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Kim JA, Schimpf S, Yano ST, Nordli D, Phitsanuwong C. Categorizing Monogenic Epilepsies by Genetic Mechanisms May Predict Efficacy of the Ketogenic Diet. Pediatr Neurol 2024; 160:11-17. [PMID: 39173306 DOI: 10.1016/j.pediatrneurol.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/19/2024] [Accepted: 07/25/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The ketogenic diet (KD) is an effective treatment for epilepsy. In recent years, studies have shown favorable efficacy of KD in epilepsy from genetic disorders. In this study, we propose an approach to KD in monogenic epilepsy: we evaluate the utility of categorizing genetic variants based on rational associations with the known mechanisms of KD. METHODS Patients with monogenic epilepsy treated with KD were reviewed. The genetic etiologies were categorized into five groups: (1) conditions causing cellular energy impairment, (2) GABA-pathies, (3) mToR-pathies, (4) ion channelopathies, and (5) no known mechanisms associated with KD mechanisms. Treatment response was defined as a median reduction in seizure frequency of greater than 50%. RESULTS Of 35 patients, 24 (69%) were responders at three months. Based on categories, Group 1 had the highest response rate with seven of seven (100%), followed by Group 2, six of seven (86%), and Group 3, two of three (67%). Patients in Groups 4 and 5 had poorer responses with three of seven (43%) and four of 11 (36%) response rates, respectively (P < 0.01). Median percentage of seizure reduction showed Group 1 with the highest reduction of 97.5%, Group 2 at 94%, and Groups 3, 4, and 5 at 62.5%, 30%, and 40%, respectively (P = 0.036). CONCLUSION Our findings show a favorable response to KD in patients with monogenic epilepsy (69% at three months) with the highest response in patients with conditions involving cellular energy impairment and GABA-pathies. The KD, therefore, should be considered early in patients with monogenic epilepsy, especially those involving genes associated with cellular energy impairment or GABA-pathies.
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Affiliation(s)
- Jeong-A Kim
- Section of Child Neurology, The University of Chicago Medicine, Chicago, Illinois
| | - Stephanie Schimpf
- Section of Child Neurology, The University of Chicago Medicine, Chicago, Illinois; Ketogenic Diet Program, The University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Sho T Yano
- Section of Child Neurology, The University of Chicago Medicine, Chicago, Illinois
| | - Douglas Nordli
- Section of Child Neurology, The University of Chicago Medicine, Chicago, Illinois
| | - Chalongchai Phitsanuwong
- Section of Child Neurology, The University of Chicago Medicine, Chicago, Illinois; Ketogenic Diet Program, The University of Chicago Comer Children's Hospital, Chicago, Illinois.
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Gallop MR, Vieira RFL, Matsuzaki ET, Mower PD, Liou W, Smart FE, Roberts S, Evason KJ, Holland WL, Chaix A. Long-term ketogenic diet causes hyperlipidemia, liver dysfunction, and glucose intolerance from impaired insulin trafficking and secretion in mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.14.599117. [PMID: 38948738 PMCID: PMC11212871 DOI: 10.1101/2024.06.14.599117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
A ketogenic diet (KD) is a very low-carbohydrate, very high-fat diet proposed to treat obesity and type 2 diabetes. While KD grows in popularity, its effects on metabolic health are understudied. Here we show that, in male and female mice, while KD protects against weight gain and induces weight loss, over long-term, mice develop hyperlipidemia, hepatic steatosis, and severe glucose intolerance. Unlike high fat diet-fed mice, KD mice are not insulin resistant and have low levels of insulin. Hyperglycemic clamp and ex vivo GSIS revealed cell-autonomous and whole-body impairments in insulin secretion. Major ER/Golgi stress and disrupted ER-Golgi protein trafficking was indicated by transcriptomic profiling of KD islets and confirmed by electron micrographs showing a dilated Golgi network likely responsible for impaired insulin granule trafficking and secretion. Overall, our results suggest long-term KD leads to multiple aberrations of metabolic parameters that caution its systematic use as a health promoting dietary intervention.
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Yannakoulia M, Scarmeas N. Diets. N Engl J Med 2024; 390:2098-2106. [PMID: 38865662 DOI: 10.1056/nejmra2211889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Affiliation(s)
- Mary Yannakoulia
- From the Department of Nutrition and Dietetics, Harokopio University of Athens (M.Y.), and the 1st Department of Neurology, Aiginintio Hospital, National and Kapodistrian University of Athens (N.S.) - both in Athens; and the Department of Neurology, Columbia University, New York (N.S.)
| | - Nikolaos Scarmeas
- From the Department of Nutrition and Dietetics, Harokopio University of Athens (M.Y.), and the 1st Department of Neurology, Aiginintio Hospital, National and Kapodistrian University of Athens (N.S.) - both in Athens; and the Department of Neurology, Columbia University, New York (N.S.)
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4
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Leitner DF, Siu Y, Korman A, Lin Z, Kanshin E, Friedman D, Devore S, Ueberheide B, Tsirigos A, Jones DR, Wisniewski T, Devinsky O. Metabolomic, proteomic, and transcriptomic changes in adults with epilepsy on modified Atkins diet. Epilepsia 2023; 64:1046-1060. [PMID: 36775798 PMCID: PMC10372873 DOI: 10.1111/epi.17540] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE High-fat and low-carbohydrate diets can reduce seizure frequency in some treatment-resistant epilepsy patients, including the more flexible modified Atkins diet (MAD), which is more palatable, mimicking fasting and inducing high ketone body levels. Low-carbohydrate diets may shift brain energy production, particularly impacting neuron- and astrocyte-linked metabolism. METHODS We evaluated the effect of short-term MAD on molecular mechanisms in adult epilepsy patients from surgical brain tissue and plasma compared to control participants consuming a nonmodified higher carbohydrate diet (n = 6 MAD, mean age = 43.7 years, range = 21-53, diet for average 10 days; n = 10 control, mean age = 41.9 years, range = 28-64). RESULTS By metabolomics, there were 13 increased metabolites in plasma (n = 15 participants with available specimens), which included 4.10-fold increased ketone body 3-hydroxybutyric acid, decreased palmitic acid in cortex (n = 16), and 11 decreased metabolites in hippocampus (n = 6), which had top associations with mitochondrial functions. Cortex and plasma 3-hydroxybutyric acid levels had a positive correlation (p = .0088, R2 = .48). Brain proteomics and RNAseq identified few differences, including 2.75-fold increased hippocampal MT-ND3 and trends (p < .01, false discovery rate > 5%) in hippocampal nicotinamide adenine dinucleotide (NADH)-related signaling pathways (activated oxidative phosphorylation and inhibited sirtuin signaling). SIGNIFICANCE Short-term MAD was associated with metabolic differences in plasma and resected epilepsy brain tissue when compared to control participants, in combination with trending expression changes observed in hippocampal NADH-related signaling pathways. Future studies should evaluate how brain molecular mechanisms are altered with long-term MAD in a larger cohort of epilepsy patients, with correlations to seizure frequency, epilepsy syndrome, and other clinical variables. [Clinicaltrials.gov NCT02565966.].
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Affiliation(s)
- Dominique F. Leitner
- Comprehensive Epilepsy Center, New York University Grossman School of Medicine, New York, New York, United States of America
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Yik Siu
- Metabolomics Core Resource Laboratory, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Aryeh Korman
- Metabolomics Core Resource Laboratory, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Ziyan Lin
- Applied Bioinformatics Laboratories, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Evgeny Kanshin
- Proteomics Laboratory, Division of Advanced Research Technologies, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Daniel Friedman
- Comprehensive Epilepsy Center, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Sasha Devore
- Comprehensive Epilepsy Center, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Beatrix Ueberheide
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
- Proteomics Laboratory, Division of Advanced Research Technologies, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Biochemistry and Molecular Pharmacology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Aristotelis Tsirigos
- Applied Bioinformatics Laboratories, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Drew R. Jones
- Metabolomics Core Resource Laboratory, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Thomas Wisniewski
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University Grossman School of Medicine, New York, New York, United States of America
- Department of Neurology, New York University Grossman School of Medicine, New York, New York, United States of America
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Gross EC, Putananickal N, Orsini AL, Schoenen J, Fischer D, Soto-Mota A. Defining metabolic migraine with a distinct subgroup of patients with suboptimal inflammatory and metabolic markers. Sci Rep 2023; 13:3787. [PMID: 36882474 PMCID: PMC9992685 DOI: 10.1038/s41598-023-28499-y] [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: 01/16/2022] [Accepted: 01/19/2023] [Indexed: 03/09/2023] Open
Abstract
Emerging evidence suggest migraine is a response to cerebral energy deficiency or oxidative stress in the brain. Beta-hydroxybutyrate (BHB) is likely able to circumvent some of the meta-bolic abnormalities reported in migraine. Exogenous BHB was given to test this assumption and, in this post-hoc analysis, multiple metabolic biomarkers were identified to predict clinical improvements. A randomized clinical trial, involving 41 patients with episodic migraine. Each treatment period was 12 weeks long, followed by eight weeks of washout phase / second run-in phase before entering the corresponding second treatment period. The primary endpoint was the number of migraine days in the last 4 weeks of treatment adjusted for baseline. BHB re-sponders were identified (those with at least a 3-day reduction in migraine days over placebo) and its predictors were evaluated using Akaike's Information Criterion (AIC) stepwise boot-strapped analysis and logistic regression. Responder analysis showed that metabolic markers could identify a "metabolic migraine" subgroup, which responded to BHB with a 5.7 migraine days reduction compared to the placebo. This analysis provides further support for a "metabolic migraine" subtype. Additionally, these analyses identified low-cost and easily accessible biomarkers that could guide recruitment in future research on this subgroup of patients.This study is part of the trial registration: ClinicalTrials.gov: NCT03132233, registered on 27.04.2017, https://clinicaltrials.gov/ct2/show/NCT03132233.
