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Early intervention in the treatment of traumatic brain injury is vital to mitigate damage to brain tissue. Administering lactate or ketones following a brain injury might lessen the damage caused by hypoxia and spare glucose for essential processes, like the recycling of the antioxidant glutathione. Glutathione helps prevent damage from oxidative stress caused by the production of reactive oxygen species that can occur after a traumatic brain injury. In this clip, Dr. Dominic D'Agostino discusses the neuroprotective potential associated with a combination of ketones and lactate in the management of traumatic brain injury.
Rhonda: Just to jump back again before I ask you this other question to George Brooks' thing is that he's doing some interesting work working with some physicians at UCLA, I believe, with traumatic brain injury. So these are people that come out with, like, head gunshot wounds. And they are looking at infusing lactate because he's the lactate guy. But ketone bodies will work the same way.
Dom: I think it would work better from what we know.
Rhonda: Maybe even better.
Dom: Yeah, I think a cocktail of the two would be... And I've been debating whether or not to really study lactate sort of the same way I'm studying ketones and maybe make lactate esters or lactate and just to see what kind of results we see starting with our oxygen toxicity model and working from there, which is an excellent model.
Rhonda: Obviously, with the lactate, you have to have a intact blood-brain barrier because if no oxygen is getting there, you will get the lactic acid build-up, right? Because then, I mean, the mitochondria aren't going to be able to use the lactate, which is converted to pyruvate as energy, so it builds up, but he has been doing some work and looking at this glucose sparing in the brain. And in this, of course, ketone bodies would work very similarly, in theory.
Dom: Do you know how he gets...? Does he use, like, a lactate? There's alpha L-polylactate, I think. That's, like, in a sports supplement and some other thing.
Rhonda: He actually designed it...
Dom: Oh, really?
Rhonda: I think he's the one that, yeah, he's got a patent on that.
Dom: Oh, wow. I was using that back in 1991 and -two.
Rhonda: Cytomax?
Dom: Cytomax, yeah.
Rhonda: That's him, that's his.
Dom: When I raced mountain bikes, that was, like, my go-to supplement, alpha-L-polylactate.
Rhonda: You should get in touch with George, he's great.
Dom: I know, wow.
Rhonda: So he... Let's see, what was I just going to say? I lost my train of thought.
Dom: The delivery or the...
Rhonda: Oh, yeah, so the delivery that he's doing...in this specific study, they're doing it intravenously, so. But I was mentioning the blood-brain barrier has to be intact, otherwise, it can go the opposite way where it's actually bad for you. But it would be really interesting to see so the question is, one, will this lactate or beta-hydroxybutyrate or whatever ketone get into the MCT shuttle better? So there's questions of which one gets in there? And can they be used together? And there's all sorts of interesting things, but I'm sort of interested in this for my own personal...
Dom: Yeah, the neuroprotective capacity seems really compelling. I mean, from what we know about lactate approaching it, going to back my old, like, PhD studies or whatever during hypoxia, but it would relate to so many traumatic brain injuries, hypoxia, so you're mitigating the damage from hypoxia.
Rhonda: Yeah, and also traumatic brain injury is inducing damage, and so, glutathione is one of the major ways of mitigating that. There's been studies showing that, early on, it's important. If you get that early on, it prevents the whole cascade so I think that ketones and lactate both seem to have huge potential for glucose sparing, but that, you know...
Dom: I think chilling the body and infusing ketones, lactate with a couple major few co-factors that are part of the bioenergetic use of these things would be a home run as far as...
Rhonda: Yeah, get some students on it.
Dom: Yeah, these are grants that I'm kind of working on and writing, but I'm not sure the funding agencies are ready to fully...they want, like, the magic pill thing.
A chemical produced in the liver via the breakdown of fatty acids. Beta-hydroxybutyrate is a type of ketone body. It can be used to produce energy inside the mitochondria and acts as a signaling molecule that alters gene expression by inhibiting a class of enzymes known as histone deacetylases.
