Nasopharyngeal Lymphatics Found to Be Crucial for Cerebrospinal Fluid Outflow

https://www.ibs.re.kr/cop/bbs/BBSMSTR_000000000738/selectBoardArticle.do?nttId=24483&pageIndex=1&searchCnd=&searchWrd=

by gmays • 2 years ago

93 38 2 years ago

ibs.re.kr

wwwtyro• 2 years ago

We aim to investigate in a reliable animal model whether activating the cervical lymphatic vessels through pharmacological or mechanical means can prevent the exacerbation of Alzheimer’s disease progression by improving CSF clearance.

Any speculation on what those mechanical means might be?

pfdietz• 2 years ago

Ultrasound?

jareklupinski• 2 years ago

sounds like https://en.wikipedia.org/wiki/Manual_lymphatic_drainage

it feels great when you're sick, but in an ideal state, you should not need to do this as your system should be able to self-drain

mnw21cam• 2 years ago

It also forms a large part of the Perrin Technique which aims to treat chronic fatigue syndrome (AKA CFS/ME).

https://me-pedia.org/wiki/The_Perrin_Technique

moh_maya• 2 years ago

In mice;

and there are some anatomical differences between mice and humans..

So its open at this point whether it is relevant directly to humans.

IIRC, mice do not get Alzheimer’s, for instance. There are mouse models (genetically engineered)that exhibit some of the physiological symptoms of Alzheimer’s; but mice make particularly poor models for human neurology [1]- so this reach for using these essentially biomechanical structures to identify parallels and try to target a cure for neuro-degerative disorders in humans: seems more like a grant application attempt. I do wish press releases were a little more circumspect about such claims.

[1] https://www.statnews.com/2019/04/16/trouble-mice-behavioral-...

NeuroCoder• 2 years ago

They do say they plan to verify findings in primates as well so perhaps the accomplishment here is more concerning the methodology. So there me be some greater merit to this work going forward.

I think it would be more interesting for this kind of study to verify these measures that can only be obtained in animals with neuroimaging. There have been some interesting attempts to move monitor aspects of CSF flow through MRI but we need to make sure we are measuring what we think we are before using in the clinic

abracadaniel• 2 years ago

Fascinating. Maybe I’m misunderstanding, but I immediately have questions about whether sleep quality links with neurodegenerative disease are instead a symptom of sleep apnea via reduced lymphatic stimulation and not sleep itself. Could diet impact it, not by the composition of the food, but by consistency and how much chewing is involved. Could chewing gum make a difference? Neck exercises? I wonder if there is a correlation with people who mouth breathe or clench their teeth at night.

shreezus• 2 years ago

There's been a lot of recent interest in mouth taping during sleep, which can help alleviate issues related to mouth breathing or snoring. Anecdotally I've seen improvement in overall sleep quality (quantified w/ a wearable device) when I use tape vs without.

farmdve• 2 years ago

How would that work for people with chronic stuffy nose due to stay a prior Staph infection and/or allergic reactions.

NoPedantsThanks• 2 years ago

My dad has Parkinson's and has very poor-quality sleep. He also has had anti-snoring surgery in the past, and chronic post-nasal drip (which I also seem to have). This article raises questions in my mind as to whether any of these are related.

Also interesting is this: "researchers were able to successfully modulate cervical lymphatics using phenylephrine (which activates α1-adrenergic receptors, causing smooth-muscle contraction)"

Phenylephrine is the so-called decongestant that has finally been called out for being a fraud in oral medications (and I can tell you from painful, painful experience that it is indeed a fraud). I was surprised to see that it allegedly accomplishes something in this particular application.

https://www.cnbc.com/2023/09/12/decongestant-phenylephrine-i...

frankus• 2 years ago

IIUC it’s the minimal bioavailability of it in pill form that’s the problem, but it works ok when injected.

andy_ppp• 2 years ago

You could try other blood flow/nitric oxide enhancers, body builders use them to increase the pump https://www.ghostlifestyle.com/search?q=PUMP.