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Affiliation(s)
- Elena C Gross
- Division of Pediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.
| | - Niveditha Putananickal
- Division of Pediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Anna-Lena Orsini
- Division of Pediatric Neurology, University Children's Hospital Basel (UKBB) & Neurology Department, University Hospital Basel (USB), University of Basel, Basel, Switzerland
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology-Citadelle Hospital, University of Liège, Liège, Belgium
| | - Dirk Fischer
- Division of Pediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Adrian Soto-Mota
- Metabolic Diseases Research Unit, National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Tlalpan, Mexico.,School of Medicine, Tecnologico de Monterrey, Mexico City, Mexico
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Modified Atkins diet versus ketogenic diet in children with drug-resistant epilepsy: A meta-analysis of comparative studies. Clin Nutr ESPEN 2022; 51:112-119. [DOI: 10.1016/j.clnesp.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/29/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022]
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Pedersen ZO, Holm-Yildiz S, Dysgaard T. Nutritional Interventions for Patients with Mitochondrial POLG-Related Diseases: A Systematic Review on Efficacy and Safety. Int J Mol Sci 2022; 23:ijms231810658. [PMID: 36142570 PMCID: PMC9502393 DOI: 10.3390/ijms231810658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022] Open
Abstract
Ketogenic diet is recommended as a treatment to reduce seizure frequency in patients with intractable epilepsy. The evidence and safety results are sparse for diet interventions in patients with pathogenic polymerase gamma (POLG) variants and intractable epilepsy. The aim of this systematic review is to summarize the efficacy of diet treatment on seizure frequency, clinical symptoms, and potential deleterious effect of liver involvement in patients with mitochondrial diseases caused by pathogenic POLG variants. Literature was searched in PubMed, Embase; and Cochrane in April 2022; no filter restrictions were imposed. The reference lists of retrieved studies were checked for additional literature. Eligibility criteria included verified pathogenic POLG variant and diet treatment. Overall, 880 studies were identified, providing eight case-reports representing nine patients eligible for inclusion. In eight of nine cases, clinical symptoms were improved; six out of nine cases reported improvements in seizure frequency. However, increasing levels of liver enzymes after initiating ketogenic diet were found in four of the nine cases, with one case revealing decreased levels of liver enzymes after initiating long-chain triglyceride restriction. Viewed together, the studies imply that ketogenic diet can have a positive impact on seizure frequency, but may induce progression of liver impairment in patients with pathogenic POLG variants.
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8
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Cai M, Xu W, Zheng Y, Ding M. Ketogenic dietary therapy in adult status epilepticus: current progress and clinical application. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00082-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractStatus epilepticus (SE) is a common fatal neurological disease with high morbidity and mortality. Even if a large proportion of patients might be relieved from anti-seizure medications, sedatives and anesthetics, some still remain out of control. The ketogenic dietary (KD) has been proven useful in patients refractory to medications and/or who have failed to respond to surgical intervention. Recently, KD has shown beneficial therapeutic effects in children with SE, but studies in adults have rarely been reported. In this paper, we review the efficacy and utility of KD in adult SE patients and highlight its application for clinical reference and management.
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9
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Brain Metabolic Alterations in Alzheimer's Disease. Int J Mol Sci 2022; 23:ijms23073785. [PMID: 35409145 PMCID: PMC8998942 DOI: 10.3390/ijms23073785] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/27/2023] Open
Abstract
The brain is one of the most energy-consuming organs in the body. Satisfying such energy demand requires compartmentalized, cell-specific metabolic processes, known to be complementary and intimately coupled. Thus, the brain relies on thoroughly orchestrated energy-obtaining agents, processes and molecular features, such as the neurovascular unit, the astrocyte-neuron metabolic coupling, and the cellular distribution of energy substrate transporters. Importantly, early features of the aging process are determined by the progressive perturbation of certain processes responsible for adequate brain energy supply, resulting in brain hypometabolism. These age-related brain energy alterations are further worsened during the prodromal stages of neurodegenerative diseases, namely Alzheimer's disease (AD), preceding the onset of clinical symptoms, and are anatomically and functionally associated with the loss of cognitive abilities. Here, we focus on concrete neuroenergetic features such as the brain's fueling by glucose and lactate, the transporters and vascular system guaranteeing its supply, and the metabolic interactions between astrocytes and neurons, and on its neurodegenerative-related disruption. We sought to review the principles underlying the metabolic dimension of healthy and AD brains, and suggest that the integration of these concepts in the preventive, diagnostic and treatment strategies for AD is key to improving the precision of these interventions.
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Koyuncu H, Fidan V, Toktas H, Binay O, Celik H. Effect of ketogenic diet versus regular diet on voice quality of patients with Parkinson's disease. Acta Neurol Belg 2021; 121:1729-1732. [PMID: 32892250 DOI: 10.1007/s13760-020-01486-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
Diets that have effects on health problems can vary in their composition. Whilst following a regular diet (RD) a person typically consumes about 30% of calories from fat. Ketogenic diet (KD) is a form of diet whereby a person consumes as much as 90% of calories from fat. KD has been trialed as a treatment for neurological diseases and obesity. Parkinson's disease (PD) is a neurologic disease that impacts the quality of voice. Voice Handicap Index (VHI) is a test that gives information to clinical and physiological assessment about voice. We assessed the impact of KD and RD on voice quality (VQ). Seventy-four patients with PD who reported a voice disorder related to their disease were randomly assigned to the KD or RD groups. We investigated the VHI change of subjects before and 3 months after diet. Sixty-eight PD patients completed the study. Baseline VHI values did not differ significantly between groups. All mean VHI parameters improved in KD group (p˂ 0.001). Currently there are different therapies that address speech and voice disorders in patients with PD. As such KD may be an alternative therapy to improve VQ of patients with PD. A larger sample size is necessary to determine the role and pathophysiology of KD on VQ of PD patients.
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Affiliation(s)
- Handan Koyuncu
- Department of Otorhinolaryngology, Eskisehir Gov Hosp, Cavdarlar Street, Eskisehir, 26080, Turkey
| | - Vural Fidan
- Department of Otorhinolaryngology, Eskisehir Gov Hosp, Cavdarlar Street, Eskisehir, 26080, Turkey.
| | - Hayal Toktas
- Department of Neurology, Atasehir Memorial Hospital, Istanbul, Turkey
| | - Omer Binay
- Department of Otorhinolaryngology, Corlu State Hospital, Tekirdag, Turkey
| | - Hamit Celik
- Department of Neurology, Buhara Hospital, Erzurum, Turkey
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Caminha MC, Moreira AB, Matheus FC, Rieger DK, Moreira JD, Dalmarco EM, Demarchi IG, Lin K. Efficacy and tolerability of the ketogenic diet and its variations for preventing migraine in adolescents and adults: a systematic review. Nutr Rev 2021; 80:1634-1647. [PMID: 34664676 DOI: 10.1093/nutrit/nuab080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Migraine is a headache of variable intensity that is associated with focal and systemic symptoms. A ketogenic diet (KD), a very-low-carbohydrate diet with a proportional increase in fat, causes brain metabolic alterations, which could be beneficial for some neurologic conditions. OBJECTIVE A systematic review was conducted to assess the efficacy and tolerability of KD in preventing migraine in adolescents and adults. DATA SOURCES The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard was used to review articles found in the PubMed, EMBASE, Scopus, Web of Science, LILACS, LIVIVO, Science Direct, and Cochrane Central Register of Controlled Trials databases. The Google Scholar, DOAJ, ProQuest, and OpenGrey databases were included. DATA EXTRACTION The population, intervention, comparison, outcome, and study design strategy included assessing the quality of the evidence using Grading of Recommendations Assessment Development and Evaluation and the risk of bias after applying the JBI critical appraisal tools. DATA ANALYSIS Most of the 10 selected studies reported that KD reduced the number and severity of migraine attacks in patients, with few reported adverse effects. The evidence on the effectiveness of the KD is low, so whether the final effect is due to the treatment remains inconclusive. CONCLUSIONS This study represents an initial effort to systematize information on the efficacy and tolerability of KD and its variations in the prevention of migraine. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020186253.
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Affiliation(s)
- Madson C Caminha
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Adriana B Moreira
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Filipe C Matheus
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Débora K Rieger
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Júlia D Moreira
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Eduardo M Dalmarco
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Izabel G Demarchi
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Katia Lin
- M. C. Caminha, A. B. Moreira and K. Lin are with the Department of Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil. F. C. Matheus is with the Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. D. K. Rieger and J. D. Moreira are with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. E. M. Dalmarco and I. G. Demarchi are with the Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. I. G. Demarchi is with the Department of Clinical Analyses and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
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12
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Sourbron J, Thevissen K, Lagae L. The Ketogenic Diet Revisited: Beyond Ketones. Front Neurol 2021; 12:720073. [PMID: 34393987 PMCID: PMC8363000 DOI: 10.3389/fneur.2021.720073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Jo Sourbron
- Department of Development and Regeneration, Section Pediatric Neurology, University Hospital Katholieke Universiteit Leuven, Leuven, Belgium
| | - Karin Thevissen
- Centre of Microbial and Plant Genetics, Department of Microbial and Molecular Systems, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Lieven Lagae
- Department of Development and Regeneration, Section Pediatric Neurology, University Hospital Katholieke Universiteit Leuven, Leuven, Belgium
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13
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Zweers H, van Wegberg AMJ, Janssen MCH, Wortmann SB. Ketogenic diet for mitochondrial disease: a systematic review on efficacy and safety. Orphanet J Rare Dis 2021; 16:295. [PMID: 34217336 PMCID: PMC8254320 DOI: 10.1186/s13023-021-01927-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/13/2021] [Indexed: 12/01/2022] Open
Abstract
Background No curative therapy for mitochondrial disease (MD) exists, prioritizing supportive treatment for symptom relief. In animal and cell models ketones decrease oxidative stress, increase antioxidants and scavenge free radicals, putting ketogenic diets (KDs) on the list of management options for MD. Furthermore, KDs are well-known, safe and effective treatments for epilepsy, a frequent symptom of MD. This systematic review evaluates efficacy and safety of KD for MD. Methods We searched Pubmed, Cochrane, Embase and Cinahl (November 2020) with search terms linked to MD and KD. From the identified records, we excluded studies on Pyruvate Dehydrogenase Complex deficiency. From these eligible reports, cases without a genetically confirmed diagnosis and cases without sufficient data on KD and clinical course were excluded. The remaining studies were included in the qualitative analysis. Results Only 20 cases (14 pediatric) from the 694 papers identified met the inclusion criteria (one controlled trial (n = 5), 15 case reports). KD led to seizure control in 7 out of 8 cases and improved muscular symptoms in 3 of 10 individuals. In 4 of 20 cases KD reversed the clinical phenotype (e.g. cardiomyopathy, movement disorder). In 5 adults with mitochondrial DNA deletion(s) related myopathy rhabdomyolysis led to cessation of KD. Three individuals with POLG mutations died while being on KD, however, their survival was not different compared to individuals with POLG mutations without KD. Conclusion Data on efficacy and safety of KD for MD is too scarce for general recommendations. KD should be considered in individuals with MD and therapy refractory epilepsy, while KD is contraindicated in mitochondrial DNA deletion(s) related myopathy. When considering KD for MD the high rate of adverse effects should be taken into account, but also spectacular improvements in individual cases. KD is a highly individual management option in this fragile patient group and requires an experienced team. To increase knowledge on this—individually—promising management option more (prospective) studies using adequate outcome measures are crucial. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01927-w.
