Cerebral glucose transport and oxygen consumption in sheep and rabbits

The role of amino acid transporters in GSH synthesis in the blood-brain barrier and central nervous system

Glutathione (GSH) plays a critical role in protecting cells from oxidative stress and xenobiotics, as well as maintaining the thiol redox state, most notably in the central nervous system (CNS). GSH concentration and synthesis are highly regulated within the CNS and are limited by availability of the sulfhydryl amino acid (AA) l-cys, which is mainly transported from the blood, through the blood-brain barrier (BBB), and into neurons. Several antiporter transport systems (e.g., x(c)(-), x(-)(AG), and L) with clearly different luminal and abluminal distribution, Na(+), and pH dependency have been described in brain endothelial cells (BEC) of the BBB, as well as in neurons, astrocytes, microglia and oligodendrocytes from different brain structures. The purpose of this review is to summarize information regarding the different AA transport systems for l-cys and its oxidized form l-cys(2) in the CNS, such as expression and activity in blood-brain barrier endothelial cells, astrocytes and neurons and environmental factors that modulate transport kinetics.

Glucose and lactate supply to the synapse

The main source of energy for the mammalian brain is glucose, and the main sink of energy in the mammalian brain is the neuron, so the conventional view of brain energy metabolism is that glucose is consumed preferentially in neurons. But between glucose and the production of energy are several steps that do not necessarily take place in the same cell. An alternative model has been proposed that states that glucose preferentially taken by astrocytes, is degraded to lactate and then exported into neurons to be oxidized. Short of definitive data, opinions about the relative merits of these competing models are divided, making it a very exciting field of research. Furthermore, growing evidence suggests that lactate acts as a signaling molecule, involved in Na(+) sensing, glucosensing, and in coupling neuronal and glial activity to the modulation of vascular tone. In the present review, we discuss possible dynamics of glucose and lactate in excitatory synaptic regions, focusing on the transporters that catalyze the movement of these molecules.

Steady-state brain glucose transport kinetics re-evaluated with a four-state conformational model

Glucose supply from blood to brain occurs through facilitative transporter proteins. A near linear relation between brain and plasma glucose has been experimentally determined and described by a reversible model of enzyme kinetics. A conformational four-state exchange model accounting for trans-acceleration and asymmetry of the carrier was included in a recently developed multi-compartmental model of glucose transport. Based on this model, we demonstrate that brain glucose (G(brain)) as function of plasma glucose (G(plasma)) can be described by a single analytical equation namely comprising three kinetic compartments: blood, endothelial cells and brain. Transport was described by four parameters: apparent half saturation constant K(t), apparent maximum rate constant T(max), glucose consumption rate CMR(glc), and the iso-inhibition constant K(ii) that suggests G(brain) as inhibitor of the isomerisation of the unloaded carrier. Previous published data, where G(brain) was quantified as a function of plasma glucose by either biochemical methods or NMR spectroscopy, were used to determine the aforementioned kinetic parameters. Glucose transport was characterized by K(t) ranging from 1.5 to 3.5 mM, T(max)/CMR(glc) from 4.6 to 5.6, and K(ii) from 51 to 149 mM. It was noteworthy that K(t) was on the order of a few mM, as previously determined from the reversible model. The conformational four-state exchange model of glucose transport into the brain includes both efflux and transport inhibition by G(brain), predicting that G(brain) eventually approaches a maximum concentration. However, since K(ii) largely exceeds G(plasma), iso-inhibition is unlikely to be of substantial importance for plasma glucose below 25 mM. As a consequence, the reversible model can account for most experimental observations under euglycaemia and moderate cases of hypo- and hyperglycaemia.

A quantitative overview of glucose dynamics in the gliovascular unit

While glucose is constantly being "pulled" into the brain by hexokinase, its flux across the blood brain barrier (BBB) is allowed by facilitative carriers of the GLUT family. Starting from the microscopic properties of GLUT carriers, and within the constraints imposed by the available experimental data, chiefly NMR spectroscopy, we have generated a numerical model that reveals several hidden features of glucose transport and metabolism in the brain. The half-saturation constant of glucose uptake into the brain (K(t)) is close to 8 mM. GLUT carriers at the BBB are symmetric, show accelerated-exchange, and a K(m) of zero-trans flux (K(zt)) close to 5 mM, determining a ratio of 3.6 between maximum transport rate and net glucose flux (T(max)/CMR(glc)). In spite of the low transporter occupancy, the model shows that for a stimulated hexokinase to pull more glucose into the brain, the number or activity of GLUT carriers must also increase, particularly at the BBB. The endothelium is therefore predicted to be a key modulated element for the fast control of energy metabolism. In addition, the simulations help to explain why mild hypoglycemia may be asymptomatic and reveal that [glucose](brain) (as measured by NMR) should be much more sensitive than glucose flux (as measured by PET) as an indicator of GLUT1 deficiency. In summary, available data from various sources has been integrated in a predictive model based on the microscopic properties of GLUT carriers.

Pharmacokinetic consequences of active drug efflux at the blood-brain barrier

PURPOSE

The objective of this simulation study was to investigate how the nature, location, and capacity of the efflux processes in relation to the permeability properties influence brain concentrations.

METHODS

Reduced brain concentrations can be due to either influx hindrance, a gatekeeper function in the luminal membrane, which has been suggested for ABCB1 (P-glycoprotein), or efflux enhancement by transporters that pick up molecules on one side of the luminal or abluminal membrane and release them on the other side. Pharmacokinetic models including passive transport, influx hindrance, and efflux enhancement were built using the computer program MATLAB. The simulations were based on experimentally obtained parameters for morphine, morphine-3-glucuronide, morphine-6-glucuronide, and gabapentin.

RESULTS

The influx hindrance process is the more effective for keeping brain concentrations low. Efflux enhancement decreases the half-life of the drug in the brain, whereas with influx hindrance the half-life is similar to that seen with passive transport. The relationship between the influx and efflux of the drug across the blood-brain barrier determines the steady-state ratio of brain to plasma concentrations of unbound drug, K(p,uu).

CONCLUSIONS

Both poorly and highly permeable drugs can reach the same steady-state ratio, although the time to reach steady state will differ. The volume of distribution of unbound drug in the brain does not influence K(p,uu), but does influence the total brain-to-blood ratio K(p) and the time to reach steady state in the brain.

Structure of the blood-brain barrier and its role in the transport of amino acids

Brain capillary endothelial cells form the blood-brain barrier (BBB). They are connected by extensive tight junctions, and are polarized into luminal (blood-facing) and abluminal (brain-facing) plasma membrane domains. The polar distribution of transport proteins mediates amino acid (AA) homeostasis in the brain. The existence of two facilitative transporters for neutral amino acids (NAAs) on both membranes provides the brain access to essential AAs. Four Na(+)-dependent transporters of NAA exist in the abluminal membranes of the BBB. Together these systems have the capability to actively transfer every naturally occurring NAA from the extracellular fluid (ECF) to endothelial cells and from there into circulation. The presence of Na(+)-dependent carriers on the abluminal membrane provides a mechanism by which NAA concentrations in the ECF of brain are maintained at approximately 10% those of the plasma. Also present on the abluminal membrane are at least three Na(+)-dependent systems transporting acidic AAs (EAAT) and a Na(+)-dependent system transporting glutamine (N). Facilitative carriers for glutamine and glutamate are found only in the luminal membrane of the BBB. This organization promotes the net removal of acidic- and nitrogen-rich AAs from the brain and accounts for the low level of glutamate penetration into the central nervous system. The presence of a gamma-glutamyl cycle at the luminal membrane and Na(+)-dependent AA transporters at the abluminal membrane may serve to modulate movement of AAs from blood to the brain. The gamma-glutamyl cycle is expected to generate pyroglutamate (synonymous with oxyproline) within the endothelial cells. Pyroglutamate stimulates secondary active AA transporters at the abluminal membrane, thereby reducing the net influx of AAs to the brain. It is now clear that BBB participates in the active regulation of the AA content of the brain.

