The influence of arterial hypoxemia upon labile phosphates and upon extracellular and intracellular lactate and pyruvate concentrations in the rat brain

Cerebrospinal fluid and arterial lactate, pyruvate and acid-base balance in patients with intracranial hemorrhages

Lactate and pyruvate concentrations and acid-base balance in cerebrospinal fluid (CSF) and arterial blood were determined in patients with intracranial hemorrhages (28 subarachnoid hemorrhages and 15 intracerebral hemorrhages). A greater increase in CSF lactate and lactate-pyruvate ratio (L/P ratio) was observed in patients with impairment of consciousness, focal neurological deficits, poor prognosis, or CSF pressures higher than 300 mm H2O. A combination of CSF lactate greater than 2.5 mM per liter, L/P ration above 20, bicarbonate less than 20.4 mEq per liter, pH below 7.276, or arterial PCO2 below 31.5 mm Hg seems to indicate poor prognosis from intracranial hemorrhage. The mechanism of hyperventilation in acute cerebrovascular diseases and of CSF pH regulation in acid-base disturbances was also discussed.

Effects of hypothermia and hyperthermia on brain energy metabolism

The influence of elevated and reduced body temperatures upon the metabolic state of the brain was evaluated from the tissue concentrations of phosphocreatine (PCr) ATP, ADP and AMP and from the concentrations of glucose, lactate and pyruvate in immobilized and artificially ventilated rats anesthetized with 70% N2O. The results were compared to the results obtained in normothermic animals. It was found that rats with body temperatures of 32 degrees and 22 degrees C had the same brain tissue concentrations of high energy phosphates and the same adenylate energy charge as the controls, but hypothermia led to a progressive decrease of both cerebral and arterial lactate and pyruvate concentrations. A metabolic acidosis but no excess lactate appeared in the blood. At a body temperature of 42 degrees C, the metabolic pattern in the brain agreed with a state of hypoxia at a time when there was no sign of substrate depletion. Arterial blood showed excess lactate which may indicate an inadequacy of the oxygen supply also to other tissues.

An analysis of the drugs acting on cerebral energy metabolism

The behaviour of (a) the redox potential of the lactate/pyruvate system and the changes of the redox potential of the lactate/pyruvate system across the brain; (b) the energy charge potential of the adenylate pool, was studied in the brain of curarized beagle dogs. The influence of certain drugs (amobarbital, nicergoline, theophylline, papaverine, bamethan, dipyridamole, bemegride) on these parameters was evaluated under control conditions, during hypoxemia and during post-hypoxiemic recovery. On the whole, the action on energetic metabolism appears to be unrelated to the action believed to be exerted by drugs on cerebral vessels.

Cerebral metabolism in hypoxic hypoxia. I. Pattern of activation of glycolysis: a re-evaluation

In order to evaluate the pattern of activation of glycolysis in cerebral cortex during hypoxic hypoxia, lightly anesthetized rats were subjected to a lowering of arterial Po2 to about 25 mm Hg and brains were frozen in situ for metabolite analyses either 1, 2, 5, 15 or 30 min following the induction of hypoxia. The lactate and pyruvate concentrations increased progressively during the 30 min period of hypoxia. At 1 and 2 min there were decreases in G-6-P and F-6-P, and increases in FDP, DHAP and 3-PG, indicating activation of phosphofructokinase. At 5 min this pattern of changes was less pronounced and at 15 min it was absent in spite of the fact that the lactate and pyruvate concentrations were further increased. At 30 min F-6-P and F-6-P had further increased but the levels of DHAP, FDP and 3-PG were normal. Evidently, phosphofructokinase activation can only be detected in the early stages of hypoxia, i.e. when the maximal increase in glycolytic flux occurs and before there has been a corresponding activation of other rate-limiting enzymatic steps. Signs of activation of phosphofructokinase were observed in the absence of changes in tissue concentrations of ATP or AMP, with minimal elevation of NH4plus, and in spite of increased (or unchanged) levels of citrate. However, since there were small but significant increases in ADP at 1 and 2 min, and pH-independent decreases in phosphocreatine, the results indicate that hypoxia is accompanied by an initial imbalance between production and utilization of ATP. The metabolic consequences of this imbalance (decrease in phosphocreatine, increases in ADP and P1) may be at least partly responsible for activation of phosphofructokinase.

The relationship between arterial po2 and cerebral blood flow in hypoxic hypoxia

The relationship between arterial oxygen tension (PaO2) and cerebral blood flow (CBF) in hypoxic hypoxia was studied in artificially ventilated and normocapnic rats. Changes in CBF were evaluated from arteriovenous differences in oxygen content after 2, 5, 15 and 30 min exposure to PaO2 85, 75, 55, 45, 35, and 25 mm Hg. In separate experiments the PaO2 was decreased to 25 mm Hg for 1, 2, 5, 15 and 30 min in animals in which PaCO2 was allowed to fall by 5-10 mm Hg. There was a small, gradual increase in CBF when PaO2 was lowered in steps from 130 to 55 mm Hg, and a more pronounced increase at PO2 values below 50 mm Hg. At PaO2 25 mm Hg CBF increased to values of 500% of normal. Significant increased in CBF were recorded at PaO2 values of 85 and 75 mm Hg in spite of the fact that previous studies have failed to record an elevated tissue lactate content at these po2 levels, and in spite of an unchanged cerebral venous PO2. When the PaO2 was reduced to 25 mm Hg CBF increased markedly already at 1 and 2 min, and this increase in CBF occurred even if PaCO2 was allowed to fall by 5-10 mm Hg. Previous results have shown that in such short periods enough lactic acid is not formed to induce a net tissue acidosis. The results thus give no support to the hypothesis that cerebral hyperemia in hypoxia is coupled to accumulation of lactic acid in the tissue.