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Affiliation(s)
- Heidi Zweers
- Department of Gastroenterology and Hepatology - Dietetics, Radboudumc, Postbus 9101, 6500 HB, Nijmegen, The Netherlands. .,Radboud Center for Mitochondrial Medicine (RCMM), Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands.
| | - Annemiek M J van Wegberg
- Department of Gastroenterology and Hepatology - Dietetics, Radboudumc, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.,Radboud Center for Mitochondrial Medicine (RCMM), Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- Radboud Center for Mitochondrial Medicine (RCMM), Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands.,Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Saskia B Wortmann
- Radboud Center for Mitochondrial Medicine (RCMM), Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands.,University Children's Hospital, Paracelsus Medical University, Salzburg, Austria
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14
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Lilamand M, Mouton-Liger F, Paquet C. Ketogenic diet therapy in Alzheimer's disease: an updated review. Curr Opin Clin Nutr Metab Care 2021; 24:372-378. [PMID: 33871419 DOI: 10.1097/mco.0000000000000759] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Ketogenic diets (KD) are validated treatments of pharmacoresistant epilepsy. Their interest in neurodegenerative diseases such as Alzheimer's disease (AD) has been suggested, because ketone bodies may reduce neuroinflammation, improve neurotransmitters transport pathway, synaptic maintenance, and reduce brain β-amyloid deposition. In this updated review, we aimed at critically examining the evidence of the past 2 years regarding KD or ketogenic supplements (KS) on cognitive and biological/neuropathological outcomes. We conducted our search in preclinical studies (animal models of AD) or in humans with or without cognitive impairment. RECENT FINDINGS Overall, 12 studies were included: four in animal models of AD and eight in humans. In preclinical studies, we found additional evidence for a decrease in cerebral inflammation as well as in specific features of AD: β-amyloid, aggregates of tau protein under KD/KS. Several AD mouse models experienced clinical improvements. Human studies reported significant cognitive benefits, improved brain metabolism and biomarkers change under KD/KS, despite rather short-term interventions. Adherence to KD or KS was acceptable with frequent, but minor gastrointestinal adverse effects. SUMMARY The present review gathered additional evidence for both pathophysiological and clinical benefits of KS/KD in AD. Further studies are warranted with a biomarker-based selection of AD participants and long-term follow-up.
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Affiliation(s)
- Matthieu Lilamand
- Université de Paris
- INSERM UMRS1144 Optimisation Thérapeutique en Neuropsychopharmacologie
- Centre de Neurologie Cognitive/CMRR Paris Nord Ile de France, APHP Nord Université de Paris, Lariboisière Hospital, Paris, France
| | - François Mouton-Liger
- Université de Paris
- INSERM UMRS1144 Optimisation Thérapeutique en Neuropsychopharmacologie
- Centre de Neurologie Cognitive/CMRR Paris Nord Ile de France, APHP Nord Université de Paris, Lariboisière Hospital, Paris, France
| | - Claire Paquet
- Université de Paris
- INSERM UMRS1144 Optimisation Thérapeutique en Neuropsychopharmacologie
- Centre de Neurologie Cognitive/CMRR Paris Nord Ile de France, APHP Nord Université de Paris, Lariboisière Hospital, Paris, France
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15
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Kishk NA, Yousof HZ, Ebraheim AM, Elkholy TAFA, Soliman SH, Mohammed RA, Shamloul RM. The effect of ketogenic diet escalation in adolescents and adults with drug-resistant epilepsy: a prospective study. Nutr Neurosci 2021; 25:2023-2032. [PMID: 34011238 DOI: 10.1080/1028415x.2021.1927604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ketogenic diet (KD) is an accepted and effective treatment modality in patients with drug-resistant epilepsy (DRE). Different versions of ketogenic diets have been studied, however, the effect of ratio escalation in adolescence and adults has not been previously investigated. METHODS The current open-labeled interventional study was conducted on 80 patients with drug-resistant epilepsy DRE, 40 patients (intervention group) were exposed to dietary intervention besides their regular antiseizure medication (ASM) and compared to 40 control patients. The intervention group received Ketogenic diet in 2:1 ratio for 1 month then were divided into 2 subgroups, group A1 continued the 2:1 ratio for another 2 months while group A2 escalated to 3:1 dietary regimen. Socio-demographic, anthropometric measurements, epilepsy clinical parameters, and laboratory tests were recorded in addition to safety and tolerability documentation. The response rate was recorded after 1month and 3month. RESULTS Significant decrease in seizure frequency and severity were detected in Group A1 and A2 patients compared to controls after the 3 month period of intervention with significant improvement of quality of life scores in both subgroups. Both subgroups also showed comparable results regarding their response rate to KD. Better acceptance of diet taste were reported by subgroup A1 with a significantly higher lipid profile detected in subgroup A2. CONCLUSION KD has a beneficial effect as adjunctive treatment in adolescents and adults with DRE. Escalation from 2:1 to 3:1 ratio is associated with less compliance rather than better response in patients with DRE.
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Affiliation(s)
- Nirmeen Adel Kishk
- Faculty of Medicine, Neurology Department, Cairo University, Cairo, Egypt
| | - Hanaa Zaghloul Yousof
- Faculty of Medicine, Public Health and Community Department, Cairo University, Cairo, Egypt.,Scientific Research Department, Armed Forces College of Medicine AFCM, Egypt
| | | | | | - Shaimaa H Soliman
- Faculty of Medicine, Neurology Department, Cairo University, Cairo, Egypt
| | - Randa Adel Mohammed
- Faculty of Home Economics, Nutrition and food Science Department, AlAzhar University, Egypt
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16
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Takeuchi F, Nishikata N, Nishimura M, Nagao K, Kawamura M. Leucine-Enriched Essential Amino Acids Enhance the Antiseizure Effects of the Ketogenic Diet in Rats. Front Neurosci 2021; 15:637288. [PMID: 33815043 PMCID: PMC8017216 DOI: 10.3389/fnins.2021.637288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/17/2021] [Indexed: 01/22/2023] Open
Abstract
The classic ketogenic diet (KD) can be used successfully to treat medically refractory epilepsy. However, the KD reduces seizures in 50-70% of patients with medically refractory epilepsy, and its antiseizure effect is limited. In the current study, we developed a new modified KD containing leucine (Leu)-enriched essential amino acids. Compared with a normal KD, the Leu-enriched essential amino acid-supplemented KD did not change the levels of ketosis and glucose but enhanced the inhibition of bicuculline-induced seizure-like bursting in extracellular recordings of acute hippocampal slices from rats. The enhancement of antiseizure effects induced by the addition of Leu-enriched essential amino acids to the KD was almost completely suppressed by a selective antagonist of adenosine A1 receptors or a selective dose of pannexin channel blocker. The addition of Leu-enriched essential amino acids to a normal diet did not induce any antiseizure effects. These findings indicate that the enhancement of the antiseizure effects of the KD is mediated by the pannexin channel-adenosine A1 receptor pathway. We also analyzed amino acid profiles in the plasma and hippocampus. A normal KD altered the levels of many amino acids in both the plasma and hippocampus. The addition of Leu-enriched essential amino acids to a KD further increased and decreased the levels of several amino acids, such as threonine, histidine, and serine, suggesting that altered metabolism and utilization of amino acids may play a role in its antiseizure effects. A KD supplemented with Leu-enriched essential amino acids may be a new therapeutic option for patients with epilepsy, including medically refractory epilepsy.
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Affiliation(s)
- Fumika Takeuchi
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Natsumi Nishikata
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Mai Nishimura
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Kenji Nagao
- Research Institute for Bioscience Products and Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Masahito Kawamura
- Department of Pharmacology, Jikei University School of Medicine, Minato-ku, Japan
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17
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Scaini G, Andrews T, Lima CNC, Benevenuto D, Streck EL, Quevedo J. Mitochondrial dysfunction as a critical event in the pathophysiology of bipolar disorder. Mitochondrion 2021; 57:23-36. [PMID: 33340709 PMCID: PMC10494232 DOI: 10.1016/j.mito.2020.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023]
Abstract
The understanding of the pathophysiology of bipolar disorder (BD) remains modest, despite recent advances in neurobiological research. The mitochondrial dysfunction hypothesis of bipolar disorder has been corroborated by several studies involving postmortem brain analysis, neuroimaging, and specific biomarkers in both rodent models and humans. Evidence suggests that BD might be related to abnormal mitochondrial morphology and dynamics, neuroimmune dysfunction, and atypical mitochondrial metabolism and oxidative stress pathways. Mitochondrial dysfunction in mood disorders is also associated with abnormal Ca2+ levels, glutamate excitotoxicity, an imbalance between pro- and antiapoptotic proteins towards apoptosis, abnormal gene expression of electron transport chain complexes, and decreased ATP synthesis. This paper aims to review and discuss the implications of mitochondrial dysfunction in BD etiology and to explore mitochondria as a potential target for novel therapeutic agents.