Localization of brain endothelial luminal and abluminal transporters with immunogold electron microscopy

Immunogold electron microscopy has identified a variety of blood-brain barrier (BBB) proteins with transporter and regulatory functions. For example, isoforms of the glucose transporter, protein kinase C (PKC), and caveolin-1 are BBB specific. Isoform 1 of the facilitative glucose transporter family (GLUT1) is expressed solely in endothelial (and pericyte) domains, and approximately 75% of the protein is membrane-localized in humans. Evidence is presented for a water cotransport function of BBB GLUT1. A shift in transporter polarity characterized by increased luminal membrane GLUT1 is seen when BBB glucose transport is upregulated; but a greater abluminal membrane density is seen in the human BBB when GLUT1 is downregulated. PKC colocalizes with GLUT1 within these endothelial domains during up- and downregulation, suggesting that a PKC-mediated mechanism regulates human BBB glucose transporter expression. Occludin and claudin-5 (like other tight-junctional proteins) exhibit a restricted distribution, and are expressed solely within interendothelial clefts of the BBB. GFAP (glial fibrillary acidic protein) is uniformly expressed throughout the foot-processes and the entire astrocyte. But the microvascular-facing membranes of the glial processes that contact the basal laminae are also polarized, and their transporters may also redistribute within the astrocyte. Monocarboxylic acid transporter and water channel (Aquaporin-4) expression are enriched at the glial foot-process, and both undergo physiological modulation. We suggest that as transcytosis and efflux mechanisms generate interest as potential neurotherapeutic targets, electron microscopic confirmation of their site-specific expression patterns will continue to support the CNS drug discovery process.

Expression of the hexose transporters GLUT1 and GLUT2 during the early development of the human brain

We used immunohistochemistry with anti-glucose transporter antibodies to document the presence of facilitative hexose transporters in the fetal human brain. GLUT1 is expressed in all regions of the fetal brain from ages 10 to 21 weeks. GLUT1 was present in the endothelial cells of the brain capillaries, the epithelial cells of the choroid plexus and neurons. High expression of GLUT2 was observed in the granular layer of the cerebellum in brains 21 weeks old, but GLUT2 immunoreactivity was absent at earlier stages. GLUT3 and GLUT4 immunoreactivities were absent at all stages studied. GLUT5 immunoreactivity was evident only in the cerebellar region of 21-week old fetal brains. We conclude that GLUT1 plays a fundamental role in early human brain development. The data also suggest that the cerebellum of the developing brain has the capacity to transport fructose, a substrate that has not been previously identified as a source of metabolic energy in the adult human brain.

Spontaneous pregnancy toxaemia (ketosis) in sheep and the role of insulin

214 ewes suffering from pregnancy toxaemia (ketosis) were examined. Clinical signs during onset and course of disease and laboratory findings were compared between animals that survived and those which died. In the latter the onset of ketosis was earlier in pregnancy (day 143 +/- 7 vs. day 146 +/- 8) and duration of the disease was shorter (10 +/- 13 vs. 14 +/- 9 days). The animals that died showed more severe clinical signs and higher values of 3-hydroxy-butyrate (4.3 +/- 3.6 vs. 3.5 +/- 2.6 mmol/l) and cortisol (72 +/- 98 vs. 52 +/- 80 mmol/l) as well as lower values of insulin (37 + 12 vs. 3.5 + 2.6 mmol/l) and potassium (4.1 + 1.0 vs. 4.4 + 1.0 mmol/1) at onset of the disease than those which survived (all of differences with P < 0.05). Glucose levels did not differ between groups. Treated animals with glucose plus fructose infusions (n = 56) or with oral application of glucose precursors plus electrolytes (n = 126) had survival rates of 53.6% and 62.7%, respectively. Oral treatment with glucose precursors plus electrolytes and an additional subcutaneous insulin treatment (n = 15) led to an enhanced survival rate of 86.7% (P < 0.05). Low insulin levels in ketotic pregnant sheep and the therapeutic effect of insulin treatment support the hypothesis that insulin plays a causative role in the pathogenesis of ovine ketosis.

Determination of cerebral glucose transport and metabolic kinetics by dynamic MR spectroscopy

A new in vivo nuclear magnetic resonance (NMR) spectroscopy method is introduced that dynamically measures cerebral utilization of magnetically labeled [1-13C]glucose from the change in total brain glucose signals on infusion. Kinetic equations are derived using a four-compartment model incorporating glucose transport and phosphorylation. Brain extract data show that the glucose 6-phosphate concentration is negligible relative to glucose, simplifying the kinetics to three compartments and allowing direct determination of the glucose-utilization half-life time [t1/2 = ln2/(k2 + k3)] from the time dependence of the NMR signal. Results on isofluorane (n = 5)- and halothane (n = 7)-anesthetized cats give a hyperglycemic t1/2 = 5.10 +/- 0.11 min-1 (SE). Using Michaelis-Menten kinetics and an assumed half-saturation constant Kt = 5 +/- 1 mM, we determined a maximal transport rate Tmax = 0.83 +/- 0.19 mumol.g-1.min-1, a cerebral metabolic rate of glucose CMRGlc = 0.22 +/- 0.03 mumol.g-1.min-1, and a normoglycemic cerebral influx rate CIRGlc = 0.37 +/- 0.05 mumol.g-1.min-1. Possible extension of this approach to positron emission tomography and proton NMR is discussed.

1H NMR studies of glucose transport in the human brain

The difference between 1H nuclear magnetic resonance (NMR) spectra obtained from the human brain during euglycemia and during hyperglycemia is depicted as well-resolved glucose peaks. The time course of these brain glucose changes during a rapid increase in plasma glucose was measured in four healthy subjects, aged 18-22 years, in five studies. Results demonstrated a significant lag in the rise of glucose with respect to plasma glucose. The fit of the integrated symmetric Michaelis-Menten model to the time course of relative glucose signals yielded an estimated plasma glucose concentration for half maximal transport, Kt, of 4.8 +/- 2.4 mM (mean +/- SD), a maximal transport rate, Tmax, of 0.80 +/- 0.45 micromol g-1 min-1, and a cerebral metabolic glucose consumption rate (CMR)glc of 0.32 +/- 0.16 micromol g-1 min-1. Assuming cerebral glucose concentration to be 1.0 micromol/g at euglycemia as measured by 13CMR, the fit of the same model to the time course of brain glucose concentrations resulted in Kt = 3.9 +/- 0.82 mM, Tmax = 1.16 +/- 0.29 micromol g-1 min-1, and CMRglc = 0.35 +/- 0.10 micromol g-1 min-1. In both cases, the resulting time course equaled that predicted from the determination of the steady-state glucose concentration by 13C NMR spectroscopy within the experimental scatter. The agreement between the two methods of determining transport kinetics suggests that glucose is distributed throughout the entire aqueous phase of the human brain, implying substantial intracellular concentration.

