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ESOC 2022 | The impact of brain clearance systems on treatment success in neurodegenerative disease

The intramural periarterial drainage (IPAD) system is responsible for the clearance of interstitial fluid and waste substances from the brain parenchyma, utilizing motor force from vascular smooth muscle cells to drive transport along basement membranes within the walls of cerebral vessels. Post-mortem studies have visualized signs of IPAD failure decades before onset of symptoms in neurodegenerative disease. Roxana Carare, MD, PhD, University of Southampton, Southampton, UK, explains why changes in these clearance systems with normal aging and in disease must be considered when designing novel therapeutics. For example, numerous immunotherapies currently under investigation for the treatment of Alzheimer’s disease aim to tackle amyloid beta accumulation. However, it is thought that the compromised IPAD pathways may not be able to cope with the excess waste clearance needed as a result. This interview took place at European Stroke Organisation Conference 2022 in Lyon, France.