Review  |   March 2016
The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine
Author Notes
• From the Department of Biomedical Sciences (Student Doctors Hitscherich, Smith, Cuoco, and Ruvolo and Drs Leheste and Torres) and the Department of Osteopathic Manipulative Medicine (Dr Mancini) at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) in Old Westbury.
• Support: Financial support for this work was provided in part by the Department of Biomedical Sciences at NYITCOM.
•  *Address correspondence to German Torres, PhD, Department of Biomedical Sciences, Division of Preclinical Medical Education, NYITCOM, PO Box 8000, Old Westbury, NY 11568-8000. E-mail: torresg@NYIT.edu

Article Information
Neuromusculoskeletal Disorders / Osteopathic Manipulative Treatment
Review   |   March 2016
The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine
The Journal of the American Osteopathic Association, March 2016, Vol. 116, 170-177. doi:10.7556/jaoa.2016.033
The Journal of the American Osteopathic Association, March 2016, Vol. 116, 170-177. doi:10.7556/jaoa.2016.033
Web of Science® Times Cited: 1
Abstract

The brain has long been thought to lack a lymphatic drainage system. Recent studies, however, show the presence of a brain-wide paravascular system appropriately named the glymphatic system based on its similarity to the lymphatic system in function and its dependence on astroglial water flux. Besides the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system also facilitates the clearance of interstitial solutes such as amyloid-β and tau from the brain. As cerebrospinal fluid and interstitial fluid are cleared through the glymphatic system, eventually draining into the lymphatic vessels of the neck, this continuous fluid circuit offers a paradigm shift in osteopathic manipulative medicine. For instance, manipulation of the glymphatic-lymphatic continuum could be used to promote experimental initiatives for nonpharmacologic, noninvasive management of neurologic disorders. In the present review, the authors describe what is known about the glymphatic system and identify several osteopathic experimental strategies rooted in a mechanistic understanding of the glymphatic-lymphatic continuum.

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