Fluid filtration and reabsorption across microvascular walls: control by oncotic or osmotic pressure? (secondary publication).

AIM: Relationships between hydrostatic and oncotic (colloid osmotic) pressures in both capillaries and interstitium are used to explain fluid filtration and reabsorption across microvascular walls. These pressures are incorporated in the Starling oncotic hypothesis of capillaries which fails, however, to explain fluid homeostasis when hydrostatic capillary pressure is high (in feet during orthostasis) and low (in lungs), or when oncotic plasma pressure is significantly decreased in experiments and some clinical states such as genetic analbuminaemia. METHODS: To explain fluid homeostasis we propose osmotic counterpressure hypothesis of capillaries which claims: 1) during water filtration across microvascular wall in arterial capillary, the plasma osmolytes are sieved (retained) so that plasma osmotic counterpressure is generated, 2) this osmotic counterpressure rises along the length of capillary and when it reaches capillary hydrostatic pressure the water filtration is halted, and 3) in venous capillaries and postcapillary venules where hydrostatic pressure is low, the osmotic counterpressure is instrumental in water reabsorption from interstitium what leads to dissipation of osmotic counterpressure. According to modified van't Hoff's equation the generation of osmotic counterpressure depends on plasma concentration of osmolytes and their restricted passage (reflection coefficient) across microvascular wall in comparison to water. RESULTS: Plasma NaCl makes 83% of plasma osmolarity and shows restricted passage across the walls of cerebral and peripheral continuous capillaries, so that Na and Cl are the most important osmolytes for generation of osmotic counterpressure. Our calculation indicates that at various rates of water filtration the osmotic counterpressure of NaCl acts as negative feedback control: higher hydrostatic pressure and water filtration rate create higher osmotic counterpressure which opposes filtration and leads to higher water reabsorption rate. Furthermore, our analysis indicates that fluid volume changes in arterial capillaries are proportionally 100 times larger than in interstial fluid. CONCLUSION: The osmotic counterpressure hypothesis explains fluid homeostasis at high, mean and low capillary hydrostatic pressures. Plasma proteins and inorganic electrolytes contribute 0.4% and 94% to plasma osmolarity, respectively, so that plasma proteins have low osmotic (oncotic) pressure and despite high restriction of their passage across microvascular wall they contribute little to build up of osmotic counterpressure in comparison to electrolytes. However, absence or very low concentration of plasma proteins increases microvascular wall permeability to water and osmolytes compromising build up of osmotic counterpressure leading to development of interstial oedema.

Transventricular and transpial absorption of cerebrospinal fluid into cerebral microvessels.

It is generally accepted that volume of cerebrospinal fluid (CSF) is secreted in brain ventricles and flows to subarachnoid space to be absorbed into dural venous sinuses or/and into lymphatics via perineural sheats of cranial nerves. Since 99% of CSF volume is water, in experiments on cats 3H-water was slowly infused into lateral ventricle and found that it does not flow to subarachnoid space but that it is rapidly absorbed transventricularly into periventricular capillaries. When 3H-water was infused in cortical subarachnoid space, it was absorbed locally into cerebral capillaries via pia mater. On the contrary, when macromolecule 3H-inulin is applied in CSF it is very slowly eliminated in bloodstream, and, with time, is carried by systolic-diastolic pulsations and mixing of CSF bidirectionally along CSF system. Thus, CSF volume (water) is absorbed rapidly into adjacent cerebral capillaries while inulin is distributed bidirectionally due to its long residence time in CSF Previously, the macromolecules have been used to study CSF volume hydrodynamics and with this misconception of CSF physiology arose.

Effect of head position on cerebrospinal fluid pressure in cats: comparison with artificial model.

AIM: To demonstrate that changes in the cerebrospinal fluid (CSF) pressure in the cranial cavity and spinal canal after head elevation from the horizontal level occur primarily due to the biophysical characteristics of the CSF system, ie, distensibility of the spinal dura. METHODS: Experiments in vivo were performed on cats and a new artificial model of the CSF system with dimensions similar to the CSF system in cats, consisting of non-distensible cranial and distensible spinal part. Measurements of the CSF pressure in the cranial and spinal spaces were performed in chloralose-anesthetized cats (n = 10) in the horizontal position on the base of a stereotaxic apparatus (reference zero point) and in the position in which the head was elevated to 5 cm and 10 cm above that horizontal position. Changes in the CSF pressure in the cranial and spinal part of the model were measured in the cranial part positioned in the same way as the head in cats (n = 5). RESULTS: When the cat was in the horizontal position, the values of the CSF pressure in the cranial (11.9 +/- 1.1 cm H2O) and spinal (11.8 +/- 0.6 cm H2O) space were not significantly different. When the head was elevated 5 cm or 10 cm above the reference zero point, the CSF pressure in the cranium significantly decreased to 7.7 +/- 0.6 cm H2O and 4.7 +/- 0.7 cm H2O, respectively, while the CSF pressure in the spinal space significantly increased to 13.8 +/- 0.7 cm H2O and 18.5 +/- 1.6 cm H2O, respectively (P<0.001 for both). When the artificial CSF model was positioned in the horizontal level and its cranial part elevated by 5 cm and 10 cm, the changes in the pressure were the same as those in the cats when in the same hydrostatic position. CONCLUSIONS: The new model of the CSF system used in our study faithfully mimicked the changes in the CSF pressure in cats during head elevation in relation to the body. Changes in the pressure in the model were not accompanied by the changes in fluid volume in the non-distensible cranial part of the model. Thus, it seems that the changes in the CSF pressure occur due to the biophysical characteristics of the CSF system rather than the displacement of the blood and CSF volumes from the cranium to the lower part of body.