Cerebral blood flow and oxygen consumption in the rat in hypoxic hypoxia

In order to measure cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRo(2)) at pronounced degrees of hypoxic hypoxia the Pao(2) of artificially ventilated and normocapnic rats was reduced to between 47 and 22 mm Hg for 15-25 min with subsequent measurements of CBF, using a -133Xenon modification of the Kety and Schmidt technique, and of the arteriovenous difference in oxygen content, the venous blood being obtained from the superior sagittal sinus. When the Pao(2) was reduced to minimal values of 22 mm Hg CBF increased 4- to 6-fold, the increase in CBF being unrelated to changes in blood pressure or Paco(2). The CMRo(2) remained unchanged at all levels of hypoxia. It is concluded that the maintenance of a normal, or near-normal, cerebral energy state even at extreme degrees of hypoxic hypoxia depends solely on a homeostatic increase in CBF.

Cerebrospinal fluid pH and monoamine and glucolytic metabolites in Alzheimer's disease

Determinations of acid monoamine metabolites, such as homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), in cerebrospinal fluid (CSF) give valid information on the metabolism of the corresponding amines in the brain tissue (Moir et al., 1970; Roos, 1970). The monoamine metabolites in the CSF are related to age. The concentrations of HVA and 5-HIAA increase with age (Gottfries et al., 1971). Probenecid blocks the elimination of HVA and 5-HIAA from brain tissue to blood (Neff et al., 1964, 1967; Werdinius, 1966) and from CSF to blood (Guldberg et al., 1966; Olsson and Roos, 1968). Probenecid thus normally induces an increase in the concentrations of the acid monoamine metabolites in the CSF, which is related to the turnover of monoamines in the brain tissue.

Energy state and glycolysis in human cerebral edema

✓ A new freeze-stop device using a liquid nitrogen reservoir and an automatic biopsy mechanism has been developed, suitable for rapid, sterile, and standardized sampling of cerebral tissue in man. In animal experiments a 200 mg piece of cerebral cortex was cooled from a room temperature of 18°C to −40°C within 7 sec which is twice as fast as when it was immersed in liquid N2. The method was then applied to metabolic tissue studies of perifocal edematous cortex from patients undergoing neurosurgery for intracranial tumors. Energy-rich phosphate compounds or parameters of the energy state were found to be less affected in this type of brain edema than the glycolytic activity which was markedly enhanced, indicated by lactic and pyruvic acid determinations. The tissue water content correlated closely with the lactic acid concentration, and very little with measurements of the energy state such as the energy charge potential or the adenosinetriphosphate-adenosinediphosphate (ATP/ADP) ratio. It is suggested that in perifocal brain edema increased levels of lactic acid are associated with mechanisms leading to an increased water uptake.

Barbiturate protection in acute focal cerebral ischemia

We have found that anesthetic technique modifies the neurological and pathological sequelae of unilateral middle cerebral artery and internal carotid artery occlusion in dogs. Occlusion was performed in seven groups of six dogs during each of the following anesthetic regimens: light (0.8%) halothane, "awake," deep (1.9%) halothane, deep halothane with mean arterial pressure reduced to 55 torr, pentobarbital (56 mg per kilogram), light halothane plus 40 mg per kilogram thiopental begun just before cerebral artery occlusion, and light halothane plus 40 mg per kilogram thiopental begun 15 minutes after occlusion. Body temperature, arterial P co co 2 P o o 2 pH, and blood pressure (except as noted above) were maintained normal. Neurological examinations were performed daily. On the seventh day the dogs were killed and their brains removed for pathological study. Hemiparesis occurred in five of six dogs under light halothane and five of six awake dogs; a mean of 10.8% and 9.6%, respectively, of their right hemispheres were infarcted. In the deep halothane groups, all of the normotensive and five of the six hypotensive dogs became severely hemiplegic; mean infarction size was 28.2% and 34.1%, respectively. Only one of the 18 dogs who received a barbiturate sustained a neurological deficit -- a transient unilateral weakness. Means of 1.4%, 2.7%, and 0.1% of the right hemisphere were infarcted in the barbiturate animals. The protective action of barbiturates in canine acute focal cerebral ischemia suggests that they should be considered for anesthesia in surgery requiring cerebral vessel occlusion and perhaps even for treatment of acute stroke.

Brain tryptophan hydroxylation: dependence on arterial oxygen tension

The accumulation of cerebral 5-hydroxytryptophan after decarboxylase inhibition was decreased in rats maintained at arterial O(2) tensions below 60 mm-Hg. In contrast, brain lactate was stable above 40 mm-Hg and brain adenosine triphosphate, adenosine diphosphate, and adenosine monophosphate were unchanged above 30 mm-Hg. There was a linear correlation of brain 5-hydroxytryptophan accumulation to cerebral venous O(2) tension. Cerebral tryptophan hydroxylase appears to have a poor affinity for oxygen and to be affected by slight hypoxia. The resultant decreases in monoamine neurotransmitter metabolism may explain the behavioral changes of mild oxygen deprivation.

Experimental brain ischemia: protection from irreversible damage with a rapid-acting barbiturate (methohexital)

Experimental brain ischemia was produced in rabbits by coupling systemic hypotension and hypoxia. The animals were paralyzed with succinylcholine and ventilated mechanically. Durally implanted electrodes were used to monitor the severity of ischemia. Five minutes of an isoelectric EEG produced irreversible brain damage in most of the rabbits. Four rabbits receiving the rapid-acting barbiturate, methohexital, in the dosage of 5 mg/kg at the onset of the isoelectric EEG showed complete protection from detectable ischemic damage and recovered dramatically. It is suggested that suppression of brain metabolism with barbiturates during cerebral ischemia is worthy of clinical assessment.