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Review article
Changes in the choroid plexuses and brain barriers associated with high blood pressure and ageing
Variaciones de los plexos coroideos y las barreras cerebrales en la hipertensión arterial y el envejecimiento
I. Gonzalez-Marreroa, L.G. Hernández-Abadb, L. Castañeyra-Ruiza,c, E.M. Carmona-Caleroa,b, A. Castañeyra-Perdomoa,b,
Corresponding author
acastane@ull.es

Corresponding author at
a Departamento de Anatomía, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
b Instituto de Investigación y Ciencias de Puerto de Rosario, Puerto del Rosario, Fuerteventura, Spain
c Departamento de Farmacología, Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, Spain
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Diagram of the brain barriers and potential biomarkers of their disruption&#46; BBB&#58; blood&#8211;brain barrier&#59; BCSFB&#58; blood&#8211;CSF barrier&#59; ChP&#58; choroid plexus&#59; CSF&#58; cerebrospinal fluid&#59; SAS&#58; subarachnoid space&#59; S100&#946;&#58; S100 calcium-binding protein B &#40;low serum concentration&#41;&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Squares&#58; disruption of the blood&#8211;brain barrier by S100&#946;&#59; circles&#58; disruption of the blood&#8211;cerebrospinal fluid barrier by monomeric transthyretin&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Gonz&#225;lez-Marrero et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1005"><span class="elsevierStyleSup">94</span></a> Al-Sarraf and Philip&#44;<a class="elsevierStyleCrossRef" href="#bib1035"><span class="elsevierStyleSup">100</span></a> Marchi et al&#46;<a class="elsevierStyleCrossRef" href="#bib1050"><span class="elsevierStyleSup">103</span></a>&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Choroid plexuses</span><p id="par0005" class="elsevierStylePara elsevierViewall">The choroid plexuses &#40;ChP&#41; are made up of a monostratified epithelium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and a central vascular fibrous axis&#44; the stroma&#46; Epithelial cells are cuboidal&#44; with a rounded nucleus located in the centre or base of the cell&#46; They possess numerous mitochondria&#44; which are more densely distributed in the base and apical poles of the cell&#44; occupying 15&#37; of the cytoplasm in primates&#46;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">1&#8211;4</span></a> The total number of epithelial cells is estimated at 100 million&#44; with the cells measuring approximately 15<span class="elsevierStyleHsp" style=""></span>&#956;m long&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">2&#44;5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The apical poles of these cells present numerous interlaced microvilli of uniform diameter&#44; with few cilia&#46; In rats&#44; the total surface area of the ChP microvilli is approximately 75<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; comparable to the surface area of the capillaries of the blood&#8211;brain barrier &#40;BBB&#41; &#40;155<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">6</span></a> At the basal poles&#44; epithelial cells are separated from the stroma by the basolateral membrane&#46; The stroma contains numerous interdigitations with multiple type IV collagen fibres and few dendritic cells&#44; with macrophages&#44; fibroblasts&#44; and large capillaries with fenestrated endothelium&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">2</span></a> ChPs are richly irrigated&#44; presenting blood flow almost 10 times greater than that of the cerebral cortex in rats&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">7</span></a> In humans&#44; the ChP of the lateral ventricle is supplied by the anterior and posterior choroidal arteries&#44; with drainage into the choroidal vein&#46; The anterior choroidal artery is usually a branch of the internal carotid artery&#44; whereas the posterior choroidal artery originates from the posterior cerebral artery&#46; The posterior choroidal artery also supplies the ChP of the third ventricle&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Functions of the choroid plexus</span><p id="par0015" class="elsevierStylePara elsevierViewall">The ChP&#39;s functions include the production of cerebrospinal fluid &#40;CSF&#41;&#44; the secretion of numerous molecules&#44;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">9</span></a> and the reabsorption of substances from the CSF&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">10</span></a> It constitutes a selective barrier between the blood and the CSF &#40;the blood&#8211;CSF barrier &#91;BCSFB&#93;&#41;&#44; which is probably involved in the immune surveillance of the brain&#46;<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">11&#44;12</span></a> ChP epithelial cells play an important role in many of these tasks and in the synthesis of numerous CSF proteins&#44; including prostaglandins and growth factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">1&#44;2</span></a> The efficiency of the BCSFB is dependent on the efficacy of the epithelial tight junctions&#59; studies conducted in the last decade support the hypothesis that functional dysregulation of ChPs &#40;and therefore of the BCSFB&#41; may be a common pathophysiological mechanism in a wide variety of neurological disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Numerous transport proteins are expressed in the apical and basal poles of epithelial cells&#59; this enables the entry and exit of molecules and the clearance of organic anions and cations from the CSF&#44; preventing the accumulation of potentially harmful substances in the brain&#46;<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">12&#44;14</span></a> The ChPs participate in brain repair processes by secreting neuroprotective substances&#44; and act as a site of neurogenesis&#44; suggesting an important role in cell repair and replacement in the central nervous system &#40;CNS&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0610"><span class="elsevierStyleSup">15&#44;16</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Secretion of proteins and peptides by the choroid plexuses</span><p id="par0025" class="elsevierStylePara elsevierViewall">The ChPs synthesise numerous neuropeptides&#44; growth factors&#44; and cytokines &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">17&#44;18</span></a> One of the main proteins synthesised by the ChPs is transthyretin &#40;TTR&#41;&#44; which is mainly found in the plasma and the CSF&#46;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">19&#8211;21</span></a> TTR is mainly synthesised in the liver&#44; the ChP&#44; and the retinal pigment epithelium&#46; TTR synthesised in the liver is secreted into the blood&#44; where it acts as a transport protein for thyroid hormone&#46;<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">22</span></a> TTR synthesised by the ChPs is