Enlarged choroid plexus in relapsing-remitting multiple sclerosis may lead to brain structural changes through glymphatic impairment

Motivation: The enlarged choroid plexus (CP) in relapsing-remitting multiple sclerosis (RRMS) patients may further cause glymphatic function change and brain tissue damage. Goal(s): To explore potential links between structural brain changes in RRMS patients and CP volume as well as glymphatic function. Approach: Brain structural volume was obtained by Freesurfer segmentation. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index was used to assess the function of glymphatic system. Results: In both cross-sectional and longitudinal studies, RRMS patients had increased CP volume and decreased DTI-ALPS index. Impaired glymphatic clearance partially mediates the effects of CP enlargement on brain structural changes. Impact: Enlarged CP and impaired glymphatic system in RRMS patient may cause brain tissue damage. Using CP as a target for interventions may be beneficial to improve glymphatic system function and become a promising treatment strategy.