An ultrasonic Doppler venous outflow method for the continuous measurement of cerebral blood flow in conscious sheep

A pulsed ultrasonic Doppler venous outflow method was developed for the continuous measurement of global cerebral blood flow (CBF) in conscious sheep. The sheep were prepared under anesthesia with a "suture down"-style ultrasonic flow probe on the dorsal sagittal sinus placed via a trephine hole. Angiographic and dye studies showed that the dorsal sagittal sinus at the point of placement of the probe collected the majority of the blood from the cerebral hemispheres. Studies of the blood velocity profile across the sinus showed that the dimensions of the dorsal sagittal sinus changed minimally with changes in CBF in vivo. The velocity measurements were calibrated under anesthesia against an in vivo direct venous outflow method. Control CBF values for six sheep ranged from 31 to 53 ml/min for the area of brain described above; for two sheep in which the weight of the brain was determined, this gave total CBF values of approximately 34 and 30 ml min-1 100 g-1. The CBF measured varied in the expected manner with changes in the end-tidal CO2 concentration in expired breath and showed transient reductions with the barbiturate thiopentone and transient increases with the opiate alfentanil. It is concluded that the method is simple and accurate.

An electron microscopic immunogold analysis of developmental up-regulation of the blood-brain barrier GLUT1 glucose transporter

Electron microscopy was used to quantitate blood-brain barrier (BBB) glucose transporters in newborn, 14-day-old suckling, 28-day-old weanling, and adult rabbits. A rabbit polyclonal antiserum to a synthetic peptide encoding the 13 C-terminal amino acids of the human erythrocyte glucose transporter (GLUT1) was labeled with 10-nm gold particle-secondary antibody conjugates and localized immunoreactive GLUT1 molecules in rabbit brain capillary endothelia. Three distinct populations of brain capillary profiles were identified in newborn rabbits: prepatent capillary buds, partially patent capillaries with highly amplified luminal membranes, and patent capillaries. Immunogold analyses indicated that the GLUT1 transporter abundance positively correlated with capillary developmental status. The mean number of gold particles per capillary profile increased at each developmental age examined, suggesting that developmental up-regulation of the BBB glucose transporter occurred in rabbits. GLUT1 immunoreactivity was three- to fourfold greater on the abluminal than luminal capillary membranes among all ages examined. Changes in the proportions of GLUT1 transporter were also seen, and possible reasons for the postnatal decrease in the percentage of cytoplasmic GLUT1 transporter are discussed. The numbers of cytoplasmic and membrane-associated immunogold particles increased with age. We conclude that regulatory modulations of BB glucose transport may be characterized by increases in BBB glucose transporter density with age and state of development. In addition, modulation of glucose transporter activity may be reflected by minor postnatal shifts of GLUT1 from cytoplasmic to membrane compartments, which can be demonstrated with quantitative immunogold electron microscopy.

Hypoglycaemia: brain neurochemistry and neuropathology

The widespread use of insulin and oral hypoglycaemic agents has increased the incidence of hypoglycaemic brain damage due to accidental, suicidal, or homicidal overdose. Hypoglycaemia is capable of damaging the brain in the face of intact cardiac function, but neuronal necrosis occurs only when the electroencephalogram (EEG) becomes isoelectric. Neurochemical changes are distinct from ischaemia, and cerebral blood flow is actually increased, in contrast to cerebral ischaemia. Salient neurochemical changes include an arrest of protein synthesis in many but not all brain regions, a shift of brain redox equilibria towards oxidation, incomplete energy failure, loss of ion homeostasis, cellular calcium influx, intracellular alkalosis, and a release of neuroactive amino acids, especially aspartate, into the extracellular space of the brain. The metabolic release of aspartate, and to a lesser extent glutamate, into the interstitial space of the brain produces histopathological patterns of neuronal death that can be distinguished from ischaemic brain damage in experimental brain tissue and, occasionally, in brains from human autopsies after hypoglycaemic brain damage. The excitatory amino acids released during profound hypoglycaemia bind to neuronal dendrites and perikarya, but not to other cell types in the nervous system, thus giving rise to selective neuronal death. The absence of acidosis, and an adequate blood supply during hypoglycaemia, protect the brain against pan-necrosis or infarction. However, the neurons die more quickly during hypoglycaemic brain damage than after cerebral ischaemia. Hypoglycaemic brain damage thus falls into the newly defined class of cerebral 'excitotoxic' neuropathologies, where neurons are selectively killed by an extracellular overflow of excitatory amino acids produced by the brain itself. The pathogenesis of hypoglycaemic brain damage is thus rather more novel and intriguing than was thought even a decade ago, when it was believed that glucose starvation and simple energy failure resulted directly in neuronal catabolism.

Cerebral lactate turnover after electroshock: in vivo measurements by 1H/13C magnetic resonance spectroscopy

We reported earlier that brain activation by 10 s of cortical electroshock caused prolonged elevation of brain lactate without significant change in intracellular pH, brain high-energy phosphorylated metabolites, or blood gases. The metabolic state of the elevated lactate has been investigated in further experiments using combined, in vivo 1H-observed 13C-edited nuclear magnetic resonance spectroscopy (NMRS), homonuclear J-edited 1H-NMRS, and high-resolution 1H-NMRS of perchloric acid extracts to monitor concentrations and 13C-isotopic fractions of brain and blood lactate and glucose. We now report that electroshock-elevated lactate pool in rabbit brain approaches equilibrium with blood glucose within 1 h. There was nearly complete turnover of the raised lactate pool in brain; any pool of metabolically inactive lactate could not have been > 5% of the total. In the same experiments, blood lactate underwent < 50% turnover in 1 h. The new 1H-spectroscopic methods used for these experiments are readily adaptable for the study of human brain and may be useful in characterizing the metabolic state of elevated lactate pools associated with epilepsy, stroke, trauma, tumors, and other pathological conditions.

Regulation of cerebral glucose metabolism in normal and polycythemic newborn lambs

In contrast to previous investigations, a recent study of polycythemic lambs suggested that cerebral glucose delivery (concentration x blood flow), not arterial glucose concentration, determined cerebral glucose uptake. In the present study, the independent effects of arterial glucose concentration and delivery on cerebral glucose uptake were examined in two groups of chronically catheterized newborn lambs (control and polycythemic). Arterial glucose concentration was varied by an infusion of insulin. CBF was reduced in one group of lambs (polycythemic) by increasing the hematocrit. At all arterial glucose concentrations, the cerebral glucose delivery of the polycythemic group was 59.6% of the control group. At arterial glucose concentrations of greater than 1.6 mmol/L, cerebral glucose uptake was constant and similar in both groups. At arterial glucose concentrations of less than or equal to 1.6 mmol/L, cerebral glucose uptake was unchanged in the control group, but was significantly decreased in the polycythemic group. In contrast, the cerebral glucose uptake was similar in both groups over a broad range of cerebral glucose delivery values. At cerebral glucose delivery values less than or equal to 83 mumols/min/100 g, there was a significant decrease in cerebral glucose uptake in both groups. During periods of low cerebral glucose delivery and uptake, cerebral oxygen uptake fell in the control group but remained unchanged in the polycythemic group. Maintenance of cerebral oxygen uptake in the polycythemic group was associated with an increased extraction and uptake of lactate and beta-hydroxybutyrate. We conclude that cerebral glucose delivery, not arterial glucose concentration alone, determines cerebral glucose uptake.

Computer simulation of the blood-brain barrier: a model including two membranes, blood flow, facilitated and non-facilitated diffusion

A mathematical model of blood-brain barrier (BBB) transport was developed to assist in experimental design and data analysis. The model includes the luminal and antiluminal endothelial cell membranes, each with separate transport systems. Substrate movement between 3 compartments can be calculated: the capillary lumen, the endothelial cell cytoplasm, and the brain parenchyma. Blood flow, substrate concentration and competition in each compartment, concentration gradients along the capillary, and non-steady-state conditions are considered. The utility of the model is demonstrated by predicting: (1) complex concentration profiles along the length of the capillary lumen under different circumstances, (2) the permeability-surface area products along the capillary lumen, (3) the time course of events during brain-uptake index (BUI) experiments, (4) the accuracy of the BUI in measuring glucose transport over a range of endogenous glucose concentrations, (5) the influence of 2 membranes in series with different kinetic constants, and (6) a comparison of kinetic constants expected from high-flow infusion and BUI experiments.