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Affiliation(s)
- Giselli Scaini
- Translational Psychiatry Program, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Taylor Andrews
- Translational Psychiatry Program, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Camila N C Lima
- Translational Psychiatry Program, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Deborah Benevenuto
- Translational Psychiatry Program, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA
| | - Emilio L Streck
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - João Quevedo
- Translational Psychiatry Program, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA; Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil; Center of Excellence on Mood Disorders, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA; Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, USA.
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18
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Conover ZR, Talai A, Klockau KS, Ing RJ, Chatterjee D. Perioperative Management of Children on Ketogenic Dietary Therapies. Anesth Analg 2020; 131:1872-1882. [PMID: 32769381 DOI: 10.1213/ane.0000000000005018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ketogenic diet therapy (KDT) is an effective treatment modality for children with drug-resistant epilepsy and certain other metabolic and neurologic disorders. With a resurgence of interest in KDT, pediatric anesthesiologists are increasingly encountering children on KDT for a variety of surgical and medical procedures. Maintenance of ketosis is critical throughout the perioperative period, and if not managed appropriately, these patients are at an increased risk of seizures. This review article provides an overview of the clinical indications, contraindications, proposed anticonvulsant mechanisms, initiation, and monitoring of children on KDTs. Recommendations for the perioperative anesthetic management of children on KDT are summarized. A comprehensive table listing the carbohydrate content of common anesthetic drugs is also included.
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Affiliation(s)
| | | | - Katherine S Klockau
- Pharmacy, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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19
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Ketogenic Diet Therapy for Intractable Epilepsy in Infantile Alexander Disease: A Small Case Series and Analyses of Astroglial Chemokines and Proinflammatory Cytokines. Epilepsy Res 2020; 170:106519. [PMID: 33395615 DOI: 10.1016/j.eplepsyres.2020.106519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022]
Abstract
In infantile Alexander disease (iAxD), one of the serious symptoms is intractable epilepsy, and some reports have suggested that neuroinflammation may be involved in the pathophysiology of the disease. Drug-resistant seizures adversely affect not only the quality of life of the caregivers and patients, but also patients' lifespan. Thus, controlling epilepsy is clinically important. For intractable childhood epilepsy, ketogenic diet therapy (KDT) is well-established, but its effects on iAxD have not been characterized. Here, we describe the use of KDT in three iAxD patients experiencing drug-resistant seizures. In all three cases, the formerly intractable epilepsies were well controlled by KDT. However, the brain magnetic resonance imaging findings deteriorated even after the epilepsy was controlled. In addition, the concentrations of monocyte chemotactic protein-1 and proinflammatory cytokines in the cerebrospinal fluid of the patients remained still high. KDT is effective in controlling epilepsy in iAxD. Our results clinically support previous reports arguing the involvement of neuroinflammation in the pathophysiology of iAxD. Although KDT cannot prevent disease progression, earlier initiation might contribute to a better prognosis.
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20
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Non-Pharmacological and Non-Surgical Treatment of Refractory Childhood Epilepsy. Indian J Pediatr 2020; 87:1062-1069. [PMID: 32048226 DOI: 10.1007/s12098-019-03164-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023]
Abstract
Nearly 20-40% of patients with epilepsy are likely to have drug resistant epilepsy (DRE). Add-on antiseizure drugs do not produce optimal seizure control in these patients. Among the non-pharmacological options, only resective surgery is curative. However, a large majority of patients are not candidates for resective epilepsy surgery. For these children with DRE, non-pharmacological non-surgery "palliative" options should be considered early than late. These include dietary therapies and neuromodulation. While there are numerous clinical trials supporting the efficacy of dietary therapies (viz ketogenic diet, modified Atkins diet and low glycemic index therapy), the evidence for neuromodulation is still evolving. Neuromodulation techniques include vagal nerve stimulation, deep brain stimulation, and transcranial magnetic stimulation. Each of the options, whether diet or neuromodulation, has its own advantages, disadvantages and adverse events profile. These have to be considered and discussed with the family before deciding the modality being chosen.
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21
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βOHB Protective Pathways in Aralar-KO Neurons and Brain: An Alternative to Ketogenic Diet. J Neurosci 2020; 40:9293-9305. [PMID: 33087477 DOI: 10.1523/jneurosci.0711-20.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022] Open
Abstract
Aralar/AGC1/Slc25a12, the mitochondrial aspartate-glutamate carrier expressed in neurons, is the regulatory component of the NADH malate-aspartate shuttle. AGC1 deficiency is a neuropediatric rare disease characterized by hypomyelination, hypotonia, developmental arrest, and epilepsy. We have investigated whether β-hydroxybutyrate (βOHB), the main ketone body (KB) produced in ketogenic diet (KD), is neuroprotective in aralar-knock-out (KO) neurons and mice. We report that βOHB efficiently recovers aralar-KO neurons from deficits in basal-stimulated and glutamate-stimulated respiration, effects requiring βOHB entry into the neuron, and protects from glutamate excitotoxicity. Aralar-deficient mice were fed a KD to investigate its therapeutic potential early in development, but this approach was unfeasible. Therefore, aralar-KO pups were treated without distinction of gender with daily intraperitoneal injections of βOHB during 5 d. This treatment resulted in a recovery of striatal markers of the dopaminergic system including dopamine (DA), 3,4-dihydroxyphenylacetic acid (DOPAC)/DA ratio, and vesicular monoamine transporter 2 (VMAT2) protein. Regarding postnatal myelination, myelin basic protein (MBP) and myelin-associated glycoprotein (MAG) myelin proteins were markedly increased in the cortices of βOHB-treated aralar-KO mice. Although brain Asp and NAA levels did not change by βOHB administration, a 4-d βOHB treatment to aralar-KO, but not to control, neurons led to a substantial increase in Asp (3-fold) and NAA (4-fold) levels. These results suggest that the lack of increase in brain Asp and NAA is possibly because of its active utilization by the aralar-KO brain and the likely involvement of neuronal NAA in postnatal myelination in these mice. The effectiveness of βOHB as a therapeutic treatment in AGC1 deficiency deserves further investigation.SIGNIFICANCE STATEMENT Aralar deficiency induces a fatal phenotype in humans and mice and is associated with impaired neurodevelopment, epilepsy, and hypomyelination. In neurons, highly expressing aralar, its deficiency causes a metabolic blockade hampering mitochondrial energetics and respiration. Here, we find that βOHB, the main metabolic product in KD, recovers defective mitochondrial respiration bypassing the metabolic failure in aralar-deficient neurons. βOHB oxidation in mitochondria boosts the synthesis of cytosolic aspartate (Asp) and NAA, which is impeded by aralar deficiency, presumably through citrate-malate shuttle. In aralar-knock-out (KO) mice, βOHB recovers from the drastic drop in specific dopaminergic and myelin markers. The βOHB-induced myelin synthesis occurring together with the marked increment in neuronal NAA synthesis supports the role of NAA as a lipid precursor during postnatal myelination.
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22
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Dashti HM, Mathew TC, Al-Zaid NS. Efficacy of Low-Carbohydrate Ketogenic Diet in the Treatment of Type 2 Diabetes. Med Princ Pract 2020; 30:223-235. [PMID: 33040057 PMCID: PMC8280429 DOI: 10.1159/000512142] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Low-carbohydrate ketogenic diet (LCKD), originally used as a treatment for childhood epilepsy is currently gaining acceptance as a nutritional therapy for obesity and type 2 diabetes. In addition, this diet has a positive effect on body weight, blood glucose level, glycosylated hemoglobin, plasma lipid profile, and neurological disorders. This review focuses on the therapeutic effectiveness, negative effects, and the rationale of using LCKD for the treatment of type 2 diabetes. It is shown that LCKD contributes to the reduction in the intake of insulin and oral antidiabetic drugs in patients with type 2 diabetes. Furthermore, the data presented in this review reveal the efficacy and cost-effectiveness of LCKD in the management of type 2 diabetes.
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Affiliation(s)
- Hussain M Dashti
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Thazhumpal C Mathew
- Department of MLS, Faculty of Allied Health Science, Kuwait University, Kuwait, Kuwait,
| | - Naji S Al-Zaid
- Departments of Physiology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
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23
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García-García FJ, Monistrol-Mula A, Cardellach F, Garrabou G. Nutrition, Bioenergetics, and Metabolic Syndrome. Nutrients 2020; 12:E2785. [PMID: 32933003 PMCID: PMC7551996 DOI: 10.3390/nu12092785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
According to the World Health Organization (WHO), the global nutrition report shows that whilst part of the world's population starves, the other part suffers from obesity and associated complications. A balanced diet counterparts these extreme conditions with the proper proportion, composition, quantity, and presence of macronutrients, micronutrients, and bioactive compounds. However, little is known on the way these components exert any influence on our health. These nutrients aiming to feed our bodies, our tissues, and our cells, first need to reach mitochondria, where they are decomposed into CO2 and H2O to obtain energy. Mitochondria are the powerhouse of the cell and mainly responsible for nutrients metabolism, but they are also the main source of oxidative stress and cell death by apoptosis. Unappropriated nutrients may support mitochondrial to become the Trojan horse in the cell. This review aims to provide an approach to the role that some nutrients exert on mitochondria as a major contributor to high prevalent Western conditions including metabolic syndrome (MetS), a constellation of pathologic conditions which promotes type II diabetes and cardiovascular risk. Clinical and experimental data extracted from in vitro animal and cell models further demonstrated in patients, support the idea that a balanced diet, in a healthy lifestyle context, promotes proper bioenergetic and mitochondrial function, becoming the best medicine to prevent the onset and progression of MetS. Any advance in the prevention and management of these prevalent complications help to face these challenging global health problems, by ameliorating the quality of life of patients and reducing the associated sociosanitary burden.
