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A Paravascular Pathway Facilitates CSF Flow Through the Brain Parenchyma and the Clearance of Interstitial Solutes, Including Amyloid β
Open accessAbstract
Cerebrospinal fluid flows through channels around brain blood vessels that are bounded by astrocytic endfeet, mediated by water transport through aquaporin-4.
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In the citing paper
“the glymphatic system, a CSF–interstitial fluid transport pathway, supported by perivascular spaces, astrocytic water channels, vascular pulsatility, and meningeal lymphatic drainage, that contributes to waste clearance and fluid homeostasis in the brain (Iliff et al., 2012).”
From 40 Years of diffusion MRI in the brain: From history to emerging frontiers (2026) · cites this paper as Iliff et al., 2012
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Deletion of AQP4 channels reduces clearance of exogenous Aβ by 65%”
From Sleep Drives Metabolite Clearance from the Adult Brain (2013) · cites this paper as [12]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The glymphatic system uses the perivascular spaces as low-resistance routes for fast influx of CSF into deep brain regions1.”
From Norepinephrine-mediated slow vasomotion drives glymphatic clearance during sleep (2025) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The glymphatic system is a highly organized, brain-wide network for cerebrospinal fluid (CSF) transport that exports protein waste, including amyloid and tau1–3.”
From Norepinephrine-mediated slow vasomotion drives glymphatic clearance during sleep (2025) · cites this paper as [1]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Previous animal studies have shown communication between the subarachnoid cerebrospinal fluid (CSF) space and perivascular compartments of the brain (6-10) and spinal cord (11).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“In 2012, a brain-wide pathway for convective transport of waste solutes from the brain was first described and denoted the glymphatic system (7).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“Impaired glymphatic function has been suggested to be instrumental in a range of brain diseases; this has been illustrated most in Alzheimer's dementia (7, 19, 20) but has also been shown to be relevant in posttraumatic encephalopathy (21), ageing (22), sleep (23, 24), depression (20), and exercise (25).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“Moreover, animal studies report diverging findings regarding the sites of perivascular brain influx and efflux and direction of perivascular flow (7, 15, 16).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“and may thus be a determining factor for parenchymal tracer enrichment more than clearance, which has rather been proposed to be dependent on convective forces and AQP4 status in the glymphatic system (7).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“Clearance of MRI contrast agents, such as gadobutrol, has previously been proposed to potentially resemble clearance of brain macromolecules with similar properties (14), including amyloidβ (7) and tau (21, 66).”
From Brain-wide glymphatic enhancement and clearance in humans assessed with MRI. (2018) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“For example, studies using injection of fluorescent tracers into cisterna magna of mice have suggested that paravascular circulation occurs via CSF convective flow through the ECS from the para-arterial to the paravenous spaces, which is regulated by AQP4 water channels on astrocytes, and therefore the system was renamed as the 'glymphatic' system (276, 293).”
From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [276]
The cited source says what the claim attributes to it.
In the citing paper
“cerebrospinal fluid (CSF) recirculates through the brain, interchanging with interstitial fluid (ISF) and removing interstitial proteins, including Aβ (12, 13).”
From Sleep Drives Metabolite Clearance from the Adult Brain (2013) · cites this paper as [12]
The cited source says what the claim attributes to it.
In the citing paper
“Influx of CSF is in part driven by arterial pulse waves that propel the movement of CSF inward along periarterial spaces (12).”
From Sleep Drives Metabolite Clearance from the Adult Brain (2013) · cites this paper as [12]
The cited source says what the claim attributes to it.
In the citing paper
“suggesting that convective movement of ISF is a substantial contributor to the removal of interstitial waste products and other products of cellular activity (12).”
From Sleep Drives Metabolite Clearance from the Adult Brain (2013) · cites this paper as [12]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“This mechanism is how curbing PCSK9 activity provides protection against the vascular aspects of Alzheimer’s pathology [33,77].”
From The Roles of PCSK9 in Alzheimer’s Disease: A Systematic Review of Clinical, Genetic, and Preclinical Evidence (2025) · cites this paper as [77]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Since it is difficult to control when rodents enter natural sleep, anesthesia is commonly used as a proxy for sleep1,24,99,100.”
From Norepinephrine-mediated slow vasomotion drives glymphatic clearance during sleep (2025) · cites this paper as [1]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“No statistical methods were used to predetermine sample sizes but our sample sizes are similar to those reported in previous publications3,4,12.”
