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The Brain and the Lymphatic System

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Book cover Immunology of the Lymphatic System

Abstract

The brain lacks a local lymphatic system, primarily due to the closed environment of the skull which sets strict requirements for control of fluid balance and intracranial pressure. Proper fluid and pressure balance are maintained in the brain through the unique systems of cerebrospinal and interstitial fluid as well as a tight coupling between these systems and the surrounding lymphatic drainage pathways, primarily in the cervical lymph nodes. In this chapter, we will review the physiology of cerebrospinal and interstitial fluid, provide an overview of their primary production and drainage mechanisms, and discuss the still-debated issue of the interconnections of these systems and their relevance to human physiology. We present the current evidence pointing to the importance of the extracranial lymphatic system as one of the key drainage pathways for cerebrospinal fluid from the brain, and conclude with the implications of these interconnected pathways to the ongoing revision for the concept of immune privilege of the brain.

Abstract

The most important function of the lymphatic system is to remove extravasated proteins from the tissues, as these cannot be effectively absorbed back into the blood capillaries. Consequently, most of the organs and tissues of the body containing blood vessels also contain lymphatics. The brain is a major exception to this rule, lacking a local lymphatic drainage system. As we will show, there are a number of important reasons for this distinction, mostly relating to the strict volume and pressure maintenance requirements, the tight control maintained by the blood–brain barrier (BBB), as well as the so-called immune privilege of the brain. At the same time, we will also show that the lymphatic system in the head and neck (primarily the cervical lymph nodes) still play an important role in fluid drainage and immune function of the brain.

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Authors and Affiliations

  1. Department of Radiology, Gruss MR Research Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Mark E. Wagshul

  2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada

    Miles Johnston

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  1. Mark E. Wagshul
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  2. Miles Johnston
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Correspondence to Mark E. Wagshul .

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    Laura Santambrogio

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Wagshul, M.E., Johnston, M. (2013). The Brain and the Lymphatic System. In: Santambrogio, L. (eds) Immunology of the Lymphatic System. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3235-7_8

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