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Topics in Medicinal Chemistry 10 Gert Fricker Melanie Ott Anne Mahringer Editors The Blood Brain Barrier (BBB) 10 Topics in Medicinal Chemistry EditorialBoard: P.R.Bernstein,RoseValley,USA A.Buschauer,Regensburg,Germany G.I.Georg,Minneapolis,USA J.A.Lowe,Stonington,USA U.Stilz,Malov,Denmark C.T.Supuran,SestoFiorentino(Firenze),Italy A.K.Saxena,Lucknow,India Aims and Scope Drugresearchrequiresinterdisciplinaryteam-workattheinterfacebetweenchemis- try,biologyandmedicine.Therefore,thenewtopic-relatedseriesTopicsinMedicinal Chemistrywillcoverallrelevantaspectsofdrugresearch,e.g.pathobiochemistry of diseases, identification and validation of (emerging) drug targets, structural biology,drugabilityoftargets,drugdesignapproaches,chemogenomics,synthet- ic chemistry including combinatorial methods, bioorganic chemistry, natural compounds, high-throughput screening, pharmacological in vitro and in vivo investigations,drug-receptorinteractionsonthemolecularlevel,structure-activ- ityrelationships,drugabsorption,distribution,metabolism,elimination,toxicol- ogyandpharmacogenomics. Ingeneral,specialvolumesareeditedbywellknownguesteditors. InreferencesTopicsinMedicinalChemistryisabbreviatedTopMedChemandis citedasajournal. Moreinformationaboutthisseriesat http://www.springer.com/series/7355 Gert Fricker Melanie Ott Anne Mahringer l l Editors The Blood Brain Barrier (BBB) With contributions by D. Belletti (cid:1) R. Chhabra (cid:1) R. van Doorn (cid:1) D. Ferna´ndez- Lo´pez (cid:1) F. Forni (cid:1) G. Fricker (cid:1) A.M. Grabrucker (cid:1) (cid:1) (cid:1) (cid:1) M. Hammarlund-Udenaes A. Mahringer S. Meairs (cid:1) (cid:1) (cid:1) (cid:1) (cid:1) D.S. Miller M.R. Mizee M. Ott A. Prat B. Ruozi (cid:1) (cid:1) (cid:1) G. Tosi M.A. Vandelli Z.S. Vexler H.E. de Vries Editors GertFricker MelanieOtt Institutfu¨rPharmazieundMolekulare AnneMahringer Biotechnologie Dept.forPharmaceuticalTechnologyand Universita¨tHeidelberg Pharmacology Heidelberg InstituteofPharmacyandMolecular Baden-Wu¨rttemberg Biotechnology Germany Heidelberg Germany ISSN1862-2461 ISSN1862-247X(electronic) ISBN978-3-662-43786-5 ISBN978-3-662-43787-2(eBook) DOI10.1007/978-3-662-43787-2 SpringerHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2014947829 #Springer-VerlagBerlinHeidelberg2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerpts inconnectionwithreviewsorscholarlyanalysisormaterialsuppliedspecificallyforthepurposeofbeing enteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthework.Duplication ofthispublicationorpartsthereofispermittedonlyundertheprovisionsoftheCopyrightLawofthe Publisher’s location, in its current version, and permission for use must always be obtained from Springer.PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter. ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Preface Since its discovery by Paul Ehrlich in the late nineteenthcentury, the blood–brain barrier has been the object of intensive research. It is formed by brain capillary endothelialcellsandrepresentsadynamicinterfacethatseparatesthebrain,themost criticalorganinourbody,fromthebloodcirculation.Itprotectsthecentralnervous system(CNS)frompotentiallyharmfulxenobioticsandmetabolites,whilesimulta- neously regulating transport of essential molecules and maintaining a stable envi- ronment within the brain. Together with pericytes, astrocytes and neurons, the capillaryendothelialcellsformtheso-calledneurovascularunit,whichisregulated by extremely complex signaling cascades. Unfortunately, the blood–brain barrier alsopreventsmosttherapeuticagentsfromreachingtheirtargetinthebrain,whichis whyeffectivetreatmentofCNSdiseasessuchasAlzheimer´sdisease,Parkinson’s Disease, Depression, Epilepsy or brain tumors, including brain metastases from peripheraltumors,remainstobeoneofthebigchallengesinmodernmedicine. This volume of “Topics in Medicinal Chemistry” is a compilation of the latest research concerning new developments in the blood–brain barrier field. Seven internationallyacknowledgedresearchgroupshavecontributedchapters,detailing their findings in this exciting and challenging area of biomedical research. Their workscoverabroadrangeoftopicsincludinggeneralstructureandfunctionofthe blood–brainbarrier,modestostudytheblood–brainbarrierinvivo,activetransport systems,drugdeliveryacrossthebarrierbycolloidalcarriersorultrasoundaswell as alterations of the barrier at various disease states. From these chapters the complexity of the blood–brain barrier becomes apparent and they also illustrate which enormous efforts still lie ahead of us before we obtain a complete under- standingofthisfascinatingarea. Ithasbeenagreatpleasureforustoactaseditorsforthisvolumeandwethank allauthorswhocontributed.Inaddition,wehopethatthevolumemightstimulate others to enter this research area and help to clarify the manifold unresolved questions. Heidelberg,Germany GertFricker April2014 MelanieOtt AnneMahringer v . Contents TheBlood–BrainBarrier:AnIntroductiontoItsStructure andFunction .................................................................... 1 AnneMahringer,MelanieOtt,andGertFricker InVivoApproachestoAssessingtheBlood–BrainBarrier ................ 21 MargaretaHammarlund-Udenaes ABCTransportersattheBlood–BrainBarrier ............................. 49 DavidS.Miller NanoparticlesasBlood–BrainBarrierPermeableCNSTargeted DrugDeliverySystems ........................................................ 71 AndreasM.Grabrucker,ReshamChhabra,DanielaBelletti,FlavioForni, MariaAngelaVandelli,BarbaraRuozi,andGiovanniTosi Blood–BrainBarrierandStroke ............................................. 