Cited by 431Alzheimer's disease research and treatmentsNeuroinflammation and Neurodegeneration MechanismsCerebrospinal fluid and hydrocephalus

Meningeal lymphatics affect microglia responses and anti-Aβ immunotherapy

Open access
Da Mesquita, Sandro, Papadopoulos, Zachary, Dykstra, Taitea, Brase, Logan, Farias, Fabiana Geraldo, Wall, Morgan, Jiang, Hong, Kodira, Chinnappa Dilip +23 more·2021·Nature

Abstract

Alzheimer’s disease (AD) is the most prevalent cause of dementia1. Although there is no effective treatment for AD, passive immunotherapy with monoclonal antibodies against amyloid beta (Aβ) is a promising therapeutic strategy2,3. Meningeal lymphatic drainage has an important role in the accumulation of Aβ in the brain4, but it is not known whether modulation of meningeal lymphatic function can influence the outcome of immunotherapy in AD. Here we show that ablation of meningeal lymphatic vessels in 5xFAD mice (a mouse model of amyloid deposition that expresses five mutations found in familial AD) worsened the outcome of mice treated with anti-Aβ passive immunotherapy by exacerbating the deposition of Aβ, microgliosis, neurovascular dysfunction, and behavioural deficits. By contrast, therapeutic delivery of vascular endothelial growth factor C improved clearance of Aβ by monoclonal antibodies. Notably, there was a substantial overlap between the gene signature of microglia from 5xFAD mice with impaired meningeal lymphatic function and the transcriptional profile of activated microglia from the brains of individuals with AD. Overall, our data demonstrate that impaired meningeal lymphatic drainage exacerbates the microglial inflammatory response in AD and that enhancement of meningeal lymphatic function combined with immunotherapies could lead to better clinical outcomes. Meningeal lymphatic drainage can affect the microglial inflammatory response and anti-amyloid-β immunotherapy in mouse models of Alzheimer’s disease.

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Crossref · 10.1038/s41586-021-03489-0

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Claims the paper makes

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  • Findingcitation

    mAducanumab treatment induces overexpression of genes in synapse organization, regulation of membrane potential, and neurotransmitter transport pathways in aged APPswe mouse hippocampus.

    “Treatment with mAducanumab induced an overexpression of genes involved in synapse organization (GO:0050808), regulation of membrane potential (GO:0042391) and neurotransmitter transport (GO:0006836; Extended Data Fig. 8k) pathways, which might be attributed to the enhanced clearance of soluble Aβ seeds28 from the brain of aged APPswe mice.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Uhlmann, R. E. et al. Acute targeting of pre-amyloid seeds in transgenic mice reduces Alzheimer-like pathology later in life. Nat. Neurosci. 23, 1580–1588 (2020). source

      Not checked in the free run.

  • Findingown data

    Meningeal lymphatic function is linked to microglial activation and the brain vascular response in Alzheimer's disease.

    “Here, using transcriptional profiling of mouse meningeal lymphatic endothelial cells (LECs), microglia and brain blood endothelial cells (BECs), we show that meningeal lymphatic function is coupled to microglia activation and brain vascular response in AD.”
    Quote in the paperSubstantial claim
  • Findingown data

    Up-regulated genes in microglia from mice with impaired meningeal lymphatics belong to Gene Ontology pathways including positive regulation of cytokine production, leukocyte migration, cell chemotaxis, and myeloid leukocyte activation.

    “Up-regulated genes in microglia from mice with impaired meningeal lymphatics were involved in Gene Ontology (GO) pathways such as positive regulation of cytokine production (GO:0001819), leukocyte migration (GO:0050900), cell chemotaxis (GO:0060326) and myeloid leukocyte activation (GO:0002274; Fig. 1m).”
    Quote in the paperSubstantial claim
  • Findingown data

    Microglia from 5xFAD mice with impaired meningeal lymphatics express higher levels of Apoe, Lyz2, Fth1, Timp2, H2-d1, Axl, Cst7, Spp1, and Lpl.

    “Analysis of homeostatic and disease-associated microglia (DAM) gene signatures in microglia from 5xFAD mice with impaired meningeal lymphatics revealed higher expression of Apoe, Lyz2, Fth1, Timp2, H2-d1, Axl, Cst7, Spp1 and Lpl (Extended Data Fig. 6e, f and Supplementary Table 2), which are involved in the transition from homeostatic to activated microglia21,26.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Keren-Shaul, H. et al. A unique microglia type associated with restricting development of Alzheimer’s disease. Cell 169, 1276–1290.e17 (2017). source

      Not checked in the free run.

