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Skwarzynska D, Sun H, Kasprzak I, Sharma S, Williamson J, Kapur J. Glycolytic lactate production supports status epilepticus in experimental animals. Ann Clin Transl Neurol 2023; 10:1873-1884. [PMID: 37632130 PMCID: PMC10578888 DOI: 10.1002/acn3.51881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE Status epilepticus (SE) requires rapid intervention to prevent cerebral injury and mortality. The ketogenic diet, which bypasses glycolysis, is a promising remedy for patients with refractory SE. We tested the role of glycolytic lactate production in sustaining SE. METHODS Extracellular lactate and glucose concentration during a seizure and SE in vivo was measured using lactate and glucose biosensors. A lactate dehydrogenase inhibitor, oxamate, blocked pyruvate to lactate conversion during SE. Video-EEG recordings evaluated seizure duration, severity, and immunohistochemistry was used to determine neuronal loss. Genetically encoded calcium indicator GCaMP7 was used to study the effect of oxamate on CA1 pyramidal neurons in vitro. Spontaneous excitatory postsynaptic currents (sEPSCs) were recorded from CA1 neurons to study oxamate's impact on neurotransmission. RESULTS The extracellular glucose concentration dropped rapidly during seizures, and lactate accumulated in the extracellular space. Inhibition of pyruvate to lactate conversion with oxamate terminated SE in mice. There was less neuronal loss in treated compared to control mice. Oxamate perfusion decreased tonic and phasic neuronal activity of GCaMP7-expressing CA1 pyramidal neurons in vitro. Oxamate application reduced the frequency, but not amplitude of sEPSCs recorded from CA1 neurons, suggesting an effect on the presynaptic glutamatergic neurotransmission. INTERPRETATION A single seizure and SE stimulate lactate production. Diminishing pyruvate to lactate conversion with oxamate terminated SE and reduced associated neuronal death. Oxamate reduced neuronal excitability and excitatory neurotransmission at the presynaptic terminal. Glycolytic lactate production sustains SE and is an attractive therapeutic target.
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Affiliation(s)
- Daria Skwarzynska
- Neuroscience Graduate ProgramUniversity of VirginiaCharlottesvilleVirginia22908USA
| | - Huayu Sun
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginia22908USA
| | - Izabela Kasprzak
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginia22908USA
| | - Supriya Sharma
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginia22908USA
| | - John Williamson
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginia22908USA
| | - Jaideep Kapur
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginia22908USA
- UVA Brain InstituteUniversity of VirginiaCharlottesvilleVirginia22908USA
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Sutula TP, Wilson ST, Franzoso S, Stafstrom CE. 2-Deoxy-D-glucose administration after seizures has disease-modifying effects on kindling progression. Epilepsy Res 2023; 193:107169. [PMID: 37263021 DOI: 10.1016/j.eplepsyres.2023.107169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
2-deoxy-D-glucose (2DG) is a glucose analog and reversible inhibitor of glycolysis with anticonvulsant and antiepileptic effects in multiple seizure models. 2DG at a dose of 250 mg/kg intraperitoneally (IP) delays progression of repeated seizures evoked by kindling in rats when administered 30 min prior to twice daily kindling stimulation. As toxicological studies have demonstrated that repeated daily oral administration of 2DG at doses of 60-375 mg/kg/day in rats induces dose-dependent, reversible cardiac myocyte vacuolation, it was of interest to determine if 2DG also slowed kindling progression when administered at or below doses causing cardiac toxicity and at various time points after evoked seizures. We found that: (1) 2DG slowed kindling progression nearly 2-fold when administered at a dose of 37.5 mg/kg given IP 30 min prior to kindling stimulation, and (2) 2DG 37.5 mg/kg IP also slowed kindling progression when given immediately after, and for as long as 10 min after evoked (kindled) seizures. These observations suggest potential clinical usefulness of post-seizure administration of 2DG to reduce seizure clusters and long-term consequences of repeated seizures at human equivalent doses that are likely to be safe and well tolerated in patients.
