Pathogenesis of neurodegenerative pathology and new concepts of transport and metabolic systems of the brain and eye

Neurodegenerative diseases of the brain and eyes have high medical and socio-economic significance. The leading among them - Alzheimer's disease (AD) and glaucoma share similar epidemiological characteristics, common molecular mechanisms of patho- and morphogenesis. A number of facts testify in favor of the pathogenetic relationship between glaucoma and AD: their frequent combination; thinning of the layer of nerve fibers of the retina both in patients with neurodegenerative diseases and in patients with glaucoma; the possibility of transporting neurotoxic metabolites in the brain-eye system; amyloid deposits in the retina in patients with AD, as well as the formation of neurotoxic forms of amyloid in the head of the optic nerve with intraocular hypertension, deposits of β-amyloid and tau protein in the lateral geniculate bodies in the binocular glaucoma model; reduction in cognitive functions in glaucoma patients, etc. These facts are consistent with the modern concept of the "glymphatic system" (GLS), which gave rise to a new stage of studying the neurodegeneration pathogenesis. GLS is a set of formations ensuring liquor exchange between the brain and the eye, and includes a number of spaces near the vessels: paravascular (between the vascular pial-adventitia sheath and the glial limiting membrane) and perivascular (between the pial sheath and the adventitia of arteries and arterioles, as well as between the vascular tunica media and the common pial-adventitia sheath). An important factor determining the glymphatic transport is the state of arterial and venous blood flow, which also successfully correlates with the basic theories of glaucoma pathogenesis. The review presents literature data on the relationship between cerebral and ocular neurodegeneration, pathogenesis of glaucoma, structural and functional features of the glymphatic system, possible pharmacotherapeutic approaches and neuroprotection for neurodegenerative pathology and glaucoma.

neurodegeneration, Alzheimer's disease, glaucoma, amyloid, glymphatic system.

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