From Brain clearance is reduced during sleep and anesthesia (2024) · cites this paper as [4]
Experimental — accuracy not yet measuredIn the citing paper
“The glymphatic system is a highly organized cerebrospinal fluid transport system that shares several key functions with the lymphatic vessels of peripheral tissues, including the export of excess interstitial fluid and proteins”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [24]
In the citing paper
“fluid transport through the glymphatic system is directionally polarized, with influx along penetrating arteries, fluid entry into the neuropil supported by AQP4, and efflux along the peri-venous spaces, as well as along the cranial and spinal nerves (24, 32–34).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [24]
In the citing paper
“Deletion of AQP4 channels reduces both the influx of CSF tracers and the efflux of solutes from the neuropil (24, 30, 31).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [24]
In the citing paper
“The polarized expression of the water channel, AQP4, in the vascular endfeet of astrocytes facilitates glymphatic fluid transport and amyloid-ß export in rodents (24, 30)(Fig. 1).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [24]
In the citing paper
“The motion of the brain is locally supplemented by the pulsatility of the penetrating arteries, as they enter the brain from the CSF-filled subarachnoid space, thereby driving CSF into the neuropil along the periarteral spaces (24).”
From Glymphatic failure as a final common pathway to dementia (2020) · cites this paper as [24]
In the citing paper
“The expression of aquaporin-4 (AQP4) in astrocytes significantly influences the transport and clearance functions of the glymphatic system.155”
From Antiageing strategy for neurodegenerative diseases: from mechanisms to clinical advances (2025) · cites this paper as [155]
In the citing paper
“It has previously been shown that neurotoxic molecules such as amyloid-β and tau are cleared from brain tissue along paravenous pathways (the glymphatic system)20”
From Cerebrospinal fluid tracer efflux to parasagittal dura in humans (2020) · cites this paper as [20]
In the citing paper
“Molecules from 0.8 to 70 kDa have been shown to penetrate the glia limitans to varying degrees, whereas molecules from 150 to 2000 kDa are confined within the perivascular space (18, 39, 40).”
From The anatomy and immunology of vasculature in the central nervous system (2019) · cites this paper as [40]
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Citations
Cites
Diffusion in Brain Extracellular Space
Syková, E., & Nicholson, C. (2008) · Physiological Reviews · doi:10.1152/physrev.00027.2007 · Cited by 1,481 · cited 5×
“1 nm, respectively (9)] pass the endfeet in a size- and structure-dependent manner (Fig.”
BackgroundInfluentialNielsen, S. M., Nagelhus, E. A., Amiry-Moghaddam, M. R., Bourque, C. W., Agre, P. C., & Ottersen, O. P. (1997) · Journal of Neuroscience · doi:10.1523/jneurosci.17-01-00171.1997 · Cited by 1,440
Self-citationReal-time imaging reveals the single steps of brain metastasis formation.
Kienast, Y., von Baumgarten, L., Fuhrmann, M., Klinkert, W. E. F., Goldbrunner, R., Herms, J., & Winkler, F. (2010) · Nature Medicine · doi:10.1038/nm.2072 · Cited by 1,138
Astrocyte-mediated control of cerebral blood flow
Takano, T., Tian, G.-F., Peng, W., Lou, N., Libionka, W., Han, X., & Nedergaard, M. (2005) · Nature Neuroscience · doi:10.1038/nn1623 · Cited by 1,137
Self-citationThree or more routes for leukocyte migration into the central nervous system
Ransohoff, R. M., Kivisäkk, P., & Kidd, G. (2003) · Nature Reviews Immunology · doi:10.1038/nri1130 · Cited by 1,052 · cited 1×
“Both lymphocytes and antigen-presenting cells in the subarachnoid CSF (49) may detect interstitial antigens delivered to the CSF by paravenous bulk outflow.”
BackgroundInterstitial-lymphatic mechanisms in the control of extracellular fluid volume
Aukland, K., & Reed, R. K. (1993) · Physiological Reviews · doi:10.1152/physrev.1993.73.1.1 · Cited by 938 · cited 1×
“The lymphatic vasculature represents a second circulation, parallel to the blood vasculature, that accounts for the clearance of interstitial fluid (ISF) with its constituent proteins and other solutes not absorbed across postcapillary venules (1, 2).”
BackgroundLehre, K. P., Levy, L., Ottersen, O. P., Storm‐Mathisen, J., & Danbolt, N. C. (1995) · Journal of Neuroscience · doi:10.1523/jneurosci.15-03-01835.1995 · Cited by 912
Mathiisen, T. M., Lehre, K. P., Danbolt, N. C., & Ottersen, O. (2010) · Glia · doi:10.1002/glia.20990 · Cited by 893
Neuronal activity regulates the regional vulnerability to amyloid-β deposition
Bero, A. W., Yan, P., Roh, J. H., Cirrito, J. R., Stewart, F. R., Raichle, M. E., Lee, J.-M., & Holtzman, D. M. (2011) · Nature Neuroscience · doi:10.1038/nn.2801 · Cited by 880 · cited 1×
“AQP4 facilitates the para-vascular clearance of interstitial amyloid b Soluble amyloid b (Ab) is present in the interstitium of the healthy young brain, yet interstitial Ab levels are correlated with amyloid plaque burden (18).”