Or you could drink beetroot juice a few times per week.

Who knows if this will work though. I have my suspicions that inversions are very good for brain health and blood flow and I sleep better if I do yoga before bed.

I quite enjoy Sivananda yoga it’s fairly easy, reminds me of a beautiful time in their Ashram outside Madurai and you can see real progress because the basic routine is always the same.

https://youtu.be/AN0fVx8gi8w

YeGoblynQueenne2• 2 years ago

Oh. I thought this was posted for its title, reminiscent of the best of grindcore and death metal bands.

Cthulhu_3• 2 years ago

    Prepare the aerosol
    Compact albuterol
    Short-acting beta-2-adrenoceptor agonist
    A metered dose shall cure me of this
    A failed commitment to a long term treatment
    Corticosteroids such as beclomethasone
    Or perhaps salmeterol in conjuction with those

https://www.youtube.com/watch?v=PqkaUphCRfw

YeGoblynQueenne2• 2 years ago

I don't know why that's supposed to be a parody. I love that stuff :D

ngneer3• 2 years ago

Can you imagine a health news (HN) forum randomly posting links about computer science, software engineering and related topics?

ipaddr• 2 years ago

Hackers also include biohackers. Health news, science news, space news all might not seem like they fit but they do.

Seeing articles on how to apply makeup would be shocking

ngneer3• 2 years ago

Look no further on how to Elevate the Makeup Experience with AI: https://www.forbes.com/sites/forbestechcouncil/2023/11/17/ad...

oh_sigh• 2 years ago

The hacker mindset that pg had in mind when naming the site isn't restricted to tech.

ngneer3• 2 years ago

I was not trying to state otherwise. It is just that there is such a massive body of work out there (e.g., on CSF or take your pick), that highlighting one discovery seems like a drop in the ocean without much context. You may as well point out that a new issue of Nature came out: https://www.nature.com/articles/s41586-023-06899-4

vixen99• 2 years ago

Why not? Sounds like a good idea if 'randomly' isn't taken too literally.

Cthulhu_3• 2 years ago

If you like it, upvote it; if you don't like it, downvote it. That's how sites with upvote systems like HN work.

Unfortunately that also means interesting articles will never bubble up to the home page because they get lost in new.

Leyledorp• 2 years ago

Does this mean my tonsillectomy and adenoidectomy surgery might increase my risk of alzheimer's? Maybe I'll just swallow more to compensate.

jbandela13• 2 years ago

We aim to investigate in a reliable animal model whether activating the cervical lymphatic vessels through pharmacological or mechanical means can prevent the exacerbation of Alzheimer’s disease progression by improving CSF clearance.

While this is interesting, I don't think it will make much of a difference clinically.

The reason is that cerebrospinal fluid (CSF) circulation and drainage is something that doctors, especially neurologists and neurosurgeons, are very keenly aware of, and we have ways of treating issues where the CSF is not being absorbed.

As the article mentions, you produce around 500ml of CSF daily. If you do not drain the CSF, you will die fairly quickly as the pressure inside your head builds up. This can happen due to a tumor or from blood, and when this happens it is an emergency.

The emergency treatment consists of drilling a small hole in the skull, and putting a small tube into the fluid filled space of the brain called a ventricle which allows the fluid to drain. This is called an external ventricular drain (EVD). You can do it at bedside with an awake patient, lidocaine, and a hand powered drill. I have probably placed dozens if not hundreds of EVDs.

Many times the blockage will clear with time (for example the blood reabsorbs) or with treatment (you take out the tumor or drain the blood clot) and then you can remove the drain. Other times, the patient will need it long term. You then place what is called a ventriculoperitonal shunt (VP Shunt). There the tube still goes into the brain, but instead of it coming out, it is tunneled under the skin to the abdomen, and the fluid is allowed to drain into the abdomen. Everything is under the skin, so the patient can go about their normal life.