Direct measurement of brain glucose concentrations in humans by 13C NMR spectroscopy

Glucose is the main fuel for energy metabolism in the normal human brain. It is generally assumed that glucose transport into the brain is not rate-limiting for metabolism. Since brain glucose concentrations cannot be determined directly by radiotracer techniques, we used 13C NMR spectroscopy after infusing enriched D-[1-13C]glucose to measure brain glucose concentrations at euglycemia and at hyperglycemia (range, 4.5-12.1 mM) in six healthy children (13-16 years old). Brain glucose concentrations averaged 1.0 +/- 0.1 mumol/ml at euglycemia (4.7 +/- 0.3 mM plasma) and 1.8-2.7 mumol/ml at hyperglycemia (7.3-12.1 mM plasma). Michaelis-Menten parameters of transport were calculated to be Kt = 6.2 +/- 1.7 mM and Tmax = 1.2 +/- 0.1 mumol/g.min from the relationship between plasma and brain glucose concentrations. The brain glucose concentrations and transport constants are consistent with transport not being rate-limiting for resting brain metabolism at plasma levels greater than 3 mM.

Blood-brain barrier glucose transporter is asymmetrically distributed on brain capillary endothelial lumenal and ablumenal membranes: an electron microscopic immunogold study

It is generally assumed that there is symmetric distribution of the glucose transporter on the lumenal and ablumenal membranes of the brain capillary endothelial cell that makes up the blood-brain barrier (BBB) in vivo. However, the presence of brain endothelial tight junctions allows for asymmetric distribution of BBB plasma membrane proteins. Glucose transporter isoform 1 (GLUT-1), the principal glucose transporter at the BBB, was assessed in rat brain in the present studies using immunogold electron microscopy. The distribution of the immunoreactive GLUT-1 protein on the endothelial lumenal membrane, the ablumenal membrane, and the cytoplasmic compartment was 12%, 48%, and 40%, respectively, and no significant immunolabeling of the neuropil was measurable. These studies suggest (i) that GLUT-1 is asymmetrically distributed on the BBB plasma membrane with an approximately 4-fold greater abundance on the ablumenal membrane as compared to the lumenal membrane; (ii) that approximately 40% of the endothelial glucose transporter protein is contained within the cytoplasmic space, which provides a mechanism for rapid up-regulation of the transporter by altered distribution of transporter between cytoplasmic and plasma membrane compartments; and (iii) that no significant labeling of neuropil is found with antisera directed against the GLUT-1 protein. These studies also suggest mechanisms of regulation of glucose transport from blood to brain that involve differential distribution of the BBB glucose transporter in subcellular compartments of brain capillary endothelial cells.

Radiorespirometric patterns of [14C]-substrates in rats. II. Differences with the nature and administration route of the injection fluid

The effects on the 14CO2 expiratory patterns of the nature and administration route of the injection fluid containing [14C]-glucose were studied. In the case of rapid intravenous injection, no difference in the radiorespirometric pattern was found with different glucose concentrations and volumes of the aqueous injection fluid. With intravenous injection, lower P1 heights and longer plateaus were recorded with the [14C]-glucose blood mixture as compared to the aqueous injection fluid. This result indicates that [14C]-glucose in the aqueous fluid injected into the blood vessel could be supplied into organs or tissues before mixing with the blood fluid in the blood vessel system. It is also suggested that larger amounts of [14C]-glucose are taken up into organs and tissues when the label was in aqueous solution rather than blood. In the case of intraduodenal infusion, a trace of glucose in a small volume (0.05 ml) of aqueous solution gave a similar radiorespirometric pattern to that given by intravenous injection of aqueous fluid. This indicates that there was fast absorption of glucose by the intestinal mucosa, which was not rate-limiting. A relatively large volume and very high concentration of glucose in the infusion fluid caused suppression of the radiorespirometric pattern. This may reflect physical suppression of intestinal peristalsis.

The flux from glucose to glutamate in the rat brain in vivo as determined by 1H-observed, 13C-edited NMR spectroscopy

The rate of incorporation of carbon from [1-13C]glucose into the [4-CH2] and [3-CH2] of cerebral glutamate was measured in the rat brain in vivo by 1H-observed, 13C-edited (POCE) nuclear magnetic resonance (NMR) spectroscopy. Spectra were acquired every 98 s during a 60-min infusion of [1-13C]glucose. Complete time courses were obtained from six animals. The measured intensity of the unresolved [4-13CH2] resonances of glutamate and glutamine increased exponentially during the infusion and attained a steady state in approximately 20 min with a first-order rate constant of 0.130 +/- 0.010 min-1 (t1/2 = 5.3 +/- 0.5 min). The appearance of the [3-13CH2] resonance in the POCE difference spectrum lagged behind that of the [4-13CH2] resonance and had not reached steady state at the end of the 60-min infusion (t1/2 = 26.6 +/- 4.1 min). The increase observed in 13C-labeled glutamate represented isotopic enrichment and was not due to a change in the total glutamate concentration. The glucose infusion did not affect the levels of high-energy phosphates or intracellular pH as determined by 31P NMR spectroscopy. Since glucose carbon is incorporated into glutamate by rapid exchange with the tricarboxylic acid (TCA) cycle intermediate alpha-ketoglutarate, the rate of glutamate labeling provided an estimate of TCA cycle flux. We have determined the flux of carbon through the TCA cycle to be approximately 1.4 mumols g-1 min-1. These experiments demonstrate the feasibility of measuring metabolic fluxes in vivo using 13C-labeled glucose and the technique of 1H-observed, 13C-decoupled NMR spectroscopy.

Kinetic analysis of blood-brain barrier transport of D-glucose in man: quantitative evaluation in the presence of tracer backflux and capillary heterogeneity

The present study deals with the analysis of double-indicator curves for blood-brain barrier studies. Two mathematical models which provide for the estimation of backflux of tracer from brain to blood in conjunction with heterogeneity of the cerebral capillary and large-vessel transit times were used for the analysis of D-glucose transport on the basis of cerebral venous outflow curves. The two models, non-mixed and well mixed, arise from differing assumptions regarding the effective region surrounding the capillary lumen. An approximate solution for the well-mixed model was developed to increase computation speed. Fourteen D-glucose outflow curves and their reference curves were obtained from nine patients and subsequently analyzed by the two models. Further, in five patients data were obtained under different physiological conditions: normal, decreased, and increased cerebral blood flow rates. The results support the appropriateness of the well-mixed model and heterogeneity of the cerebral capillary transit times. The median value for the average extraction was 0.18 and the median distribution space was 0.14. The latter value is similar to the brain extracellular space that has been estimated by other methods. The extraction values calculated from the peak of the venous outflow curves were significantly smaller than the whole-brain average extraction values estimated with the well-mixed model (0.157 vs 0.178, P less than 0.0005). In summary: (a) capillary heterogeneity is present in the human brain and changes with cerebral blood flow; (b) after crossing the blood-brain barrier, D-glucose distributes in the brain extracellular fluid; and (c) the extraction curve is significantly influenced by backflux.