BackgroundEvidence for bulk flow of brain interstitial fluid: significance for physiology and pathology
Abbott, N. J. (2004) · Neurochemistry International · doi:10.1016/j.neuint.2003.11.006 · Cited by 786 · cited 5×
“Interstitial solutes have been thought to be cleared to the CSF by the convective bulk flow of ISF, which courses diffusely through brain tissue, rather than through an anatomically or functionally discrete structure (3, 4, 9).”
BackgroundMethodInfluential
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An immunohistochemical study of lymphatic elements in the human brain
Mezey, É., Szalayova, I., Hogden, C. T., Brady, A., Dósa, A., Sótonyi, P., & Palkovits, M. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2002574118 · Cited by 74
“We cannot say anything about how CSF flows through the brain lymphatic system based on our observations of postmortem human material, and we have not tried to relate our data to the glymphatic hypothesis (71).”
Parodi‐Rullán, R. M., Javadov, S. A., & Fossati, S. (2021) · Cells · doi:10.3390/cells10112903 · Cited by 75
“This suggests that CSF flows into the brain tissue along para-arterial spaces and exits via a para-venous route, aided by astrocytic end-feet through aquaporin 4 [49,54].”
BackgroundImaging Neuroinflammation in Neurodegenerative Disorders
Masdeu, J. C., Pascual, B., & Fujita, M. (2022) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.263200 · Cited by 77
Stevens, K. A., Cai, S., Ladrón-de-Guevara, A., Sun, J., Zheng, X., Du, T., Thomas, J. H., Nedergaard, M., Karniadakis, G. E., & Kelley, D. H. (2023) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2217744120 · Cited by 75
Self-citationNoninvasive Magnetic Resonance Imaging Measures of Glymphatic System Activity
Kamagata, K., Saito, Y., Andica, C., Uchida, W., Takabayashi, K., Yoshida, S., Hagiwara, A., Fujita, S., Nakaya, M., Akashi, T., et al. (2023) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.28977 · Cited by 76
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Karakousi, T. R., Mudianto, T., & Lund, A. W. (2024) · Nature reviews. Cancer · doi:10.1038/s41568-024-00681-y · Cited by 79
“Mice with lymphatic vessel abnormalities develop adult-onset obesity, highlighting the importance of the lymphatic vasculature in maintaining organ-ismal energy homeostasis.”
O’Donnell, J., Ding, F., & Nedergaard, M. (2015) · Current Sleep Medicine Reports · doi:10.1007/s40675-014-0004-6 · Cited by 72
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Cherian, I., Bernardo, A., & Grasso, G. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2016.01.072 · Cited by 74
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Sahyouni, R., Goshtasbi, K., Mahmoodi, A., Tran, D. K., & Chen, J. W. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.09.063 · Cited by 72
Direct imaging of glymphatic transport using H217O MRI
Alshuhri, M. S., Gallagher, L., Work, L. M., & Holmes, W. M. (2021) · JCI Insight · doi:10.1172/jci.insight.141159 · Cited by 75
“studies has been the use of tracer molecules that are much larger than water (18 Da) — for example, in ex vivo fluorescence imaging (700–3000 Da) (1) and in vivo MRI (Gd-DTPA, 938 Da) (15).”
BackgroundMolecular trans-dural efflux to skull bone marrow in humans with CSF disorders
Ringstad, G. A., & Eide, P. K. (2021) · Brain · doi:10.1093/brain/awab388 · Cited by 77
“…lumbar level in human subjects, its brain-wide distribution could be confirmed after 24h, 16 and was suggested to enter brain tissue in part along perivascular spaces as proposed in the glymphatic system 15 and by diffusion, 25 which may be a dominating factor for low-molecular weight substances.”
Propagation of tau and α-synuclein in the brain: therapeutic potential of the glymphatic system
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Lee, D. A., Park, B. S., Ko, J., Park, S. H., Lee, Y. J., Kim, I. H., Park, J. H., & Park, K. M. (2022) · Epilepsia Open · doi:10.1002/epi4.12594 · Cited by 75
“We retrospectively enrolled TLE patients with HS based on the following criteria: (1) presence of typical ictal semiology compatible with TLE; (2) presence of ictal epileptiform discharges originating from the temporal lobe on electroencephalogram; (3) presence of typical HS features on brain MRI, including high signa…”
MethodMehta, R. I., Carpenter, J. S., Mehta, R. I., Haut, M. W., Wang, P., Ranjan, M., Najib, U., D’Haese, P.-F., & Rezai, A. R. (2023) · Fluids and Barriers of the CNS · doi:10.1186/s12987-023-00447-y · Cited by 74
Xin, W., Pan, Y., Wei, W., Tatenhorst, L., Graf, I., Popa-Wagner, A., Gerner, S. T., Huber, S., Kilic, E., Hermann, D. M., et al. (2023) · Theranostics · doi:10.7150/thno.84059 · Cited by 77
“AQP4 knockout mice display an approximately seventy percent decrease in CSF influx and an about fifty-five decrease of the parenchymal solute clearance capacity [49, 52].”
