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Lymphatic Surgery for Alzheimer's Disease- Technical Feasibility Study of a Mouse Model
Sonia Kukreja-Pandey, Wei F. Chen
Lymphatic Supermicrosurgery, Dept of Plastic Surgery, Cleveland Clinic
2024-01-15
Presenter: Sonia Kukreja- Pandey
Affidavit:
Original writing and work of the fellow, not presented or published before.
Director Name: Wei F. Chen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Accumulation of brain's waste proteins in neurodegenerative conditions like Alzheimer's is linked to degenerated glymphatic and meningeal lymphatic system, as shown in mice studies. Based on our observation of systemic effects of limb lymphatic surgery, we hypothesize that the intracranial lymphatic dysfunction can be alleviated by potentiating the 'extracranial' lymphatic flow surgically. We investigated feasibility of performing various lymphatic surgery procedures in mouse neck, as a preliminary step.
Methods: After IACUC approval, we conducted neck dissections on 7 mice (aged 2 months)- 5 post euthanasia and 2 under ketamine anesthesia. 3 mice had Alzheimer's and 4 were normal. After a ventral neck midline incision, submandibular glands and sternocleidomastoid muscles (SCM) were retracted, facial vessels and external jugular vein (EJV) identified, and field was explored for lymphatic structures. Various lymphatic reconstruction procedures were attempted.
Results: Along the external jugular vein, superficial to the SCM, 2 to 4 lymph nodes on either side were found. Additionally, one deep lymph node was identified in each paratracheal side. The superficial nodes appeared well encapsulated, firm with average size of 2.2 ± 0.3 mm by 1.9 ± 0.2 mm. The deep nodes were paler, soft, friable, with average size of 1.6 ± 0.2 mm by 1.1 ± 0.3 mm. Lymphatic afferents (0.2mm) to superficial LN were visualized in the live mice only and LVA performed using EJV. LN to vein anastomosis performed between superficial LN and EJV.
Conclusion: Neck dissection of mice revealed usable targets for lymphatic reconstructive procedures for future investigations related to Alzheimer's management.
