title: Insulin and the Brain: A Sweet Relationship With Intensive Care.
abstract: BACKGROUND
  Insulin receptors (IRs) in the brain have unique molecular features and a characteristic pattern of distribution. Their possible functions extend beyond glucose utilization. In this systematic review, we explore the interactions between insulin and the brain and its implications for anesthesiologists, critical care physicians, and other medical disciplines.
  
  
  METHODS
  A literature search of published preclinical and clinical studies between 1978 and 2014 was conducted, yielding 5996 articles. After applying inclusion and exclusion criteria, 92 studies were selected for this systematic review.
  
  
  RESULTS
  The IRs have unique molecular features, pattern of distribution, and mechanism of action. It has effects on neuronal function, metabolism, and neurotransmission. The IRs are involved in neuronal apoptosis and neurodegenerative processes.
  
  
  CONCLUSIONS
  In this systematic review, we present a close relationship between insulin and the brain, with discernible effects on memory, learning abilities, and motor functions. The potential therapeutic effects extend from acute brain insults such as traumatic brain injury, brain ischemia, and hemorrhage, to chronic neurodegenerative diseases such as Alzheimer and Parkinson disease. An understanding of the wider effects of insulin conveyed in this review will prompt anaesthesiologists and critical care physicians to consider its therapeutic potential and guide future studies.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bilotta
authors.affiliation: Anesthesia and Intensive Care Department, "La Sapienza" University of Rome, Rome, Italy mplitalia2@hotmail.com mariapaola.lauretta@uclh.nhs.uk.|Critical Care Department, University College London Hospital, London, United Kingdom.
authors.forename: M P
authors.initials: MP
authors.lastname: Lauretta
authors.affiliation: Department of Pediatric Neuroanesthesia and IONM, Cincinnati Children Hospital & Medical Center, Cincinnati, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Tewari
authors.affiliation: Anesthesia and Critical Care Department, University College London Hospital, London, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Haque
authors.affiliation: Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Uchino
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Rosa
mesh_terms: D001921:Brain / Q000378:metabolism* / Q000503:physiopathology; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D019636:Neurodegenerative Diseases / Q000378:metabolism / Q000503:physiopathology*; D011972:Receptor, Insulin / Q000378:metabolism*; D015398:Signal Transduction
chemical_list: D007328:Insulin; D011972:Receptor, Insulin
keywords: Insulin receptor; neurodegenerative disease critical care management; neuronal metabolism