The glymphatic system clears amyloid beta and tau from brain to plasma in humans
Dagum, P., Elbert, D. L., Giovangrandi, L., Singh, T., Venkatesh, V., Corbellini, A., Kaplan, R. M., Levendovszky, S. R., Ludington, E., Yarasheski, K. E., et al. (2026) · Nature Communications · doi:10.1038/s41467-026-68374-8 · Cited by 88
Self-citationNew Therapeutic Approaches for Alzheimer’s Disease and Cerebral Amyloid Angiopathy
Saitô, S., & Ihara, M. (2014) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2014.00290 · Cited by 77
Evaluation of the Production and Absorption of Cerebrospinal Fluid
Miyajima, M., & Arai, H. (2015) · Neurologia medico-chirurgica · doi:10.2176/nmc.ra.2015-0003 · Cited by 78
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Karimy, J. K., Kahle, K. T., Kurland, D. B., Yu, E., Gerzanich, V., & Simard, J. M. (2014) · Journal of Neuroscience Methods · doi:10.1016/j.jneumeth.2014.12.015 · Cited by 69
Volume Transmission in the Brain: Beyond the Synapse
Taber, K. H., & Hurley, R. A. (2014) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.13110351 · Cited by 75
Neuro-immune dysfunction during brain aging: new insights in microglial cell regulation
Matt, S. M., & Johnson, R. W. (2015) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2015.10.009 · Cited by 75
Brain interference: Revisiting the role of IFNγ in the central nervous system
Monteiro, S., Roque, S., Marques, F., Correia‐Neves, M., & Cerqueira, J. (2017) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2017.05.003 · Cited by 75
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Albrecht, U., & Ripperger, J. A. (2018) · Trends in Neurosciences · doi:10.1016/j.tins.2018.07.007 · Cited by 75
Current understanding of lymphatic vessels in the central nervous system
Tamura, R., Yoshida, K., & Toda, M. (2019) · Neurosurgical Review · doi:10.1007/s10143-019-01133-0 · Cited by 74
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Frič, R., & Eide, P. K. (2019) · Acta Neurochirurgica · doi:10.1007/s00701-019-04100-2 · Cited by 72
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das Neves, S. P., Delivanoglou, N., & Mesquita, S. D. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.655052 · Cited by 71
“…by microglia and astrocytes (Weldon et al., 1998; Jones et al., 2013), receptormediated excretion across the BBB (Shibata et al., 2000; Silverberg et al., 2010), and perivascular efflux into CSF-filled compartments (namely the subarachnoid space) via the glymphatic system (Iliff et al., 2012).”
BackgroundInfluentialBurks, S. R., Kersch, C. N., Witko, J. A., Pagel, M. A., Sundby, M., Muldoon, L. L., Neuwelt, E. A., & Frank, J. A. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2021915118 · Cited by 76
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Wu, C., Yang, L., Feng, S., Zhu, L., Yang, L., Liu, T. C., & Duan, R. (2022) · Inflammation and Regeneration · doi:10.1186/s41232-022-00216-8 · Cited by 71
Saito, Y., Hayakawa, Y. K., Kamagata, K., Kikuta, J., Mita, T., Andica, C., Taoka, T., Uchida, W., Takabayashi, K., Tuerxun, R., et al. (2023) · Japanese Journal of Radiology · doi:10.1007/s11604-023-01463-6 · Cited by 72
“Thus, glymphatic function is essential for maintaining brain homeostasis throughout life [5–7].”
BackgroundMethodInfluentialCurrent views on meningeal lymphatics and immunity in aging and Alzheimer’s disease
Rego, S., Sánchez, G., & Mesquita, S. D. (2023) · Molecular Neurodegeneration · doi:10.1186/s13024-023-00645-0 · Cited by 79
“The glymphatic system is comprised of the brain perivascular routes formed by the glia limitans and the blood endothelial basement membrane and has been put forward as one of the possible mechanisms responsible for molecular exchange between the CSF and the brain inter-stitium [24–26].”
