The video opens pinch a man successful his 80s slumped successful a infirmary bed, his look hollow arsenic he scrunches his eyes. A jump trim advances the segment 3 days: the man is alert now, words gathering arsenic he identifies his son.
Six months later, he is pictured sitting upright, engaged successful conversation. His regard is animated. At 8 months, the man walks briskly down a infirmary corridor. He recites a near-century-old Maoist subject anthem from memory. He is practically unrecognizable from the withered fig successful the opening frame.
The footage records the betterment of a man who, successful September 2020, became the first personification successful the world to acquisition a room known arsenic heavy cervical lymphatic-venous anastomosis (dcLVA) to dainty Alzheimer’s disease. The process involves connecting mini lymphatic vessels successful the cervix — portion of the drainage strategy that carries discarded distant from the encephalon — to adjacent veins, creating a way that, successful theory, allows fluid and discarded proteins to travel much easy into the bloodstream.
The curen was first reported1 successful 2022 successful a Chinese-language diary by microsurgeon Qingping Xie, president of the Qiushi Hospital successful Hangzhou, China. At the time, it drew small notice. But that changed the pursuing year, erstwhile Wei Chen, a lymphatic microsurgeon astatine the Cleveland Clinic successful Ohio, began showing the footage (with consent from Xie and the man’s family) astatine surgical meetings astir the world.
“A batch of jaws dropped,” recalls Chen. “It fundamentally started a frenzy of this room being performed near and right.”
Almost each of the surgeries took spot successful China, wherever hundreds of hospitals were soon offering the experimental procedure. Propelled by viral testimonial videos and fierce trading campaigns connected social-media platforms specified arsenic Douyin and WeChat, it was sought retired by thousands — pinch galore group paying much than 200,000 yuan (US$30,000) for a chance of recovery.
The accelerated adoption, successful the absence of difficult evidence, prompted Chinese regulators to intervene. Last year, they restricted the process to more-formalized objective investigation settings, alternatively than the advertisement hoc usage that had proliferated previously. And Xie, the pioneer of the technique, has been successful detention since September for undisclosed reasons.
The awesome encephalon clearance and dementia debate
Now, arsenic controlled studies get nether measurement astir the world, the technological organization remains divided complete whether aliases not the process really alters the people of the disease. Mechanistic explanations for why the room mightiness activity stay difficult to quadrate pinch really quickly immoderate individuals look to improve, clinicians say. And galore researchers stay concerned astir the risks, including infection, bleeding and wounded to adjacent nerves.
Nature spoke to much than 2 twelve researchers successful the field, revealing a operation of qualified enthusiasm and heavy scepticism.
“The conception is scientifically valid and biologically plausible,” says Young-Kwon Hong, a lymphatics interrogator astatine the Beth Israel Deaconess Medical Center successful Boston, Massachusetts. But he worries that the excitement has outpaced the evidence. “The dream is high,” he says, “and whenever dream is high, the hype besides follows.”
Medical maverick
Xie did not group retired to reinvent Alzheimer’s treatment. He trained arsenic a reconstructive microsurgeon, and is much astatine location pinch reconnecting severed vessels than pinch troubleshooting encephalon drainage. But according to interviews Xie gave earlier his detention, and corroborated by his girl Angela, who said to Nature, a stray lawsuit of tinnitus group him connected a different path.
In 2019, while performing room to relieve unit connected nerves that transportation sound signals to the brain, Xie noticed abnormalities successful lymphatic structures heavy successful the cervix of a middle-aged female pinch persistent ringing successful her ears. To bypass the problem area, he connected lymph vessels to adjacent veins, adapting a method first developed successful the 1960s to dainty achy swelling successful the arms and legs that tin hap erstwhile lymph nodes are removed aliases damaged during crab treatment.
After the surgery, the female reported not only that her tinnitus improved, but truthful had her intelligence acuity. Intrigued, Xie dug into the lit and recovered investigation that seemed to explicate the phenomenon. In 2015, a squad led by neuroimmunologist Jonathan Kipnis identified a web of lymphatic vessels successful the protective membranes that encase the brain, overturning the long-held thought that the encephalon lacked a accepted lymphatic system2. Three years later, Kipnis and his colleagues showed that disrupting these vessels successful mice impaired clearance of toxic amyloid-β proteins and accelerated cognitive decline3.
Qingping Xie (right) talks pinch Wei Chen (left) astatine the Cleveland Clinic.Credit: ANQI XIE
Together, the findings pointed to a benignant of hidden plumbing keeping the encephalon clean. This echoed earlier activity by neuroscientists Jeff Iliff and Maiken Nedergaard astatine the University of Rochester Medical Center successful New York. In 2012, they described an array of fluid-filled channels, chopped from existent lymphatic vessels, that tally alongside humor vessels and move fluid done encephalon insubstantial to flush retired waste4.
For Xie, the pieces clicked: if the brain’s discarded yet drains done these fluid-clearing pathways into lymphatic vessels successful the neck, he reasoned, past improving the outflow location mightiness heighten clearance upstream. And if clogs successful that plumbing lend to disease, past fixing the travel mightiness moreover thief to dainty neurodegenerative conditions specified arsenic Alzheimer’s. The 84-year-old man successful Xie’s video was his first trial case.
Weifeng Zeng first stumbled connected Xie’s activity successful February 2023, buried successful a China Medical News bulletin listing the “Seven awesome advances successful microsurgery successful 2022”; Xie’s dcLVA method classed sixth. By then, Xie had performed it connected much than 60 people, the bulletin noted.
Keen to study more, Zeng, a reconstructive microsurgeon astatine the University of Wisconsin–Madison, tracked down Xie’s study and cold-called the mobile number listed for the corresponding author. Xie picked up connected the first ring. He was eager to stock his surgical experiences, Zeng recalls, and excited to study that Chen and Zeng had been considering akin ideas astir lymphatic room for Alzheimer’s for much than a decade — though they had not performed specified an cognition astatine that point.
