Metabolic abnormalities and grade of encephalopathy in acute hepatic failure.

Acute hepatic failure is associated with many biochemical abnormalities in plasma and brain. Changes that correlate well with the degree of behavioral impairment may be important factors in the development of encephalopathy. We measured the concentrations of intermediary metabolites, ammonia, and amino acids in brain and plasma and the rate of whole-brain glucose utilization in rats with an acutely devascularized liver. In all rats an estimate of the grade of encephalopathy (reflected by behavioral impairment) was made. Rats underwent portacaval shunting and hepatic artery ligation (or sham operation) and were kept normoglycemic and normothermic thereafter. We sampled blood and whole brain (by near-instantaneous freeze-blowing) 2, 4, or 6 h later. There were no alterations in levels of high-energy phosphate metabolites in the brain or in metabolites associated with the glycolytic pathway and Krebs cycle, except lactate and pyruvate. Brain glucose use was decreased similarly at all times after surgery. Levels of ammonia and many amino acids were increased in brain and plasma; brain aspartate, glutamate, and arginine levels were decreased. The increases in content of plasma ammonia and brain glutamine, proline, alanine, and aromatic amino acids and the decreases in brain aspartate and glutamate were most strongly correlated with behavioral impairment.

Optimizing the measurement of regional cerebral glucose consumption with [6-14C]glucose.

[6-14C]Glucose is used to trace the cerebral metabolic rate of glucose (CMRGlc) in vivo in experiments lasting 5-10 min. Initially 14C is trapped in intermediary metabolite pools. Subsequently 14C is lost as a function of time and metabolic rate, primarily as 14CO2. Experiments were designed to evaluate the rate of 14C lost as 14CO2 or as [14C]lactate from brain labeled with [6-14C]glucose during times up to 15 min. CMRGlc was measured during 5, 7.5, 10 and 15 min in 60 brain areas. At longer times the loss of 14C was reflected by lower apparent values of brain CMRGlc. Arteriovenous measurements across brain revealed no significant loss of [14C]lactate in normal rats or rats with bicuculline-induced seizures. It was concluded that the primary form in which 14C was lost was as 14CO2. As expected, the rate of 14CO2 loss was greater in structures with high metabolic rates. The data were analyzed to determine the parameters necessary to rectify the data so that uniform values of CMRGlc were obtained up to 15 min. Tables were made to predict the degree of 14C loss as well as the 14C-metabolites/[6-14C]glucose ratio as a function of time and metabolic rate. These tables can be used to plan the maximum and minimum experimental times for optimal results.

Neomycin reduces the intestinal production of ammonia from glutamine.

The mechanism by which neomycin treatment reduces circulating ammonia concentrations was studied in normal and portacaval shunted rats. Rats were given neomycin for 3 days and then fasted for 24 hours to eliminate feces. Neomycin decreased arteriovenous differences of ammonia across the intestine even when the intestines were empty. Neomycin treatment lowered the activity of glutaminase in the intestinal mucosa and the rate of ammonia production from glutamine by isolated intestinal segments. The intestines from portacaval shunted rats had higher glutaminase activity (by 57%), and produced ammonia from glutamine at a greater rate (by 31%), than intestines from controls. Neomycin treatment lowered glutaminase activity and ammonia production in shunted rats, but glutaminase activity still remained higher than in controls (by 23%). The data indicate that the mechanism by which neomycin lower plasma ammonia is owing, at least in part, to a direct effect on the intestines. Specifically, neomycin causes a reduction in mucosal glutaminase activity and thereby decreases the ability of the mucosa to consume glutamine and produce ammonia.

Effect of reducing brain glutamine synthesis on metabolic symptoms of hepatic encephalopathy.

Liver failure, or shunting of intestinal blood around the liver, results in hyperammonemia and cerebral dysfunction. Recently it was shown that ammonia caused some of the metabolic signs of hepatic encephalopathy only after it was metabolized by glutamine synthetase in the brain. In the present study, small doses of methionine sulfoximine, an inhibitor of cerebral glutamine synthetase, were given to rats either at the time of portacaval shunting or 3-4 weeks later. The effects on several characteristic cerebral metabolic abnormalities produced by portacaval shunting were measured 1-3 days after injection of the inhibitor. All untreated portacaval-shunted rats had elevated plasma and brain ammonia concentrations, increased brain glutamine and tryptophan content, decreased brain glucose consumption, and increased permeability of the blood-brain barrier to tryptophan. All treated rats had high ammonia concentrations, but the brain glutamine content was normal, indicating inhibition of glutamine synthesis. One day after shunting and methionine sulfoximine administration, glucose consumption, tryptophan transport, and tryptophan brain content remained near control values. In the 3-4-week-shunted rats, which were studied 1-3 days after methionine sulfoximine administration, the effect was less pronounced. Brain glucose consumption and tryptophan content were partially normalized, but tryptophan transport was unaffected. The results agree with our earlier conclusion that glutamine synthesis is an essential step in the development of cerebral metabolic abnormalities in hyperammonemic states.