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Affiliation(s)
- Francesc Josep García-García
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Anna Monistrol-Mula
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Francesc Cardellach
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Glòria Garrabou
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
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Della Marina A, Leiendecker B, Roesch S, Wortmann SB. Ketogenic diet for treating alopecia in BCS1l-related mitochondrial disease (Bjornstad syndrome). JIMD Rep 2020; 53:10-11. [PMID: 32395403 PMCID: PMC7203648 DOI: 10.1002/jmd2.12109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Adela Della Marina
- Department of Neuropediatrics, Developmental Neurology and Social PediatricsUniversity of Duisburg‐Essen, Children's HospitalEssenGermany
| | - Baerbel Leiendecker
- Department of Neuropediatrics, Developmental Neurology and Social PediatricsUniversity of Duisburg‐Essen, Children's HospitalEssenGermany
| | - Sebastian Roesch
- Department of Otorhinolaryngology, Head and Neck SurgeryParacelsus Medical UniversitySalzburgAustria
| | - Saskia B. Wortmann
- University Children's Hospital, Paracelsus Medical UniversitySalzburgAustria
- Institute of Human GeneticsTechnical University MünchenMunichGermany
- Institute of Human Genetics, Helmholtz ZentrumNeuherbergGermany
- Radboud Center for Mitochondrial Medicine, Department of PediatricsAmalia Children's Hospital, RadboudumcNijmegenThe Netherlands
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25
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Neth BJ, Mintz A, Whitlow C, Jung Y, Solingapuram Sai K, Register TC, Kellar D, Lockhart SN, Hoscheidt S, Maldjian J, Heslegrave AJ, Blennow K, Cunnane SC, Castellano CA, Zetterberg H, Craft S. Modified ketogenic diet is associated with improved cerebrospinal fluid biomarker profile, cerebral perfusion, and cerebral ketone body uptake in older adults at risk for Alzheimer's disease: a pilot study. Neurobiol Aging 2019; 86:54-63. [PMID: 31757576 DOI: 10.1016/j.neurobiolaging.2019.09.015] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 11/29/2022]
Abstract
There is currently no established therapy to treat or prevent Alzheimer's disease. The ketogenic diet supplies an alternative cerebral metabolic fuel, with potential neuroprotective effects. Our goal was to compare the effects of a modified Mediterranean-ketogenic diet (MMKD) and an American Heart Association Diet (AHAD) on cerebrospinal fluid Alzheimer's biomarkers, neuroimaging measures, peripheral metabolism, and cognition in older adults at risk for Alzheimer's. Twenty participants with subjective memory complaints (n = 11) or mild cognitive impairment (n = 9) completed both diets, with 3 participants discontinuing early. Mean compliance rates were 90% for MMKD and 95% for AHAD. All participants had improved metabolic indices following MMKD. MMKD was associated with increased cerebrospinal fluid Aβ42 and decreased tau. There was increased cerebral perfusion and increased cerebral ketone body uptake (11C-acetoacetate PET, in subsample) following MMKD. Memory performance improved after both diets, which may be due to practice effects. Our results suggest that a ketogenic intervention targeted toward adults at risk for Alzheimer's may prove beneficial in the prevention of cognitive decline.
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Affiliation(s)
- Bryan J Neth
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Akiva Mintz
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Radiology, Columbia University, New York, NY, USA
| | - Christopher Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Youngkyoo Jung
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Thomas C Register
- Department of Pathology - Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Derek Kellar
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samuel N Lockhart
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Siobhan Hoscheidt
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph Maldjian
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amanda J Heslegrave
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Stephen C Cunnane
- Research Centre on Aging, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Suzanne Craft
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Gupta L, Khandelwal D, Kalra S, Gupta P, Dutta D, Aggarwal S. Ketogenic diet in endocrine disorders: Current perspectives. J Postgrad Med 2019; 63:242-251. [PMID: 29022562 PMCID: PMC5664869 DOI: 10.4103/jpgm.jpgm_16_17] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for "diabesity."
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Affiliation(s)
- L Gupta
- Department of Dietetics, Maharaja Agrasen Hospital, New Delhi, India
| | - D Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India
| | - S Kalra
- Department of Endocrinology, Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - P Gupta
- Department of Paediatrics, Maharaja Agrasen Hospital, New Delhi, India
| | - D Dutta
- Department of Endocrinology, Venkateshwar Hospitals, New Delhi, India
| | - S Aggarwal
- Department of Medicine, Division of Endocrinology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Gross EC, Klement RJ, Schoenen J, D'Agostino DP, Fischer D. Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention. Nutrients 2019; 11:E811. [PMID: 30974836 PMCID: PMC6520671 DOI: 10.3390/nu11040811] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022] Open
Abstract
An increasing amount of evidence suggests that migraines are a response to a cerebral energy deficiency or oxidative stress levels that exceed antioxidant capacity. The ketogenic diet (KD), a diet mimicking fasting that leads to the elevation of ketone bodies (KBs), is a therapeutic intervention targeting cerebral metabolism that has recently shown great promise in the prevention of migraines. KBs are an alternative fuel source for the brain, and are thus likely able to circumvent some of the abnormalities in glucose metabolism and transport found in migraines. Recent research has shown that KBs-D-β-hydroxybutyrate in particular-are more than metabolites. As signalling molecules, they have the potential to positively influence other pathways commonly believed to be part of migraine pathophysiology, namely: mitochondrial functioning, oxidative stress, cerebral excitability, inflammation and the gut microbiome. This review will describe the mechanisms by which the presence of KBs, D-BHB in particular, could influence those migraine pathophysiological mechanisms. To this end, common abnormalities in migraines are summarised with a particular focus on clinical data, including phenotypic, biochemical, genetic and therapeutic studies. Experimental animal data will be discussed to elaborate on the potential therapeutic mechanisms of elevated KBs in migraine pathophysiology, with a particular focus on the actions of D-BHB. In complex diseases such as migraines, a therapy that can target multiple possible pathogenic pathways seems advantageous. Further research is needed to establish whether the absence/restriction of dietary carbohydrates, the presence of KBs, or both, are of primary importance for the migraine protective effects of the KD.
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Affiliation(s)
- Elena C Gross
- Division of Paediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, 4056 Basel, Switzerland.
| | - Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, 97422 Schweinfurt, Germany.
| | - Jean Schoenen
- Headache Research Unit, University of Liège, Dept of Neurology-Citadelle Hospital, 4000 Liège, Belgium.
| | - Dominic P D'Agostino
- Department of Molecular Pharmacology and Physiology, Metabolic Medicine Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.
- Institute for Human and Machine Cognition, Ocala, FL 34471, USA.
| | - Dirk Fischer
- Division of Paediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, 4056 Basel, Switzerland.
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Fogle KJ, Smith AR, Satterfield SL, Gutierrez AC, Hertzler JI, McCardell CS, Shon JH, Barile ZJ, Novak MO, Palladino MJ. Ketogenic and anaplerotic dietary modifications ameliorate seizure activity in Drosophila models of mitochondrial encephalomyopathy and glycolytic enzymopathy. Mol Genet Metab 2019; 126:439-447. [PMID: 30683556 PMCID: PMC6536302 DOI: 10.1016/j.ymgme.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/13/2022]
Abstract
Seizures are a feature not only of the many forms of epilepsy, but also of global metabolic diseases such as mitochondrial encephalomyopathy (ME) and glycolytic enzymopathy (GE). Modern anti-epileptic drugs (AEDs) are successful in many cases, but some patients are refractory to existing AEDs, which has led to a surge in interest in clinically managed dietary therapy such as the ketogenic diet (KD). This high-fat, low-carbohydrate diet causes a cellular switch from glycolysis to fatty acid oxidation and ketone body generation, with a wide array of downstream effects at the genetic, protein, and metabolite level that may mediate seizure protection. We have recently shown that a Drosophila model of human ME (ATP61) responds robustly to the KD; here, we have investigated the mechanistic importance of the major metabolic consequences of the KD in the context of this bioenergetics disease: ketogenesis, reduction of glycolysis, and anaplerosis. We have found that reduction of glycolysis does not confer seizure protection, but that dietary supplementation with ketone bodies or the anaplerotic lipid triheptanoin, which directly replenishes the citric acid cycle, can mimic the success of the ketogenic diet even in the presence of standard carbohydrate levels. We have also shown that the proper functioning of the citric acid cycle is crucial to the success of the KD in the context of ME. Furthermore, our data reveal that multiple seizure models, in addition to ATP61, are treatable with the ketogenic diet. Importantly, one of these mutants is TPIsugarkill, which models human glycolytic enzymopathy, an incurable metabolic disorder with severe neurological consequences. Overall, these studies reveal widespread success of the KD in Drosophila, further cementing its status as an excellent model for studies of KD treatment and mechanism, and reveal key insights into the therapeutic potential of dietary therapy against neuronal hyperexcitability in epilepsy and metabolic disease.
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Affiliation(s)
- Keri J Fogle
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
| | - Amber R Smith
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Sidney L Satterfield
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Alejandra C Gutierrez
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - J Ian Hertzler
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Caleb S McCardell
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Joy H Shon
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Zackery J Barile
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Molly O Novak
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Michael J Palladino
- Department of Pharmacology & Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA; Pittsburgh Institute for Neurodegenerative Diseases (PIND), University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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Gross E, Putananickal N, Orsini AL, Schmidt S, Vogt DR, Cichon S, Sandor P, Fischer D. Efficacy and safety of exogenous ketone bodies for preventive treatment of migraine: A study protocol for a single-centred, randomised, placebo-controlled, double-blind crossover trial. Trials 2019; 20:61. [PMID: 30654835 PMCID: PMC6337840 DOI: 10.1186/s13063-018-3120-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/09/2018] [Indexed: 01/22/2023] Open
Abstract
Background Currently available prophylactic migraine treatment options are limited and are associated with many, often intolerable, side-effects. Various lines of research suggest that abnormalities in energy metabolism are likely to be part of migraine pathophysiology. Previously, a ketogenic diet (KD) has been reported to lead to a drastic reduction in migraine frequency. An alternative method to a strict KD is inducing a mild nutritional ketosis (0.4–2 mmol/l) with exogenous ketogenic substances. The aim of this randomised, placebo-controlled, double-blind, crossover, single-centre trial is to demonstrate safety and superiority of beta-hydroxybutyrate (βHB) in mineral salt form over placebo in migraine prevention. Methods/design Forty-five episodic migraineurs (5–14 migraine days/months), with or without aura, aged between 18 and 65 years, will be recruited at headache clinics in Switzerland, Germany and Austria and via Internet announcements. After a 4-week baseline period, patients will be randomly allocated to one of the two trial arms and receive either the βHB mineral salt or placebo for 12 weeks. This will be followed by a 4-week wash-out period, a subsequent second baseline period and, finally, another 12-week intervention with the alternative treatment. Co-medication with triptans (10 days per months) or analgesics (14 days per months) is permitted. The primary outcome is the mean change from baseline in the number of migraine days (meeting International Classification of Headache Disorders version 3 criteria) during the last 4 weeks of intervention compared to placebo. Secondary endpoints include mean changes in headache days of any severity, acute migraine medication use, migraine intensity and migraine and headache-related disability. Exploratory outcomes are (in addition to routine laboratory analysis) genetic profiling and expression analysis, oxidative and nitrosative stress, as well as serum cytokine analysis, and blood βHB and glucose analysis (pharmacokinetics). Discussion A crossover design was chosen as it greatly improves statistical power and participation rates, without increasing costs. To our knowledge this is the first RCT using βHB salts worldwide. If proven effective and safe, βHB might not only offer a new prophylactic treatment option for migraine patients, but might additionally pave the way for clinical trials assessing its use in related diseases. Trial registration ClinicalTrials.gov, NCT03132233. Registered on 27 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3120-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Gross
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Niveditha Putananickal
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland.