91 DavidFerna´ndez-Lo´pezandZinaidaS.Vexler InflammationattheBlood–BrainBarrierinMultipleSclerosis ......... 117 MarkR.Mizee,RubenvanDoorn,AlexandrePrat,andHelgaE.deVries DrugDeliveryAcrosstheBlood–BrainBarrierwithFocused UltrasoundandMicrobubbles .............................................. 143 StephenMeairs Index .......................................................................... 159 vii TopMedChem(2014)10:1–20 DOI:10.1007/7355_2013_20 ©Springer-VerlagBerlinHeidelberg2013 Publishedonline:13December2013 The Blood–Brain Barrier: An Introduction to Its Structure and Function AnneMahringer,MelanieOtt,andGertFricker Abstract Theblood-brainbarrier(BBB)formedbythebrainsmicrovascularsystem isimpermeableformosttherapeuticallyusedcompoundsandovercomingthisbarrier remains to be one of the big challenges in modern medicine. It is composed of highly specialized endothelial cells, which are surrounded by pericytes and a basal membrane.Togetherwithnearbyastrocytesandneuronstheyconstitutetheso-called neurovascular unit, which restricts substance transfer from blood to brain and vice versa and maintains the cerebral ion homeostasis. Chapters of this book describe the discovery of the BBB, its evolutionary development as well as the cellular and molecularmechanisms,whichunderlayitsstructureandfunctioninhealthanddisease. The organization of tight junctional complexes or specific transport processes at the BBBwillbeaddressedaswellasmethodstoinvestigateBBBfunctioninvitroandin vivo.Changesinthebarrierfunctionunderseveraldiseasesconditionssuchasstroke or inflammation will be discussed as well as approaches to overcome the barrier by colloidalcarriersorultrasound. Keywords Blood–brainbarrier,Neurovascularunit,Morphology,Transporter Contents 1 TheBBB:AHistoricalPerspective.......................................................... 2 2 EvolutionaryDevelopmentofaBBB....................................................... 5 3 AnatomicPrinciplesoftheBBB............................................................. 5 4 Pericytes...................................................................................... 7 5 Astrocyte:EndotheliumInteractions........................................................ 8 A.Mahringer(*),M.OttandG.Fricker InstituteofPharmacyandMolecularBiotechnology,Ruprecht-KarlsUniversity,ImNeuenheimer Feld366,69120Heidelberg,Germany e-mail:[email protected];[email protected];[email protected] 2 A.Mahringeretal. 6 Neurons...................................................................................... 8 7 BasalMembrane............................................................................ 9 8 JunctionalComplexesattheBBB.......................................................... 9 9 TransportProteinsattheBBB.............................................................. 12 10 CytoticProcessesattheBBB............................................................... 14 11 Outlook...................................................................................... 15 References........................................................................................ 16 The brain is the most critical organ in our body, which requires a very well- balancedionhomeostasis.Itisextremelysensitivetoalargevarietyofchemicals, whichincludepotentiallytoxicmetabolitesorconstituentsofourdailyfoodintake without being toxic to other parts of the body. Therefore, it is obvious that the centralnervoussystem(CNS)needsspecialprotection,whichissetupbythebrain capillaries, the so called blood–brain barrier (BBB). This microvessel network operates as a dynamic regulator of ion balance, a mediator of nutrient transport, and an impediment to harmful molecules. This barrier also represents a major obstacletothedevelopmentofCNSdrugs.Approximately98%ofsmallmolecule and all large molecule drugs, e.g., recombinant peptides or anti-sense-agents are normallyexcludedfromthebrain[1,2].Hence,theunderstandingofthemorpho- logyoftheBBBaswellasthemolecularandcellularmechanismsthatdetermineits functionisaninevitableprerequisiteforsuccessfuldrugdeliverytothebrain.Here, wereviewtheBBBfromahistoricalperspectiveanddiscussthecurrentknowledge aboutthecomponentsofthatbarrierandtheirintegratedfunction. 1 The BBB: A Historical Perspective Thefirstexperimentsindicatingtheexistenceofthebarrierwereperformedin1885 by the German immunologist Paul Ehrlich. He observed that a peripherally administered dye stained animal organs but failed to color brain tissue [3]. The initial interpretation of this finding was based on different binding affinities [4]. Subsequent pharmacological studies by Bield and Kraus [5] and Lewandowsky provokedtheexistenceofabarrieratthelevelofcerebralvessels(1900),especially whenLewandowskywasstudyingthelimitedpermeationofpotassiumferrocyanate into the brain. This barrier was named “blood–brain barrier” by Goldmann [6]. Goldmann, a student of Ehrlich, also performed staining experiments with dogs andrabbitswherehedemonstratedaclear,exclusivestainingofthechoroidplexus after injection of water soluble dyes into the peripheral circulation, whereas the surrounding brain tissue and cerebrospinal fluid (CSF) remained colorless [7], thus confirming observations of other scientists in the years before [5, 8–10]. He also found that after sub-arachnoidal injection the brain was stained except the choroid plexusandconcludedthattheplexusepitheliumwastheverybarrierpreventingthe transfer of dye into the brain [6]. However, the Russian physiologist Lina Stern observedthatsometestcompoundscouldbefoundselectivelyinthebrainandinthe

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