Pentobarbital-enhanced [3H]flunitrazepam binding throughout the rat brain: an autoradiographic study.

The gamma-aminobutyric acidA/benzodiazepine receptor contains distinct ligand binding sites for hypnotic barbiturates and benzodiazepines. It is thought that barbiturate-induced sedation is produced, in part, by enhancing agonist binding to this receptor. The present study tested the hypothesis that pentobarbital would enhance benzodiazepine binding in a site-specific manner across the rat brain. In vitro receptor autoradiography was used to localize and quantitatively map [3H]flunitrazepam ([3H]FLU) binding in the absence and presence of pentobarbital in 133 brain areas. Each area demonstrated a statistically significant increase in [3H]FLU binding in the presence of in vitro pentobarbital (P < or = 0.05). Hindbrain nuclei dominated the top 20% of brain areas demonstrating the greatest pentobarbital-induced increases in [3H]FLU binding. The greatest mean percent increase in [3H]FLU binding occurred in the medulla, including areas known to be important for cardiovascular control, breathing, motor tone and regulating levels of arousal. These findings show that differential enhancement of benzodiazepine binding in the presence of pentobarbital occurred in brain areas controlling physiological functions known to be impaired by systemically administered pentobarbital.

Ischemic brain damage is not ameliorated by 1,3-butanediol in hyperglycemic rats.

BACKGROUND AND PURPOSE: Treatment with the ketone body precursor 1,3-butanediol has been suggested to ameliorate hypoxic/ischemic brain damage. Butanediol could provide an alternative energy substrate for the brain, thereby decreasing the amount of glycolytically produced lactate. Hyperglycemia aggravates brain damage after brain ischemia and causes fatal postischemic seizures, probably by increasing the production of lactate and decreasing the pH. We studied whether butanediol treatment altered the adverse consequences following ischemia complicated by hyperglycemia. METHODS: Hyperglycemic adult male rats were given 25 or 50 mmol.kg-1 body wt butanediol intravenously 30 minutes before 10 minutes of transient forebrain ischemia. Morphological evaluation was performed following perfusion-fixation after 15 hours of recovery. Blood concentrations of beta-hydroxybutyrate, acetoacetate, glucose, and lactate and brain tissue concentrations of energy metabolites were measured before and after ischemia. RESULTS: Blood levels of ketone bodies increased in the butanediol-treated rats. Ischemia decreased the blood levels of acetoacetate but increased the levels of beta-hydroxybutyrate by a similar amount, resulting in unchanged high levels of total ketone bodies in the animals that received butanediol. Brain tissue levels of glucose, energy metabolites, and lactate showed no difference between butanediol- and saline-treated rats. Furthermore, compared with saline-treated animals butanediol-treated rats showed no decrease in brain damage and no attenuation in the development of postischemic seizures. CONCLUSIONS: The ketone body precursor 1,3-butanediol offers no protective effect in transient forebrain ischemia complicated by hyperglycemia.

Regional distribution and kinetics of three sites on the GABAA receptor: lack of effect of portacaval shunting.

The regional distribution of binding sites on the GABAA receptor and their kinetic parameters were measured by quantitative autoradiography in brains from normal rats and rats with a portacaval shunt, a model of portal systemic encephalopathy in which GABA neurotransmission may be altered. The ligands used were [3H]flunitrazepam (a benzodiazepine-site agonist), [3H]-Ro15-1788 (a benzodiazepine-site antagonist), [3H]muscimol (a GABA-site agonist), and [35S]t-butylbicyclophosphorothionate (35S-TBPS, a convulsant that binds to a site near the chloride channel). Some brains were analyzed by computerized image analysis and three-dimensional reconstruction. The regional distribution of binding of the benzodiazepines was very similar, but the patterns obtained with [3H]muscimol and [35S]TBPS were different in many areas, suggesting a heterogeneous distribution of several subtypes of the GABAA receptor. The kinetic parameters were determined in brain regions for [3H]flunitrazepam, [3H]Ro15-1788, and [3H]muscimol. For each ligand, the Kd showed a significant heterogeneity among brain regions (at least threefold), contrary to conclusions drawn from earlier studies. In portacaval shunted rats, binding of all four ligands was essentially unchanged from that in control rats, indicating that, if there was an abnormality in GABA neurotransmission during portal systemic shunting, it was not reflected by altered binding to the main sites on the GABAA receptor.

Regional blood-brain barrier transport of ketone bodies in portacaval-shunted rats.