    • cites [26] Zhou, Y. et al. Human and mouse single-nucleus transcriptomics reveal TREM2-dependent and TREM2-independent cellular responses in Alzheimer’s disease. Nat. Med. 26, 131–142 (2020). source

      Not checked in the free run.

  • Findingown data

    Viral-mediated mVEGF-C treatment alters the transcriptional signature of meningeal lymphatic endothelial cells in 20-24-month-old mice, linked to activation of mitochondrial gene expression, fatty acid homeostasis, and smoothened signaling pathways.

    “Here we show that transcriptional signature of meningeal LECs in 20–24-month-old mice is altered following viral-mediated mVEGF-C treatment, which is linked to the activation of gene pathways such as mitochondrial gene expression (GO:0140053), fatty acid homeostasis (GO:0055089) and smoothened signaling pathway (GO:0007224; Extended Data Fig. 7n–q).”
    Quote in the paperSubstantial claim
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  • Classified as probably not a substantial claim. 36
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    Findingown data

    In 5xFAD mice with impaired meningeal lymphatic drainage, IBA1+ cell coverage, peri-plaque IBA1+ cell counts, CD68 levels on IBA1+ cells, and fibrinogen coverage indicate aberrant myeloid activation and elevated brain fibrinogen.

    “Accordingly, measurements of IBA1+ cell coverage, number of peri-Aβ plaque IBA1+ cells, levels of CD68 on IBA1+ cells and fibrinogen coverage revealed an aberrant activation of myeloid cells and increased fibrinogen levels in the brain of mice with impaired meningeal lymphatic drainage (Fig. 1f–j and Extended Data Fig. 3m–q).”
    Quote in the paperSubstantial claim
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    Findingown data

    Neither mAducanumab nor mAb158 changes the average size of amyloid-beta plaques in 5xFAD mice.

    “Neither mAducanumab nor mAb158 affected the average size of Aβ plaques (Extended Data Fig. 3i, j).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Treatment with mAducanumab or mAb158 reduces amyloid-beta plaque density in 5xFAD mice.

    “Treatments with mAducanumab or mAb158 proved to be efficient in reducing the density of Aβ plaques (Fig. 1b, c and Extended Data Fig. 3g, h).”
    Quote in the paperSubstantial claim
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    Findingown data

    mAducanumab treatment lowers expression of disease-related genes in microglia and significantly raises expression of the homeostatic genes P2ry12, Tmem119, and Selplg.

    “Interestingly, treatments with mAducanumab reduced the expression of the aforementioned disease-related genes in microglia, and significantly increased the expression of the homeostatic P2ry12, Tmem119 and Selplg (Extended Data Fig. 6f and Supplementary Table 2).”
    Quote in the paperSubstantial claim
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    Findingown data

    Mice with impaired meningeal lymphatics spend less time in the open field center and take longer to locate the submerged platform during Morris water maze acquisition than controls.

    “Notably, mice with impaired meningeal lymphatics spent less time in the center of the open field arena (Extended Data Fig. 4a–d and h–k) and took more time to find the submerged platform in the acquisition of the Morris water maze test (Extended Data Fig. 4e–g and l–n), when compared to their control counterparts.”
    Quote in the paperSubstantial claim
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    Findingown data

    In 5xFAD mice with ablated meningeal lymphatics, less mAb158 colocalizes with brain parenchymal amyloid-beta aggregates, while vascular amyloid-beta localization is unchanged.

    “Interestingly, although there were no differences in the amount of mAb158 localized to brain vascular Aβ (Extended Data Fig. 5j, k), significantly less mAb158 was found to be colocalized with brain parenchymal Aβ aggregates in 5xFAD mice with ablated meningeal lymphatics (Extended Data Fig. 5j, l).”
    Quote in the paperSubstantial claim
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    Findingown data

    Prolonged meningeal lymphatic ablation increases amyloid-beta burden in the meninges and brain parenchyma, impairs amyloid-beta plaque clearance by cerebrospinal fluid-injected mAb158, and raises ferric iron deposits.

    “Prolonged ablation of meningeal lymphatics led to significantly higher Aβ burden in the meninges and brain parenchyma, interfered with Aβ plaque clearance by CSF-injected mAb158 (Extended Data Fig. 5b–g) and resulted in increased ferric iron deposits (Prussian blue staining) (Extended Data Fig. 5h, i).”
    Quote in the paperSubstantial claim
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    Findingown data

    Mice treated with mVEGF-C and mAb158 show significantly less peri-amyloid-beta microgliosis and lower CD68 levels in IBA1+ cells.

