title: Extracorporeal methods of blood glutamate scavenging: a novel therapeutic modality.
abstract: Pathologically elevated glutamate concentrations in the brain's extracellular fluid are associated with several acute and chronic brain insults. Studies have demonstrated that by decreasing the concentration of glutamate in the blood, thereby increasing the concentration gradient between the brain and the blood, the rate of brain-to-blood glutamate efflux can be increased. Blood glutamate scavengers, pyruvate and oxaloacetate have shown great promise in providing neuroprotection in many animal models of acute brain insults. However, glutamate scavengers' potential systemic toxicity, side effects and pharmacokinetic properties may limit their use in clinical practice. In contrast, extracorporeal methods of blood glutamate reduction, in which glutamate is filtered from the blood and eliminated, may be an advantageous adjunct in treating acute brain insults. Here, we review the current evidence for the glutamate-lowering effects of hemodialysis, peritoneal dialysis and hemofiltration. The evidence reviewed here highlights the need for clinical trials.
authors: Department of Anesthesiology and Critical Care, National Research Center for Oncology and Transplantation, Astana, Kazakhstan.|Department of Anesthesiology and Critical Care, National Research Center for Oncology and Transplantation, Astana, Kazakhstan.
authors: Agzam
authors: A
authors: Zhumadilov
authors: Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Matthew
authors: M
authors: Boyko
authors: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
authors: Shaun E
authors: SE
authors: Gruenbaum
authors: Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Evgeny
authors: E
authors: Brotfain
authors: Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy.
authors: Federico
authors: F
authors: Bilotta
authors: Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors: Alexander
authors: A
authors: Zlotnik
mesh_terms: D000818:Animals; D001921:Brain / Q000187:drug effects*; D001927:Brain Diseases / Q000097:blood* / Q000628:therapy*; D018698:Glutamic Acid / Q000097:blood*; D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D062907:Oxaloacetic Acid / Q000097:blood; D019289:Pyruvic Acid / Q000097:blood
chemical_list: D018696:Neuroprotective Agents; D062907:Oxaloacetic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid
keywords: blood glutamate scavenging; extracorporeal methods; hemodialysis; hemofiltration; neuroprotection; peritoneal dialysis