secreted into the CSF&#44; and is involved in transporting thyroid hormone from the blood to the brain&#46;<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">22&#8211;25</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Brain barriers</span><p id="par0030" class="elsevierStylePara elsevierViewall">The first discoveries about the BBB&#44; a vascular barrier separating the blood and the CNS&#44; were made over 100 years ago&#46; In the 1880s&#44; Paul Ehrlich<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">26</span></a> found that when he injected certain dyes into the vascular system&#44; they reached all organs but the brain and spinal cord&#46; Erhlich<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">26</span></a> interpreted these results as the nervous system&#39;s lack of affinity for these dyes&#46; Soon after&#44; Goldmann<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">27</span></a> demonstrated that when the same dyes were injected into the CSF&#44; they easily reached the nervous tissue but no other tissue&#44; suggesting that once within the CNS&#44; dyes did not cross into the blood circulation&#46; Additional studies have demonstrated that neurotoxic agents affect brain function only when they are injected directly into the brain&#44; but not when injected into the vascular system&#46;<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">28&#44;29</span></a> Only with advances in electron microscopy was it possible to correlate the ultrastructural location of the BBB with the endothelial cells of cerebral vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">30</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The CSF is separated from the vascular system by the BCSFB&#44; while the BBB&#44; which maintains cerebral homeostasis&#44; is located between the brain parenchyma and the vascular system&#46; While both barriers serve similar purposes&#44; they differ in terms of morphological and functional properties&#46; Both barrier systems are permeable not only to small molecules&#44; but also to macromolecules and circulating cells&#46; The transportation of molecules across the BBB and the BCSFB is regulated by passive diffusion &#40;e&#46;g&#46;&#44; albumin&#44; immunoglobulins&#41; and facilitated or active transport &#40;e&#46;g&#46;&#44; glucose&#41;&#46; The BCSFB may also serve as a route of drug administration to the CNS&#46;<a class="elsevierStyleCrossRefs" href="#bib0690"><span class="elsevierStyleSup">31&#44;32</span></a> The volume of the extracellular space&#44; potassium buffering&#44; CSF circulation&#44; and interstitial fluid absorption are mainly regulated by aquaporin-4 channels&#44; which are abundant in blood&#8211;brain and brain-CSF interfaces&#46;<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">32&#8211;36</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">These barriers protect the CNS&#44; preventing or restricting the passage of undesired molecules&#46; However&#44; this description does not fully capture the dynamic function of the cerebral barriers&#44; which includes the regulation of transporters&#44; signalling between endothelial cells and neurovascular structures&#44; and&#44; importantly&#44; the regulation of CSF composition via the ChP during development and ageing&#46;<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">37</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The composition of the CSF shows a high dynamic range&#44; with the levels of different proteins depending on several factors&#44; such as the place of production &#40;brain or derived from blood&#41;&#44; the sampling site &#40;ventricular or lumbar&#41;&#44; the flow of CSF &#40;BCSFB function&#41;&#44; daily fluctuations in the rate of CSF production&#44; and the molecular size of blood-derived proteins &#40;IgM vs albumin&#41; and circadian rhythm &#40;glucose&#44; prostaglandin-D synthase&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">33&#8211;36</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The majority of studies into the brain barriers have addressed the BBB&#59; however&#44; some researchers stress the importance of the BCSFB&#44; made up of ChP epithelial cells and their junctions&#44; which constitutes a truly selective barrier between the blood and the CSF&#46;<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">33&#8211;36</span></a> Its permeability increases during embryogenesis&#44; enabling compounds of low molecular weight to enter the brain more easily than in adults&#46; During embryonic development&#44; the ChPs occupy a proportionally larger volume than the brain&#44; and are essential for the correct formation of the nervous system&#44; secreting morphogens&#44; mitogens&#44; and specific growth factors into the CSF&#46;<a class="elsevierStyleCrossRefs" href="#bib0585"><span class="elsevierStyleSup">10&#44;34&#8211;36</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The intercellular junctions between ChP epithelial cells include both tight and adherens junctions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">38</span></a> Tight junctions are made up of 3 proteins &#40;claudins&#44; occludins&#44; and cell adhesion molecules&#41;&#44; whereas adherens junctions are formed by cadherins&#46; The associated cytoplasmic accessory proteins &#40;zonula occludens proteins in tight junctions and catenins in adherens junctions&#41; connect transmembrane proteins to the cell cytoskeleton &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0725"><span class="elsevierStyleSup">38&#44;39</span></a> These junctions are responsible for maintaining the structural integrity of the epithelium&#44; forming the BCSFB &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The BCSFB prevents passive diffusion of TTR from the blood to the CSF&#59; therefore&#44; the TTR found in CSF is produced almost exclusively in the ChP&#46;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">40</span></a> In rats&#44; serum TTR concentrations are 10 times higher than CSF concentrations&#44; despite the proportion of TTR protein in the CSF &#40;estimated at 25&#37; of intraventricular proteins&#41; being much higher than in the serum &#40;0&#46;5&#37; of total proteins&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">40</span></a> In vitro&#44; TTR accounts for 20&#37; of recently synthesised proteins and 50&#37; of proteins secreted by the ChP&#46;<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">36</span></a> TTR levels are lower in CSF than in plasma &#40;15<span class="elsevierStyleHsp" style=""></span>mg&#47;mL vs 200<span class="elsevierStyleHsp" style=""></span>mg&#47;mL&#41;&#59; these data support the hypothesis that CSF is not an ultrafiltrate of plasma&#44; but rather is actively secreted by the ChP&#46;<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">41</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">However&#44; researchers including Hladky and