    “Mice treated with mVEGF-C and mAb158 also presented significantly less peri-Aβ microgliosis and decreased levels of CD68 in IBA1+ cells (Extended Data Fig. 7d–g).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In 5xFAD mice, lymphatic vessel coverage along the superior sagittal sinus, transverse sinus, and confluence of sinuses declines significantly by 13-14 months but not at 5-6 months.

    “No changes were observed at 5–6 months (Extended Data Fig. 1a–e), but a significant decrease in lymphatic vessel coverage along the superior sagittal sinus (SSS), transverse sinus (TS) and the confluence of sinuses (COS) was evident at 13–14 months in the meninges of 5xFAD mice (Extended Data Fig. 1c, d).”
    Quote in the paperSubstantial claim
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    Findingown data

    Mouse microglial phenotypes show enrichment for homeostatic microglia in cluster 1, activated microglia in cluster 2 with a disease-associated signature, and alternatively activated microglia in cluster 3.

    “Concerning mouse microglial phenotypes, there was an obvious enrichment for homeostatic in cluster 1, activated in cluster 2 (showing a DAM signature) and alternatively activated in cluster 3 (Extended Data Fig. 10d).”
    Quote in the paperSubstantial claim
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    Findingown data

    The microglia gene set shows significant connections with age at onset (P = 4.82E-12), CSF soluble TREM2 (P = 3.59E-07), Aβ42 (P = 0.021), phospho-Tau (P = 0.029), and Tau (P = 0.005) levels.

    “Significant connections were observed between the microglia gene-set and age at onset (P = 4.82E-12), and CSF soluble TREM2 (P = 3.59E-07), Aβ42 (P = 0.021), phospho-Tau (P = 0.029) and Tau (P = 0.005) levels.”
    Quote in the paperSubstantial claim
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    Findingown data

    More than half of microglial nuclei from non-AD patients show a resting-state phenotype, while presymptomatic AD samples are enriched in alternatively activated cluster 3 microglia.

    “More than half of the microglial nuclei from the brains of non-AD patients presented a resting-state phenotype, whereas the samples from presymptomatic AD patients (patients showing characteristic AD brain pathology but a clinical dementia rating of 0.5 or less) were enriched in alternatively activated cluster 3 microglia (Fig. 3e).”
    Quote in the paperSubstantial claim
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    Findingown data

    The brain blood endothelial cell gene set is strongly associated with amyloid imaging (P = 0.0089) and age at onset (P = 1.04E-10).

    “A strong association was observed between the brain BECs’ gene-set, amyloid imaging (P = 0.0089) and age at onset (P = 1.04E-10).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Principal component analysis separated meningeal LEC transcriptomes of WT and 5xFAD mice.

    “Principal component analysis (PCA) plot showing segregation between WT (blue) and 5xFAD (purple) meningeal LEC transcriptomes.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Brains of 5xFAD mice with ablated meningeal lymphatics have a significantly lower fraction of cluster 1 resting-state microglia (P = 0.00026) and higher fractions of clusters 2 (P = 0.00191) and 3 (P = 0.03535) activated microglia than mice with intact meningeal lymphatics.

    “Noticeably, the brains of 5xFAD mice with ablated meningeal lymphatics showed a significantly lower fraction of cluster 1 resting-state microglia (P = 0.00026) and higher fractions of clusters 2 (P = 0.00191) and 3 (P = 0.03535) activated microglia, when compared to mice with intact meningeal lymphatics (Fig. 3e).”
    Quote in the paperSubstantial claim
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    Findingown data

    Thirty-nine Alzheimer's disease-associated genes lie within the 10th percentile of highly expressed genes in meningeal lymphatic endothelial cells, including Apoe, which is among the few highly expressed genes shared by all three cell types.

    “In fact, 39 AD-associated genes were found within the 10th percentile of highly expressed genes in meningeal LECs, including Apoe, which is intrinsically linked to altered risk for late onset AD15,31 and was one of the few highly expressed genes found at the intersection between all three cell types (Extended Data Fig. 9o).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [15] Yamazaki, Y., Zhao, N., Caulfield, T. R., Liu, C. C. & Bu, G. Apolipoprotein E and Alzheimer disease: pathobiology and targeting strategies. Nat. Rev. Neurol. 15, 501–518 (2019). source

      Not checked in the free run.

    • cites [31] Corder, E. H. et al. Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer’s disease in late onset families. Science 261, 921–923 (1993). source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In 5xFAD mouse meninges at 11-12 months, several immune cell populations increase significantly: B cells, CD4+ T cells 1, CD8+ T cells, ILC3s, and undefined cells.