The permeability of the blood-brain barrier to ketone bodies, substrates of the monocarboxylic acid carrier, was measured in individual brain structures of control and portacaval-shunted rats. The measurements were made 5-7 wk after the shunt or sham operation by quantitative autoradiography. Portacaval shunting caused the permeability to ketone bodies to decrease throughout the brain by approximately 70%. There was a striking change in the transport pattern in the cerebral cortex; deeper cortical layers were affected more than superficial layers. Ketone body consumption by brain is limited by the transport capacity of the monocarboxylic acid system. Therefore, in portacaval-shunted rats the very low activity of this system makes it unlikely that ketone bodies can make a substantial contribution during situations such as fasting. Likewise, other substrates of the monocarboxylic acid system, e.g., lactate and pyruvate, will have greatly restricted access to the brain after portacaval shunting. If the carrier is symmetrical, another consequence will be that exit of endogenously produced lactate will be retarded.

Hyperammonaemia causes many of the changes found after portacaval shunting.

1. Portacaval shunting in rats results in several metabolic alterations similar to those seen in patients with hepatic encephalopathy. The characteristic changes include: (a) diminution of cerebral function; (b) raised plasma ammonia and brain glutamine levels; (c) increased neutral amino acid transport across the blood-brain barrier; (d) altered brain and plasma amino acid levels; and (e) changes in brain neurotransmitter content. The aetiology of these abnormalities remains unknown. 2. To study the degree to which ammonia could be responsible, rats were made hyperammonaemic by administering 40 units of urease/kg body weight every 12 h and killing the rats 48 h after the first injection. 3. The changes observed in the urease-treated rats were: (a) whole-brain glucose use was significantly depressed, whereas the levels of high-energy phosphates remained unchanged; (b) the permeability of the blood-brain to barrier to two large neutral amino acids, tryptophan and leucine, was increased; (c) blood-brain barrier integrity was maintained, as indicated by the unchanged permeability-to-surface-area product for acetate; (d) plasma and brain amino acid concentrations were altered; and (e) dopamine, 5-hydroxytryptamine (serotonin) and noradrenaline levels in brain were unchanged, but 5-hydroxyindoleacetic acid (5-HIAA), a metabolite of 5-hydroxytryptamine, was elevated. 4. The depressed brain glucose use, increased tryptophan permeability-to-surface-area product, elevated brain tryptophan content and rise in the level of cerebral 5-HIAA were closely correlated with the observed rise in brain glutamine content. 5. These results suggest that many of the metabolic alterations seen in rats with portacaval shunts could be due to elevated ammonia levels. Furthermore, the synthesis or accumulation of glutamine may be closely linked to cerebral dysfunction in hyperammonaemia.

Early establishment of cerebral dysfunction after portacaval shunting.

Portacaval shunting in rats results in brain dysfunction, as indicated by reduced energy metabolism and behavioral abnormalities, as well as many biochemical changes in plasma and brain. No etiological connections have been made between these findings, which have been studied mainly 2 wk or more after shunting. To determine how soon the various abnormalities occur and which are associated temporally with the decrease in brain glucose use, we studied shunted and sham-operated rats between 6 h and 11 days after surgery. Six hours after portacaval shunting, plasma aromatic amino acids, brain glutamine, aromatic amino acids, 5-hydroxyindoleacetic acid, and tryptophan transport into the brain were all significantly higher than normal. Brain glucose use showed a downward trend and was fully depressed within 1 day. Plasma branched-chain amino acids and threonine were decreased, and brain serotonin and norepinephrine content increased only after 2 days; these changes were therefore dissociated from the other abnormalities that developed in a shorter period. The results showed that the cerebral dysfunction characteristic of portacaval shunting began within hours and was fully established by 2 days.

The influence of ketamine on regional brain glucose use.

The purpose of this study was to determine the effect of different doses of ketamine on cerebral function at the level of individual brain structures as reflected by glucose use. Rats received either 5 or 30 mg/kg ketamine intravenously as a loading dose, followed by an infusion to maintain a steady-state level of the drug. An additional group received 30 mg/kg as a single injection only, and was studied 20 min later, by which time they were recovering consciousness (withdrawal group). Regional brain energy metabolism was evaluated with [6-14C]glucose and quantitative autoradiography during a 5-min experimental period. A subhypnotic, steady-state dose (5 mg/kg) of ketamine caused a stimulation of glucose use in most brain areas, with an average increase of 20%. At the larger steady-state dose (30 mg/kg, which is sufficient to cause anesthesia), there was no significant effect on most brain regions; some sensory nuclei were depressed (inferior colliculus, -29%; cerebellar dentate nucleus, -18%; vestibular nucleus, -16%), but glucose use in the ventral posterior hippocampus was increased by 33%. In contrast, during withdrawal from a 30-mg/kg bolus, there was a stimulation of glucose use throughout the brain (21-78%), at a time when plasma ketamine levels were similar to the levels in the 5 mg/kg group. At each steady-state dose, as well as during withdrawal, ketamine caused a notable stimulation of glucose use by the hippocampus.

