Researchers explore surgical treatment’s potential in Alzheimer’s
They urge more studies of LVA, which helps clear molecular waste from brain
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Researchers are calling for more studies to determine whether lymphovenous anastomosis (LVA), a surgical procedure that helps clear molecular waste from the brain, might benefit people with Alzheimer’s disease.
“LVA represents a novel therapeutic strategy that may complement existing treatments, offering new hope for addressing the [disease biology] of [Alzheimer’s disease]. Through collaborative, long-term clinical trials, LVA may emerge not only as an adjunct to current [Alzheimer’s] therapies but also as a potential treatment avenue for other neurodegenerative diseases,” Khong Yik Chew, MD, a senior consultant at Singapore General Hospital, said in a press release.
Chew and colleagues wrote a review paper outlining the biological rationale for using LVA in Alzheimer’s patients and offering suggestions for how best to study this intervention. The paper, “Exploring Lymphovenous Anastomosis for Alzheimer Disease: Addressing Brain Lymphatic Dysfunction, Feasibility, and Outcome Metrics,” was published in Plastic and Reconstructive Surgery.
LVA could help promote better lymphatic drainage in the brain
Alzheimer’s is a neurological disorder marked by progressive problems with memory and cognition. The disease’s causes aren’t fully understood, but it’s thought that Alzheimer’s is driven at least in part by toxic clumps of certain proteins, particularly beta-amyloid and tau.
The lymphatic system is a series of vessels and tubes throughout the body that act as the body’s sewer system, collecting waste and runoff for filtration. LVA is a surgical procedure that works by connecting lymphatic vessels in the brain with blood vessels, allowing some fluid from the lymph vessels to drain into the bloodstream.
LVA is nothing new, and it has previously been used to help manage blocks in the brain’s lymphatic vessels. In their paper, the researchers argued that LVA might be repurposed as a potential Alzheimer’s treatment. The researchers noted that people with Alzheimer’s often have poor flow through brain lymph vessels. The idea is that LVA could help promote better lymphatic drainage in the brain to flush out toxins, such as clumps of beta-amyloid and tau protein, ultimately helping minimize damage to brain cells.
A few clinical trials have tested LVA in patients with Alzheimer’s. In some of these studies, patients have reported improvements in cognitive measures following the surgery. However, the researchers noted that these trials “vary considerably in inclusion criteria and outcome measures,” making it difficult to draw firm conclusions. Studies to date have also focused mainly on functional outcomes.
LVA represents a novel surgical strategy targeting brain lymphatic dysfunction – potentially addressing a key factor involved in the development and progression of [Alzheimer’s].
The researchers offered several recommendations for future trials testing LVA in Alzheimer’s. They advocated for trials to focus on adults ages 50 to 80 with mild-to-moderate disease and to exclude patients with co-occurring conditions that might make it harder to interpret the results.
“This stringent selection process ensures the reliability and specificity of the trial outcomes,” the researchers wrote.
The scientists also offered guidance on specific surgical approaches for Alzheimer’s patients and stressed that future trials should assess not only functional outcomes, such as cognitive scores, but also biological markers, including brain lymph flow imaging.
“This comprehensive framework ensures a robust evaluation of LVA’s potential impact on [Alzheimer’s disease biology] and clinical outcomes,” the researchers said.
The scientists also noted that LVA is not without risk. Like any surgical procedure, there’s a risk of complications, such as infections or bleeding. The researchers also acknowledged that it’s theoretically possible that increased fluid flow in the brain could lead to complications, such as increased brain inflammation.
“These concerns, although largely theoretical, should be monitored as secondary outcomes in future trials,” the scientists wrote.
Overall, the researchers said LVA holds promise as a potential Alzheimer’s treatment, but stressed that more studies are needed.
“LVA represents a novel surgical strategy targeting brain lymphatic dysfunction – potentially addressing a key factor involved in the development and progression of [Alzheimer’s],” Chew said. “However, much more research will be needed to establish the true benefits of this procedure.”