    “Numbers of different meningeal immune cells showing a statistically significant increase in B cells, CD4+ T cells 1, CD8+ T cells, type 3 innate lymphoid cells (ILC3s) and undefined cells in the meninges of 5xFAD mice at 11-12 months of age.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In the learning or memory pathway, gene upregulation is amplified when mVEGF-C is given alone and sometimes counteracted when combined with mAducanumab.

    “However, in the learning or memory pathway (Extended Data Fig. 8l), gene upregulation was amplified when mVEGF-C was administered alone and, in some instances, counteracted when combined with mAducanumab.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In reanalysis of GSE98816, five of seven BEC clusters matched the arterial, capillary, and venous BEC categories from Vanlandewijck et al.

    “Five out of the seven identified clusters matched a similar transcriptional profile to the arterial, capillary, and venous BECs identified by Vanlandewijck et al25 and were subset and re-clustered.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Vanlandewijck et al25

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Reclustering produced four brain BEC groups: capillary 1, capillary 2, arterial, and venous.

    “This analysis resulted in 4 clusters of brain BECs: capillary 1, capillary 2, arterial and venous (in Extended Data Fig. 9j).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Gene-set analyses show significant correlations between up-regulated genes in microglia from 5xFAD mice with dysfunctional meningeal lymphatics and amyloid imaging (P = 0.017), CSF Tau levels (P = 0.036), age at onset (P = 0.027), and AD risk (P = 0.011).

    “Furthermore, gene-set based analyses for genome-wide associations of AD-related phenotypes and risk revealed significant correlations between the set of up-regulated genes in microglia isolated from 5xFAD mice with dysfunctional meningeal lymphatics and amyloid imaging (P = 0.017), CSF Tau levels (P = 0.036), age at onset (P = 0.027) and AD risk (P = 0.011; Supplementary Table 6).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Findingown data

    The meningeal lymphatic dysfunction microglial signature comprised 54 genes with log2 fold change greater than 1 and false discovery rate q-value less than 0.05 that were overexpressed in the Vis./photo. plus mIgG group compared with the Vis. plus mIgG group and mapped to human orthologs.

    “A microglial gene signature of meningeal lymphatic dysfunction (Supplementary Table 5) was created by selecting the 54 genes that showed a log2 (fold change) > 1 and were significantly overexpressed (false discovery rate q-value < 0.05) in the Vis./photo. plus mIgG group, when compared to the Vis. plus mIgG group (Fig. 1l), and mapped to a human gene ortholog.”
    Quote in the paperSubstantial claim
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    Interpretationown data

    Impaired meningeal lymphatic drainage in 5xFAD mice reduces mAb158 influx from cerebrospinal fluid into the brain, leading to less targeting of amyloid-beta plaques for clearance.

    “These findings suggest that impairment of meningeal lymphatic drainage in 5xFAD mice leads to decreased influx of mAb158 from the CSF into the brain, resulting in less targeting of Aβ plaques for clearance.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationown data

    Reduced meningeal lymphatic drainage has a harmful effect on brain fibrinogen levels and neuroinflammation in 5xFAD mice, affecting neuronal function and leading to greater anxiety and faster cognitive decline.

    “Altogether, this data is indicative of a deleterious effect of reduced meningeal lymphatic drainage on brain fibrinogen levels and neuroinflammation in 5xFAD mice, which impact neuronal function, as previously shown19, and translate into heightened anxiousness and accelerated cognitive decline.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Ryu, J. K. et al. Fibrin-targeting immunotherapy protects against neuroinflammation and neurodegeneration. Nat. Immunol. 19, 1212–1223 (2018). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Alzheimer's disease involves accumulation of toxic amyloid-beta aggregates in the brain, partly because cleansing mechanisms progressively fail.

    “Alzheimer’s disease (AD) is characterized by accumulation of toxic Aβ aggregates in the brain1, in part, due to progressive impairment of cleansing mechanisms2–6.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [1] Jack, C. R. Jr et al. NIA-AA Research Framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 14, 535–562 (2018). source

      Not checked in the free run.

    • cites [2] Logovinsky, V. et al. Safety and tolerability of BAN2401—a clinical study in Alzheimer’s disease with a protofibril selective Aβ antibody. Alzheimers Res. Ther. 8, 14 (2016). source

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    • cites [3] Sevigny, J. et al. The antibody aducanumab reduces Aβ plaques in Alzheimer’s disease. Nature 537, 50–56 (2016). source

      Not checked in the free run.