This inability to drain, can also be less dramatic. There is a condition called "Normal Pressure Hydrocephalus" which happens gradually. You often see it in older adults, and it can present as mental slowing. If a CT Scan and MRI of the brain show evidence of this, without any signs of tumor or blood, you can do what is called a therapeutic lumbar puncture (spinal tap). What you do is you insert a large needle into the fluid around the base of the spinal cord, and measure the pressure and drain some of the fluid. Then you let the patient go home and see how they do. If they improve, then you can place a VP Shunt (as described above) so that the fluid is continuously draining instead of requiring them to come in and have a spinal tap all the time.

So, while the circulation and absorption of cerebrospinal fluid is very important, I am not sure how much these lymphatics translate from mice to humans, and it is not like doctors are not aware of and don't have treatments for too much cerebrospinal fluid. If progression in Alzheimer's disease was just a matter of draining cerebrospinal fluid, we can already do that today.

Source: I was a neurosurgery resident.

vjaswal• 2 years ago

Incidentally, I know of a few people, friends of my parents, that have gotten a shunt for NPH. They suffered from one of the 3 "W" symptoms of NPH, wet, wobbly, wackiness, that you're certainly aware of.

One had a dramatic improvement very quickly, where one or more of the Ws was resolved. Another had the spinal tap indicating she was a good candidate, but the shunt is still not resolving all the issues even after 2 months.

Do you have any clinical experience with the success rates of the shunt?

jbandela13• 2 years ago

My survey of papers revealed from around 25% to 90% depending on who you read.

I think a lot is dependent on which patients you choose since some other diseases can mimic NPH.

I think my anecdotal experience is around 1/3 to 2/3 had improvement, which is similar to what you saw as well.

po• 2 years ago

Really interesting. Amazing we can just drill a hole and drain fluid into our abdomen and it's no biggie.

Are you (or anybody reading) aware of any Alzheimer's studies that looked at CSF drainage? I just found this 2017 paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577629/

jbandela13• 2 years ago

I am not aware of clinical studies on that.

One thing that to me makes me think it might be more correlation than causation is that the nasal turbinate pathway is not the major CSF absorption pathway. We know this because people who have blocked CSF circulation lower than that, end up with high pressures inside the skull and require an EVD or else they die.

In addition, lumbar punctures collecting CSF for analysis are used for some diagnostic studies. I did not see anyone suggesting that the lumbar puncture itself might help with Alzheimer’s.

o_____________o• 2 years ago

Interesting timing, I just read about a doctor that thinks cosmetic fillers are interfering with the lymphatic system in the face:

https://www.irishexaminer.com/news/spotlight/arid-41319373.h...

Horffupolde• 2 years ago

At this point you have to assume that nothing in our body is a coincidence. Also there’s no free lunch.

m3kw9• 2 years ago

I know ppl that breathe with mouth during sleep say they felt much better after taping their mouths so they use their nose instead. Don’t tape it shut tho lol (disclaimer

methou• 2 years ago

Last time at a pharmacy, I saw they selling these tapes, to my surprise, quite many brands are making these. I thought it was a niche market, but after tried it anyway, I can feel the improvement actually. (Isolated case)

Cthulhu_3• 2 years ago

I've seen chin straps (wrap something around your head), probably similar effect. I couldn't do tape, I have a beard xD

pug_mode• 2 years ago

What is the logic behind making this the title when presumably the majority of the techy crowd on hn would not be able to understand what it means or even why it's important?

smallnamespace• 2 years ago

If people don't understand the title then presumably they're not going to upvote it. That's why I think this sort of language policing to be not very useful—if you don't understand, then ignore it, and the system will sort itself out.

Personally, I found the title to be immediately understandable. I'm at techie but have had health issues where I believe poor brain CSF drainage has been a factor.

"Nasopharyngeal" can be a tricky word but "naso-" is a prefix that predictably means "nose", which lets you guess the rest.

The lymphatic system is quite important as your body's second circulatory system, but it's unfortunately not mentioned much in school here. Hopefully doctors are taught more about its importance.

Nasopharyngeal Lymphatics Found to Be Crucial for Cerebrospinal Fluid Outflow

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