BackgroundHuman-derived neural progenitors functionally replace astrocytes in adult mice
Chen, H., Qian, K. X., Chen, W., Hu, B., Blackbourn, L., Du, Z., Ma, L., Liu, H., Knobel, K. M., Ayala, M., et al. (2015) · Journal of Clinical Investigation · doi:10.1172/jci69097 · Cited by 72
Glymphatic fluid transport controls paravascular clearance of AAV vectors from the brain
Murlidharan, G., Crowther, A., Reardon, R. A., Song, J., & Asokan, A. (2016) · JCI Insight · doi:10.1172/jci.insight.88034 · Cited by 72
Boespflug, E. L., Schwartz, D. L., Lahna, D. L., Pollock, J. M., Iliff, J. J., Kaye, J. A., Rooney, W. D., & Silbert, L. C. (2017) · Radiology · doi:10.1148/radiol.2017170205 · Cited by 72
Self-citationWostyn, P., Groot, V. D., Dam, D. V., Audenaert, K., Killer, H. E., & Deyn, P. P. D. (2017) · BioMed Research International · doi:10.1155/2017/5123148 · Cited by 70
Lam, M. A., Hemley, S. J., Najafi, E., Vella, N. G. F., Bilston, L. E., & Stoodley, M. A. (2017) · Scientific Reports · doi:10.1038/s41598-017-13455-4 · Cited by 71
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Chachaj, A., Gąsiorowski, K., Szuba, A., Sieradzki, A., & Leszek, J. (2022) · Current Neuropharmacology · doi:10.2174/1570159x20666220411091332 · Cited by 73
“lliff end colleagues, based on in vivo twophoton imaging of small fluorescent tracers, have identified the entire pathway of subarachnoid CSF and its solute across brain parenchyma in mice [11].”
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Circadian Rhythms and Astrocytes: The Good, the Bad, and the Ugly
Hastings, M. H., Brancaccio, M., Gonzalez-Aponte, M. F., & Herzog, E. D. (2023) · Annual Review of Neuroscience · doi:10.1146/annurev-neuro-100322-112249 · Cited by 72
Eide, P. K., Lashkarivand, A., Pripp, A. H., Valnes, L. M., Hovd, M. H., Ringstad, G. A., Blennow, K., & Zetterberg, H. (2023) · Nature Communications · doi:10.1038/s41467-023-37685-5 · Cited by 70
“…facilitated by the discoveries of CSF-mediated molecular clearance from the brain via paravascular pathways (denoted the glymphatic system) in 2012 5 , and of functional meningeal lymphatic vessels (enabling molecular egress from CSF to extracranial lymph) in 2015 6,7 ; for review see also 2 .”
InfluentialYoo, R., Kim, J.-H., Moon, H. Y., Park, J. Y., Cheon, S., Shin, H.-S., Han, D., Kim, Y., Park, S., & Choi, S. H. (2025) · Nature Communications · doi:10.1038/s41467-025-58726-1 · Cited by 75
“The fi eld of brain waste clearance has undergone signi fi cant advancements over the past decade, particularly with the discovery and characterization of the glymphatic system and meningeal lymphatic vessels (mLVs) 1 – 3 .”
Cisternostomy: Replacing the age old decompressive hemicraniectomy?
Cherian, I., Yi, G., & Munakomi, S. (2013) · Asian Journal of Neurosurgery · doi:10.4103/1793-5482.121684 · Cited by 70
Shook, B. A., Lennington, J. B., Acabchuk, R. L., Halling, M., Sun, Y., Peters, J. J., Wu, Q., Mahajan, A. K., Fellows, D. W., & Conover, J. C. (2013) · Aging Cell · doi:10.1111/acel.12184 · Cited by 71
Kang, T., Zhu, Q., Jiang, D., Feng, X., Feng, J., Jiang, T., Yao, J., Jing, Y., Song, Q., Jiang, X., et al. (2016) · Biomaterials · doi:10.1016/j.biomaterials.2016.05.037 · Cited by 70
Visual system manifestations of Alzheimer's disease
Kusne, Y. N., Wolf, A. B., Townley, K., Conway, M. D., & Peyman, G. A. (2016) · Acta Ophthalmologica · doi:10.1111/aos.13319 · Cited by 74
Ratner, V., Gao, Y., Lee, H., Elkin, R., Nedergaard, M., Benveniste, H., & Tannenbaum, A. (2016) · NeuroImage · doi:10.1016/j.neuroimage.2017.03.021 · Cited by 78
Self-citationIntracerebroventricular drug administration
Atkinson, A. J. (2017) · Translational and Clinical Pharmacology · doi:10.12793/tcp.2017.25.3.117 · Cited by 70
Goodman, J. R., Adham, Z. O., Woltjer, R. L., Lund, A. W., & Iliff, J. J. (2018) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2018.07.020 · Cited by 70
Self-citationThe Role of Brain Vasculature in Glioblastoma
KANE, J. R. (2019) · Molecular Neurobiology · doi:10.1007/s12035-019-1561-y · Cited by 72
Mutant Huntingtin Is Cleared from the Brain via Active Mechanisms in Huntington Disease
Caron, N. S., Banos, R., Yanick, C., Aly, A. E., Byrne, L. M., Smith, E. D., Xie, Y., Smith, S. E. P., Potluri, N., Findlay Black, H., et al. (2021) · The Journal of Neuroscience · doi:10.1523/jneurosci.1865-20.2020 · Cited by 66
“This system relies on aquaporin-4 (AQP4) water channels localized at astrocyte perivascular endfeet to facilitate the bulk flow of CSF through the brain parenchyma allowing clearance of interstitial fluids and solutes (Iliff et al., 2012).”
