Drug Transport by Fluid Motion
The rate of molecular movement by diffusion decreases dramatically with distance, and is generally inadequate for transport over distances greater than 100 μm. The movement of molecules over distances greater than 100 μm occurs in specialized compartments in the body: blood circulates through arteries and veins; interstitial fluid collects in lymphatic vessels before returning to the blood; cerebrospinal fluid (CSF) percolates through the central nervous system (CNS) in the brain ventricles and subarachnoid space. In these systems, molecules move primarily by bulk flow, or convection. Diffusive transport is driven by differences in concentration; convective transport is driven by differences in hydrostatic and osmotic pressure. This chapter introduces the principles of drug distribution by pressure-driven transport. The elaborate network of arteries, capillaries, and veins that carry blood throughout the body are described first in this chapter. Hydrostatic pressure within the blood vasculature drives fluid through the vessel wall (recall Equation 5-28) and into the extravascular space of tissues. Fluid flow through the interstitial space is not well understood, although the importance of interstitial flows in moving drug molecules through tissue is beginning to be appreciated. Engineering approaches for analyzing fluid flows in the interstitium are described in the second section of the chapter. Finally, the specialized systems for returning interstitial fluid to the blood are essential for clearance of molecules from the interstitial space; therefore, the chapter also provides a description of the dynamics of lymph flow in the periphery and CSF production and circulation in the brain. Our bodies appear, from the outside, to be solid masses that are slow to change, but, just beneath the surface, is a torrent of fluid motion. Blood moves at high velocity throughout the body within an interconnected and highly branched network of vessels. The cross-sectional area changes significantly along the network, and blood flow to the periphery emerges from the heart within a single vessel, which branches and rebranches to distribute blood to every tissue and organ.