    • cites [4] Da Mesquita, S. et al. Functional aspects of meningeal lymphatics in ageing and Alzheimer’s disease. Nature 560, 185–191 (2018). source

      Not checked in the free run.

    • cites [5] Mawuenyega, K. G. et al. Decreased clearance of CNS beta-amyloid in Alzheimer’s disease. Science 330, 1774 (2010). source

      Not checked in the free run.

    • cites [6] Tarasoff-Conway, J. M. et al. Clearance systems in the brain—implications for Alzheimer diseaser. Nat. Rev. Neurol. 12, 248 (2016). source

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  • May combine two claims.

    Interpretationown data

    Meningeal lymphatic ablation causes loss of homeostatic microglia and acquisition of a disease-associated microglial signature, effects that passive immunotherapy counteracts.

    “These observations suggest that meningeal lymphatic ablation leads to a loss of homeostatic microglia, and acquisition of the DAM signature (and/or the neurodegenerative microglial signature)21,22,26, all of which is counteracted by passive immunotherapy.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [21] Keren-Shaul, H. et al. A unique microglia type associated with restricting development of Alzheimer’s disease. Cell 169, 1276–1290.e17 (2017). source

      Not checked in the free run.

    • cites [22] Krasemann, S. et al. The TREM2-APOE pathway drives the transcriptional phenotype of dysfunctional microglia in neurodegenerative diseases. Immunity 47, 566–581.e9 (2017). source

      Not checked in the free run.

    • cites [26] Zhou, Y. et al. Human and mouse single-nucleus transcriptomics reveal TREM2-dependent and TREM2-independent cellular responses in Alzheimer’s disease. Nat. Med. 26, 131–142 (2020). source

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    Study design and conductown data

    The Morris water maze test was administered by an experimenter who was blinded.

    “All MWM testing was performed between 10 a.m. and 6 p.m., during the lights-on phase, by a blinded experimenter.”
    Quote in the paperNot a substantial claim
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    Study design and conductown data

    Sample sizes were generally not recalculated or predetermined by statistical methods.

    “In general, statistical methods were not used to re-calculate or predetermine sample sizes.”
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    Study design and conductreasoning

    Dispersion was estimated using estimateGLMRobustDisp to make the analysis more robust to outliers.

    “Dispersion was estimated with estimateGLMRobustDisp to increase robustness against outliers and a quasi-likelihood model was fit with glmQLFit.”
    Quote in the paperNot a substantial claim
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    Study design and conductcitation

    Brain single-nucleus RNA-seq data were annotated using a marker gene list curated previously.

    “We employed a list of marker genes that we had previously curated64 to annotate brain single-nucleus RNA-seq data.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Del-Aguila, J. L. et al. A single-nuclei RNA sequencing study of Mendelian and sporadic AD in the human brain. Alzheimers Res. Ther. 11, 71 (2019). source

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    Study design and conductown data

    Low-quality cells were removed based on unique molecular counts, unique gene counts, and mitochondrial gene percentage.

    “The resulting gene by count matrices were then read into R and filtered to remove low quality cells based on unique molecular counts, unique genes, and percent mitochondrial gene expression.”
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    Study design and conductcitation

    Multiple testing in the eQTL analysis was corrected while accounting for linkage disequilibrium, following an approach used in prior bulk RNA-seq eQTL studies.

    “We followed an approach previously employed in bulk RNA-seq expression quantitative trait loci (eQTL) analyses66–69 to correct for multiple testing while accounting for linkage disequilibrium.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [66] Sul, J. H. et al. Accurate and fast multiple-testing correction in eQTL studies. Am. J. Hum. Genet. 96, 857–868 (2015). source

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    • cites [67] Duong, D. et al. Using genomic annotations increases statistical power to detect eGenes. Bioinformatics 32, i156–i163 (2016). source

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    • cites [68] Darnell, G., Duong, D., Han, B. & Eskin, E. Incorporating prior information into association studies. Bioinformatics 28, i147–i153 (2012). source

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    • cites [69] Eskin, E. Increasing power in association studies by using linkage disequilibrium structure and molecular function as prior information. Genome Res. 18, 653–660 (2008). source

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  • May combine two claims.

    Interpretationown data

    In 5xFAD mice, meningeal lymphatic dysfunction produces anxious-like behavior and poorer spatial learning and memory.

    “Extended Data Figure 4 | Meningeal lymphatic dysfunction leads to anxious-like behavior and worsened spatial learning and memory in 5xFAD mice.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    To ensure randomization, animals were selected from different cages within each experimental group.

