Cerebral Lactate Metabolism After Traumatic Brain Injury.

Details

Serval ID
serval:BIB_881133C464C1
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Cerebral Lactate Metabolism After Traumatic Brain Injury.
Journal
Current Neurology and Neuroscience Reports
Author(s)
Patet C., Suys T., Carteron L., Oddo M.
ISSN
1534-6293 (Electronic)
ISSN-L
1528-4042
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
16
Number
4
Pages
31
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Cerebral energy dysfunction has emerged as an important determinant of prognosis following traumatic brain injury (TBI). A number of studies using cerebral microdialysis, positron emission tomography, and jugular bulb oximetry to explore cerebral metabolism in patients with TBI have demonstrated a critical decrease in the availability of the main energy substrate of brain cells (i.e., glucose). Energy dysfunction induces adaptations of cerebral metabolism that include the utilization of alternative energy resources that the brain constitutively has, such as lactate. Two decades of experimental and human investigations have convincingly shown that lactate stands as a major actor of cerebral metabolism. Glutamate-induced activation of glycolysis stimulates lactate production from glucose in astrocytes, with subsequent lactate transfer to neurons (astrocyte-neuron lactate shuttle). Lactate is not only used as an extra energy substrate but also acts as a signaling molecule and regulator of systemic and brain glucose use in the cerebral circulation. In animal models of brain injury (e.g., TBI, stroke), supplementation with exogenous lactate exerts significant neuroprotection. Here, we summarize the main clinical studies showing the pivotal role of lactate and cerebral lactate metabolism after TBI. We also review pilot interventional studies that examined exogenous lactate supplementation in patients with TBI and found hypertonic lactate infusions had several beneficial properties on the injured brain, including decrease of brain edema, improvement of neuroenergetics via a "cerebral glucose-sparing effect," and increase of cerebral blood flow. Hypertonic lactate represents a promising area of therapeutic investigation; however, larger studies are needed to further examine mechanisms of action and impact on outcome.
Keywords
Age Distribution, Cerebral Infarction/epidemiology, Female, Hospital Mortality, Humans, Incidence, Ischemic Attack, Transient/epidemiology, Male, Registries, Spain/epidemiology, Stroke/diagnosis, Stroke/epidemiology
Pubmed
Web of science
Create date
07/07/2013 12:29
Last modification date
03/03/2018 19:03
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