Comparison of [14C]glucose and [14C]deoxyglucose as tracers of brain glucose use.

Because glucose metabolism and functional activity in brain regions are normally coupled, knowledge of regional brain glucose use can yield insights into regional functional activity. The deoxyglucose (DG) method is widely used for this purpose in experimental animals and humans but questions have arisen regarding its limits and accuracy. Therefore an experiment was designed to compare the DG method on a structure-by-structure basis with another tracer of glucose use, [6-14C]glucose, in normal rats. The cerebral metabolic rates obtained using the two tracers were similar in the telencephalon, but the results using DG were substantially lower in the midbrain and hindbrain (diencephalon, 18%; mesencephalon, 20%; metencephalon, 29%; and myelencephalon, 35%). The primary DG metabolite, DG 6-phosphate (DG-6-P) was found to disappear in a non-uniform manner from the major brain structures: telencephalon less than diencephalon less than mesencephalon = metencephalon less than myelencephalon. Thus a correlation was found between the rate of DG-6-P loss and the extent to which the DG method gave lower values of glucose use. Thus this may explain, at least in part, the discrepancies between the two methods.

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.

Regional brain glucose use in unstressed rats after two days of starvation.

Regional brain glucose use was measured in conscious, unrestrained, fed rats and after 2 days of starvation, using quantitative autoradiography and [6-14C]glucose. Plasma glucose, lactate, and ketone body concentrations and brain glucose and lactate content were measured in separate groups of rats. Glucose concentrations were lower in starved rats in both plasma and brain; plasma ketone body concentrations were elevated. Glucose use was found to be lower throughout the brain by about 12%. While some areas seemed to be affected more than others, statistical analysis showed that none were exceptionally different. The results could not be explained by increased loss of 14C as lactate or pyruvate during the experimental period, because the arteriovenous differences of these species were insignificant. The calculated contribution by ketone bodies to the total energy consumption was between 3 and 9% for the brain as a whole in the starved rats and could, therefore, partially account for the depression seen in glucose use. It was concluded that glucose oxidation is slightly depressed throughout the brain after 2 days of starvation.

Regional amino acid transport into brain during diabetes: effect of plasma amino acids.

Transport of phenylalanine and lysine into the brain was measured in 4-wk streptozotocin-diabetic rats to assess the effect on the neutral and basic amino acid transport systems at the blood-brain barrier. Amino acid concentrations in plasma and brain were also measured. Regional permeability-times-surface area (PS) products and influx were determined using a continuous infusion method and quantitative autoradiography. The PS of phenylalanine was decreased by an average of 40% throughout the entire brain. Influx was depressed by 35%. The PS of lysine was increased by an average of 44%, but the influx was decreased by 27%. Several plasma neutral amino acids (branched chain) were increased, whereas all basic amino acids were decreased. Brain tryptophan, phenylalanine, tyrosine, methionine, and lysine contents were markedly decreased. The transport changes were almost entirely accounted for by the alterations in the concentrations of the plasma amino acids that compete for the neutral and basic amino acid carriers. The reduced influx could be responsible for the low brain content of some essential amino acids, with possibly deleterious consequences for brain function.

Regional brain monoamines and their metabolites after portacaval shunting.

Disturbances in brain monoamine neurotransmitter metabolism have been implicated in the development of hepatic encephalopathy produced by portacaval shunting or liver disease. We have measured the content of serotonin, norepinephrine and dopamine, as well as their metabolites 5-hydroxyindoleacetic acid, dihydroxyphenylacetic acid and homovanillic acid in nine selected brain areas of rats with portacaval shunts and sham-operated control rats. All substances were measured in single samples using high performance liquid chromatography with electrochemical detection, after a simple extraction procedure. In shunted rats serotonin content was 26% higher in the raphe nuclei area, and 5-hydroxyindoleacetic acid throughout the brain (by 51 to 137%), suggesting increased serotonin turnover. Norepinephrine content was higher by 26% in the frontal cortex. Dopamine content was unaffected; however its metabolites were higher in a few areas including the caudate and ventral tegmentum. Brain content of the monoamine precursor amino acids tryptophan, tyrosine and phenylalanine was higher throughout the brain in the shunted rats. The results suggest that serotonin metabolism is altered throughout the brain after portacaval shunting, which could be related to some of the characteristic behavioral abnormalities found in this condition. Catecholamine metabolism appears to be more selectively and less extensively affected.