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Frontiers in Neurology


Hypothesis and Theory ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01036

Albumin exchange in Alzheimer’s disease: might CSF be an alternative route to plasma?

  • 1Neurology, Central University Hospital of Asturias, Spain
  • 2Grupo de Investigación Básica-Clínica en Neurología, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA), Spain
  • 3Morphology and Cell Biology, Universidad de Oviedo, Spain
  • 4Mind Research Network (MRN), United States

Amyloid β (Aβ) in brain parenchyma is thought to play a central role in the pathogenesis of Alzheimer’s disease (AD). Aβ is transported from the brain into the plasma via complex transport mechanisms at the blood-brain barrier (BBB). About 90-95% of plasma Aβ may be bound to albumin. Replacement of serum albumin in plasma has been proposed as a promising therapy for AD. However, the efficacy of this approach may be compromised by altered BBB Aβ receptors in AD, as well as multiple pools of Aβ from other organs in exchange with plasma Aβ, competing for albumin binding sites. The flow of interstitial fluid (ISF) into cerebrospinal fluid (CSF) is another major route of Aβ clearance. Though the concentration of albumin in CSF is much lower than in plasma, the mixing of CSF with ISF is not impeded by a highly selective barrier and, hence, Aβ in the two pools are in more direct exchange. Furthermore, unlike in plasma, Aβ in CSF is not in direct exchange with multiple organ sources of Aβ. Here we consider albumin replacement in CSF as an alternative method for therapeutic brain Aβ removal and describe the possible advantages and rationale supporting this hypothesis.

Keywords: Alzheimer ' s disease, Amyloid - beta- protein, CSF (cerebrospinal fluid), BBB – Blood–Brain Barrier, therapy

Received: 05 Jun 2019; Accepted: 12 Sep 2019.

Copyright: © 2019 Menéndez-González and Gasparovic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Manuel Menéndez-González, Central University Hospital of Asturias, Neurology, Oviedo, Spain,