| | - Anna-Lena Orsini
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Simone Schmidt
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Deborah R Vogt
- Department of Clinical Research, Clinical Trial Unit, University of Basel Hospital, University of Basel, Basel, Switzerland
| | - Sven Cichon
- Department of Medical Genetics, University of Basel Hospital, University of Basel, Basel, Switzerland
| | | | - Dirk Fischer
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
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Goswami JN, Sharma S. Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management. Neuropsychiatr Dis Treat 2019; 15:3273-3285. [PMID: 31819454 PMCID: PMC6883945 DOI: 10.2147/ndt.s201862] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/18/2019] [Indexed: 12/31/2022] Open
Abstract
Drug-refractory epilepsy is a commonly prevalent pediatric neurological illness of global significance. Ketogenic diet (KD) is a time-tested therapeutic modality for refractory epilepsy, which has reemerged as a robust alternative to anti-epileptic pharmacotherapy. There is a growing body of evidence which supports the anti-seizure efficacy, safety profile and feasibility of KD use in childhood epilepsy. In addition, this modality has been recognized to reduce anti-epileptic exposure, improve cognition and behavioral profile of patients as well as improve the quality-of-life of care-givers. Current indications of KD include refractory epilepsy syndromes, selected metabolic disorders (such as pyruvate dehydrogenase deficiency) and a host of varied neurological entities. KD research has broadened the knowledge-base about its mechanisms of action. Four types of KD are in vogue currently with varying nutritional constitution, palatability, administration protocols and comparable efficacy. KD initiation and maintenance are the result of concerted effort of a team of pediatric neurologist/epileptologist, nutritionist and patient's primary care-giver. Consensus is being formulated about various practical aspects of KD such as patient-selection, parental counseling, baseline work-up, dietary prescription, nutritional supplementation, concurrent anti-epileptic drug administration, follow-up and treatment-duration. Novel applications of KD include its use in neonatal epilepsy and super-refractory status epilepticus and tailor-made formulations such as cooking oil-based KD in predominantly rice-fed populations. Increasing body of clinical experience, improved nutritional designs and translational research are promoting KD as a major therapeutic modality. Currently, KD forms a core essence in the armamentarium against refractory epilepsy. In this review, we summarize the recent advances and current perspectives in the use of KD in refractory epilepsy.
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Affiliation(s)
| | - Suvasini Sharma
- Neurology Division, Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India
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31
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Brietzke E, Mansur RB, Subramaniapillai M, Balanzá-Martínez V, Vinberg M, González-Pinto A, Rosenblat JD, Ho R, McIntyre RS. Ketogenic diet as a metabolic therapy for mood disorders: Evidence and developments. Neurosci Biobehav Rev 2018; 94:11-16. [DOI: 10.1016/j.neubiorev.2018.07.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/14/2022]
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Use of cooking oils in a 2:1 ratio classical ketogenic diet for intractable pediatric epilepsy: Long-term effectiveness and tolerability. Epilepsy Res 2018; 147:75-79. [DOI: 10.1016/j.eplepsyres.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
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Williams L. Ketogenic Therapy: First-Line Management of Intractable Seizures in Children. AACN Adv Crit Care 2018; 29:91-94. [PMID: 29496717 DOI: 10.4037/aacnacc2018593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lori Williams
- Lori Williams is Clinical Nurse Specialist, Universal Care Unit and Float Team, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, 1675 Highland Avenue, Madison, Wisconsin 53792
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Melo IT, M Rêgo E, Bueno NB, Gomes TC, Oliveira SL, Trindade-Filho EM, Cabral CR, Machado TS, Galvão JA, R Ataide T. Ketogenic Diet Based on Extra Virgin Coconut Oil Has No Effects in Young Wistar Rats With Pilocarpine-Induced Epilepsy. Lipids 2018; 53:251-254. [PMID: 29570799 DOI: 10.1002/lipd.12019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022]
Abstract
This study evaluated the effects of a ketogenic diet (KD) based on extra virgin coconut oil (Cocos nucifera L., VCO), on the treatment of epileptic rats. Two sets of experiments were conducted. First, male Wistar rats underwent induction of status epilepticus (SE) with the administration of pilocarpine intraperitoneally 21 animals reached spontaneous recurrent seizures (SRS) and were randomly allocated to the dietary regimens and video-monitored for 19 days. In the second experiment, 24 animals were randomized immediately after the induction of SE and followed for 67 days. Diets were as follows: Control (AIN-93G; 7% lipid), KetoTAGsoya (KD based on soybean oil; 69.79% lipid), and KetoTAGcoco (KD based on VCO; 69.79% lipid). There were no differences in the latency to the first crisis, total frequency, and duration of the SRS between groups in 2 experiments. The data suggest no effects of KD, with or without VCO, in rats with pilocarpine-induced epilepsy.
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Affiliation(s)
- Isabelle T Melo
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Elisabete M Rêgo
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Nassib B Bueno
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Tâmara C Gomes
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Suzana L Oliveira
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Euclides M Trindade-Filho
- Laboratório de Neurofisiologia, Universidade Estadual de Ciências da Saúde de Alagoas, R. Dr. Jorge de Lima, 113, Trapiche da Barra, Maceió, AL, 57010-300, Brazil
| | - Cyro R Cabral
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Tacy S Machado
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Jaqueline A Galvão
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
| | - Terezinha R Ataide
- Laboratório de Nutrição Experimental, Faculdade de Nutrição, Universidade Federal de Alagoas, Campus A. C. Simões, Cidade Universitária, BR 104 Norte, Km 97, Tabuleiro dos Martins, Maceió, AL, 57.072-970, Brazil
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Zhang J, Culp ML, Craver JG, Darley-Usmar V. Mitochondrial function and autophagy: integrating proteotoxic, redox, and metabolic stress in Parkinson's disease. J Neurochem 2018; 144:691-709. [PMID: 29341130 PMCID: PMC5897151 DOI: 10.1111/jnc.14308] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 12/14/2022]
Abstract
Parkinson's disease (PD) is a movement disorder with widespread neurodegeneration in the brain. Significant oxidative, reductive, metabolic, and proteotoxic alterations have been observed in PD postmortem brains. The alterations of mitochondrial function resulting in decreased bioenergetic health is important and needs to be further examined to help develop biomarkers for PD severity and prognosis. It is now becoming clear that multiple hits on metabolic and signaling pathways are likely to exacerbate PD pathogenesis. Indeed, data obtained from genetic and genome association studies have implicated interactive contributions of genes controlling protein quality control and metabolism. For example, loss of key proteins that are responsible for clearance of dysfunctional mitochondria through a process called mitophagy has been found to cause PD, and a significant proportion of genes associated with PD encode proteins involved in the autophagy-lysosomal pathway. In this review, we highlight the evidence for the targeting of mitochondria by proteotoxic, redox and metabolic stress, and the role autophagic surveillance in maintenance of mitochondrial quality. Furthermore, we summarize the role of α-synuclein, leucine-rich repeat kinase 2, and tau in modulating mitochondrial function and autophagy. Among the stressors that can overwhelm the mitochondrial quality control mechanisms, we will discuss 4-hydroxynonenal and nitric oxide. The impact of autophagy is context depend and as such can have both beneficial and detrimental effects. Furthermore, we highlight the potential of targeting mitochondria and autophagic function as an integrated therapeutic strategy and the emerging contribution of the microbiome to PD susceptibility.