How to debar dementia — what the subject really says
A general collaboration ensued. Xie was soon connected a level to Cleveland, demonstrating his dcLVA method connected cadavers for Chen’s team. Chen folded Xie’s objective findings into his ain convention talks, and past the 2 (with Zeng and others) co-authored a little study laying retired the surgical method and its early results — the video of the first personification Xie treated included — successful the charismatic diary of the American Society of Plastic Surgeons5.
Word dispersed fast, some successful China and abroad. Surgeons astir the world made pilgrimages to Hangzhou to witnesser the cognition first-hand. Among them was J Mocco, a cerebrovascular neurosurgeon now astatine Weill Cornell Medicine successful New York City, who travelled to Qiushi Hospital successful August 2025. “I had ne'er seen thing for illustration it,” Mocco recalls.
“My first thought was: americium I seeing a revival-tent preacher acquisition here?” he says. “But I came distant from the sojourn to China saying: I don’t cognize if this is real, but it should beryllium investigated successful a rigorous and meaningful measurement to find if it is.”
Burden of proof
The grounds guidelines truthful acold chiefly consists of mini studies from China. Most were done astatine a azygous site, lacked a comparison group and offered small mechanistic grounds arsenic to really the curen mightiness nutrient benefits.
More than a twelve specified reports, involving a fewer 100 participants successful total, person been published truthful far. Collectively, they propose that the room tin trim levels of toxic amyloid-β and tau proteins successful the fluid that bathes the encephalon and spinal cord, and sharpen representation and attraction connected nonsubjective cognitive tests. The gains are typically humble erstwhile averaged crossed ample cohorts. But drastic turnarounds for illustration the 1 successful Xie’s original study proceed to aboveground — successful China and elsewhere.
“We are seeing immoderate incredibly encouraging data,” says Joon Pio (JP) Hong, a integrative surgeon astatine the University of Ulsan College of Medicine successful Seoul. He has worked pinch Xie directly, co-authoring different striking study past twelvemonth involving a 58-year-old female pinch terrible Alzheimer’s who could hardly locomotion earlier room and was capable to move unaided afterwards6. Hong is now moving his ain proceedings successful South Korea and says that he is uncovering the aforesaid spectacular gains successful immoderate individuals, though not successful everyone.
That echoes what is emerging successful larger, more-rigorous studies. In February, clinicians published a study involving much than 100 group — the largest cohort truthful acold — pinch terrible Alzheimer’s, who underwent dcLVA astatine the First People’s Hospital of Zunyi, successful southwestern China. Over respective months of follow-up, participants, connected average, showed humble improvements successful cognitive and functional scores alongside declines successful amyloid-β and tau levels successful cerebrospinal fluid7.
Independent imaging studies uncover immoderate preliminary backing for those gains. MRI scans taken earlier and aft room show accrued post-treatment connectivity successful the brain’s default mode network, a cardinal hub for memory-related activity8. Ultrasound scans uncover accrued humor travel done the neck’s jugular veins and carotid arteries9 — evidence, albeit preliminary, of restored circulation and encephalon connectivity underlying the objective and behavioural benefits.
But moreover those signals time off sizeable ambiguity astir whether the observed changes bespeak existent illness modification aliases conscionable a impermanent reprieve — and interviews pinch caregivers, conducted arsenic portion of a general study10 successful China’s Henan province, connection small clarity. If anything, specified accounts propose that perceived benefits are often subtle and inconsistent, shaped arsenic overmuch by anticipation and affectional finance arsenic by nonsubjective objective change. And, anecdotally astatine least, respective clinicians opportunity they’ve heard from colleagues successful China that the mostly of individuals backslide wrong a twelvemonth of surgery, echoing broader concerns that immoderate gains mightiness not last.
Lasting impressions
The mobility of durability now hangs complete the full field.
Kipnis, for one, isn’t convinced that the improvements will last. Just arsenic a roadworthy detour doesn’t hole a postulation jam — it only reroutes cars for a while — dcLVA mightiness amended the travel of encephalon discarded for a time. But without addressing immoderate caused the blockage successful the first place, he says, congestion will inevitably build backmost up. “The strategy will get clogged again and again,” warns Kipnis, who is based astatine Washington University School of Medicine successful St. Louis, Missouri.
Still, for families watching a loved 1 vanish into terrible dementia, and pinch fewer different curen options, short-term benefits could beryllium meaningful, notes JP Hong: “If the diligent is capable to amended moreover for a year, that’s a full freaking occurrence for the diligent and their family.” (Both he and Kipnis consult for Medical Microinstruments (MMI), a surgical robotics institution based successful Jacksonville, Florida, that is down a 15-person study of dcLVA now nether measurement successful the United States.)
Another point that is giving scientists region is the velocity pinch which symptoms statesman to displacement aft the surgery. “The point that doesn’t fresh for maine is the truth that the effects look comparatively immediate,” says Iliff, now astatine the University of Washington School of Medicine successful Seattle and a paid advisor for MMI. “I person a difficult clip knowing really those science of motion work.”
The early of Alzheimer’s treatment
It could beryllium that, by improving drainage from the brain, the room simply relieves unit successful fluid-filled spaces, easing accent connected surrounding insubstantial and improving cognitive function. Or it mightiness thief to flush retired inflammatory molecules and different toxic metabolites that accent neurons and thrust synaptic dysfunction. It mightiness moreover person a accelerated effect connected amyloid-β and tau, clearing soluble forms of the proteins that tin harm neurons, moreover though the plaques and tangles that specify Alzheimer’s pathology are near behind.
