Neurovascular pathology concurs with protein accumulation, as the brain vasculature is important for waste clearance. Interstitial solutes, such as amyloid-β, were previously thought to be primarily cleared from the brain by blood-brain barrier transport. Recently, the glymphatic system was discovered, in which cerebrospinal fluid is exchanged with interstitial fluid, facilitated by the aquaporin-4 water channels on the astroglial endfeet. Glymphatic flow can clear solutes from the interstitial space. Blood-brain barrier transport and glymphatic clearance likely serve complementary roles with partially overlapping mechanisms providing a well-conditioned neuronal environment. Disruption of these mechanisms can lead to protein accumulation and may initiate neurodegenerative disorders, for instance amyloid-β accumulation and Alzheimer’s disease. Although both mechanisms seem to have a similar purpose, their interaction has not been clearly discussed previously. This review focusses on this interaction in healthy and pathological conditions. Future health initiatives improving waste clearance might delay or even prevent onset of neurodegenerative disorders. Defining glymphatic flow kinetics using imaging may become an alternative way to identify those at risk of Alzheimer’s disease.

神经血管病理学与蛋白质积累同时存在，因为脑血管对于清除废物很重要。以前，人们认为间质溶质（例如淀粉样蛋白-β）主要是通过血脑屏障转运而从大脑清除的。最近，发现了一种淋巴系统，其中在星形胶质尾脚上的Aquaporin-4水通道的促进下，脑脊液与组织液交换。淋巴流可以清除间隙空间中的溶质。血脑屏障运输和淋巴清除可能通过部分重叠的机制提供互补的作用，从而提供条件良好的神经元环境。这些机制的破坏会导致蛋白质积聚，并可能引发神经退行性疾病，例如β淀粉样蛋白积聚和阿尔茨海默氏病。尽管这两种机制似乎都具有相似的目的，但是它们之间的相互作用以前并未得到明确讨论。这篇综述着重于健康和病理条件下的这种相互作用。未来提高废物清除率的健康措施可能会延迟甚至阻止神经退行性疾病的发作。使用成像定义淋巴流动动力学可能成为识别那些有患阿尔茨海默氏病风险的人的替代方法。