Barrand<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">42</span></a> argue that although the BBB is crucial for correct brain function&#44; it is not evident that the ChPs are essential in adults&#46; Indeed&#44; while secretion from the ChPs explains most of the net fluid entry to the brain&#44; an appropriate disposition of transporter proteins in the BBB could easily produce a similar secretion&#46; Subtler reasons are needed to explain the role of the ChPs as the main source of CSF&#46; Firstly&#44; it may allow the BBB to serve local needs&#44; without the restrictions of having to maintain fluid secretion&#44; for example in response to changes in nervous activity&#46; Secondly&#44; it prevents the need to provide pathways and sufficient pressure gradients for all the fluid entering the brain to flow across the parenchyma&#46; Thirdly&#44; secretion of fluids directly into the ventricles may contribute to maintaining their permeability&#46; The presence of these spaces&#44; which are of variable volume and present little flow resistance&#44; enables compensation for changes in blood volume during the cardiac and respiratory cycles and in response to postural changes&#46; It should also be noted that the ChPs are necessary in fluid secretion during the development of the CNS&#44; and allowing this process to continue in adults may be an economical solution&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">42&#44;43</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Cerebrospinal fluid</span><p id="par0070" class="elsevierStylePara elsevierViewall">CSF production in the ChP of the cerebral ventricles occurs in 2 phases&#58; first&#44; fluid is passively filtered through capillaries of the ChP&#44; facilitated by hydrostatic pressure<a class="elsevierStyleCrossRef" href="#bib0755"><span class="elsevierStyleSup">44</span></a>&#59; and second&#44; proteins are actively secreted from the ChP epithelium into the ventricle&#46;<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">5&#44;44&#8211;50</span></a> CSF is produced at a rate of 3 and 350<span class="elsevierStyleHsp" style=""></span>&#956;L&#47;minute in rats and in humans&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0760"><span class="elsevierStyleSup">45&#44;50&#8211;54</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">One of the most important proteins in the passive filtration of fluid through the ChP is the water channel aquaporin-1 &#40;AQP1&#41;&#46; This protein has been identified in the apical pole of the membranes of ChP epithelial cells&#44; although its location may vary during embryonic development and in the context of hydrocephalus or ventricular dilation&#46;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">50&#8211;56</span></a> The aquaporins are a family of integral membrane proteins that function as water channels&#46; The production of CSF in the ChPs involves an osmotic gradient&#44; which is mainly caused by the action of carbonic anhydrase and Na<span class="elsevierStyleSup">&#43;</span>&#47;K<span class="elsevierStyleSup">&#43;</span>-ATPase&#46;<a class="elsevierStyleCrossRefs" href="#bib0775"><span class="elsevierStyleSup">48&#8211;52</span></a> AQP1 enables water to follow the osmotic gradient in the apical membrane&#44; making this protein highly important for the transfer of water across the ChPs&#46;<a class="elsevierStyleCrossRefs" href="#bib0760"><span class="elsevierStyleSup">45&#8211;51</span></a> AQP1 is also involved in maintaining this osmotic permeability&#58; permeability is 4&#46;8 times lower in mutant mice that do not express the protein&#46;<a class="elsevierStyleCrossRefs" href="#bib0820"><span class="elsevierStyleSup">57&#44;58</span></a> These mutant mice also produced approximately 20&#37; less CSF than wild-type mice &#40;0&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;02 vs 0&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;01<span class="elsevierStyleHsp" style=""></span>&#956;L<span class="elsevierStyleHsp" style=""></span>minute<span class="elsevierStyleSup">&#8211;1</span>&#41;&#46; Intracranial pressure was also 56&#37; lower in mutant mice lacking AQP1&#46;<a class="elsevierStyleCrossRefs" href="#bib0745"><span class="elsevierStyleSup">42&#44;52&#44;53</span></a> CSF is not simply an ultrafiltrate of blood&#44; as its composition is different to that of plasma&#46;<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">56</span></a> It is composed of 99&#37; water&#44; with a much lower concentration of proteins &#40;&#8776;350<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41; than in serum &#40;70<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#41;&#59; Na<span class="elsevierStyleSup">&#43;</span>&#44; K<span class="elsevierStyleSup">&#43;</span>&#44; Ca<span class="elsevierStyleSup">2&#43;</span>&#44; and HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span> levels are much lower than in plasma&#44; and approximately 80&#37; of CSF proteins are present in blood plasma&#46; Seventy percent of the CSF originates in the ChP&#44; with the rest being secreted by minor pathways in the brain parenchyma&#46;<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">43&#44;50&#8211;60</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Maintenance of the interstitial fluid and the purity of CSF composition depend on efficient clearance mechanisms&#46; As the CNS lacks lymphatic capillaries&#44; CSF-mediated elimination of metabolites and toxins is essential to neuronal function&#46; The ChP plays an important role in clearing these harmful substances&#46; Clearance takes 3 forms&#58; firstly&#44; reabsorption by transporters in the apical membrane of the ChP epithelium actively removes organic anions and peptides from the ventricular CSF&#46;<a class="elsevierStyleCrossRefs" href="#bib0840"><span class="elsevierStyleSup">61&#8211;63</span></a> This clearance by the ChP is complementary to active reabsorption of unnecessary metabolites from the interstitial fluid through brain capillaries&#46;<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">64</span></a> Secondly&#44; the continuous production of CSF flowing from inside the brain acts as a drainage mechanism&#44; reducing the concentration of the metabolites passing into the ventricles&#46;<a class="elsevierStyleCrossRefs" href="#bib0600"><span class="elsevierStyleSup">13&#44;65&#44;66</span></a> A third means of toxin clearance is the passage of circulating metabolites from the CSF through arachnoidal-lymphatic-venous interfaces&#46;<a class="elsevierStyleCrossRefs" href="#bib0795"><span class="elsevierStyleSup">52&#44;67</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Effects of arterial hypertension on the central nervous system</span><p id="par0085" class="elsevierStylePara elsevierViewall">The cerebral circulation has control mechanisms guaranteeing adequate blood supply at all times&#59; therefore&#44; if the brain&#39;s energy demand increases