BackgroundNeuroimmune contributions to Alzheimer’s disease: a focus on human data
Haage, V., & De Jager, P. L. (2022) · Molecular Psychiatry · doi:10.1038/s41380-022-01637-0 · Cited by 74
Emerging Applications of Therapeutic Ultrasound in Neuro-oncology
Hersh, D. S., Kim, A. J., Winkles, J. A., Eisenberg, H. M., Woodworth, G. F., & Frenkel, V. (2016) · Neurosurgery · doi:10.1227/neu.0000000000001399 · Cited by 69
A Sentinel in the Crosstalk Between the Nervous and Immune System: The (Immuno)-Proteasome
Limanaqi, F., Biagioni, F., Gaglione, A., Busceti, C. L., & Fornai, F. (2019) · Frontiers in Immunology · doi:10.3389/fimmu.2019.00628 · Cited by 69
Chandra, A., Farrell, C. M., Wilson, H., Dervenoulas, G., de Natale, E. R., & Politis, M. (2020) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2020.06.007 · Cited by 71
“Polarized aquaporin-4 (AQP4) water channels at perivascular astrocytic end feet modulate this process (Iliff et al., 2012).”
Sleep and its regulation: An emerging pathogenic and treatment frontier in Alzheimer’s disease
Kent, B. A., Feldman, H., & Nygaard, H. B. (2020) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2020.101902 · Cited by 72
“Glymphatic clearance was first described in 2012 as an efficient mechanism facilitated by astrocytic aquaporin 4 water channels that enables convective flow of ISF from para-arterial to para-venous space, removing Aβ and other metabolic waste products from the brain (Iliff et al., 2012) (reviewed by (Boespflug and Ili…”
BackgroundFanelli, G. N., Grassini, D., Ortenzi, V., Pasqualetti, F., Montemurro, N., Perrini, P., Naccarato, A. G., & Scatena, C. (2021) · Genes · doi:10.3390/genes12030445 · Cited by 72
Xiao, M., Wu, T., Liu, Y., Hu, P., Zhai, S., Feng, W., Zhang, R., Li, Q., & Marshall, C. (2022) · Neural Regeneration Research · doi:10.4103/1673-5374.335169 · Cited by 71
“AQP4–/– mice have normal expression levels of enzymes and proteins related to Aβ production and degradation, as well as an intact meningeal lymphatic draining pathway (Iliff et al., 2012; Xu et al., 2015; Mestre et al., 2018; Feng et al., 2020).”
BackgroundMethodResultInfluentialCardinali, D. P., Brown, G. M., & Pandi-Perumal, S. R. (2021) · Handbook of clinical neurology · doi:10.1016/b978-0-12-819975-6.00023-6 · Cited by 76
A network model of glymphatic flow under different experimentally-motivated parametric scenarios
Tithof, J., Boster, K. A. S., Bork, P. A. R., Nedergaard, M., Thomas, J. H., & Kelley, D. H. (2022) · iScience · doi:10.1016/j.isci.2022.104258 · Cited by 70
Self-citationTian, Y., Zhao, M., Chen, Y., Yang, M., & Wang, Y. (2022) · Biomolecules · doi:10.3390/biom12060748 · Cited by 69
How I treat unique and difficult to manage cases of CAR T-cell therapy associated neurotoxicity
Santomasso, B., Gust, J., & Perna, F. (2023) · Blood · doi:10.1182/blood.2022017604 · Cited by 69
Schilling, K. G., Newton, A. T., Tax, C. M. W., Nilsson, M., Chamberland, M., Anderson, A., Landman, B. A., & Descoteaux, M. (2025) · Human Brain Mapping · doi:10.1002/hbm.70282 · Cited by 69
Engineering and Pharmacology of Blood–Brain Barrier-Permeable Bispecific Antibodies
Stanimirovic, D. B., Kemmerich, K., Haqqani, A. S., & Farrington, G. K. (2014) · Advances in pharmacology · doi:10.1016/bs.apha.2014.06.005 · Cited by 74
Astrocyte Aquaporin Dynamics in Health and Disease
Potokar, M., Jorgačevski, J., & Zorec, R. (2016) · International Journal of Molecular Sciences · doi:10.3390/ijms17071121 · Cited by 69
Kulbe, J. R., & Hall, E. D. (2017) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2017.08.003 · Cited by 70
Winsky‐Sommerer, R., de Oliveira, P., Loomis, S., Wafford, K. A., Dijk, D., & Gilmour, G. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.09.027 · Cited by 69
Evidence for lymphatic Aβ clearance in Alzheimer's transgenic mice
Pappolla, M., Sambamurti, K., Vidal, R., Pacheco-Quinto, J., Poeggeler, B., & Matsubara, E. (2014) · Neurobiology of Disease · doi:10.1016/j.nbd.2014.07.012 · Cited by 69
Role of microRNA-126 in vascular cognitive impairment in mice
Yu, P., Venkat, P., Chopp, M., Zacharek, A., Shen, Y., Ning, R., Liang, L., Li, W., Zhang, L., Landschoot‐Ward, J., et al. (2018) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x18800593 · Cited by 67
Eide, P. K., Valnes, L. M., Lindstrøm, E. K., Mardal, K., & Ringstad, G. A. (2021) · Fluids and Barriers of the CNS · doi:10.1186/s12987-021-00251-6 · Cited by 68
“Introduction Over the last few years, the impact of cerebrospinal fluid (CSF) homeostasis for brain function has gained renewed interest, not least facilitated by the description of the glymphatic system in 2012 [1], and the meningeal lymphatic vessels in 2015 [2, 3].”