    “Animals from different cages, but within the same experimental group, were selected to assure randomization.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Benjamini-Hochberg correction was applied to differential expression P-values across all datasets, and adjusted P-values below 0.05 were treated as significant.

    “The Benjamini-Hochberg correction was used to adjust the associated P-values for differentially expressed genes in all datasets and those with adjusted P-values below 0.05 were considered to be significant.”
    Quote in the paperNot a substantial claim
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    Study design and conductnone given

    For all independent experiments, experimenters did not know group identities from euthanasia until data collection and analysis ended.

    “Experimenters were blinded to the identity of experimental groups from the time of euthanasia until the end of data collection and analysis for all the independent experiments.”
    Quote in the paperNot a substantial claim
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    Study design and conductnone given

    All quantitative measurements were made by an experimenter who was blinded.

    “All measurements were performed by a blinded experimenter, Microsoft Excel was used to calculate average values in each experiment and statistical analysis performed using Prism 8.3.4.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Within and between independent groups of the same experiment, variance was comparable.

    “Variance was similar within independent groups of the same experiment and between groups from independent experiments.”
    Quote in the paperNot a substantial claim
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    Study design and conductnone given

    Neuropathological changes of AD were evaluated with National Institute on Aging-Alzheimer's Association criteria.

    “AD neuropathological changes were assessed according to the criteria of the National Institute on Aging-Alzheimer’s Association (NIA-AA).”
    Quote in the paperNot a substantial claim
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    Study design and conductown data

    The results shown in panels a-i were reproduced in two separate experiments.

    “Data in a-i are representative of 2 independent experiments”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    In 5xFAD mice, impairing meningeal lymphatic function restricts mAb158-mediated brain Aβ clearance and changes neuritic dystrophy, microglial activation, and fibrinogen levels.

    “Extended Data Figure 3 | Compromising meningeal lymphatic function in 5xFAD mice limits brain Aβ clearance by mAb158 and modulates neuritic dystrophy, microglial activation and fibrinogen levels.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Live lymphatic endothelial cells were gated as DAPI-negative, CD45-negative, CD31-positive, and PDPN-positive using the same gating strategy as a prior publication.

    “The live LECs were then gated as DAPI−CD45−CD31+PDPN + (using the exact same gating strategy as described in a previous publication5) and sorted into a 96-well plate containing 100 μL of RNA extraction lysis buffer using the Influx™ Cell Sorter (BD Biosciences) that is available at the University of Virginia Flow Cytometry Core Facility.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Mawuenyega, K. G. et al. Decreased clearance of CNS beta-amyloid in Alzheimer’s disease. Science 330, 1774 (2010). source

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    Study design and conductcitation

    A previously proposed dynamic model guided removal of nuclei with high mitochondrial gene expression.

    “We removed nuclei with high mitochondria gene expression following a previously proposed dynamic model61.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Mathys, H. et al. Single-cell transcriptomic analysis of Alzheimer’s disease. Nature 570, 332–337 (2019). source

      Not checked in the free run.

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    Study design and conductcitation

    Sequencing depth per cell, number of unique features, and mitochondrial gene percentage were regressed out.

    “The resulting normalized counts were then transformed from log2 scale to the natural log scale for compatibility with Seurat v355 and the effects of sequencing depth per cell, number of unique features, and percentage of mitochondrial genes were regressed out.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Stuart, T. et al. Comprehensive integration of single-cell data. Cell 177, 1888–1902.e21 (2019). source

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  • May combine two claims.

    Interpretationown data

    The advanced disease stage or advanced age at which antibody therapies are given might explain part of their marginal benefits and potential harmful side effects, which could be due to compromised meningeal lymphatic function.

    “The advanced stage of disease (or simply the advanced age) at which antibody-based therapies are administered, might explain part of their marginal beneficial effects (and potential deleterious side effects), which could be attributed to a compromised meningeal lymphatic function.”
    Quote in the paperSubstantial claim
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    Study design and conductown data

    The open field test was conducted by a blinded experimenter.

    “Individual mice were then placed into the open field arena (made of opaque white plastic material, 35 cm × 35 cm) by a blinded experimenter and allowed to explore it for 15 min.”
    Quote in the paperNot a substantial claim
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    Study design and conductreasoning

    Samples were barcoded with six palladium isotopes to reduce variability between tubes.

    “Individual samples were barcoded using six palladium metal isotopes according to the manufacturer’s instructions (Cell-ID 20-plex Pd barcoding kit, Fluidigm) to reduce tube-to-tube variability.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No exclusion criteria were established before the study.

