title: Cerebral glutamine and glutamate levels in relation to compromised energy metabolism: a microdialysis study in subarachnoid hemorrhage patients.
abstract: Astrocytic glutamate (Glt) uptake keeps brain interstitial Glt levels low. Within the astrocytes Glt is converted to glutamine (Gln), which is released and reconverted to Glt in neurons. The Glt-Gln cycle is energy demanding and impaired energy metabolism has been suggested to cause low interstitial Gln/Glt ratios. Using microdialysis (MD) measurements from visually noninjured cortex in 33 neurointensive care patients with subarachnoid hemorrhage, we have determined how interstitial Glt and Gln, as a reflection of the Glt-Gln cycle turnover, relate to perturbed energy metabolism. A total of 3703 hourly samples were analyzed. The lactate/pyruvate (L/P) ratios correlated to the Gln/Glt ratios (r=-0.66), but this correlation was not stronger than the correlation between L/P and Glt (r=0.68) or the correlation between lactate and Glt (r=0.65). A novel observation was a linear relationship between interstitial pyruvate and Gln (r=0.52). There were 13 periods (404 h) of 'energy crisis', defined by L/P ratios above 40. All were associated with high interstitial Glt levels. Periods with L/P ratios above 40 and low pyruvate levels were associated with decreased interstitial Gln levels, suggesting ischemia and failing astrocytic Gln synthesis. Periods with L/P ratios above 40 and normal or high pyruvate levels were associated with increased interstitial Gln levels, which may represent an astrocytic hyperglycolytic response to high interstitial Glt levels. The results imply that moderately elevated L/P ratios cannot always be interpreted as failing energy metabolism and that interstitial pyruvate levels may discriminate whether or not there is sufficient astrocytic capacity for Glt-Gln cycling in the brain.
authors.affiliation: Department of Neuroscience, Neurosurgery, Uppsala University Hospital, Uppsala, Sweden. carolina.samuelsson@neurokir.uu.se
authors.forename: Carolina
authors.initials: C
authors.lastname: Samuelsson
authors.forename: Lars
authors.initials: L
authors.lastname: Hillered
authors.forename: Maria
authors.initials: M
authors.lastname: Zetterling
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
authors.forename: Göran
authors.initials: G
authors.lastname: Hesselager
authors.forename: Mats
authors.initials: M
authors.lastname: Ryttlefors
authors.forename: Eva
authors.initials: E
authors.lastname: Kumlien
authors.forename: Anders
authors.initials: A
authors.lastname: Lewén
authors.forename: Niklas
authors.initials: N
authors.lastname: Marklund
authors.forename: Pelle
authors.initials: P
authors.lastname: Nilsson
authors.forename: Konstantin
authors.initials: K
authors.lastname: Salci
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ronne-Engström
mesh_terms: D001253:Astrocytes / Q000378:metabolism; D001921:Brain / Q000378:metabolism*; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism*; D005973:Glutamine / Q000378:metabolism*; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis; D009474:Neurons / Q000378:metabolism; D019289:Pyruvic Acid / Q000378:metabolism; D013345:Subarachnoid Hemorrhage / Q000378:metabolism* / Q000473:pathology
chemical_list: D005973:Glutamine; D019344:Lactic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid