PMC:6194691 / 41381-43691
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6194691","sourcedb":"PMC","sourceid":"6194691","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6194691","text":"Is there a glymphatic circulation?\nThe answer depends partly on what one means by glymphatic circulation. If the meaning is “Convective glymphatic fluxes of CSF and ISF propel the waste products of neuron metabolism into the paravenous space” [136], then the answer is almost certainly no (compare [40, 140], though it should be noted that [54, 137] still argue in favour of the original glymphatic hypothesis). However, if glymphatic circulation is taken to mean only that there is a net inward periarterial flow, a net outward perivenous flow, and some connection between them, then the answer still isn’t known with any certainty. The results discussed above [24, 76, 79, 142, 143] provide powerful experimental support for the widely held view that a glymphatic circulation is not needed to explain solute movements over the short distances that are important in the parenchyma. Furthermore the calculations of Asgari et al. [73, 78], Jin et al. [77] and Holter et al. [80] (see also Footnote 8) suggest that flow through the interstitial spaces of grey matter or along the basement membranes of microvessels in the parenchyma is negligible. However, it is not yet clear that the available experimental results exclude the possibility that there is a net flow between the perivascular spaces of arterioles and venules that is large enough to complete a recirculation pathway inwards from CSF via periarterial routes and back to CSF via perivenous routes.9 If that flow exists it could be important for transport of solutes over the relatively large distances encountered along the perivascular spaces (see e.g. [76]) while still being negligible relative to diffusion for transport over the relatively short distances within the parenchyma. Interestingly this scenario was proposed recently by Coles et al. [1] (see also Iliff et al. [145]) based on detailed consideration of the evidence available even before publication of the results in [16, 79].\nWhile there have now been hundreds of references to the glymphatic mechanism, almost all of these treat it as accepted dogma and do not test the assumptions or the evidence on which it is based. At present it would be better to refer to perivascular elimination and delivery of substances without prejudice to the mechanism(s) by which these are 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