Entry of circulating inflammatory cells into the CNS

At baseline, cerebrovascular endothelial cells express few adhesion molecules and nonactivated lymphocytes and monocyte/macrophages do not enter the CNS with any efficiency. With infection, however, a variety of adhesion molecules including ICAM-1 and VCAM-1 are upregulated on endothelial cell surfaces. Activated lymphocytes and monocytes can then extravasate across the BBB without regard to their antigenic specificity. The entry of T cells in particular is dependent on the expression of LFA-1. Lymphocytes that identify their antigen are selectively retained within the CNS while the remaining cells depart. Although multiple cell types within the CNS can probably present antigen to activated T cells, it is controversial whether any serve as primary activators of naive T cells.

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