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Affiliation(s)
- Jianhua Zhang
- Center for Free Radical Biology, University of Alabama at Birmingham
- Department of Pathology, University of Alabama at Birmingham
- Department of Veterans Affairs, Birmingham VA Medical Center
| | - M Lillian Culp
- Center for Free Radical Biology, University of Alabama at Birmingham
- Department of Pathology, University of Alabama at Birmingham
| | - Jason G Craver
- Center for Free Radical Biology, University of Alabama at Birmingham
- Department of Pathology, University of Alabama at Birmingham
| | - Victor Darley-Usmar
- Center for Free Radical Biology, University of Alabama at Birmingham
- Department of Pathology, University of Alabama at Birmingham
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Gietzen DW, Lindström SH, Sharp JW, Teh PS, Donovan MJ. Indispensable Amino Acid-Deficient Diets Induce Seizures in Ketogenic Diet-Fed Rodents, Demonstrating a Role for Amino Acid Balance in Dietary Treatments for Epilepsy. J Nutr 2018; 148:480-489. [PMID: 29546295 PMCID: PMC6669944 DOI: 10.1093/jn/nxx030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/21/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Low protein amounts are used in ketogenic diets (KDs), where an essential (indispensable) amino acid (IAA) can become limiting. Because the chemically sensitive, seizurogenic, anterior piriform cortex (APC) is excited by IAA limitation, an imbalanced KD could exacerbate seizure activity. Objective We questioned whether dietary IAA depletion worsens seizure activity in rodents fed KDs. Methods In a series of 6 trials, male rats or gerbils of both sexes (6-8/group) were given either control diets (CDs) appropriate for each trial, a KD, or a threonine-devoid (ThrDev) diet for ≥7 d, and tested for seizures using various stimuli. Microchip analysis of rat APCs was also used to determine if changes in transcripts for structures relevant to seizurogenesis are affected by a ThrDev diet. Glutamate release was measured in microdialysis samples from APCs during the first meal after 7 d on a CD or a ThrDev diet. Results Adult rats showed increased susceptibility to seizures in both chemical (58%) and electroshock (doubled) testing after 7 d on a ThrDev diet compared with CD (each trial, P ≤ 0.05). Seizure-prone Mongolian gerbils had fewer seizures after receiving a KD, but exacerbated seizures (68%) after 1 meal of KD minus Thr (KD-T compared with CD, P < 0.05). In kindled rats fed KD-T, both counts (19%) and severities (77%) of seizures were significantly elevated (KD-T compared with CD, P < 0.05). Gene transcript changes were consistent with enhanced seizure susceptibility (7-21 net-fold increases, P = 0.045-0.001) and glutamate release into the APC was increased acutely (4-fold at 20 min, 2.6-fold at 60 min, P < 0.05) after 7 d on a ThrDev diet. Conclusion Seizure severity in rats and gerbils was reduced after KDs and exacerbated by ThrDev, both in KD- and CD-fed animals, consistent with the mechanistic studies. We suggest that a complete protein profile in KDs may improve IAA balance in the APC, thereby lowering the risk of seizures.
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Miller VJ, Villamena FA, Volek JS. Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health. J Nutr Metab 2018; 2018:5157645. [PMID: 29607218 PMCID: PMC5828461 DOI: 10.1155/2018/5157645] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023] Open
Abstract
Impaired mitochondrial function often results in excessive production of reactive oxygen species (ROS) and is involved in the etiology of many chronic diseases, including cardiovascular disease, diabetes, neurodegenerative disorders, and cancer. Moderate levels of mitochondrial ROS, however, can protect against chronic disease by inducing upregulation of mitochondrial capacity and endogenous antioxidant defense. This phenomenon, referred to as mitohormesis, is induced through increased reliance on mitochondrial respiration, which can occur through diet or exercise. Nutritional ketosis is a safe and physiological metabolic state induced through a ketogenic diet low in carbohydrate and moderate in protein. Such a diet increases reliance on mitochondrial respiration and may, therefore, induce mitohormesis. Furthermore, the ketone β-hydroxybutyrate (BHB), which is elevated during nutritional ketosis to levels no greater than those resulting from fasting, acts as a signaling molecule in addition to its traditionally known role as an energy substrate. BHB signaling induces adaptations similar to mitohormesis, thereby expanding the potential benefit of nutritional ketosis beyond carbohydrate restriction. This review describes the evidence supporting enhancement of mitochondrial function and endogenous antioxidant defense in response to nutritional ketosis, as well as the potential mechanisms leading to these adaptations.
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Affiliation(s)
- Vincent J. Miller
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Frederick A. Villamena
- Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jeff S. Volek
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
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Veyrat-Durebex C, Reynier P, Procaccio V, Hergesheimer R, Corcia P, Andres CR, Blasco H. How Can a Ketogenic Diet Improve Motor Function? Front Mol Neurosci 2018; 11:15. [PMID: 29434537 PMCID: PMC5790787 DOI: 10.3389/fnmol.2018.00015] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/10/2018] [Indexed: 12/12/2022] Open
Abstract
A ketogenic diet (KD) is a normocaloric diet composed by high fat (80-90%), low carbohydrate, and low protein consumption that induces fasting-like effects. KD increases ketone body (KBs) production and its concentration in the blood, providing the brain an alternative energy supply that enhances oxidative mitochondrial metabolism. In addition to its profound impact on neuro-metabolism and bioenergetics, the neuroprotective effect of specific polyunsaturated fatty acids and KBs involves pleiotropic mechanisms, such as the modulation of neuronal membrane excitability, inflammation, or reactive oxygen species production. KD is a therapy that has been used for almost a century to treat medically intractable epilepsy and has been increasingly explored in a number of neurological diseases. Motor function has also been shown to be improved by KD and/or medium-chain triglyceride diets in rodent models of Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and spinal cord injury. These studies have proposed that KD may induce a modification in synaptic morphology and function, involving ionic channels, glutamatergic transmission, or synaptic vesicular cycling machinery. However, little is understood about the molecular mechanisms underlying the impact of KD on motor function and the perspectives of its use to acquire the neuromuscular effects. The aim of this review is to explore the conditions through which KD might improve motor function. First, we will describe the main consequences of KD exposure in tissues involved in motor function. Second, we will report and discuss the relevance of KD in pre-clinical and clinical trials in the major diseases presenting motor dysfunction.
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Affiliation(s)
- Charlotte Veyrat-Durebex
- Département de Biochimie et Génétique, Centre Hospitalier Universitaire, Angers, France
- INSERM 1083, CNRS, Equipe Mitolab, Institut MITOVASC, UMR 6015, Université d’Angers, Angers, France
| | - Pascal Reynier
- Département de Biochimie et Génétique, Centre Hospitalier Universitaire, Angers, France
- INSERM 1083, CNRS, Equipe Mitolab, Institut MITOVASC, UMR 6015, Université d’Angers, Angers, France
| | - Vincent Procaccio
- Département de Biochimie et Génétique, Centre Hospitalier Universitaire, Angers, France
- INSERM 1083, CNRS, Equipe Mitolab, Institut MITOVASC, UMR 6015, Université d’Angers, Angers, France
| | | | - Philippe Corcia
- INSERM U930, Université François Rabelais de Tours, Tours, France
- Service de Neurologie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Christian R. Andres
- INSERM U930, Université François Rabelais de Tours, Tours, France
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Hélène Blasco
- INSERM 1083, CNRS, Equipe Mitolab, Institut MITOVASC, UMR 6015, Université d’Angers, Angers, France
- INSERM U930, Université François Rabelais de Tours, Tours, France
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire de Tours, Tours, France
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McArtney R, Bailey A, Champion H. What is a ketogenic diet and how does it affect the use of medicines? Arch Dis Child Educ Pract Ed 2017; 102:194-199. [PMID: 27469127 DOI: 10.1136/archdischild-2014-307000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/24/2016] [Accepted: 07/07/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Rowena McArtney
- Pharmacy Department, University Hospital of Wales, Cardiff, UK
| | | | - Helena Champion
- Nutrition and Dietetic Department, Addenbrooke's Hospital, Cambridge, UK
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Non-invasive, multimodal analysis of cortical activity, blood volume and neurovascular coupling in infantile spasms using EEG-fNIRS monitoring. NEUROIMAGE-CLINICAL 2017; 15:359-366. [PMID: 28580292 PMCID: PMC5447509 DOI: 10.1016/j.nicl.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/10/2017] [Accepted: 05/08/2017] [Indexed: 11/21/2022]
Abstract
Although infantile spasms can be caused by a variety of etiologies, the clinical features are stereotypical. The neuronal and vascular mechanisms that contribute to the emergence of infantile spasms are not well understood. We performed a multimodal study by simultaneously recording electroencephalogram and functional Near-infrared spectroscopy in an intentionally heterogeneous population of six children with spasms in clusters. Regardless of the etiology, spasms were accompanied by two phases of hemodynamic changes; an initial change in the cerebral blood volume (simultaneously with each spasm) followed by a neurovascular coupling in all children except for the one with a large porencephalic cyst. Changes in cerebral blood volume, like the neurovascular coupling, occurred over frontal areas in all patients regardless of any brain damage suggesting a diffuse hemodynamic cortical response. The simultaneous motor activation and changes in cerebral blood volume might result from the involvement of the brainstem. The inconstant neurovascular coupling phase suggests a diffuse activation of the brain likely resulting too from the brainstem involvement that might trigger diffuse changes in cortical excitability.
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Key Words
- Cerebral blood volume
- EEG, electroencephalogram/electroencephalography
- EMG, electromyography
- Electroencephalography
- HRF, hemodynamic response function
- Hb, deoxyhemoglobin
- HbO, oxyhemoglobin
- HbT, total hemoglobin
- Infantile spasm
- NVC, neurovascular coupling
- Neurovascular coupling
- Optical imaging
- PET, positron emission tomography
- SPECT, Single photon emission computed tomography
- TFR, time frequency representation
- fNIRS, functional near infrared spectroscopy
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Zilberter Y, Zilberter M. The vicious circle of hypometabolism in neurodegenerative diseases: Ways and mechanisms of metabolic correction. J Neurosci Res 2017; 95:2217-2235. [PMID: 28463438 DOI: 10.1002/jnr.24064] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 12/13/2022]
Abstract
Hypometabolism, characterized by decreased brain glucose consumption, is a common feature of many neurodegenerative diseases. Initial hypometabolic brain state, created by characteristic risk factors, may predispose the brain to acquired epilepsy and sporadic Alzheimer's and Parkinson's diseases, which are the focus of this review. Analysis of available data suggests that deficient glucose metabolism is likely a primary initiating factor for these diseases, and that resulting neuronal dysfunction further promotes the metabolic imbalance, establishing an effective positive feedback loop and a downward spiral of disease progression. Therefore, metabolic correction leading to the normalization of abnormalities in glucose metabolism may be an efficient tool to treat the neurological disorders by counteracting their primary pathological mechanisms. Published and preliminary experimental results on this approach for treating Alzheimer's disease and epilepsy models support the efficacy of metabolic correction, confirming the highly promising nature of the strategy. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuri Zilberter
- Aix-Marseille Université, INSERM UMR1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - Misha Zilberter
- Gladstone Institute of Neurological Disease, 1650 Owens Street, San Francisco, California, 94158, USA
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Ostendorf AP, Ng YT. Treatment-resistant Lennox-Gastaut syndrome: therapeutic trends, challenges and future directions. Neuropsychiatr Dis Treat 2017; 13:1131-1140. [PMID: 28461749 PMCID: PMC5404809 DOI: 10.2147/ndt.s115996] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Lennox-Gastaut syndrome is a severe, childhood-onset electroclinical syndrome comprised of multiple seizure types, intellectual and behavioral disturbances and characteristic findings on electroencephalogram of slow spike and wave complexes and paroxysmal fast frequency activity. Profound morbidity often accompanies a common and severe seizure type, the drop attack. Seizures often remain refractory, or initial treatment efficacy fades. Few individuals are seizure free despite the development of multiple generations of antiseizure medications over decades and high-level evidence on several choices. Approved medications such as lamotrigine, topiramate, rufinamide, felbamate and clobazam have demonstrated efficacy in reducing seizure burden. Cannabidiol has emerged as a promising investigational therapy with vast social interest yet lacks a standard, approved formulation. Palliative surgical procedures, such as vagal nerve stimulation and corpus callosotomy may provide reduction in total seizures and drop attacks. Emerging evidence suggests that complete callosotomy provides greater improvement in seizures without additional side effects. Etiologies such as dysplasia or hypothalamic hamartoma may be amenable for focal resection and thus offer potential to reverse this devastating epileptic encephalopathy.