due to elevated neuronal activity&#44; cerebral blood flow &#40;CBF&#41; also increases&#44; in a phenomenon known as hyperaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0875"><span class="elsevierStyleSup">68</span></a> In normal conditions&#44; CBF rate is approximately 50-60<span class="elsevierStyleHsp" style=""></span>mL&#47;100<span class="elsevierStyleHsp" style=""></span>g&#47;minute&#46;<a class="elsevierStyleCrossRef" href="#bib0880"><span class="elsevierStyleSup">69</span></a> Increased CBF increases the supply of nutrients&#44; removes metabolic waste&#44; and dissipates heat produced by brain activity&#59; however&#44; it may also affect neuronal activity through its effects on astrocytes&#46;<a class="elsevierStyleCrossRefs" href="#bib0875"><span class="elsevierStyleSup">68&#44;70</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">CBF is defined as the sufficient capacity of blood for adequate perfusion of the brain tissue&#44; according to the formula <span class="elsevierStyleItalic">CBF</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cerebral perfusion pressure &#40;CPP&#41;&#47;cerebrovascular resistance&#46;</span></p><p id="par0095" class="elsevierStylePara elsevierViewall">CPP is defined as the pressure needed to perfuse the nervous tissue for good metabolic function&#44; and represents the difference between arterial pressure driving blood into the cerebral circulation and venous back-pressure&#46; Under normal conditions&#44; venous back-pressure is minimal&#44; meaning that CPP is similar to systemic arterial pressure&#46; Therefore&#44; if CPP is normal&#44; then changes in CBF are explained by changes in cerebrovascular resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0890"><span class="elsevierStyleSup">71</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In normotensive individuals&#44; the cerebral circulation is self-regulating&#58; within a broad range &#40;50-150<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg mean arterial pressure&#41;&#44; blood flow remains constant in order to maintain the integrity of the BBB&#46;<a class="elsevierStyleCrossRef" href="#bib0895"><span class="elsevierStyleSup">72</span></a> This process is regulated by the calibre of the small arteries and arterioles&#44; which contract when arterial blood pressure increases and dilate when it decreases&#46; Due to the vascular remodelling that accompanies chronic high blood pressure &#40;HBP&#41;&#44; self-regulation adapts to the high blood pressure values&#44; displacing the self-regulation curve to the right and thereby reducing the risk of hyperperfusion when blood pressure increases&#44; but also increasing the likelihood of ischaemia when it decreases&#46;<a class="elsevierStyleCrossRef" href="#bib0900"><span class="elsevierStyleSup">73</span></a> According to some studies&#44; certain antihypertensive drugs may reverse this alteration&#46;<a class="elsevierStyleCrossRef" href="#bib0905"><span class="elsevierStyleSup">74</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">CBF is reduced in spontaneously hypertensive rats&#44; and cerebral circulation may be compromised from the age of 4 months&#46;<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">75</span></a> One possible explanation for the reduced CBF observed in the context of HBP is that atherosclerosis of the carotid arteries plays a role in the insufficient blood supply to the brain&#46; Whatever the underlying mechanism&#44; reduced CBF seems always to accompany chronic HBP&#46;<a class="elsevierStyleCrossRefs" href="#bib0915"><span class="elsevierStyleSup">76&#8211;79</span></a> Animal models offer good insight into the possible mechanisms underlying the association between reduced CBF and the state of capillaries in the brain&#46; For example&#44; permanent bilateral common carotid artery ligation in rats has been suggested as a model of chronic cerebral hypoperfusion&#44; reducing blood supply to approximately 70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0935"><span class="elsevierStyleSup">80&#44;81</span></a> Similarly&#44; hypertensive rats present structural anomalies in cerebral vessels after 14 months of cerebral hypoperfusion&#44; manifesting as thickening of the basement membrane due to accumulation of collagen in hippocampal blood vessels&#46;<a class="elsevierStyleCrossRef" href="#bib0945"><span class="elsevierStyleSup">82</span></a> As a result&#44; it has been suggested that chronic hypoperfusion is functionally related to cerebral small vessel damage&#44; with cerebral hypoperfusion triggering the ultrastructural alterations and the vascular deformities observed&#46;<a class="elsevierStyleCrossRef" href="#bib0910"><span class="elsevierStyleSup">75</span></a> These findings further support the hypothesis of a causal interaction between chronic reduction of CBF and microvascular degeneration in patients with HBP&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Despite the physiological phenomenon of the brain&#39;s self-regulation&#44; sustained high blood pressure results in constant vasoconstriction of cerebral arterioles and small arteries&#44; leading to structural changes to vessels and the appearance of several types of brain lesions&#46; These changes are fundamentally characterised by &#8220;vascular remodelling&#44;&#8221; the reordering of the layers of smooth muscle cells of the vessel walls&#44; as well as adaptive and degenerative structural changes&#44; such as atherosclerosis&#44; arteriosclerosis&#44; arterial wall thickening&#44; reduced arterial lumen&#44; and smooth muscle hypertrophy&#46;<a class="elsevierStyleCrossRefs" href="#bib0890"><span class="elsevierStyleSup">71&#44;82&#8211;85</span></a>As the vascular lumen continues to decrease in diameter&#44; cerebral perfusion is reduced&#44; potentially causing lacunar infarcts and&#47;or periventricular or deep white matter ischaemic lesions&#59; this process is known as leukoaraiosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0965"><span class="elsevierStyleSup">86&#44;87</span></a> Hypertension also leads to vascular stiffness&#44; with increased collagen content in the tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0975"><span class="elsevierStyleSup">88</span></a> Finally&#44; hypertensive rats also present variations in CSF proteins and in certain circumventricular organs in addition to the ChPs &#40;e&#46;g&#46;&#44; the subfornical organ&#44; which lacks BBB&#44; and the subcommissural organ&#44; which does have an effective BBB&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0980"><span class="elsevierStyleSup">89&#8211;91</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">This article reviews the effects of HBP on the structure&#44; morphology&#44; and function of the ChP&#46; We also aim to interpret whether these effects are present in the brain barriers&#44; and whether they are of greater relevance in the BCSFB or the