    “No exclusion criteria were pre-established.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    One outlier in the Visudyne group was identified and excluded in Extended Data Fig. 3e.

    “An outlier was identified and excluded in Extended Data Fig. 3e, in the Visudyne group (the outlier is indicated in the correspondent source data file).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Potentially contaminating oligodendrocyte precursor cells, oligodendrocytes, neurons, and astrocytes were identified and removed using Cspg4, Mbp, Cam2ka, and Gfap expression, respectively.

    “In the cortical myeloid single-cell dataset obtained using 5xFAD mice, small populations of potentially contaminating oligodendrocyte precursor cells, oligodendrocytes, neurons and astrocytes were identified and removed based on the expression levels of Cspg4, Mbp, Cam2ka, and Gfap genes, respectively.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All experiments were approved by the University of Virginia Institutional Animal Care and Use Committee.

    “All experiments were approved by the Institutional Animal Care and Use Committee of the University of Virginia.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    For viSNE visualization, an equal number of cells was randomly sampled from each replicate, totaling 12,000 cells per condition.

    “A subset of cells was selected for viSNE visualization by randomly sampling an equal number of cells from each replicate, totaling 12,000 cells from each condition.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    Microglia are unlikely to respond directly to mVEGF-C because few express Flt4, though a direct effect on brain blood endothelial cells cannot be excluded.

    “Although we cannot rule out a direct effect of mVEGF-C on brain BECs, which show some expression of Flt4, microglia are unlikely to respond to mVEGF-C due to the low frequency of Flt4-expressing cells (Extended Data Fig. 8t).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Potential outliers were identified and discarded using the ROUT test.

    “The ROUT test was used to identify and discard potential outliers.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Genes with fewer than five counts in at least two samples, or with high within-sample standard deviations, were removed.

    “Genes were filtered to remove those with fewer than five counts in at least two samples as well as those with high intra-sample standard deviations.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Raw mass cytometry data were normalized for detector sensitivity by adding five element beads.

    “Raw data were normalized for detector sensitivity by adding five element beads to the sample and processed as described previously42.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Finck, R. et al. Normalization of mass cytometry data with bead standards. Cytometry A 83, 483–494 (2013). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Fluorescent microsphere drainage was counted by a blinded experimenter.

    “Fluorescent microsphere drainage was analyzed in FIJI software by drawing a line demarcating the draining lymphatic vessel afferent to the dCLN and manually counting the microspheres passing the line by a blinded experimenter.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Doublets were detected and discarded with Doublet Finder, which removes nuclei whose expression profiles resemble synthetically mixed nuclei.

    “To detect and discard doublets, we used Doublet Finder62, which removes nuclei with expression profiles that resemble synthetically mixed nuclei from the dataset.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] McGinnis, C. S., Murrow, L. M. & Gartner, Z. J. DoubletFinder: doublet detection in single-cell RNA sequencing data using artificial nearest neighbors. Cell Syst. 8, 329–337.e4 (2019). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Power calculations (α = 0.05, power = 0.8) based on similar previously published experiments guided the choice of sample sizes.

    “Sample sizes were chosen on the basis of standard power calculations (with α = 0.05 and power of 0.8) performed for similar experiments that were previously published5,12.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Mawuenyega, K. G. et al. Decreased clearance of CNS beta-amyloid in Alzheimer’s disease. Science 330, 1774 (2010). source

      Not checked in the free run.

    • cites [12] Louveau, A. et al. CNS lymphatic drainage and neuroinflammation are regulated by meningeal lymphatic vasculature. Nat. Neurosci. 21, 1380–1391 (2018). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Genes were retained only if they were expressed in more than five cells.

    “Additionally, genes were filtered to retain only those which were expressed more than five cells.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    For hippocampal bulk RNA sequencing, differential expression results were filtered using a Benjamini-Hochberg adjusted P-value threshold of 0.05.

    “Expression differential was tested with empirical Bayes quasi-likelihood F-test and results were then filtered using as threshold a Benjamini-Hochberg adjusted P-value < 0.05 (statistically significant).”
    Quote in the paperNot a substantial claim
61 of 61
  • The paper relies on this without support.

    5xFAD mice model Alzheimer's disease pathology in a way that is relevant to human Alzheimer's disease for conclusions about meningeal lymphatics and immunotherapy.

    “Ablation of meningeal lymphatics in 5xFAD mice exacerbated Aβ deposition, microgliosis and neurovascular function, affecting the outcome of anti-Aβ passive immunotherapy and behavior.”
  • The paper relies on this without support.