BackgroundAn, L., Shen, Y., Chopp, M., Zacharek, A., Venkat, P., Chen, Z., Li, W., Yu, Q., Landschoot‐Ward, J., & Chen, J. (2021) · Aging and Disease · doi:10.14336/ad.2020.0523 · Cited by 64
“In addition, astroglial water channel aquaporin-4 (AQP-4) regulates the glymphatic system [45], a brain-wide network of perivascular pathways that facilitates the exchange of interstitial and cerebrospinal fluid to support the clearance neurotoxin from the brain interstitium which can otherwise contribute to dementia…”
BackgroundAddressing Blood–Brain Barrier Impairment in Alzheimer’s Disease
Sharma, C., Woo, H., & Kim, S. R. (2022) · Biomedicines · doi:10.3390/biomedicines10040742 · Cited by 72
Wen, Q., Tong, Y., Zhou, X., Džemidžić, M., Ho, C. Y., & Wu, Y. (2022) · NeuroImage · doi:10.1016/j.neuroimage.2022.119464 · Cited by 67
“Cerebrospinal fluid (CSF) aids in the removal of metabolic waste from the brain (Iliff et al., 2012).”
BackgroundUchida, Y., Kan, H., Sakurai, K., Oishi, K., & Matsukawa, N. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1111448 · Cited by 70
Matrongolo, M. J., Ang, P. S., Wu, J., Jain, A., Thackray, J. K., Reddy, A., Sung, C.-C., Barbet, G., Hong, Y., & Tischfield, M. A. (2023) · Journal of Clinical Investigation · doi:10.1172/jci171468 · Cited by 72
“Interest-ingly, streaks of tracer were evident in the cerebellar tentorium, tively permeable water channel that is polarized to glial endfeet (34).”
Capone, C., Dabertrand, F., Baron‐Menguy, C., Chalaris, A., Ghezali, L., Domenga, V., Schmidt, S., Huneau, C., Rose‐John, S., Nelson, M. T., et al. (2016) · eLife · doi:10.7554/elife.17536 · Cited by 72
Lloret, M.-A., Cervera-Ferri, A., Nepomuceno, M., Monllor, P., Esteve, D., & Lloret, A. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21031168 · Cited by 68
Huber, V. J., Igarashi, H., Ueki, S., Kwee, I. L., & Nakada, T. (2018) · Neuroreport · doi:10.1097/wnr.0000000000000990 · Cited by 68
Neuromodulation of Glial Function During Neurodegeneration
Stevenson, R., Samokhina, E., Rossetti, I., Morley, J. W., & Buskila, Y. (2020) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2020.00278 · Cited by 72
“Indeed, AQP4 knockout mice experienced a 55–65% reduction in Aβ clearance compared to WT mice (Iliff et al., 2012).”
BackgroundInfluentialAnnexin A1 restores cerebrovascular integrity concomitant with reduced amyloid-β and tau pathology
Ries, M., Watts, H. R., Mota, B. C., Lopez, M. Y., Donat, C. K., Baxan, N., Pickering, J. A., Chau, T. W., Semmler, A., Gurung, B., et al. (2021) · Brain · doi:10.1093/brain/awab050 · Cited by 66
Arterial vasodilation drives convective fluid flow in the brain: a poroelastic model
Kedarasetti, R. T., Drew, P. J., & Costanzo, F. (2022) · Fluids and Barriers of the CNS · doi:10.1186/s12987-022-00326-y · Cited by 71
Glymphatic System and Psychiatric Disorders: A Rapid Comprehensive Scoping Review
Barlattani, T., Grandinetti, P., Cintio, A. D., Montemagno, A., Testa, R., D’Amelio, C., Olivieri, L., Tomasetti, C., Rossi, A., Pacitti, F., et al. (2024) · Current Neuropharmacology · doi:10.2174/1570159x22666240130091235 · Cited by 69
“Articles selected were published between August 2012, when the glymphatic system was first described and defined [1], and February 2023.”
