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Anatomy of Neck and Blood Supply of Brain
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
The carotid sheath is a part of the deep cervical fascia of the neck situated on both sides of the neck lateral to the trachea. It contains important structures which include: (i) carotid artery- the common carotid artery (Figure 2.33) below the level of fourth cervical vertebra, internal and external carotid arteries above the level of fourth cervical vertebra, (ii) internal jugular vein (Figure 2.34), (iii) vagus nerve, (iv) part of recurrent laryngeal nerve and (v) deep cervical lymph nodes.
Facial anatomy
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Posterior auricular lymph nodes: Located posterior to the ear. Afferent drainage is of the parietal and temporal regions of the scalp and posterior pinna. Drain efferently to the deep cervical lymph nodes.
Emerging therapeutic targets for cerebral edema
Published in Expert Opinion on Therapeutic Targets, 2021
Ruchira M. Jha, Sudhanshu P. Raikwar, Sandra Mihaljevic, Amanda M. Casabella, Joshua S. Catapano, Anupama Rani, Shashvat Desai, Volodymyr Gerzanich, J. Marc Simard
The concept of CNS immune privilege has continued to evolve. Previously thought to be devoid of conventional lymphatic vasculature, the role of mLVs in cerebral edema clearance was initially described in 2015 [75,76]. Work in mouse models identified a lymphatic vessel network in the dura matter that absorbs CSF from subarachnoid and interstitial spaces via the glymphatic system [75]. This network ultimately transports this fluid into deep cervical lymph nodes, potentially assisting in the clearance of cerebral edema [75]. Recent zebrafish models suggest that cerebrovascular injury induces rapid ingrowth of mLVs into the injured parenchyma where they become lumenized and drain interstitial fluid (alleviating cerebral edema), and additionally serve as growing tracks for nascent blood vessels [77]. These findings were not corroborated in rodent/primate models: transgenic mice with mLV absence had attenuated clearance of macromolecules and a compromised peripheral immune response, but no difference in brain water content; however, these mice did not have cerebral edema pathology [75,78]. Murine models of glioblastoma multiforme (GBM) and SAH demonstrated impaired lymphatic outflow, increased edema and unfavorable markers of neuroinflammation and apoptosis, suggesting that mLVs. may indeed play a role in both cerebral edema and secondary injury after ABI[72,79,80]. There is emerging evidence that meningeal lymphatic drainage is functionally connected with glymphatic flow.
Sustained localized delivery of immunotherapy to lymph nodes reverses immunosuppression and increases long-term survival in murine glioblastoma
Published in OncoImmunology, 2021
John Choi, Ayush Pant, Ravi Medikonda, Young-Hoon Kim, Denis Routkevitch, Laura Saleh, Luqing Tong, Hok Yee Chan, Jessie Nedrow, Christopher Jackson, Christina Jackson, Michael Lim
Recently, there has been much interest in targeting GBM locally in the intracranial compartment with both chemotherapy and immunotherapy. However, our study offers an alternative target that prescribes local therapy to lymph nodes – in this case the deep cervical and inguinal lymph nodes. Interestingly, while there was a greater trend toward reversing immunosuppression with treatment of the deep cervical lymph nodes when looking at IFN-γ expression alone, the therapeutic efficacy of targeting either the inguinal or deep cervical lymph nodes was similar in our murine model. This may be in part accounted by other activating cytokines such as TNF-α that showed trends toward increased activation of lymphocytes in inguinal lymph nodes compared to cervical lymph nodes. In either case, however, placement of anti-PD-1 releasing hydrogels in inguinal and cervical lymph nodes demonstrates increased activation of CD4+ and CD8+ populations compared to mice injected systemically with anti-PD-1. While there are many more avenues to explore regarding local lymph node delivery, our data demonstrate proof of principle of targeting lymph nodes with sustained delivery as a viable target for reactivating immune cells.
Immunotherapy for gliomas: shedding light on progress in preclinical and clinical development
Published in Expert Opinion on Investigational Drugs, 2020
Maria B. Garcia-Fabiani, Maria Ventosa, Andrea Comba, Marianela Candolfi, Alejandro J. Nicola Candia, Mahmoud S. Alghamri, Padma Kadiyala, Stephen Carney, Syed M. Faisal, Anna Schwendeman, James J. Moon, Lindsay Scheetz, Joerg Lahann, Ava Mauser, Pedro R. Lowenstein, Maria G. Castro
The afferent arm of the immune system refers to antigen presentation to T-cells, resulting in their proliferation and activation. In general, this is achieved in the draining lymph nodes, by the drainage of antigen-presenting cells (APC) bearing the antigen from the immune-compromised site or by the transport of the soluble antigen to the lymph node. In the absence of inflammation, there is a paucity of dendritic cells (DCs) in the brain parenchyma and, although the presence of resident macrophages, they rarely migrate to the lymph node to act as APC [33,37]. However, brain parenchyma has soluble antigen drainage along the walls of cerebral capillaries and arteries to cervical lymph nodes [33,37]. This perivascular pathway is probably too narrow to allow the migration of immune cells from the brain parenchyma, which may be the principal factor involved in the immune privilege of the CNS. In contrast, the direct drainage of cerebrospinal fluid to deep cervical lymph nodes allows the trafficking of T-cells, monocytes, and DCs, which could explain in the immunological competence of the compartments surrounding the brain [33]. In summary, the afferent arm of the immune system in the brain lacks the classical cellular pathway, but it relies on the soluble antigen trafficking pathway.