title: A ketogenic diet suppresses seizures in mice through adenosine A₁ receptors.
abstract: A ketogenic diet (KD) is a high-fat, low-carbohydrate metabolic regimen; its effectiveness in the treatment of refractory epilepsy suggests that the mechanisms underlying its anticonvulsive effects differ from those targeted by conventional antiepileptic drugs. Recently, KD and analogous metabolic strategies have shown therapeutic promise in other neurologic disorders, such as reducing brain injury, pain, and inflammation. Here, we have shown that KD can reduce seizures in mice by increasing activation of adenosine A1 receptors (A1Rs). When transgenic mice with spontaneous seizures caused by deficiency in adenosine metabolism or signaling were fed KD, seizures were nearly abolished if mice had intact A1Rs, were reduced if mice expressed reduced A1Rs, and were unaltered if mice lacked A1Rs. Seizures were restored by injecting either glucose (metabolic reversal) or an A1R antagonist (pharmacologic reversal). Western blot analysis demonstrated that the KD reduced adenosine kinase, the major adenosine-metabolizing enzyme. Importantly, hippocampal tissue resected from patients with medically intractable epilepsy demonstrated increased adenosine kinase. We therefore conclude that adenosine deficiency may be relevant to human epilepsy and that KD can reduce seizures by increasing A1R-mediated inhibition.
authors.affiliation: Department of Psychology and Neuroscience Program, Trinity College, Hartford, Connecticut, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Masino
authors.forename: Tianfu
authors.initials: T
authors.lastname: Li
authors.forename: Panos
authors.initials: P
authors.lastname: Theofilas
authors.forename: Ursula S
authors.initials: US
authors.lastname: Sandau
authors.forename: David N
authors.initials: DN
authors.lastname: Ruskin
authors.forename: Bertil B
authors.initials: BB
authors.lastname: Fredholm
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Geiger
authors.forename: Eleonora
authors.initials: E
authors.lastname: Aronica
authors.forename: Detlev
authors.initials: D
authors.lastname: Boison
mesh_terms: D000248:Adenosine Kinase / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000818:Animals; D000927:Anticonvulsants / Q000627:therapeutic use; D055423:Diet, Ketogenic; D004569:Electroencephalography; D004827:Epilepsy / Q000178:diet therapy* / Q000188:drug therapy; D006624:Hippocampus / Q000166:cytology / Q000201:enzymology; D006801:Humans; D051379:Mice; D018345:Mice, Knockout; D008822:Mice, Transgenic; D043682:Receptor, Adenosine A1 / Q000235:genetics / Q000378:metabolism*; D012640:Seizures / Q000178:diet therapy* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D043682:Receptor, Adenosine A1; D000248:Adenosine Kinase