Future Advances in Liquorpheresis Systems and Other Procedures Promoting the Clearance of CSF

This final chapter provides a perspective on the future advances in the development of liquorpheresis systems and upcoming applications that might benefit from these new developments, which are still in the preclinical stage today. We will focus on medtech innovations to filter CSF, increase CSF Flow, or enhance glymphatic function. We will disregard solely pharmacological strategies but will cover combinational solutions where medical devices act in combination with drugs. Different strategies based on medical devices are being explored, from enhancing CSF Flow and glymphatic function to CSF shunts. One of the most promising innovations is the combination of implantable devices with drugs, which can offer selectivity on the molecules to be cleared from the CSF. IT pseudodelivery of drugs is a novel concept to administer drugs to treat NDD, based on the CSF-sink therapeutic strategy by means of implanted devices. The mechanism of action relies on the properties of nanoporous membranes enabling selective molecular permeability. Being an invasive procedure, the expected safety issues of IT pseudodelivery are related to device implantation and functioning. However, the promising advantages of IT pseudodelivery of drugs in terms of efficacy and drug-related safety would overcome the disadvantages. Potentially, there are a number of NDDs where IT pseudodelivery might be of interest.