Inhibition of brain glutamine accumulation prevents cerebral edema in hyperammonemic rats.
The mechanism of brain swelling during hyperammonemia is not understood, but glutamine accumulation is consistently observed. We tested the hypothesis that brain swelling associated with hyperammonemia is a consequence of the osmotic effect of intracellular glutamine accumulation in brain. Increases in plasma ammonium levels from 31 +/- 3 to 601 +/- 38 mumol/l (+/- SE) were produced by 6 h of infusion of ammonium acetate in anesthetized rats. Hyperammonemia resulted in increased brain water content accompanied by more than a tripling of brain glutamine concentration compared with control rats receiving sodium acetate (5.6 +/- 0.4 vs. 18.8 +/- 0.4 mmol/kg). Inhibition of glutamine synthetase activity by pretreatment with L-methionine sulfoximine prevented both the increase in brain glutamine levels and the increase in brain water content despite elevated plasma ammonium levels (908 +/- 196 mumol/l). Thus cerebral edema during hyperammonemia is associated with glutamine accumulation. We suggest that accumulated glutamine may serve as an idiogenic osmole causing swelling. Because brain swelling eventually leads to increased intracranial pressure and tissue hypoxia, these data suggest a unifying mechanism to account for the many pathophysiological abnormalities found during coma associated with various forms of liver disease, inborn errors of metabolism, and Reye's syndrome.
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
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H
Takahashi
R C
RC
Koehler
S W
SW
Brusilow
R J
RJ
Traystman
D000085:Acetates / Q000494:pharmacology*; D019342:Acetic Acid; D000641:Ammonia / Q000097:blood / Q000378:metabolism*; D000818:Animals; D001794:Blood Pressure; D001929:Brain Edema / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D002245:Carbon Dioxide / Q000097:blood; D005974:Glutamate-Ammonia Ligase / Q000378:metabolism; D005971:Glutamates / Q000378:metabolism; D005973:Glutamine / Q000187:drug effects / Q000378:metabolism*; D006454:Hemoglobins / Q000032:analysis; D006863:Hydrogen-Ion Concentration; D008297:Male; D008717:Methionine Sulfoximine / Q000494:pharmacology*; D009994:Osmolar Concentration; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D051381:Rats; D011919:Rats, Inbred Strains; D012016:Reference Values
D000085:Acetates; D005971:Glutamates; D006454:Hemoglobins; D005973:Glutamine; D002245:Carbon Dioxide; D008717:Methionine Sulfoximine; D000641:Ammonia; D005974:Glutamate-Ammonia Ligase; D019342:Acetic Acid; C018824:ammonium acetate; D010100:Oxygen