BBB&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Development</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Effects of arterial hypertension on the structure and morphology of the choroid plexus</span><p id="par0120" class="elsevierStylePara elsevierViewall">Spontaneously hypertensive rats present increased stromal thickness&#44; flattening of the epithelium&#44; and increased vascular lumen diameter in the ChP as compared to controls&#59; these changes become more marked with age&#44; with the combination of the changes associated with HBP and age-related changes&#46;<a class="elsevierStyleCrossRefs" href="#bib0965"><span class="elsevierStyleSup">86&#44;92&#8211;94</span></a> However&#44; it should also be stressed that the increased vascular lumen diameter in the ChP stands in contrast to the effects observed in other vessels of the brain&#44; where HBP causes lumen diameter to decrease&#46;<a class="elsevierStyleCrossRefs" href="#bib1010"><span class="elsevierStyleSup">95&#8211;97</span></a> Previous studies have classified vessels according to lumen diameter&#44; with a first group of diameter 5&#46;0-15<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; a second group of diameter 15-30<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; and a third group of diameter greater than 30<span class="elsevierStyleHsp" style=""></span>&#956;m&#46; The mean vessel lumen diameter was greater in hypertensive rats than in controls in the 3 ranges selected&#59; in fact&#44; control rats did not present vessels with diameter greater than 30<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;<a class="elsevierStyleCrossRefs" href="#bib1005"><span class="elsevierStyleSup">94&#8211;97</span></a> These results suggest that HBP and cerebral hypoperfusion reduce the lumen diameter of vessels in the brain parenchyma&#44; with the opposite being the case in choroidal vessels&#46; Probably because of their highly vascularised structure&#44; the ChPs receive 10 times more blood than cerebral vessels&#44; and are therefore more sensitive to changes in blood perfusion&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">7&#44;97</span></a> Regarding this contradictory effect&#44; it is possible that the increase in lumen diameter may be a compensatory mechanism in response to a lack of oxygen and nutrients due to poor cerebral perfusion&#59; in this case&#44; maintaining blood pressure would not require a decrease in diameter&#44; as occurs in cerebral vessels&#46; For this reason&#44; the vessels of the ChP are thought to be much more sensitive to reduced perfusion and to present greater changes than cerebral vessels&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Effects of arterial hypertension on choroid plexus function</span><p id="par0125" class="elsevierStylePara elsevierViewall">Morphological changes secondary to HBP may lead to changes in protein secretion&#44; function&#44; and expression in the ChPs&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">TTR accounts for 25&#37; of the total protein synthesised by the ChP and 5&#37; of protein present in the CSF<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">47</span></a>&#59; therefore&#44; TTR expression is indicative of the state of the ChP&#39;s secretory function&#46; Decreased ChP TTR levels are reported in middle-aged hypertensive rats as compared against controls&#44; potentially indicating reduced secretory function&#44; but the most striking observation is the small increase in TTR levels in older hypertensive animals with respect to controls&#46; This may be a compensatory mechanism in response to reduced CSF TTR levels in hypertensive rats secondary to BCSFB disruption<a class="elsevierStyleCrossRef" href="#bib1000"><span class="elsevierStyleSup">93</span></a>&#59; this matter is addressed later in the article&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">CSF production is one of the most important functions of the ChPs&#46; As mentioned above&#44; AQP1 protein in the apical poles of epithelial cells is responsible for allowing water to pass from the blood to the CSF via a transcellular mechanism&#59; therefore&#44; AQP1 is a good indicator for evaluating CSF production&#46;<a class="elsevierStyleCrossRef" href="#bib0820"><span class="elsevierStyleSup">57</span></a> Previous studies report elevated AQP1 expression in hypertensive rats as compared to controls&#46; This may be the cause of the ventricular dilation described by Ritter et al&#46;<a class="elsevierStyleCrossRef" href="#bib1025"><span class="elsevierStyleSup">98</span></a> in spontaneously hypertensive rats&#44; and may be explained by the fact that HBP increases the amount of water in the ChPs&#44; which are responsible for eliminating this excess&#44; hence the increased AQP1 levels&#46;<a class="elsevierStyleCrossRefs" href="#bib1000"><span class="elsevierStyleSup">93&#44;94&#44;99&#44;100</span></a> However&#44; AQP1 levels also decrease in line with age&#44; perhaps in association with the reduction in water flow across the ChPs when CSF production by the ChPs decreases in the contexts of older age or HBP&#59; this process results in a decrease in CSF circulation&#44; which affects the clearance of toxins from the brain and their reabsorption&#46;<a class="elsevierStyleCrossRefs" href="#bib0995"><span class="elsevierStyleSup">92&#44;94</span></a> We may deduce that the structural and morphological changes caused in the ChP due to HBP &#40;and ageing&#41; will accelerate the deterioration of such processes as CSF production&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Studies with aged rats have found that the microvilli of ChP epithelial cells decrease considerably in number and size in comparison to younger animals&#59; these changes are only observed in the ChP of the lateral and third ventricles &#40;not in the ChP of the fourth ventricle&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0995"><span class="elsevierStyleSup">92</span></a> In a recent study&#44; AQP1 was detected in the CSF&#44; suggesting that the appearance of this protein may be caused by a loss of choroidal microvilli&#44; whose content &#40;including AQP1&#41; would pass into the CSF&#46;<a class="elsevierStyleCrossRef" href="#bib1015"><span class="elsevierStyleSup">96</span></a> Interestingly&#44; some studies report a relationship between the amount of AQP1 in the ChPs and in the CSF&#44; with greater labelling of the protein in the ChPs being associated with lower concentration in the CSF&#44; and vice versa&#46;<a class="elsevierStyleCrossRefs" href="#bib1005"><span class="elsevierStyleSup">94&#44;101</span></a> In addition&#44; some of the few studies evaluating AQP1 in the CSF relate this finding to the loss of microvilli with ageing&#44; with the consequent release of AQP1 into the ChP&#46;<a class="elsevierStyleCrossRef" href="#bib1040"><span class="elsevierStyleSup">101</span></a> Therefore&#44; HBP may accelerate ageing and increase the