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Boosting the injured brain with supplemental energy fuels

  • Mauro Oddo
  • Paul Vespa
  • David K. Menon
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Background

Clinical investigation, using cerebral metabolic assessment with positron emission tomography, magnetic resonance spectroscopy, and regional cerebral microdialysis, has repeatedly disclosed major alterations of cerebral energy metabolism in the aftermath of traumatic brain injury (TBI). Impairment of cerebral energy metabolism is characterized by elevated cerebral glucose demand, increased glycolysis, and diversion of the main substrate, glucose, to be used in injury-related reparative pathways, such as the pentose phosphate pathway. Ultimately, these secondary processes lead to a reduction of the cerebral metabolic rate of glucose and a decreased availability of cerebral extracellular glucose. To compensate for glucose shortage, cerebral lactate metabolism and uptake are increased in patients with TBI [1]. Use of alternative cerebral energy substrates—including lactate (LAC), but also ketone bodies (KB) such as β-hydroxybutyrate (BHB) and acetoacetate (AcAc)—may therefore...

Notes

Acknowledgements

Mauro Oddo is supported by research grants from the Swiss National Science Foundation.

Compliance with ethical standards

Conflicts of interest

The authors have no conflict of interest to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Intensive Care Medicine, Critical Care Clinical Research UnitCHUV-Lausanne University HospitalLausanneSwitzerland
  2. 2.Division of Neurosurgery and Department of NeurologyUniversity of California at Los Angeles School of MedicineLos AngelesUSA
  3. 3.USC Stevens Neuroimaging and Informatics Institute, University of Southern CaliforniaLos AngelesUSA
  4. 4.NIHR Global Health Research Group on NeurotraumaUniversity of CambridgeCambridgeUK
  5. 5.Division of Anesthesia, Department of MedicineUniversity of CambridgeCambridgeUK

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