Improved brain metabolism with fructose 1-6 diphosphate during insulin-induced hypoglycemic coma

The effect of fructose 1-6 diphosphate (FDP) on brain metabolism and brain function was investigated in hypoglycemic rabbits. The electroencephalogram and differences in oxygen content of arterial and cerebral venous blood were used as indicators for brain metabolic activity. Hypoglycemic coma was induced and maintained for 1 hour by insulin administration. At the onset of isoelectric EEG, six rabbits were treated with FDP and five rabbits received 0.9% saline. The animals were killed by an overdose of barbiturate 60 minutes after hypoglycemic recovery with glucose. FDP-treated rabbits had lower arterial glucose concentration after 40 minutes of treatment (p less than .05) and a significantly greater difference between the oxygen content of arterial and venous blood after 40 minutes (p less than .01), and after 60 minutes (p less than .025) of FDP infusion than saline-treated rabbits. FDP-treated rabbits also had a lower cerebral glucose-oxygen index than did saline-treated rabbits (p less than .005, after 20 and 40 minutes of FDP infusion). FDP administration was followed by a return of EEG activity during hypoglycemia, whereas saline produced no such effect. After glucose infusion, EEG activity was improved in FDP-treated rabbits; in saline-treated rabbits, minimal or no EEG activity was observed. The data suggest the possibility that, at the doses given in this study, FDP is taken up and used as a metabolic substrate by the brain.

Glucose transfer into rat brain during acute and chronic hyperglycemia

Chronic hyperglycemia has been reported to decrease the maximum velocity of glucose transport across the blood-brain barrier by 30 to 40%. However, available measurements of brain glucose content during chronic hyperglycemia are consistent with an unaltered transport system. Because of this discrepancy the brain capillary permeability-surface area product (PA) was measured in awake-restrained rats during acute and chronic hyperglycemia. Acute hyperglycemia was produced by intraperitoneal injection of glucose, and chronic hyperglycemia was produced by treatment with streptozotocin. PA was measured using an intravenous tracer method. PA decreased during hyperglycemia, consistent with saturation kinetics for transfer. However, PA was similar in acutely and chronically hyperglycemic rats. These data suggest that down-regulation of facilitated glucose transport into the brain does not occur during chronic hyperglycemia.

Tracer 2-deoxyglucose kinetics in brain regions of rats given kainic acid

The initial distribution of tracer amounts of 2-deoxyglucose between plasma and brain tissue, relative to native glucose, and the rate of accumulation of 2-deoxyglucose-6-phosphate were determined in brain regions of rats given kainic acid intravenously. Regional plasma flow was measured in a comparable group of animals. A previously described compartmental model was used to obtain estimates of rates of glucose transport and of glucose phosphorylation. Both rates were significantly increased in entorhinal cortex, hippocampus, amygdala, and septal nucleus. From measured brain tissue and plasma glucose concentrations, glucose fluxes were also calculated in terms of either irreversible or reversible Michaelis-Menten kinetics. In all brain regions of control rats and in six of the ten regions studied in rats given kainic acid, rates of glucose transport calculated in terms of the Michaelis-Menten models were consistent with those estimated by the tracer 2-deoxyglucose procedure. However, in the four regions in which glucose metabolism was stimulated, rates of glucose transport calculated from the behaviour of tracer 2-deoxyglucose were considerably higher than rates calculated from measured concentrations of glucose in plasma and brain tissue using Michaelis-Menten models. The possibility is considered that in those regions that are metabolically stimulated by kainate, there is an increasing asymmetry between the luminal and abluminal membranes of the capillary endothelium in the permeability to glucose and its analogs. An alternative proposal is that in the model used to analyse the tracer 2-deoxyglucose data, the assumption of a rapid mixing of tracer throughout the endogenous pool of tissue glucose prior to phosphorylation becomes invalid. The discrepancies between tracer and native glucose in these particular regions of rats given kainate are consistent with an apparent metabolic compartmentation. The influence of kainate on plasma flow was found to differ regionally, with flow in entorhinal cortex, hippocampus, and amygdala being unchanged. There is some evidence for increased rates of glycolysis relative to oxidative metabolism in these regions.

Brain energy metabolism in streptozotocin-diabetes

Regional brain glucose use was measured in rats with streptozotocin-induced diabetes (65 mg/kg intravenously) of 1 or 4 weeks duration, by using [6-14C]glucose and quantitative autoradiography. The concentrations of several metabolites were measured in plasma and brain. Results were compared with those from normal untreated rats. Glucose concentrations were increased in both plasma and brain, to similar degrees in both diabetic groups. Plasma ketone-body concentrations were 0.25, 1.0, and 3.15 mumol/ml in the control, 1-week and 4-week groups respectively (sum of acetoacetate and 3-hydroxybutyrate). Glucose use was increased throughout the brain (differences were statistically significant in 55 of 59 brain areas) after 1 week of diabetes, with an increase of 25% for the brain as a whole. In contrast, normal rates were found throughout the brain after 4 weeks of diabetes. None of the brain areas was affected significantly differently from the others, in either diabetic group. There was no significant loss of 14C as lactate or pyruvate during the experimental period, nor was there any indication of net production of lactate in any of the groups. Other methodological considerations that could have affected the results obtained in the diabetic rats were likewise ruled out. Because the ketone bodies are expected to supplement glucose as a metabolic fuel for the brain, our results indicate that brain energy consumption is increased during streptozotocin-diabetes.

Blood-brain transport of thiamine monophosphate in the rat: a kinetic study in vivo

To calculate the kinetic parameters of thiamine monophosphate transport across the rat blood-brain barrier in vivo, different doses of a [35S]thiamine monophosphate preparation with a specific activity of 14.8 mCi.mmol-1 were injected in the femoral vein and the radioactivity was measured in arterial femoral blood and in the cerebellum, cerebral cortex, pons, and medulla 20 s after the injection. This short experimental time was used to prevent thiamine monophosphate hydrolysis. Thiamine monophosphate was transported into the nervous tissue by a saturable mechanism. The maximal transport rate (Jmax) and the half-saturation concentration (Km) equaled 27-39 pmol.g-1.min-1 and 2.6-4.8 microM, respectively. When compared with that of thiamine, thiamine monophosphate transport seemed to be characterized by a lower affinity and a lower maximal influx rate. At physiological plasma concentrations, thiamine monophosphate transport rate ranged from 2.06 to 4.90 pmol.g-1.min-1, thus representing a significant component of thiamine supply to nervous tissue.

Studies on the relationship between cerebral glucose transport and phosphorylation using 2-deoxyglucose

Regional rates of blood-brain glucose transfer and phosphorylation have been measured in anaesthetized fasted and conscious fed and fasted rats using a dual-label 2-deoxyglucose technique that exploits differences in the early-time distribution of analogue and native glucose between blood and brain. Regional cerebral blood flow was also measured in comparable groups of rats. Estimates of glucose influx in the anaesthetized group were compared with those calculated from previously published kinetic constants obtained using [14C]D-glucose as tracer. The close agreement of these two sets of results served to validate estimates of influx obtained using the glucose analogue. Comparisons between all three groups showed that regional rates of glucose influx were maintained at levels appropriate to the rate of cerebral glucose phosphorylation. This occurred despite wide variations in plasma glucose concentration. The results indicate that at least two factors are involved in the adaptation of glucose supply to meet metabolic demand. One is related to blood flow, and probably reflects changes in the surface area of the capillary endothelium perfused. The second involves changes in the blood-brain barrier permeability to glucose and could reflect changes in the density of functioning glucose transporters within capillary endothelial cell membranes.

