheimer Hastalığı AH , Crutzfeld-Jacobs Hastalığı CJH , Parkinson Hastalığı PH , Kronik Travmatik Ensefalomiyopati KTE , Frontotemporal Demans FTD , Sporadik Amiyotrofik Lateral Skleroz SALS gibi proteinopatileri kapsayan hastalıkların patofizyolojileriyle ilişkilidirler. Bulgular: Bizim düşüncemize gore, PEYA toksik, dejenere olmuş, olasılıkla kullanılmış, artık anormal proteinlerin ekstrasellüler ortamdan eliminasyonundaki yetersizlik ile karakterize bir hastalıktır. Bu proteinlerin anormal bir şekilde katlanmış olan çeşitlerinin nasıl toksik hale gelebildikleri ve hastalığa yol açtıkları ile ilgili bu yeni görüşler, hastalığın patogenezi ile ilgili yeni anlayışlar getirmekte ve ayrıca yeni bazı tedavi olanakları için de imkân sunmaktadır. Sonuç: Bu derlemede biz, beyin interstisyel sıvısının İSS beyinde öncelikli yolaklar boyunca akışı, beyin omurilik sıvısı BOS ile ilişkisi ve beyin parankiminden lenfatik drenajın blokajının sonuçlarıyla ilgili bulguları gözden geçirmekteyiz.

Anahtar Kelimeler:

Beynin lenfatik drenajı, Protein eliminasyon yetmezliği, Arteriyopatiler

Cerebral Arteriopathies due to Failure of Lymphatic Drainage and Protein Elimination

Aim: In most organs of the body, lymphatic drainage involves the drainage of solutes, antigens, antigen presenting cells and tissue debris along the defined lymphatic channels to the regional lymph nodes. The Central Nervous System CNS is considered to be an immunologically privileged organ without conventional lymphatic system and lymphatic drainage. Although there are no conventional lymphatic pathways in the brain, physiological studies revealed a substantial and immunologically significant lymphatic drainage from brain to cervical lymph nodes in humans. Methods: Disturbance of the perivascular drainage of fluids and solutes abnormal- garbage proteins from the brain parenchyma is called as Protein Elimination Failure Arteriopathies PEFA . Those protein deposits are associated with the pathophysiology of these diseases and include Cerebral Amyloid Angiopathy CAA , Alzheimer's Disease AD , Cruzfeld-Jacobs Disease CJD , Parkinson's Disease, Chronic Traumatic Encephalomyopathy CTE , Results: According to our opinion PEFA is a disease characterized by the failure of elimination of toxic, degenerated and possibly used garbage abnormal proteins from the extracellular milieu. In lights of this new idea about how abnormally folded versions of these proteins may be toxic and lead to disease, our findings are yielding insights into the disease pathogenesis but may also provide some new therapeutic insights. Conclusion: In this review we survey the evidences for the flow of brain interstitial fluid ISF via the preferential pathways through the brain, its relation to cerebrospinal fluid CSF and the results of the blockage of lymphatic drainage form the brain parenchyma.

Keywords:

Lymphatic drainage of the brain, Protein elimination failure, Arteriopathies,

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