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Affiliation(s)
- Thomas P Sutula
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA.
| | | | - Sheilah Franzoso
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Sutula TP, Fountain NB. 2DG and glycolysis as therapeutic targets for status epilepticus. Epilepsy Behav 2023; 140:109108. [PMID: 36804714 PMCID: PMC10032166 DOI: 10.1016/j.yebeh.2023.109108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/21/2023] [Indexed: 02/18/2023]
Abstract
2-deoxy-D-glucose (2DG) is a glucose analog differing from glucose only by removal of an oxygen atom at the 2 position, which prevents the isomerization of glucose-6-phosphate to fructose-6-phosphate, and thereby reversibly inhibits glycolysis. PET studies of regional brain glucose utilization positron-emitting 18F-2DG demonstrate that brain regions generating seizures have diminished glucose utilization during interictal conditions, but rapidly transition to markedly increased glucose delivery and utilization during seizures, particularly in status epilepticus (SE). 2-deoxy-D-glucose has acute antiseizure actions in multiple in vivo and in vitro seizure models, including models of SE induced by the chemo convulsants pilocarpine and kainic acid, suggesting that focal enhanced delivery of 2DG to ictal brain circuits is a potential novel anticonvulsant intervention for the treatment of SE.
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Affiliation(s)
- Thomas P Sutula
- Department of Neurology, University of Wisconsin, Madison, WI, USA; Hexokine Therapeutics, Inc., Madison, WI, USA.
| | - Nathan B Fountain
- Department of Neurology, F.E. Dreifuss Comprehensive Epilepsy Program, University of Virginia, Charlottesville, VA, USA; Hexokine Therapeutics, Inc., Madison, WI, USA
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Bharathi SS, Zhang BB, Paul E, Zhang Y, Schmidt AV, Fowler B, Wu Y, Tiemeyer M, Inamori KI, Inokuchi JI, Goetzman ES. GM3 synthase deficiency increases brain glucose metabolism in mice. Mol Genet Metab 2022; 137:342-348. [PMID: 36335793 PMCID: PMC11061803 DOI: 10.1016/j.ymgme.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
GM3 synthase (GM3S) deficiency is a rare neurodevelopmental disorder caused by an inability to synthesize gangliosides, for which there is currently no treatment. Gangliosides are brain-enriched, plasma membrane glycosphingolipids with poorly understood biological functions related to cell adhesion, growth, and receptor-mediated signal transduction. Here, we investigated the effects of GM3S deficiency on metabolism and mitochondrial function in a mouse model. By indirect calorimetry, GM3S knockout mice exhibited increased whole-body respiration and an increased reliance upon carbohydrate as an energy source. 18F-FDG PET confirmed higher brain glucose uptake in knockout mice, and GM3S deficient N41 neuronal cells showed higher glucose utilization in vitro. Brain mitochondria from knockout mice respired at a higher rate on Complex I substrates including pyruvate. This appeared to be due to higher expression of pyruvate dehydrogenase (PDH) and lower phosphorylation of PDH, which would favor pyruvate entry into the mitochondrial TCA cycle. Finally, it was observed that blocking glucose metabolism with the glycolysis inhibitor 2-deoxyglucose reduced seizure intensity in GM3S knockout mice following administration of kainate. In conclusion, GM3S deficiency may be associated with a hypermetabolic phenotype that could promote seizure activity.
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Affiliation(s)
- Sivakama S Bharathi
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Bob B Zhang
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Eli Paul
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Yuxun Zhang
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Alexandra V Schmidt
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Benjamin Fowler
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Yijen Wu
- Department of Developmental Biology, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Michael Tiemeyer
- Complex Carbohydrate Research Center, University of Georgia, Athens, GA, United States of America
| | - Kei-Ichiro Inamori
- Division of Glycopathology, Institute of Molecular Biomembrane and Glycobiology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi 981-8558, Japan
| | - Jin-Ichi Inokuchi
- Division of Glycopathology, Institute of Molecular Biomembrane and Glycobiology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi 981-8558, Japan
| | - Eric S Goetzman
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America..
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Pottkämper JCM, Verdijk JPAJ, Hofmeijer J, van Waarde JA, van Putten MJAM. Seizures induced in electroconvulsive therapy as a human epilepsy model: A comparative case study. Epilepsia Open 2021; 6:672-684. [PMID: 34351710 PMCID: PMC8633469 DOI: 10.1002/epi4.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Standardized investigation of epileptic seizures and the postictal state may contribute to a better understanding of ictal and postictal phenomena. This comparative case study aims to assess whether electrically induced seizures in electroconvulsive therapy (ECT) show sufficient similarities with spontaneous seizures to serve as a human epilepsy model. METHODS We compared six EEG recordings, three ECT-induced seizures and three generalized tonic-clonic seizures, using quantitative electroencephalography (EEG) analyses. EEG recordings during and after ECT sessions (under general anesthesia and muscle paralysis) were collected prospectively, whereas epilepsy data were selected retrospectively. Time-frequency representations, dominant ictal frequencies, and postictal alpha-delta ratios were calculated. RESULTS In all EEG recordings, a decrease in dominant ictal frequency was observed, as well as postictal suppression. Postictal alpha-delta ratio indicated the same trend for all: a gradual increase from predominantly delta to alpha frequencies on timescales of hours after the seizure. Postictal spectral representation was similar. Muscle artifacts were absent in ECT-induced seizures and present in spontaneous seizures. Ictal amplitude was higher in epileptic than in ECT-induced seizures. Temporospectral ictal dynamics varied slightly between groups. SIGNIFICANCE We show that ictal and postictal characteristics in ECT and patients with generalized tonic-clonic seizures are essentially similar. ECT-induced seizures may be used to investigate aspects of ictal and postictal states in a highly predictable manner and well-controlled environment. This suggests that clinical and electrophysiological observations during ECT may be extrapolated to epilepsy with generalized tonic-clonic seizures.