Progress review: hypoglycemic brain damage

The central question to be addressed in this review can be stated as "How does hypoglycemia kill neurons?" Initial research on hypoglycemic brain damage in the 1930s was aimed at demonstrating the existence of any brain damage whatsoever due to insulin. Recent results indicate that uncomplicated hypoglycemia is capable of killing neurons in the brain. However, the mechanism does not appear to be simply glucose starvation of the neuron resulting in neuronal breakdown. Rather than such an "internal catabolic death" current evidence suggests that in hypoglycemia, neurons are killed from without, i.e. from the extracellular space. Around the time the EEG becomes isoelectric, an endogenous neurotoxin is produced, and is released by the brain into tissue and cerebrospinal fluid. The distribution of necrotic neurons is unlike that in ischemia, being related to white matter and cerebrospinal fluid pathways. The toxin acts by first disrupting dendritic trees, sparing intermediate axons, indicating it to be an excitotoxin. Exact mechanisms of excitotoxic neuronal necrosis are not yet clear, but neuronal death involves hyperexcitation, and culminates in cell membrane rupture. Endogenous excitotoxins produced during hypoglycemia may explain the tendency toward seizure activity often seen clinically. The recent research results on which these findings are based are reviewed, and clinical implications are discussed.

Regional blood-brain glucose transfer in the rat: a novel double-membrane kinetic analysis

Regional blood-brain glucose transfer was studied in pentobarbitone-anaesthetized rats using a programmed intravenous infusion technique that maintained steady levels of unlabeled (up to 55 mM) and tracer D-glucose in the circulating plasma. Regional cerebral blood flow, glucose phosphorylation rate, and tissue glucose content were also measured under comparable conditions. Data were analysed in terms of irreversible Michaelis-Menten kinetics assuming independent influx and efflux (Type I) and reversible Michaelis-Menten kinetics (Type II) across both the luminal and the abluminal membranes of the endothelial cell. The latter analysis corresponds to simple stereospecific membrane pores. The mathematical model allowed for changes in tissue glucose content and back-diffusion of tracer during the experiments. Type I analyses gave Kt values of approximately 6.6 mM, whereas those by Type II were consistently lower. Interregional differences were not significant using either scheme. Comparison of Type II with Type I analyses revealed a possible explanation for discrepancies in the estimates of nonsaturable glucose transfer by different methods and highlighted the importance of tissue glucose measurements in studies of unidirectional glucose influx. Since the experimental data may be described equally well by either scheme and some interaction between influx and efflux across the endothelial cell might be expected, consideration of this alternative approach is suggested.

Insufficient supply of reducing equivalents to the respiratory chain in cerebral cortex during severe insulin-induced hypoglycemia in cats

The ability of endogenous substrates in brain to substitute for glucose as sources for energy metabolism during insulin-induced hypoglycemia was studied. The ratio of the arteriovenous difference of glucose to the arteriovenous difference of oxygen in the cerebral cortex was measured during progressive hypoglycemia in paralyzed, artificially ventilated cats that were anesthetized with pentobarbital sodium and nitrous oxide. The ratio did not change when blood glucose fell from a mean of 7.68 to approximately 2 mumol/ml. Below 2 mumol/ml the ratio decreased, indicating that substrates other than the glucose supplied by the blood were being utilized. In another series of experiments, changes in the redox state of respiratory chain NAD were monitored from the cerebral cortex using microfluorometry during the onset of hypoglycemia and the recovery. Hypoglycemia severe enough to produce isoelectric EEG was accompanied by an oxidation of NADH, demonstrating that the supply of reducing equivalents to the respiratory chain was decreased. Recovery from hypoglycemia, produced by intravenous glucose injections, was accompanied by an increase in blood glucose concentrations, the return of EEG activity, and a decrease in the NAD/NADH ratio. When blood glucose concentration reached 2.23 during the recovery, further increases in blood glucose had no effect on the redox state of NAD. Although alternative substrates appear to be utilized for energy metabolism during severe hypoglycemia, they cannot fully replace glucose as the source of reducing equivalent to the respiratory chain.

Hypotension as a complication of hypoglycemia leads to enhanced energy failure but no increase in neuronal necrosis

The hypothesis that arterial hypotension aggravates hypoglycemic brain damage was tested. Thirty minutes of insulin induced hypoglycemia with a flat EEG ("isoelectricity") was compared in seven series of rats. In three series of animals, the energy state of the cerebral cortex was determined at blood pressures of 140, 100 and 80 mm Hg respectively. Hypotension during hypoglycemia exacerbated cortical energy failure. In the fourth to sixth series, blood pressure was adjusted during isoelectricity to 160, 100 and 60 mm Hg, respectively. A seventh series had induced hypotension to 60 mm Hg only in the recovery period. Quantitation of neuronal death was performed in the fourth to seventh series of rats by direct visual counting of acidophilic neurons in sub-serially sectioned brains after one week survival. Although the first three series demonstrated enhanced deterioration of the cerebral energy state with lower blood pressures during hypoglycemia, the fourth to seventh series showed no augmentation of quantitated hypoglycemic neuronal necrosis. The distinct distribution of hypoglycemic brain damage, suggesting a fluid-borne toxin, was present at normal and reduced blood pressures, with no tendency toward an ischemic pattern of pathology. In spite of previously demonstrated reductions of cerebral blood flow to ischemic levels in regions with pronounced loss of autoregulation, no regional exacerbation of neuronal necrosis was seen in these brain areas. It is concluded that hypoglycemic brain damage is distinct from ischemic brain damage, and that the two insults are not additive. Furthermore, moderate hypotension to 60 mm Hg does not aggravate the damage in spite of an enhanced energy failure.

Steady-state distribution of cycloleucine and alpha-aminoisobutyric acid between plasma and cerebrospinal fluid

Estimates of the steady-state distribution ratios of two nonmetabolizable amino acids, alpha-aminoisobutyric acid and aminocyclopentane carboxylic acid (cycloleucine), between plasma and cerebrospinal fluid were made with a view to establishing whether or not the low values found with metabolizable amino acids, such as glycine or leucine, could be accounted for by uptake and metabolism by the brain. The estimates, based on the ratios found after i.p. injections either in bolus form or by implantation of "osmotic pumps" containing the labeled amino acids, were comparable with those found for metabolizable amino acids.

The transport of sugars across the perfused choroid plexus of the sheep

The blood-perfused choroid plexuses from the lateral ventricles of the sheep were used to determine the nature of sugar exchanges between blood and cerebrospinal fluid (c.s.f.). There was a net entry of sugars from blood to c.s.f. at all concentrations of sugars which were used and this net entry was seen when the sugars were measured either directly by enzymic analysis or by the use of isotopically labelled sugars. From competition experiments the order of affinity of the transporting system from both blood to c.s.f. and c.s.f. to blood was the same, i.e. 2-deoxy-D-glucose much greater than D-glucose greater than 3-O-methyl-D-glucose much greater than D-galactose. The transport of sugars from c.s.f. to blood and blood to c.s.f. consists in both cases of a non-saturable and a saturable component. However, the affinity of the two systems is markedly different, the blood to c.s.f. being a system of low affinity and high capacity while that of the c.s.f. to blood has a high affinity and a low capacity. The concentration of glucose in the newly formed c.s.f. was estimated from the rate of c.s.f. secretion and the net flux of glucose across the choroid plexus. The concentration of glucose in this fluid was some 45-60% of that in plasma and so the low glucose concentration observed in bulk c.s.f. would appear to be a result of the entry process and not that of cerebral metabolism.