    Gene expression signatures from mouse microglia can be meaningfully compared with human microglia to infer shared activation states.

    “We performed an integrated transcriptional analysis of microglia from human donor brains (from non-AD, presymptomatic sporadic AD, familial AD and sporadic AD patients; Supplementary Table 4) and from the brains of 5xFAD mice with intact or defective meningeal lymphatics (Fig. 3b and Extended Data Fig. 10a).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Meningeal lymphatic dysfunction induces microglial activation and acquisition of DAM signature, accompanied by Aβ deposition in the brains of 5xFAD mice.

    “meningeal lymphatic dysfunction induces microglial activation and acquisition of DAM signature, accompanied by Aβ deposition in the brains of 5xFAD mice.”
  • Ablation of meningeal lymphatics impedes anti-amyloid-β therapy by exacerbating microgliosis, neurovascular dysfunction, and behavior defects in the 5XFAD model of Alzheimer's disease.

    “the ablation of meningeal lymphatics impedes anti-amyloid-β therapy by exacerbating microgliosis, neurovascular dysfunction, and behavior defects in the 5XFAD model of Alzheimer’s disease”

    From Living on the Edge of the CNS: Meninges Cell Diversity in Health and Disease (2021) · cites this paper as Da Mesquita et al., 2021

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Microsphere diameter differs between the methods and figure legend

    Minor

    The methods specify 0.5-μm microspheres for the CSF drainage measurement, but the legend for that experiment specifies 1-μm microspheres.

  • Cortical microglia count differs between the methods and figure legend

    Minor

    The methods give 649 as the final number of microglia in the cortical single-cell dataset, whereas the legend describes analysis of 651 microglia from that dataset.

2 of 2

Cites

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Authors
Da Mesquita, S., Papadopoulos, Z., Dykstra, T., Brase, L., Farias, F. G., Wall, M., Jiang, H., Kodira, C. D., de Lima, K. A., Herz, J., Louveau, A., Goldman, D. H., Salvador, A. F., Onengut-Gumuscu, S., Farber, E., Dabhi, N., Kennedy, T., Milam, M. G., Baker, W., Smirnov, I., Rich, S. S., Dominantly Inherited Alzheimer Network, Benitez, B. A., Karch, C. M., Perrin, R. J., Farlow, M., Chhatwal, J. P., Holtzman, D. M., Cruchaga, C., Harari, O., & Kipnis, J.
Affiliations
  • Washington University in St. Louis (US)
  • University of Virginia (US)
  • PureTech (United States) (US)
  • Cleveland Clinic (US)
  • Harvard University (US)
Corresponding author
Kipnis, Jonathan
Venue
Nature
Published
2021-04-28
Volume
593
Issue
7858
Pages
255-260
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W3159116119
Cited by
431
References
72
Citations by year
2026: 84 · 2025: 83 · 2024: 101 · 2023: 77 · 2022: 57 · 2021: 29
FWCI
41.73
Type
journal article
Language
en
Open access
Locations
  • Nature (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • Purdue University Indianapolis (Indiana University) (submittedVersion)
Funders
  • Cure Alzheimer's Fund
  • Japan Agency for Medical Research and Development
  • Korea Health Industry Development Institute
  • Deutsches Zentrum für Neurodegenerative Erkrankungen
  • Fleni
  • National Institutes of Health (AG066444, AG034113)
  • Charles F. and Joanne Knight Alzheimer Disease Research Center, Washington University in St. Louis (P30 AG066444)
  • National Institute on Aging (RF1AG044546, AG034113, RF1AG057496, R01AG062734, RF1AG053303, AG066444, AG057496, R56AG067764, UF1AG032438, P50AG005681, P01 AG0 3991, P01AG003991, R01AG034113, AG057777, U19AG032438, U01AG032438, RF1AG058501, R01AG057777, R37AG034113, P30AG066444, P01AG026276)
  • National Institute of Neurological Disorders and Stroke (R01NS118146)
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
Keywords
meningeal lymphatic drainage, Alzheimer's disease, amyloid-beta, anti-amyloid immunotherapy, passive immunotherapy, microglia, microglial activation, microglial inflammation, 5xFAD mice, VEGF-C, neurovascular dysfunction, amyloid deposition
MeSH terms
Aging, Alzheimer Disease, Animals, Brain, Disease Models, Animal, Hippocampus, Humans, Immunotherapy, Inflammation, Male, Meninges, Transcription, Genetic, Amyloid beta-Peptides, Microglia, Vascular Endothelial Growth Factor C, Lymphatic Vessels, Mice, Antibodies, Monoclonal, Humanized

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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