Elimination of phenolsulfonphthalein from the cerebrospinal fluid via capillaries in central nervous system in cats by active transport.

It was recently proposed that organic anions, such as cerebral acidic metabolites and phenolsulfonphthalein (PSP), are eliminated from cerebrospinal fluid (CSF) by diffusion into the central nervous system (CNS) and further by active transport into capillaries. To test this hypothesis, PSP was injected into cisternal CSF and its distribution into various parts of the CNS was measured 1 and 3 h later in control cats and those pretreated with probenecid, which blocks active transport of organic anions into capillaries. PSP in tissue shows an intensive pink color when exposed to 1 N NaOH. Planimetric analysis of color pictures of coronal CNS slices showed that at the first hour, diffusion and distribution of PSP into the CNS in both groups of animals was similar, while at the third hour, a great reduction of PSP distribution in the CNS in control and only a slight reduction in probenecid pretreated cats was observed. The results support the hypothesis that active transport across the capillary wall in the CNS is the main avenue for elimination of cerebral acidic metabolites from both CSF and CNS and in such a way that central homeostasis is maintained.

Recent insights into a new hydrodynamics of the cerebrospinal fluid.

According to the traditional hypothesis, the cerebrospinal fluid (CSF) is secreted inside the brain ventricles and flows unidirectionally along subarachnoid spaces to be absorbed into venous sinuses across arachnoid villi and/or via paraneural sheaths of nerves into lymphatics. However, according to recent investigations, it appears that interstitial fluid (ISF) and CSF are formed by water filtration across the walls of arterial capillaries in the central nervous system (CNS), while plasma osmolytes are sieved (retained) so that capillary osmotic counterpressure is generated, which is instrumental in ISF/CSF water absorption into venous capillaries and postcapillary venules. This hypothesis is supported by experiments showing that water, which constitutes 99% of CSF and ISF bulk, does not flow along CSF spaces since it is rapidly absorbed into adjacent CNS microvessels, while distribution of other substances along CSF spaces depends on the rate of their removal into microvessels: faster removal means more limited distribution. Furthermore, the acute occlusion of aqueduct of Sylvius does not change CSF pressure in isolated ventricles, suggesting that the formation and the absorption of CSF are in balance. Multidirectional distribution of substances inside CSF, as well as between CSF and ISF, is caused by to-and-fro pulsations of these fluids and their mixing. Absorption of CSF into venous sinuses and/or lymphatics under the physiological pressure should be of minor importance due to their minute surface area in comparison to the huge absorptive surface area of microvessels.

Dynamics of distribution of 3H-inulin between the cerebrospinal fluid compartments.

Since the distribution of substances between various cerebrospinal fluid (CSF) compartments is poorly understood, we studied (3)H-inulin distribution, over time, after its injection into cisterna magna (CM) or lateral ventricle (LV) or cisterna corporis callosi (CCC) in dogs. After the injection into CM (3)H-inulin was well distributed to cisterna basalis (CB), lumbar (LSS) and cortical (CSS) subarachnoid spaces and less distributed to LV. When injected in LV (3)H-inulin was well distributed to all CSF compartments. However, after injection into CCC (3)H-inulin was mostly localized in CCC and adjacent CSS, while its concentrations were much lower in CM and CB and very low in LSS and LV. Concentrations of (3)H-inulin in venous plasma of superior sagittal sinus and arterial plasma were very low and did not differ significantly, while its concentration in urine was very high. In (3)H-inulin distribution it seems that two simultaneous processes are relevant: a) the pulsation of CSF with to-and-fro displacement of CSF and its mixing, carrying (3)H-inulin in all directions, and b) the passage of (3)H-inulin from CSF into nervous parenchyma and its rapid distribution to a huge surface area of capillaries by vessels pulsations. (3)H-inulin then slowly diffuses across capillary walls into the bloodstream to be eliminated in the urine.