Water and solute secretion by the choroid plexus

The cerebrospinal fluid (CSF) provides mechanical and chemical protection of the brain and spinal cord. This review focusses on the contribution of the choroid plexus epithelium to the water and salt homeostasis of the CSF, i.e. the secretory processes involved in CSF formation. The choroid plexus epithelium is situated in the ventricular system and is believed to be the major site of CSF production. Numerous studies have identified transport processes involved in this secretion, and recently, the underlying molecular background for some of the mechanisms have emerged. The nascent CSF consists mainly of NaCl and NaHCO3, and the production rate is strictly coupled to the rate of Na+ secretion. In contrast to other secreting epithelia, Na+ is actively pumped across the luminal surface by the Na+ ,K+-ATPase with possible contributions by other Na+ transporters, e.g. the luminal Na+,K+,2Cl(-) cotransporter. The Cl(-)p and HCO3- ions are likely transported by a luminal cAMP activated inward rectified anion conductance, although the responsible proteins have not been identified. Whereas Cl- most likely enters the cells through anion exchange, the functional as well as the molecular basis for the basolateral Na+ entry are not yet well-defined. Water molecules follow across the epithelium mainly through the water channel, AQP1, driven by the created ionic gradient. In this article, the implications of the recent findings for the current model of CSF secretion are discussed. Finally, the clinical implications and the prospects of future advances in understanding CSF production are briefly outlined.