loss of epithelial microvilli and consequently of AQP1&#44; which has a negative impact on CSF circulation&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Effects of high blood pressure on brain barriers</span><p id="par0145" class="elsevierStylePara elsevierViewall">Some studies suggest that HBP causes alterations in the brain barriers&#59; specifically&#44; radioactively labelled sucrose has been used to evaluate the permeability of these barriers&#44; with the BCSFB reported to show greater disruption than the BBB&#46;<a class="elsevierStyleCrossRefs" href="#bib1000"><span class="elsevierStyleSup">93&#44;100&#44;102</span></a> We may deduce from this that HBP causes greater damage to the cerebral structures constituting the BCSFB &#40;i&#46;e&#46;&#44; the ChP&#41; than to BBB structures&#46; Marchi et al&#46;<a class="elsevierStyleCrossRef" href="#bib1050"><span class="elsevierStyleSup">103</span></a> describe a method of evaluating BCSFB permeability by determining levels of TTR monomer &#40;which has a molecular weight of 14 kilodaltons &#91;kDa&#93;&#41; in the blood&#46; TTR is a homotetramer made up of different subunits&#44; with tetrameric &#40;55<span class="elsevierStyleHsp" style=""></span>kDa&#41;&#44; dimeric &#40;28<span class="elsevierStyleHsp" style=""></span>kDa&#41;&#44; and monomeric &#40;14<span class="elsevierStyleHsp" style=""></span>kDa&#41; forms also existing&#46; In the blood&#44; TTR is mainly present in the tetrameric form&#44; whereas the monomeric form is more common in the CSF&#46;<a class="elsevierStyleCrossRef" href="#bib1050"><span class="elsevierStyleSup">103</span></a> Marchi et al&#46;<a class="elsevierStyleCrossRef" href="#bib1050"><span class="elsevierStyleSup">103</span></a> analysed serum TTR monomer levels to measure BBB openings induced with intra-arterial mannitol&#46; Based on the hypothesis that HBP itself may cause BCSFB opening&#44; some studies report markedly lower levels of TTR monomer in the CSF of hypertensive rats than in controls&#44; and considerably higher levels in the blood of hypertensive rats than in controls&#46;<a class="elsevierStyleCrossRefs" href="#bib1000"><span class="elsevierStyleSup">93&#44;94</span></a> According to several studies&#44; TTR monomer is transferred from the CSF to the blood in hypertensive individuals due to a possible disruption of the BCSFB caused by the effects of HBP&#46;<a class="elsevierStyleCrossRefs" href="#bib1000"><span class="elsevierStyleSup">93&#44;94&#44;103</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Blood S100&#946; protein levels are measured to ascertain the effects of hypertension on the BBB&#46; According to some authors&#44; blood S100&#946; concentrations are normally low but increase in certain pathological situations&#59; the protein is mainly expressed in astrocyte endfeet and released into the blood if the BBB is disrupted&#44; although it is also detected in the CSF&#46;<a class="elsevierStyleCrossRefs" href="#bib1025"><span class="elsevierStyleSup">98&#44;100&#44;103&#8211;107</span></a> Therefore&#44; blood S100&#946; levels are higher in hypertensive animals than in controls&#44; suggesting BBB damage in these animals&#46; According to Al-Sarraf and Philip&#44;<a class="elsevierStyleCrossRef" href="#bib1035"><span class="elsevierStyleSup">100</span></a> the BCSFB is damaged to a greater extent than the BBB&#44; as the quantity of TTR monomer transferred from the CSF to the blood is almost double the level of S100&#946; in the blood of hypertensive animals&#44; and the differences between hypertensive animals and controls are greater for TTR than for S100&#946; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Several other studies report that increases in the levels of certain proteins&#44; including albumin&#44; immunoglobulin G &#40;IgG&#41;&#44; and haptoglobin&#44; may be caused by damage to the BCSFB&#44; which allows them to cross into the CSF&#46;<a class="elsevierStyleCrossRefs" href="#bib0830"><span class="elsevierStyleSup">59&#44;60&#44;94&#44;100&#44;104</span></a> A proteomics study of the CSF of hypertensive rats found differences in these proteins&#44; with higher CSF levels of albumin&#44; IgG&#44; and haptoglobin in hypertensive rats&#46;<a class="elsevierStyleCrossRef" href="#bib0975"><span class="elsevierStyleSup">88</span></a> These data show that HBP causes an increase in the levels of some plasma proteins in the CSF&#44; which also supports the hypothesis of BCSFB disruption&#46; These studies also describe an accumulation of IgG in the ChP of hypertensive animals&#44; which would also suggest that chronic hypertension damages the BCSFB&#44; increasing its permeability&#46;<a class="elsevierStyleCrossRefs" href="#bib1000"><span class="elsevierStyleSup">93&#44;94</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">Morphological changes to the ChP due to hypertension accentuate the changes caused by ageing due to the decrease in cerebral perfusion&#46; Data from analysis of TTR and AQP1 levels suggest that HBP decreases the secretory function of the ChP and its production of CSF&#46; Furthermore&#44; determining levels of S100&#946; and TTR monomer in the serum and CSF has made it possible to verify that the brain barriers are disrupted in the context of HBP&#44; that the changes in the BCSFB become more marked as untreated hypertension progresses&#44; and that the BCSFB is more severely affected than the BBB&#46; Future studies should address the clinical use of these biomarkers to assess the state of the brain barriers&#44; which may clarify whether these changes can be prevented or reduced if hypertension is treated&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">This study received funding from the <span class="elsevierStyleGrantSponsor" id="gs1">Canarian Institute of Research and Science</span> &#40;INIPRO&#41;&#59; project no&#46; 03&#47;14&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Choroid plexuses"
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              "titulo" => "Functions of the choroid plexus"
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              "titulo" => "Secretion of proteins and peptides by the choroid plexuses"
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              "titulo" => "Brain barriers"
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              "titulo" => "Cerebrospinal fluid"
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              "titulo" => "Effects of arterial hypertension on the central nervous system"
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              "titulo" => "Effects of arterial hypertension on the structure and morphology of the choroid plexus"
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              "titulo" => "Effects of arterial hypertension on choroid plexus function"
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              "titulo" => "Effects of high blood pressure on brain barriers"
