Iodine and Potassium Iodide

In a paper published online in the journal Brain Stimulation, a team of researchers led by University of Wisconsin-Madison biomedical engineers Kip Ludwig and Justin Williams demonstrated that stimulating the cervical vagus nerve in the neck increased the penetration of cerebrospinal fluid in the brain. That’s evidence, the authors note, of an increased flow of fluid through the brain’s clearance systems, carrying with it waste products and misfolded proteins.

Those misfolded proteins, of course, are known to collect and strangle off neurons in a host of neurodegenerative diseases.

“It’s a completely new paradigm that might explain existing vagus nerve stimulation effects for epilepsy and depression, but it’s also a completely untapped mechanism,” says Ludwig, an associate professor of biomedical engineering and neurological surgery. “The hope is that we can start looking at hijacking the nervous system to prevent diseases like Alzheimer’s and Parkinson’s from ever occurring.”

The researchers used a fluorescent tracer to track the cerebrospinal fluid (CSF) of mice that were stimulated with an implanted cervical vagus nerve cuff. The fluid moves through the brain’s glymphatic system, one of two complementary clearance systems discovered by researchers since 2012 that are believed to play crucial roles in maintaining homeostasis in our brains.

“In that system, you can imagine sort of a pipeline,” says Kevin Cheng (PhDBME ’16), an assistant scientist in the Department of Biomedical Engineering and co-first author on the paper along with assistant researcher Sarah Brodnick. “You have CSF flowing into the brain, and as it flows in, it collects extracellular molecules like toxic byproducts, metabolic byproducts, and then flushes that out toward the paravenous drainage. So by measuring CSF entering, we are, in effect, measuring that flow.”

By employing an implanted cuff electrode and stimulation parameters—length, intensity and frequency—that are both already approved for clinical use by the U.S. Food and Drug Administration, Ludwig says the group can now quickly move on to imaging brains of patients to confirm the effect in humans.

“We can literally go test this in the clinic in the next year,” says Ludwig, who is also the neuroengineering lead for UW-Madison’s Grainger Institute for Engineering.

Ultimately, Ludwig aims to connect the research to his group’s work on an injectable electrode—the “injectrode”—to explore potential preventative treatments for neurodegenerative diseases through minimally invasive means.

“What we’re trying to do is create something that we can do before all these proteins have aggregated into plaques,” he says. “But to do that, we need to get to something that can be really minimally invasive. If you’re going to do it to prevent someone from ever getting Alzheimer’s disease or Parkinson’s disease, you need to get to something that’s trivially invasive.”


Eiriu Eolas is trivially invasive. But can it help get iodine into the brain?

Papers:

 
1. The purpose of the experiments reported here on dogs was to study the rates and amounts of bromide, iodide and thiocyanate passing from the serum into the cerebrospinal fluid and from the cerebrospinal fluid into the serum.

2. After intravenous injections these ions begin to pass promptly into the cerebrospinal fluid, drawn from the cisterna magna. The maximum passage from the serum to the cerebrospinal fluid requires 7 hours or more at which time there is a constant ratio between the serum and the cerebrospinal fluid. Subsequently, as the serum level falls, the serum/CSF quotient rises. The passage of these ions into the cerebrospinal fluid differs from their passage into transudates and most other tissue fluids in two respects; (a) the cerebrospinal fluid concentration never reaches that of the serum; (b) the rate of passage is slower.

3. The difference in the passage of bromide, iodide and thiocyanate into the cerebrospinal fluid and other body fluids is most strikingly shown by the threshold figures. The cerebrospinal fluid may contain no iodide or thiocyanate at a time when the serum contains measurable quantities. In other words the serum must attain a certain minimum concentration of iodide or thiocyanate before these ions pass into the cerebrospinal fluid. The bromide may also have a threshold value, but if so it is much lower than the threshold value for the others. It follows that with low concentrations in serum the difference between the individual passage of bromide, iodide and thiocyanate into the cerebrospinal fluid is much more pronounced than with large doses. The above facts bring out sharply the selective capacity of the barrier between serum and central nervous system.

4. In the passage from the cerebrospinal fluid into the circulation no appreciable difference is seen between the ions. When injected into the cistern they all pass out quickly at the same rate. There is thus no evidence of any barrier regulating their passage from cerebrospinal fluid to blood.


1. Even when a steady level of (131)I(-) is maintained in the blood for long periods, the uptake by brain and spinal cord is very small, and the possibility that this is due to an active transport of I(-) from brain-tissue to blood has been examined.

2. Most of the phenomena, however, can be explained on the basis of a slow passive diffusion across the blood-brain barrier associated with an active transport of (131)I(-) out of the c.s.f. across the choroid plexuses, so that, except possibly for the spinal cord, active transport from central nervous parenchyma into the blood need not be postulated. If it does occur, it contributes very little to the net exchanges between the three compartments, plasma, c.s.f. and extracellular fluid.

3. The steady-state distribution of bromide between plasma and c.s.f. is normally such that the concentration in the c.s.f. is only some 70% of that in plasma; it has been shown that this is most probably due to an active transport of Br(-) across the choroid plexuses.

 
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