title: Intrastriatal convection-enhanced delivery results in widespread perivascular distribution in a pre-clinical model.
abstract: BACKGROUND
  Convection-enhanced delivery (CED), a direct method for drug delivery to the brain through intraparenchymal microcatheters, is a promising strategy for intracerebral pharmacological therapy. By establishing a pressure gradient at the tip of the catheter, drugs can be delivered in uniform concentration throughout a large volume of interstitial fluid. However, the variables affecting perivascular distribution of drugs delivered by CED are not fully understood. The aim of this study was to determine whether the perivascular distribution of solutes delivered by CED into the striatum of rats is affected by the molecular weight of the infused agent, by co-infusion of vasodilator, alteration of infusion rates or use of a ramping regime. We also wanted to make a preliminary comparison of the distribution of solutes with that of nanoparticles.
  
  
  METHODS
  We analysed the perivascular distribution of 4, 10, 20, 70, 150 kDa fluorescein-labelled dextran and fluorescent nanoparticles at 10 min and 3 h following CED into rat striatum. We investigated the effect of local vasodilatation, slow infusion rates and ramping on the perivascular distribution of solutes. Co-localisation with perivascular basement membranes and vascular endothelial cells was identified by immunohistochemistry. The uptake of infusates by perivascular macrophages was quantified using stereological methods.
  
  
  RESULTS
  Widespread perivascular distribution and macrophage uptake of fluorescein-labelled dextran was visible 10 min after cessation of CED irrespective of molecular weight. However, a significantly higher proportion of perivascular macrophages had taken up 4, 10 and 20 kDa fluorescein-labelled dextran than 150 kDa dextran (p < 0.05, ANOVA). Co-infusion with vasodilator, slow infusion rates and use of a ramping regime did not alter the perivascular distribution. CED of fluorescent nanoparticles indicated that particles co-localise with perivascular basement membranes throughout the striatum but, unlike soluble dextrans, are not taken up by perivascular macrophages after 3 h.
  
  
  CONCLUSIONS
  This study suggests that widespread perivascular distribution and interaction with perivascular macrophages is likely to be an inevitable consequence of CED of solutes. The potential consequences of perivascular distribution of therapeutic agents, and in particular cytotoxic chemotherapies, delivered by CED must be carefully considered to ensure safe and effective translation to clinical trials.
authors.affiliation: Department of Neurosurgery, Frenchay Hospital, Bristol, BS16 1LE, UK. Steven.Gill@nbt.nhs.uk.
authors.forename: Neil U
authors.initials: NU
authors.lastname: Barua
authors.forename: Alison S
authors.initials: AS
authors.lastname: Bienemann
authors.forename: Shirley
authors.initials: S
authors.lastname: Hesketh
authors.forename: Marcella J
authors.initials: MJ
authors.lastname: Wyatt
authors.forename: Emma
authors.initials: E
authors.lastname: Castrique
authors.forename: Seth
authors.initials: S
authors.lastname: Love
authors.forename: Steven S
authors.initials: SS
authors.lastname: Gill