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    "fechaAceptado" => "2018-06-11"
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          "clase" => "keyword"
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            0 => "Choroid plexuses"
            1 => "Brain barriers"
            2 => "Hypertension"
            3 => "Ageing"
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          "palabras" => array:4 [
            0 => "Plexos coroideos"
            1 => "Barreras cerebrales"
            2 => "Hipertensi&#243;n"
            3 => "Envejecimiento"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The choroid plexuses&#44; blood vessels&#44; and brain barriers are closely related both in terms of morphology and function&#46; Hypertension causes changes in cerebral blood flow and in small vessels and capillaries of the brain&#46; This review studies the effects of high blood pressure &#40;HBP&#41; on the choroid plexuses and brain barriers&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Development</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The choroid plexuses &#40;ChP&#41; are structures located in the cerebral ventricles&#44; and are highly conserved both phylogenetically and ontogenetically&#46; The ChPs develop during embryogenesis&#44; forming a functional barrier during the first weeks of gestation&#46; They are composed of highly vascularised epithelial tissue covered by microvilli&#44; and their main function is cerebrospinal fluid &#40;CSF&#41; production&#46; The central nervous system &#40;CNS&#41; is protected by the blood&#8211;brain barrier &#40;BBB&#41; and the blood&#8211;CSF barrier &#40;BCSFB&#41;&#46; While the BBB is formed by endothelial cells of the microvasculature of the CNS&#44; the BCSFB is formed by epithelial cells of the choroid plexuses&#46; Chronic hypertension induces vascular remodelling&#46; This prevents hyperperfusion at HBPs&#44; but increases the risk of ischaemia at low blood pressures&#46; In normotensive individuals&#44; in contrast&#44; cerebral circulation is self-regulated&#44; blood flow remains constant&#44; and the integrity of the BBB is preserved&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">HBP induces changes in the choroid plexuses that affect the stroma&#44; blood vessels&#44; and CSF production&#46; HBP also exacerbates age-related ChP dysfunction and causes alterations in the brain barriers&#44; which are more marked in the BCSFB than in the BBB&#46; Brain barrier damage may be determined by quantifying blood S-100&#946; and TTRm levels&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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            "titulo" => "Development"
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        "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducci&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los plexos coroideos&#44; los vasos sangu&#237;neos y las barreras cerebrales est&#225;n &#237;ntimamente relacionados tanto morfol&#243;gica como funcionalmente&#46; Por otro lado&#44; la hipertensi&#243;n produce cambios en el flujo sangu&#237;neo y en los peque&#241;os vasos y capilares cerebrales&#46; El prop&#243;sito de la presente revisi&#243;n es estudiar los efectos de la hipertensi&#243;n arterial sobre los plexos coroideos y las barreras cerebrales&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Desarrollo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los plexos coroideos &#40;PC&#41; son una estructura del cerebro situada en los ventr&#237;culos cerebrales&#44; altamente conservada filogen&#233;tica y ontog&#233;nicamente&#46; Los PC se desarrollan temprano durante la embriog&#233;nesis y constituyen una barrera funcional en las primeras semanas de gestaci&#243;n&#46; Est&#225;n compuestos por tejido epitelial altamente vascularizado&#44; cubiertos por microvellosidades y su funci&#243;n principal es la producci&#243;n del l&#237;quido cefalorraqu&#237;deo &#40;LCR&#41;&#46; El sistema nervioso central se encuentra aislado y protegido por la barrera hematoencef&#225;lica &#40;BHE&#41; y por la barrera sangre-LCR &#40;BSLCR&#41;&#46; Mientras que la BHE se localiza al nivel de las c&#233;lulas endoteliales en la microvasculatura del enc&#233;falo&#44; la BSLCR est&#225; formada por las c&#233;lulas epiteliales de los plexos coroideos&#46; La hipertensi&#243;n arterial cr&#243;nica induce una remodelaci&#243;n vascular para adaptarse a los valores elevados de presi&#243;n arterial&#44; con lo que se evita el riesgo de hiperperfusi&#243;n ante presiones elevadas&#44; pero se incrementa el riesgo de isquemia a presiones bajas&#59; en cambio&#44; en las personas normotensas la circulaci&#243;n cerebral se autorregula y el flujo sangu&#237;neo permanece constante y se mantiene la integridad de la BHE&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La hipertensi&#243;n arterial induce variaciones en los plexos coroideos que afecta al estroma&#44; los vasos sangu&#237;neos&#44; la producci&#243;n de LCR y agrava el deterioro de los PC producidos por envejecimiento&#46; Adem&#225;s&#44; la hipertensi&#243;n tambi&#233;n produce alteraciones en las barreras cerebrales que son m&#225;s ostensibles en la BSLCR que en BHE&#59; estos da&#241;os de las barreras cerebrales se podr&#237;an determinar detectando los niveles en sangre de S100&#946; y TTRm&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gonzalez-Marrero I&#44; Hern&#225;ndez-Abad LG&#44; Casta&#241;eyra-Ruiz L&#44; Carmona-Calero EM&#44; Casta&#241;eyra-Perdomo A&#46; Variaciones de los plexos coroideos y las barreras cerebrales en la hipertensi&#243;n arterial y el envejecimiento&#46; Neurolog&#237;a&#46; 2022&#59;37&#58;371&#8211;382&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Optical microscopy image &#40;Kl&#252;ver&#8211;Barrera staining&#41; of a coronal slice from the brain of a rat&#44; showing the choroid plexus within the lateral ventricles&#46; B&#41; Closer image of the choroid plexus &#40;64&#215;&#41;&#44; with the same staining technique&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Scale bar&#58; &#40;A&#41; 1600<span class="elsevierStyleHsp" style=""></span>&#956;m&#59; &#40;B&#41; 40<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">CE&#58; choroid plexus epithelium&#59; L&#58; lumen&#59; LV&#58; lateral ventricle&#59; ST&#58; stroma&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2126
            "Ancho" => 2263
            "Tamanyo" => 202016
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Schematic diagram of the tight and adherens junctions present between the cells of the choroid plexus epithelium&#46; Adapted from Vorbrodt and Dobrogowska&#46;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">39</span></a></p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1967
            "Ancho" => 2884
            "Tamanyo" => 242326