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Affiliation(s)
- Julia C. M. Pottkämper
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of PsychiatryRijnstate HospitalArnhemThe Netherlands
- Department of NeurologyRijnstate HospitalArnhemThe Netherlands
| | - Joey P. A. J. Verdijk
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of PsychiatryRijnstate HospitalArnhemThe Netherlands
| | - Jeannette Hofmeijer
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of NeurologyRijnstate HospitalArnhemThe Netherlands
| | | | - Michel J. A. M. van Putten
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
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Janicot R, Shao LR, Stafstrom CE. 2-deoxyglucose and β-hydroxybutyrate fail to attenuate seizures in the betamethasone-NMDA model of infantile spasms. Epilepsia Open 2021; 7:181-186. [PMID: 34784103 PMCID: PMC8886066 DOI: 10.1002/epi4.12561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Infantile spasms (IS) is an epileptic encephalopathy with a poor neurodevelopmental prognosis, and limited, often ineffective treatment options. The effectiveness of metabolic approaches to seizure control is being increasingly shown in a wide variety of epilepsies. This study investigates the efficacy of the glycolysis inhibitor 2‐deoxyglucose (2‐DG) and the ketone body β‐hydroxybutyrate (BHB) in the betamethasone‐NMDA model of rat IS. Prenatal rats were exposed to betamethasone on gestational day 15 (G15) and NMDA on postnatal day 15 (P15). Video‐electroencephalography (v‐EEG) was used to monitor spasms. NMDA consistently induced hyperflexion spasms associated with interictal sharp‐slow wave EEG activity and ictal flattening of EEG signals, reminiscent of hypsarrhythmia and electrodecrement, respectively. 2‐DG (500 mg/kg, i.p), BHB (200 mg/kg, i.p.), or both were administered immediately after occurrence of the first spasm. No experimental treatment altered significantly the number, severity, or progression of spasms compared with saline treatment. These data suggest that metabolic inhibition of glycolysis or ketogenesis does not reduce infantile spasms in the NMDA model. The study further validates the betamethasone‐NMDA model in terms of its behavioral and electrographic resemblance to human IS and supports its use for preclinical drug screening.
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Affiliation(s)
- Remi Janicot
- Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Li-Rong Shao
- Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carl E Stafstrom
- Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ziobro JM, Eschbach K, Shellhaas RA. Novel Therapeutics for Neonatal Seizures. Neurotherapeutics 2021; 18:1564-1581. [PMID: 34386906 PMCID: PMC8608938 DOI: 10.1007/s13311-021-01085-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 02/04/2023] Open
Abstract
Neonatal seizures are a common neurologic emergency for which therapies have not significantly changed in decades. Improvements in diagnosis and pathophysiologic understanding of the distinct features of acute symptomatic seizures and neonatal-onset epilepsies present exceptional opportunities for development of precision therapies with potential to improve outcomes. Herein, we discuss the pathophysiology of neonatal seizures and review the evidence for currently available treatment. We present emerging therapies in clinical and preclinical development for the treatment of acute symptomatic neonatal seizures. Lastly, we discuss the role of precision therapies for genetic neonatal-onset epilepsies and address barriers and goals for developing new therapies for clinical care.
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Affiliation(s)
- Julie M Ziobro
- Department of Pediatrics, Michigan Medicine, C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr, Ann Arbor, MI, USA.
| | - Krista Eschbach
- Department of Pediatrics, Section of Neurology, Denver Anschutz School of Medicine, Children's Hospital Colorado, University of Colorado, Aurora, CO, 80045, USA
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, C.S. Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr, Ann Arbor, MI, USA
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Janicot R, Stafstrom CE, Shao LR. The efficacy of fructose-1,6-bisphosphate in suppressing status epilepticus in developing rats. Epilepsy Res 2020; 168:106500. [DOI: 10.1016/j.eplepsyres.2020.106500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/12/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
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