BackgroundMethodTransport of β-amyloid from brain to eye causes retinal degeneration in Alzheimer’s disease
Cao, Q., Yang, S. D., Wang, X., Sun, H., Chen, W., Wang, Y., Gao, J., Wu, Y., Yang, Q., Chen, X., et al. (2024) · The Journal of Experimental Medicine · doi:10.1084/jem.20240386 · Cited by 67
Self-citationYamamoto, E. A., Bagley, J. H., Geltzeiler, M. N., Sanusi, O. R., Dog⫧an, A., Liu, J. J., & Piantino, J. A. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2407246121 · Cited by 70
“The glymphatic pathway was described as a network of perivascular spaces (PVS) that facilitates the organized movement of cerebrospinal fluid (CSF) between the subarachnoid space and brain parenchyma ( 1 ).”
Jiang, Y., Fay, J. M., Poon, C., Vinod, N., Zhao, Y., Bullock, K. M., Qin, S., Manickam, D. S., Yi, X., Banks, W. A., et al. (2017) · Advanced Functional Materials · doi:10.1002/adfm.201703982 · Cited by 68
Discovery of Lipidome Alterations Following Traumatic Brain Injury via High-Resolution Metabolomics
Hogan, S., Phan, J. H., Alvarado‐Velez, M., Wang, M. D., Bellamkonda, R. V., Fernández, F. M., & LaPlaca, M. C. (2018) · Journal of Proteome Research · doi:10.1021/acs.jproteome.8b00068 · Cited by 68
Self-citationWan, H., Brathwaite, S., Ai, J., Hynynen, K., & Macdonald, R. L. (2021) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x20980296 · Cited by 65
“If the dye was freely diffusing through the CSF, the small molecular weight dye would theoretically diffuse throughout the glymphatic system and label capillaries and venules, if it exists.(37,38) The relatively specific labelling of perivascular and meningeal macrophages therefore indicates a specific uptake of eryth…”
BackgroundDisruption of the leptomeningeal blood barrier in neuromyelitis optica spectrum disorder
Asgari, N., Flanagan, E. P., Fujihara, K., Kim, H. J., Skejø, H. P. B., Wuerfel, J. T., Kuroda, H., Kim, S. H., Maillart, É., Marignier, R., et al. (2017) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000000343 · Cited by 67
Effects of traumatic brain injury on sleep and enlarged perivascular spaces
Opel, R. A., Christy, A. L., Boespflug, E. L., Weymann, K. B., Case, B. M., Pollock, J. M., Silbert, L. C., & Lim, M. M. (2018) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1177/0271678x18791632 · Cited by 67
Metadata
- Authors
- Iliff, J. J., Wang, M., Liao, Y., Plogg, B. A., Peng, W., Gundersen, G. A., Benveniste, H., Vates, G. E., Deane, R., Goldman, S. A., Nagelhus, E. A., & Nedergaard, M.
- Affiliations
- University of Rochester Medicine (US)
- University of Oslo (NO)
- Stony Brook University (US)
- Corresponding author
- Iliff, Jeffrey J.
- Nedergaard, Maiken
- ORCID
- Venue
- Science Translational Medicine
- Published
- 2012-08-15
- Volume
- 4
- Issue
- 147
- Pages
- 147ra111-147ra111
- ISSN
- 1946-6234 (ISSN-L)
- 1946-6242
- PMC
- PMC3551275
- OpenAlex
- W2167183660
- Cited by
- 5,824
- References
- 56
- Citations by year
- 2026: 871 · 2025: 767 · 2024: 669 · 2023: 605 · 2022: 546 · 2021: 456 · 2020: 400 · 2019: 358 · 2018: 281 · 2017: 279 · 2016: 203 · 2015: 160 · 2014: 128 · 2013: 83 · 2012: 13
- FWCI
- 50.61
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Science Translational Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (R01NS078304, R01NS078167, R01NS075177, R01NS075345, R01NS052534)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Cerebrospinal fluid and hydrocephalus
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion Transport and Channel Regulation
- Life Sciences › Neuroscience › Neurology › Barrier Structure and Function Studies
- Keywords
- cerebrospinal fluid flow, interstitial fluid clearance, amyloid-beta clearance, aquaporin-4, astrocytes, Alzheimer's disease, neurodegeneration
- MeSH terms
- Animals, Astrocytes, Biological Transport, Brain, Cerebral Ventricles, Cerebrospinal Fluid, Male, Mice, Inbred C57BL, Water, Amyloid beta-Peptides, Imaging, Three-Dimensional, Microscopy, Fluorescence, Multiphoton, Extracellular Fluid, Mice, Aquaporin 4
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