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagram demonstrating ion transport in the choroid plexus for cerebrospinal fluid production&#46; Adapted from Johanson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">52</span></a></p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1514
            "Ancho" => 1417
            "Tamanyo" => 168911
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Diagram of the brain barriers and potential biomarkers of their disruption&#46; BBB&#58; blood&#8211;brain barrier&#59; BCSFB&#58; blood&#8211;CSF barrier&#59; ChP&#58; choroid plexus&#59; CSF&#58; cerebrospinal fluid&#59; SAS&#58; subarachnoid space&#59; S100&#946;&#58; S100 calcium-binding protein B &#40;low serum concentration&#41;&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Squares&#58; disruption of the blood&#8211;brain barrier by S100&#946;&#59; circles&#58; disruption of the blood&#8211;cerebrospinal fluid barrier by monomeric transthyretin&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Gonz&#225;lez-Marrero et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib1005"><span class="elsevierStyleSup">94</span></a> Al-Sarraf and Philip&#44;<a class="elsevierStyleCrossRef" href="#bib1035"><span class="elsevierStyleSup">100</span></a> Marchi et al&#46;<a class="elsevierStyleCrossRef" href="#bib1050"><span class="elsevierStyleSup">103</span></a>&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Adapted from Chodobski and Szmydynger-Chodobska&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">15</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Polypeptides identified in the ChP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Molecules for which receptors have been identified in the ChP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adrenomedullin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiotensin II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apolipoprotein J&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apolipoprotein E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arginine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Apolipoprotein J&#47;clusterin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basic fibroblast growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atrial natriuretic peptide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#946;-Amyloid precursor protein&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basic fibroblast growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brain-derived neurotrophic factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bradykinin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystatin C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brain-derived neurotrophic factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Endothelin-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Corticotropin-releasing factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatocyte growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Endothelin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insulin-like growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Growth hormone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Interleukin-1&#946;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insulin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Interleukin-6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Insulin-like growth factor-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nerve growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Interleukin-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neurotrophin 3 and 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leptin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostaglandin D synthase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nerve growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transferrin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neurotrophin 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transthyretin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prolactin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tumour necrosis factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular endothelial growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vascular endothelial growth factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasoactive intestinal polypeptide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasopressin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasopressin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2929042.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Polypeptides identified in the choroid plexus and molecules for which receptors have been identified in the choroid plexus&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:107 [
            0 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The ependyma&#58; a protective barrier between brain and cerebrospinal fluid"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/glia.440140102"
                      "Revista" => array:7 [
                        "tituloSerie" => "Glia"
                        "fecha" => "1995"
                        "volumen" => "14"
                        "paginaInicial" => "1"
                        "paginaFinal" => "13"
                        "link" => array:1 [ …1]
                        "itemHostRev" => array:3 [ …3]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The choroid plexus&#58; a historical review"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0006-8993(70)90324-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain Res"
                        "fecha" => "1970"
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                        "paginaInicial" => "197"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The structure of the choroid plexus and the physiology of the choroid plexus epithelium"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.addr.2004.07.005"
                      "Revista" => array:6 [
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                        "fecha" => "2004"
                        "volumen" => "56"
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                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new angle on blood&#8211;CNS interfaces&#58; a role for connexins&#63;"
                      "autores" => array:1 [
                        0 => array:2 [ …2]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.febslet.2014.02.060"
                      "Revista" => array:6 [
                        "tituloSerie" => "FEBS Lett"
                        "fecha" => "2014"
                        "volumen" => "588"
                        "paginaInicial" => "1259"
                        "paginaFinal" => "1270"
                        "link" => array:1 [ …1]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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es en pt

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