A highly selective semi-permeable barrier in the brain made up of endothelial cells connected by tight junctions. The blood-brain barrier separates the circulating blood from the brain's extracellular fluid in the central nervous system. Whereas water, lipid-soluble molecules, and some gases can pass through the blood-brain barrier via passive diffusion, molecules such as glucose and amino acids that are crucial to neural function enter via selective transport. The barrier prevents the entry of lipophilic substances that may be neurotoxic via an active transport mechanism.
A survival mechanism the brain relies on during starvation. Glucose sparing occurs when the body utilizes fatty acids as its primary fuel and produces ketone bodies. The ketone bodies cross the blood-brain barrier and are used instead of glucose, thereby “sparing” glucose for use in other metabolic pathways, such as the pentose-phosphate pathway, which produces NADPH. NADPH is essential for the production of glutathione, one of the major antioxidants used in the body and brain.
An antioxidant compound produced by the body’s cells. Glutathione helps prevent damage from oxidative stress caused by the production of reactive oxygen species.
Condition in which the body or a region of the body is deprived of adequate oxygen supply. Hypoxia may be classified as either generalized, affecting the whole body, or local, affecting a region of the body.
Molecules (often simply called “ketones”) produced by the liver during the breakdown of fatty acids. Ketone production occurs during periods of low food intake (fasting), carbohydrate restrictive diets, starvation, or prolonged intense exercise. There are three types of ketone bodies: acetoacetate, beta-hydroxybutyrate, and acetone. Ketone bodies are readily used as energy by a diverse array of cell types, including neurons.
Lactate is thought to participate in a sort of "lactate shuttle" where, after being produced in muscle from exercise, it is transported in to tissues like the heart, and brain, where it is used as an energy source. Lactate is one of many molecules that falls under a loose group of molecules referred to as exerkines, a broad group of exercise-induced hormonal-like factors. Evidence suggests that lactate is the preferred fuel of the brain. Additionally, rodent studies suggest that lactate mediates some of the benefits of exercise on learning and memory via inducing neuronal brain-derived neurotrophic factor (BDNF) expression.[1] In clinical studies, lactate shows promise as a treatment for inflammatory conditions including traumatic brain injury and as a means to deliver fuel to working muscles.
Lactate that is produced from an oxygen-independent metabolic pathway (glycolysis) is shuttled to various tissues including muscle, heart, and brain, where it is used as a substrate for oxygen-dependent energy production.
Tiny organelles inside cells that produce energy in the presence of oxygen. Mitochondria are referred to as the "powerhouses of the cell" because of their role in the production of ATP (adenosine triphosphate). Mitochondria are continuously undergoing a process of self-renewal known as mitophagy in order to repair damage that occurs during their energy-generating activities.
Oxygen-containing chemically-reactive molecules generated by oxidative phosphorylation and immune activation. ROS can damage cellular components, including lipids, proteins, mitochondria, and DNA. Examples of ROS include: peroxides, superoxide, hydroxyl radical, and singlet oxygen.
A related byproduct, reactive nitrogen species, is also produced naturally by the immune system. Examples of RNS include nitric oxide, peroxynitrite, and nitrogen dioxide.
The two species are often collectively referred to as ROS/RNS. Preventing and efficiently repairing damage from ROS (oxidative stress) and RNS (nitrosative stress) are among the key challenges our cells face in their fight against diseases of aging, including cancer.
Damage to the brain caused by a sudden blow, penetrating injury, or lack of oxygen, ranging from mild to severe. TBIs can induce a wide range of short- or long-term changes in the brain that affect thinking, sensation, language, personality, and emotion. In addition, TBI may increase the risk for developing epilepsy, Alzheimer’s disease, Parkinson’s disease, and other brain disorders. Nearly 75 percent of TBIs that occur each year are concussions or other forms of mild TBI. Even mild TBIs damage the delicate tissues and blood vessels of the brain and can result in altered brain function that can persist for days, weeks, or months. Approximately 15 percent of concussed athletes experience symptoms as long as one year after their injury, a condition called persistent post-concussion syndrome, or PPCS, typically after returning to play too quickly.
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