Regional cerebral blood flow decreases during hyperglycemia

The presence of hyperglycemia before brain ischemia increases stroke-related morbidity and mortality in experimental animals and humans. However, little is known of the effect of hyperglycemia on regional cerebral blood flow (rCBF). Acute hyperglycemia was induced in awake but restrained rats by intraperitoneal injection of 50% D-glucose. Regional flow was determined using [14C]iodoantipyrine and quantitative autoradiography. Elevation of plasma glucose from 11 to 39 mM was associated with a 24% reduction in rCBF when compared with controls that received normal saline. Intraperitoneal D-mannitol produced an elevation of plasma osmolality equivalent to that observed with glucose. However, rCBF was only reduced by 10%. Hyperglycemia appears to produce a global decrease in rCBF in awake rats that cannot be completely explained by the attendant increase in plasma osmolality. If a similar influence is present during brain ischemia, hyperglycemia could extend areas of critical flow limitation.

The vasculature of experimental brain tumours. Part 4. The quantification of vascular permeability

In order to quantify changes in vessel permeability seen previously in experimental astrocytomas produced in rats by an intracerebral injection of cultured neoplastic glial cells, the flux of mannitol across the vascular endothelium from the blood into the normal brain or tumour tissue was measured using a specially devised technique by which a steady level of radioactively labelled mannitol can be achieved rapidly and maintained in the bloodstream. This is done by a continuous injection given at a rate which is adjusted by a predetermined programme so as to replace the tracer at the rate at which it has been found to leave the circulation in previous experiments. In separate experiments on both tumour-bearing and control rats steady levels of the tracer were maintained in the circulation for progressively longer times of up to 30 min. The kinetic parameters of the process gave estimates for the apparent transfer constant of mannitol across the vascular endothelium and of the size of the extravascular extracellular mannitol space in the tumours. The apparent transfer constant for the movement of mannitol across the blood-brain barrier was increased more than a hundred-fold in the region of the tumour compared to the values for the brain of control rats or that of tumour-bearing rats remote from the tumour site. The extracellular extravascular space within the tumour was estimated to be 22%, somewhat larger than accepted normal values.

Estimates of Michaelis-Menten constants for the two membranes of the brain endothelium

Tracer studies on facilitated diffusion across the blood-brain barrier lead to the calculation of Michaelis-Menten constants that describe the rate of transport. However, the barrier consists of two endothelial cell membranes, and the relevance of single Michaelis-Menten constants in relation to the two cell membranes is unknown. We have formulated a model of two endothelial cell membranes and show that the measured Michaelis-Menten constants are simple functions of the properties of the individual membranes when transport across the endothelium is rapid (P1 greater than 10(-6) cm s-1). We also show that the Michaelis-Menten constants determined in tracer experiments describe facilitated diffusion in the steady state only if the two membranes have similar transport properties. As an application of this observation, we have examined three experimental studies that measure glucose transport in the steady state and show that the Michaelis-Menten constants for glucose transport calculated from the tracer experiments are equal to the constants calculated from the steady-state experiments. We conclude that the luminal and abluminal membranes of brain capillary endothelial cells have equal glucose transport properties.

Effect of hypoglycemia on the brain free fatty acid level and the uptake of fatty acids by phospholipids

The effect of hypoglycemia on the uptake of [1-14C]arachidonate and [1-14C]oleate into a synaptosomal and microsomal glycerophospholipids was investigated. In the presence of ATP, Mg2+ and CoA, rat brain synaptosomes and microsomes catalyze the transfer of arachidonate and oleate into glycerophospholipids. Arachidonate was mainly incorporated into phosphatidylinositol (PI) and phosphatidylcholine (PC), whereas oleate was incorporated into phosphatidylcholine and phosphatidylethanolamine (PE). Hypoglycemia was produced by intraperitoneal injection of 10 or 100 units of crystalline insulin per kg body weight. Two hours after injection the blood glucose level decreased to 10-20 mg%. The content of brain phospholipids was slightly decreased but the change was not statistically significant. The level of free fatty acids (FFA) was increased. More pronounced and reproducible changes were found when hypoglycemia was produced by injection of 100 units of insulin per/kg body weight. Changes in brain cortex were similar to those observed in microsomes and synaptosomes. Hypoglycemia affected the incorporation of arachidonic acid into glycerophospholipids of brain membranes. Uptake of [1-14C]arachidonate was decreased selectively by 50% (into phosphatidic acid/PA/) when hypoglycemia was produced by injection of 10 units of insulin per kg body weight. The higher dose of insulin 100 units per kg body weight produced a 20% inhibition of arachidonate incorporation into synaptosomal PI and a 13% decrease of incorporation into microsomal phosphatidylcholine. Incorporation of [1-14C]oleate into membrane phospholipids was not changed by hypoglycemic insult. It is proposed that the disturbances in fatty acid level, particularly arachidonate, and decreased uptake of arachidonic acid by synaptosomal glycerophospholipids may be responsible for alteration of membrane function and changes of synaptic processes.

Nervous tissue thiamine metabolism in vivo. I. Transport of thiamine and thiamine monophosphate from plasma to different brain regions of the rat

The transport of thiamine (T) and thiamine monophosphate (TMP) across the blood-brain barrier was measured in vivo in the rat. Different doses of [14C]T (15-550 nmol) and [14C]TMP (11-110 nmol) were injected into the femoral vein. The content of T and its phosphoesters in blood and brain tissue (cerebellum, pons, medulla and cerebral cortex) 20 s after the injection was determined radiometrically after electrophoretic separation. Blood flow and blood volume in the same regions of the brain was also determined. Both T and TMP entered rapidly the cerebral tissue, where they were found chemically unmodified. The cerebral tissue extracted less than 7% of plasma T. At physiological plasma T concentrations, the rate of transport ranged from 0.43 to 0.65 nmol X g-1 X h-1 with only minor differences among the various regions. T was transported into the nervous tissue by two separate mechanisms: one saturable, that at physiological plasma T levels accounted for 95% (cerebellum) to 91% (cerebral cortex) of the total T taken up, and one non-saturable, that was most efficient in the cerebral cortex. The Km (half-saturation constant) of the former transport mechanism ranged from 1.95 to 2.75 nmol X ml-1 in the 4 areas investigated. Vmax (maximal transport rate) values ranged from 6 to 9 nmol X g-1 X h-1, the highest value being found in the cerebellum. The overall transport rate of TMP was on average 5-10 times as low as that of T and also showed a saturable and a non-saturable component. Both components were slower than those observed for T.

Cerebral endogenous substrate utilization during the recovery period after profound hypoglycemia

Markedly decreased levels of energy-rich phosphates were seen in cerebral cortex after severe hypoglycemia, followed by their partial restitution during the recovery period. During hypoglycemia the nonglucose endogenous substrates were provided by glycolytic intermediates, by Krebs cycle intermediates, and by related amino acids. Other potential substrates for brain oxidation were provided by the breakdown of phospholipids and fatty acids. After a 20-min period of posthypoglycemic recovery, partial restoration of carbohydrates and amino acids occurred, although the amino acid pool size was still reduced. The alterations in phospholipids and fatty acids persisted, while there was a tendency toward normalization of the free fatty acid content. During the posthypoglycemic recovery, treatment with some specific metabolic modulators (6-aminonicotinamide, hopantenate, uridine, L-acetylcarnitine) suggested the possibility of an alternative cerebral substrate utilization owing to modulation of the cerebral biochemical machinery. Thus, increased carbohydrate utilization by hopantenate was consistent with decreased lipid breakdown, while increased carbohydrate utilization by uridine was concomitant with decreased amino acid degradation. In this way, decreased cerebral carbohydrate utilization by 6-amino-nicotinamide was associated with increased lipid and amino acid breakdown. Furthermore, the increased loss of cerebral phospholipids and phospholipid-bound fatty acids by L-acetylcarnitine occurred in the presence of a large glucose availability and was associated with an extensive reduction of cerebral glycolytic flux.

