Blood-cerebrospinal fluid barrier

The blood-brain barrier (BBB) is a membrane that controls the passage of substances from the blood into the central nervous system. It is a physical barrier between the local blood vessels and most parts of the central nervous system itself, and stops many substances from travelling across it. The BBB is permeable to alcohol, and some heavy metals can cross the blood-brain barrier as well.

History
The existence of such a barrier was first noticed in experiments by Paul Ehrlich in the late-19th century. Ehrlich was a bacteriologist who was studying staining, used for many studies to make fine structures visible. Some of these dyes, notably the aniline dyes that were then popular, would stain all of the organs of an animal except the brain when injected. At the time, Ehrlich attributed this to the brain simply not picking up as much of the dye.

However, in a later experiment in 1913, Edwin Goldmann (one of Ehrlich's students) injected the dye into the spine directly. He found that in this case the brain would become dyed, but the rest of the body remained dye-free. This clearly demonstrated the existence of some sort of barrier between the two sections of the body. At the time, it was thought that the blood vessels themselves were responsible for the barrier, as there was no obvious membrane that could be found. It was not until the introduction of the scanning electron microscope to the medical research fields in the 1960s that this could be demonstrated.

Physiology
Throughout the body, the walls of the capillaries (the smallest of the blood vessels) are made up of endothelial cells separated by small gaps. This allows soluble chemicals within tissues to pass into the blood stream, where they can be carried throughout the body, and subsequently pass out of the blood into different tissues. In the brain, these endothelial cells are packed much tighter together, due to the existence of zonula occludens (tight junctions) between them, blocking the passage of most molecules. The blood-brain barrier blocks all molecules except those that cross cell membranes by means of lipid solubility (such as oxygen, carbon dioxide, ethanol, and steroid hormones) and those that are allowed in by specific transport systems (such as sugars and some amino acids). Substances with a molecular weight higher than 500 daltons (AMUs) generally cannot cross the blood-brain barrier, while smaller molecules often can. Many drugs are unable to pass the barrier, since 98 percent of them are heavier than 500 daltons. In addition, the endothelial cells metabolize certain molecules to prevent their entry into the central nervous system; the most-studied example of this is L-DOPA.

The blood-brain barrier protects the brain from the many chemicals flowing around the body. Many bodily functions are controlled by hormones, which are detected by receptors on the plasma membranes of targeted cells throughout the body. The secretion of many hormones is controlled by the brain, but these hormones generally do not penetrate the brain from the blood, so in order to control the rate of hormone secretion effectively, there are specialised sites where neurons can "sample" the composition of the circulating blood. At these sites, the blood-brain barrier is 'leaky'; these sites include three important 'circumventricular organs', the subfornical organ, the area postrema and the organum vascolosum of the lamina terminalis (OVLT).

The blood-brain barrier is an effective way to protect the brain from common infections. Thus infections of the brain are very rare; however, as antibodies are too large to cross the blood-brain barrier, infections of the brain when they do occur can be very serious and difficult to treat.

Drugs targeting the brain
A major challenge for treatment of most brain disorders is overcoming the difficulty of delivering therapeutic agents to specific regions of the brain. In its neuroprotective role, the blood-brain barrier functions to hinder the delivery of many potentially important diagnostic and therapeutic agents to the brain. Therapeutic molecules and genes that might otherwise be effective in diagnosis and therapy do not cross the BBB in adequate amounts.

Mechanisms for drug targeting in the brain involve going either "through" or "behind" the BBB. Modalities for drug delivery through the BBB entail disruption of the BBB by osmotic means, biochemically by the use of vasoactive substances such as bradykinin, or even by localized exposure to ultrasound. The potential for using BBB opening to target specific agents to brain tumors has just begun to be explored. Other strategies to go through the BBB may entail the use of endogenous transport systems, including carrier-mediated transporters such as glucose and amino acid carriers; receptor-mediated transcytosis for insulin or transferrin; and blocking of active efflux transporters such as p-glycoprotein. Strategies for drug delivery behind the BBB include intracerebral implantation and convection-enhanced distribution. Nanotechnology could also help in the transfer of drugs across the BBB. Recently researchers have been trying to build nanoparticles loaded with liposomes to gain access through the BBB. More research is needed to determine which strategies are most effective and how they can be improved for patients with brain tumors.

Meningitis
Meningitis is inflammation of the membranes which surround the brain and spinal cord. These membranes are also known as meninges. Meningitis is most commonly caused by infections with various pathogens. When the meninges are inflamed, the blood-brain barrier may be disrupted. This disruption may increase the penetration of various substances (including antibiotics) into the brain. Usually third generation cephalosporin or fourth generation cephalosporin is preferred.

Multiple sclerosis (MS)
Multiple sclerosis (MS) is considered an auto-immune disorder in which the immune system attacks the myelin protecting the nerves in the central nervous system. Normally, a person's nervous system would be inaccessible for the white blood cells due to the blood-brain barrier. However, it has been shown using Magnetic Resonance Imaging that, when a person is undergoing an MS "attack," the blood-brain barrier has broken down in a section of his/her brain or spinal cord, allowing white blood cells called T lymphocytes to cross over and destroy the myelin. It has been suggested that, rather than being a disease of the immune system, MS is a disease of the blood-brain barrier. The yellow ingredient turmeric, found in curry, has been shown to strengthen the blood-brain barrier to resist attacks.

Late-stage neurological trypanosomiasis (Sleeping sickness)
Late-stage neurological trypanosomiasis, or sleeping sickness, is a condition in which trypanosoma protozoa have crossed the blood-brain barrier.

Progressive multifocal leukoencephalopathy (PML)
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by reactivation of a latent papovavirus (the JC virus) infection. It affects immune-compromised patients and is usually seen with patients having AIDS.

Other diseases

 * De Vivo disease (also known as GLUT1 deficiency syndrome)
 * De Vivo disease is a rare condition caused by inadequate transport of glucose across the barrier, resulting in mental retardation and other neurological problems. Genetic defects in glucose transporter type 1 (GLUT1) appears to be the main cause of De Vivo disease.