The present invention provides methods and systems for conditioning cerebrospinal fluid (CSF) by removing target compounds from CSF. The systems provide for a multilumen flow path and exchange of a majority volume portion of CSF in the CSF space. The removal and/or delivery of specific compounds can
The present invention provides methods and systems for conditioning cerebrospinal fluid (CSF) by removing target compounds from CSF. The systems provide for a multilumen flow path and exchange of a majority volume portion of CSF in the CSF space. The removal and/or delivery of specific compounds can be tailored to the pathology of the specific disease. The removal is targeted and specific, for example, through the use of specific size-exclusion thresholds, antibodies against specific toxins, and other chromatographic techniques, as well as delivery and/or removal of targeted therapeutic agents.
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1. A method for conditioning cerebrospinal fluid (CSF) in a patient, said method comprising: selecting a patient having a symptom of Alzheimer's disease;introducing a catheter apparatus into a first location in a CSF space of the patient, the catheter apparatus comprising a distal port and a proxima
1. A method for conditioning cerebrospinal fluid (CSF) in a patient, said method comprising: selecting a patient having a symptom of Alzheimer's disease;introducing a catheter apparatus into a first location in a CSF space of the patient, the catheter apparatus comprising a distal port and a proximal port spaced axially apart from one another;withdrawing a volume of endogenous CSF from the first location through one of said ports at a first flow rate;conditioning the withdrawn CSF; andreturning the conditioned CSF to the patient at a second location in the CSF space through the other of said ports at a second flow rate;wherein the withdrawing and returning steps are performed concurrently during at least a portion of a conditioning treatment;wherein the first and second flow rates are substantially the same rate;wherein, while an initial volume of endogenous CSF is withdrawn from the first location through the one of said ports, a volume of fluid from a primed system is infused at substantially the same rate through the other of said ports;wherein conditioning the withdrawn CSF comprises withdrawing proteins selected from a group consisting of tau proteins, IL-1, IL-2, IL-6, IL-12, and interferon-γ; andwherein withdrawing proteins selected from the group comprises withdrawing proteins using a combination of size, biospecific affinity, and charge-based selection criteria by contacting CSF with multiple substrates. 2. The method of claim 1, wherein the CSF is withdrawn and returned at a flow rate in the range from about 0.04 ml/min to about 30 ml/min. 3. The method of claim 2, wherein the volume of CSF removed from the patient is below a volume that would induce a spinal headache. 4. The method of claim 1, wherein a distance between the first location and the second location is at least about 4 cm. 5. The method of claim 1, wherein a distance between the first location and the second location is separated by at least about two vertebrae. 6. The method of claim 1, wherein the first location is at S1 or above and the second location is at L3 or above. 7. The method of claim 1, wherein the second location is in a cervical CSF space or a brain ventricle. 8. The method of claim 1, wherein a flow direction during the steps of removing and returning CSF is periodically reversed such that CSF is returned to the first location and removed from the second location during a portion of the conditioning treatment. 9. The method of claim 8, wherein reversing the flow direction comprises a pulse to dislodge debris from a lumen defined in the catheter apparatus, the distal port, the proximal port, or both ports. 10. The method of claim 1, further comprising mixing the conditioned CSF with endogenous, unconditioned CSF as the conditioned CSF is returned to the CSF space under conditions which enhance mixing of the returned CSF with the unconditioned CSF. 11. The method of claim 10, wherein the conditions that enhance mixing of the returned CSF include one or more selected from the group consisting of inducing a turbulent flow, directed outflow, high pressure injection, injection though multiple ports, a helical catheter, a T-catheter, bellows, ribbed catheter, fins and balloons. 12. A method for conditioning cerebrospinal fluid (CSF) in a patient, said method comprising: selecting a patient having a symptom of Alzheimer's disease;introducing a catheter apparatus into a first location in a CSF space of the patient, the catheter apparatus comprising a distal port and a proximal port spaced axially apart from one another;withdrawing a volume of endogenous CSF from the first location through one of said ports at a first flow rate;conditioning the withdrawn CSF; andreturning the conditioned CSF to the patient at a second location in the CSF space through the other of said ports at a second flow rate;wherein the removing and returning steps are performed concurrently during at least a portion of a conditioning treatment;wherein the first and second flow rates are substantially the same rate;wherein, while an initial volume of endogenous CSF is withdrawn from the first location through the one of said ports, a volume of fluid from a primed system is infused at substantially the same rate through the other of said ports;wherein conditioning the withdrawn CSF comprises removing proteins selected from a group consisting of tau proteins, IL-1, IL-2, IL-6, IL-12, and interferon-γ; andwherein removing proteins selected from the group comprises removing proteins using a combination of size, biospecific affinity, and charge-based selection criteria by contacting CSF with multiple substrates,wherein conditioning comprises processing CSF over an antibody cartridge comprising antibodies or antibody fragments secured to an ex-vivo immunoaffinity column, and wherein the method further comprises periodically re-using or re-charging the antibody cartridge, including using an eluent to release captured proteins and regenerate active antigen binding sites of the antibodies or antibody fragments. 13. The method of claim 1, wherein the catheter apparatus comprises a single catheter body having a lumen connected to the distal port and a separate lumen connected to the proximal port. 14. The method of claim 1, wherein at least one of the multiple substrates comprises a filtration component selected from the group consisting of membranous, nanoparticular, flat, tubular or capillary components, the filtration component having specific size-exclusion thresholds for the targeted removal of proteins. 15. The method of claim 1, wherein the multiple substrates are located within one or more cartridges replaceable as part of a rapid exchange system. 16. The method of claim 12, wherein one or more of the captured proteins released by using the eluent are collected for use. 17. The method of claim 1, wherein the multiple substrates are located within a single cartridge.
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