Regional differences in vascular autoregulation in the rat brain in severe insulin-induced hypoglycemia

The present experiments were undertaken to determine if loss of vascular autoregulation during severe hypoglycemia shows regional differences that could help to explain the localization of hypoglycemic cell damage. Artificially ventilated rats (70% N2O) were subjected to a 30-min insulin-induced hypoglycemic coma (with cessation of EEG activity), with mean arterial blood pressure being maintained at 140, 120, 100, and 80 mm Hg. After 30 min of hypoglycemia, local cerebral blood flow (CBF) in 25 brain structures was measured autoradiographically with a [14C]iodoantipyrine technique. Since local CBF values did not differ between the 120 and the 100 mm Hg groups, the animals of these groups were pooled (110 mm Hg group). The results showed that at a blood pressure of 140 mm Hg, CBF was increased in 22 of 25 structures analyzed, the maximal values approximating 300% of control. At 110 mm Hg, cerebral cortical structures had CBF values that were either decreased, normal, or slightly increased; however, many subcortical structures (and cerebellum) showed markedly increased flow rates. Although a lowering of blood pressure to 80 mm Hg usually further reduced flow rates, some of these latter structures also had well-maintained CBF values at that pressure. Thus, there were large interstructural variations of local CBF at any of the pressures examined. Analysis of the pressure-flow relationship showed loss of autoregulation in some structures, whereas others had remarkably well-preserved CBF values at low pressures. The results indicate that during severe hypoglycemia, even relatively moderate arterial hypotension may add a circulatory insult to the primary one, and they strongly suggest that any such insult affects some brain structures more than others.

The physiologic action of insulin on glucose uptake and its relevance to the interpretation of the metabolic clearance rate of glucose

Glucose uptake (Ru) is dependent upon the concentrations of both glucose and insulin. The metabolic clearance rate of glucose (MCRG), has been used as an in vivo measure of insulin action, because it was said to be independent of the prevailing glucose concentration. The validity of this assumption has recently been challenged. In this study, the effect of insulin concentration on the rate of glucose uptake (Ru) and on the MCRG was studied during euglycemia (5.1 +/- 0.3 mmol/L) and moderate hyperglycemia (10.4 +/- 0.5 mmol/L) in 17 experiments on nine normal ambulant volunteers. Stable plasma insulin levels were maintained with fixed infusion rates of insulin (0-300 mU/kg/h) and somatostatin (7.5 micrograms/min). At low insulin concentrations (less than 5 microU/mL) the increase in glucose uptake in response to hyperglycemia was small (5.3 +/- 2.3 mumol/kg/min). In contrast, with insulin levels more than 25 microU/mL, there was a steep rise in glucose uptake with hyperglycemia (55 +/- 3 mumol/kg/min; range: 44-74 mumol/kg/min). The metabolic clearance rate of glucose fell by an average of 32% with hyperglycemia in the studies at the lowest insulin levels (2.2 +/- 0.6 v 1.5 +/- 0.1 mL/kg/min; 0.15 greater than P greater than 0.1). There was no change in the MCRG in the subjects studied at higher insulin levels. It is concluded that (1) low concentrations of insulin are essential for the increase in glucose disposal during hyperglycemia; and (2) provided insulin levels are more than 25 microU/mL and plasma glucose less than 11 mmol/L, MCRG is independent of the plasma glucose concentration and is therefore a valid measure of insulin-mediated glucose uptake.

Net transport of glucose from blood to cerebrospinal fluid in the cat

The net transport of glucose from blood to the cerebrospinal fluid compartment of cats was measured by ventriculocisternal perfusion to determine over a large range of serum glucose concentrations the influence of serum glucose levels and their changes on the net transport rate. Changes in serum glucose levels were followed within minutes by corresponding changes in cerebroventricular effluent fluid glucose concentration. At mean values of serum glucose concentration of 6.2 mM and cerebrospinal fluid formation rate of 24.3 microliter/min, the net glucose influx rate was 1.6 mmol/min. The effluent fluid-to-serum glucose concentration ratio was 0.25 and decreased when serum glucose was greater than 11.1 mM. The rate of glucose transport from blood to effluent fluid during ventricular perfusion was saturable, and approached a maximum of 3.5 mumol/min at serum glucose levels above 22 mM. From the cerebrospinal fluid formation and net glucose influx rates the calculated glucose concentration of nascent cerebrospinal fluid was 6.5 mM and higher than the corresponding serum glucose of 5.6 mM. It is concluded that during perfusion over a wide range of serum glucose concentrations, a saturable mediated glucose transport mechanism can be demonstrated. Changes in serum glucose are rapidly reflected in corresponding effluent fluid glucose levels. From effluent fluid-to-serum glucose concentration ratios and calculations of the glucose in newly formed cerebrospinal fluid, the technique, however, overestimates the glucose influx rates at normal serum glucose levels.

Determination of ribonucleosides, deoxyribonucleosides, and purine and pyrimidine bases in adult rabbit cerebrospinal fluid and plasma

Purine and pyrimidine base and nucleoside levels were measured in adult rabbit cisternal CSF and plasma by reversed-phase high-performance liquid chromatography. The concentrations of bases, nucleosides, and nucleoside phosphates were similar in plasma and CSF except for the adenosine phosphates and uracil which were higher in the plasma. In plasma and CSF, adenosine levels were low (0.12 microM) and guanosine, deoxyadenosine, deoxyguanosine, and deoxyinosine were not detectable (less than 0.1 microM); inosine and xanthine concentrations were 1-2 microM and hypoxanthine concentrations were approximately 5 microM; uridine (approximately 8 microM), cytidine (2-3 microM), and thymidine, deoxyuridine, and deoxycytidine (0.5-1.4 microM) were easily detectable. In both plasma and CSF, guanine, and thymine were undetectable (less than 0.1 microM), adenine and cytosine were less than 0.2 microM, but uracil was present (greater than 1 microM). Adenosine, inosine, and guanosine phosphates were also detectable at low concentrations in CSF and plasma. These results are consistent with the hypothesis that purine deoxyribonucleosides are synthesized in situ in the adult rabbit brain. In contrast, pyrimidine deoxyribonucleosides and ribonucleosides, and purine and pyrimidine bases are available in the CSF for use by the brain.

Relation between the increase in the diffusional permeability of the blood-central nervous system barrier and other changes during the development of experimental allergic encephalomyelitis in the Lewis rat

The reduction in the effectiveness of the blood-brain and blood-spinal cord barriers, previously seen in rats at the height of the acute episode of experimental allergic encephalomyelitis, has now been measured at various stages in the development of the disease up to 60 days after inoculation with guinea pig spinal cord in complete Freund's adjuvants. The marker of extracellular space, radioactively labelled mannitol, only crosses the blood-central nervous system barriers very slowly by passive diffusion in normal rats. An abnormal penetration of this marker into the central nervous system began to develop during the second week after inoculation, appearing first in the lower spinal cord, where it also reaches the highest level during the acute phase of the attack. The leak begins before either the clinical signs become evident or cuffing is seen around blood vessels in stained sections. As the clinical signs are disappearing, from about 15 days onwards, the permeability of the barrier returns steadily to its normal low value, starting in the spinal cord, especially the caudal part. The timing of the reduction in the effectiveness of the blood-central nervous system barrier in relation to other clinical and histological changes suggests that it may play a part in the development of the lesion. The relation between the timing of these changes in EAE and that in the development of a new lesion in (exacerbation of) multiple sclerosis is discussed.