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Affiliation(s)
- Adam P Ostendorf
- Department of Pediatrics, Neurology Section, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Yu-Tze Ng
- Department of Pediatrics, Baylor College of Medicine, The Children’s Hospital of San Antonio, San Antonio, TX, USA
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Sampaio LPDB, Takakura C, Manreza MLGD. The use of a formula-based ketogenic diet in children with refractory epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:234-237. [DOI: 10.1590/0004-282x20170028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/06/2017] [Indexed: 01/01/2023]
Abstract
ABSTRACT The ketogenic diet (KD) is a nonpharmacologic treatment that has been used for refractory epilepsy since 1921. The KD is a high-fat, low-carbohydrate, and restricted protein diet, which is calculated and weighed for each individual patient. Introducing and maintaining the diet for a long time remains a challenge. In this study, we evaluated the acceptability, tolerance, and efficacy of a formula-based KD in 10 children with refractory epilepsy. The ketogenic formula tested herein caused only mild KD-related adverse events and adequate adherence. Moreover, 60% of patients had more than 50% seizure frequency reduction and 10% were seizure-free.
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Zarnowska I, Luszczki JJ, Zarnowski T, Wlaz P, Czuczwar SJ, Gasior M. Proconvulsant effects of the ketogenic diet in electroshock-induced seizures in mice. Metab Brain Dis 2017; 32:351-358. [PMID: 27644408 PMCID: PMC5346421 DOI: 10.1007/s11011-016-9900-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/19/2016] [Indexed: 11/03/2022]
Abstract
Among non-pharmacological treatments, the ketogenic diet (KD) has the strongest demonstrated evidence of clinical success in drug resistant epilepsy. In an attempt to model the anticonvulsant effects of the KD pre-clinically, the present study assessed the effects of the KD against electroshock-induced convulsions in mice. After confirming that exposure to the KD for 2 weeks resulted in stable ketosis and hypoglycemia, mice were exposed to electroshocks of various intensities to establish general seizure susceptibility. When compared to mice fed the standard rodent chow diet (SRCD), we found that mice fed the KD were more sensitive to electroconvulsions as reflected by a significant decrease in seizure threshold (3.86 mA in mice on the KD vs 7.29 mA in mice on the SRCD; P < 0.05) in the maximal electroshock seizure threshold (MEST) test. To examine if this increased seizure sensitivity to electroconvulsions produced by the KD would affect anticonvulsant effects of antiepileptic drugs (AEDs), anticonvulsant potencies of carbamazepine (CBZ), phenobarbital (PB), phenytoin (PHT), and valproate (VPA) against maximal electroshock (MES)-induced convulsions were compared in mice fed the KD and SRCD. We found that potencies of all AEDs studied were decreased in mice fed the KD in comparison to those on the SRCD, with decreases in the anticonvulsant potencies ranging from 1.4 fold (PB) to 1.7 fold (PHT). Finally, the lack of differences in brain exposures of the AEDs studied in mice fed the KD and SRCD ruled out a pharmacokinetic nature of the observed findings. Taken together, exposure to the KD in the present study had an overall pro-convulsant effect. Since electroconvulsions require large metabolic reserves to support their rapid spread throughout the brain and consequent generalized tonic-clonic convulsions, this effect may be explained by a high energy state produced by the KD in regards to increased energy storage and utilization.
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Affiliation(s)
- Iwona Zarnowska
- Department of Pathophysiology, Medical University, Jaczewskiego 8, 20-090, Lublin, Poland.
| | - Jarogniew J Luszczki
- Department of Pathophysiology, Medical University, Jaczewskiego 8, 20-090, Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, 20-950, Lublin, Poland
| | - Tomasz Zarnowski
- Chair of Ophthalmology, Medical University, Chmielna 1, 20-079, Lublin, Poland
| | - Piotr Wlaz
- Department of Animal Physiology, Institute of Biology and Biochemisry, Faculty of Biology and Biotechnology, Maria Curie-Skłodowska University, Akademicka 19, 20-033, Lublin, Poland
| | - Stanislaw J Czuczwar
- Department of Pathophysiology, Medical University, Jaczewskiego 8, 20-090, Lublin, Poland
- Department of Physiopathology, Institute of Agricultural Medicine, Jaczewskiego 2, 20-950, Lublin, Poland
| | - Maciej Gasior
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA.
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Katsu-Jiménez Y, Alves RMP, Giménez-Cassina A. Food for thought: Impact of metabolism on neuronal excitability. Exp Cell Res 2017; 360:41-46. [PMID: 28263755 DOI: 10.1016/j.yexcr.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/11/2022]
Abstract
Neuronal excitability is a highly demanding process that requires high amounts of energy and needs to be exquisitely regulated. For this reason, brain cells display active energy metabolism to support their activity. Independently of their roles as energy substrates, compelling evidence shows that the nature of the fuels that neurons use contribute to fine-tune neuronal excitability. Crosstalk of neurons with glial populations also plays a prominent role in shaping metabolic flow in the brain. In this review, we provide an overview on how different carbon substrates and metabolic pathways impact neurotransmission, and the potential implications for neurological disorders in which neuronal excitability is deregulated, such as epilepsy.
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Affiliation(s)
- Yurika Katsu-Jiménez
- Karolinska Institutet, Department of Medical Biochemistry and Biophysics, Scheeles väg 2, 171 77 Stockholm, Sweden
| | - Renato M P Alves
- Karolinska Institutet, Department of Medical Biochemistry and Biophysics, Scheeles väg 2, 171 77 Stockholm, Sweden
| | - Alfredo Giménez-Cassina
- Karolinska Institutet, Department of Medical Biochemistry and Biophysics, Scheeles väg 2, 171 77 Stockholm, Sweden; Centro de Biología Molecular "Severo Ochoa", Universidad Autónoma de Madrid, Department of Molecular Biology, C/ Nicolás Cabrera 1, 28049 Madrid, Spain.
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48
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Burroni J, Taylor P, Corey C, Vachnadze T, Siegelmann HT. Energetic Constraints Produce Self-sustained Oscillatory Dynamics in Neuronal Networks. Front Neurosci 2017; 11:80. [PMID: 28289370 PMCID: PMC5326782 DOI: 10.3389/fnins.2017.00080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/03/2017] [Indexed: 12/27/2022] Open
Abstract
Overview: We model energy constraints in a network of spiking neurons, while exploring general questions of resource limitation on network function abstractly. Background: Metabolic states like dietary ketosis or hypoglycemia have a large impact on brain function and disease outcomes. Glia provide metabolic support for neurons, among other functions. Yet, in computational models of glia-neuron cooperation, there have been no previous attempts to explore the effects of direct realistic energy costs on network activity in spiking neurons. Currently, biologically realistic spiking neural networks assume that membrane potential is the main driving factor for neural spiking, and do not take into consideration energetic costs. Methods: We define local energy pools to constrain a neuron model, termed Spiking Neuron Energy Pool (SNEP), which explicitly incorporates energy limitations. Each neuron requires energy to spike, and resources in the pool regenerate over time. Our simulation displays an easy-to-use GUI, which can be run locally in a web browser, and is freely available. Results: Energy dependence drastically changes behavior of these neural networks, causing emergent oscillations similar to those in networks of biological neurons. We analyze the system via Lotka-Volterra equations, producing several observations: (1) energy can drive self-sustained oscillations, (2) the energetic cost of spiking modulates the degree and type of oscillations, (3) harmonics emerge with frequencies determined by energy parameters, and (4) varying energetic costs have non-linear effects on energy consumption and firing rates. Conclusions: Models of neuron function which attempt biological realism may benefit from including energy constraints. Further, we assert that observed oscillatory effects of energy limitations exist in networks of many kinds, and that these findings generalize to abstract graphs and technological applications.
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Affiliation(s)
- Javier Burroni
- Biologically Inspired Neural and Dynamical Systems Laboratory, College of Information and Computer Sciences, University of Massachusetts Amherst, MA, USA
| | - P Taylor
- Biologically Inspired Neural and Dynamical Systems Laboratory, College of Information and Computer Sciences, University of MassachusettsAmherst, MA, USA; Neuroscience and Behavior Program, University of MassachusettsAmherst, MA, USA
| | - Cassian Corey
- Biologically Inspired Neural and Dynamical Systems Laboratory, College of Information and Computer Sciences, University of Massachusetts Amherst, MA, USA
| | - Tengiz Vachnadze
- Biologically Inspired Neural and Dynamical Systems Laboratory, College of Information and Computer Sciences, University of Massachusetts Amherst, MA, USA
| | - Hava T Siegelmann
- Biologically Inspired Neural and Dynamical Systems Laboratory, College of Information and Computer Sciences, University of MassachusettsAmherst, MA, USA; Neuroscience and Behavior Program, University of MassachusettsAmherst, MA, USA
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Ichikawa N, Alves M, Pfeiffer S, Langa E, Hernández-Santana YE, Suzuki H, Prehn JH, Engel T, Henshall DC. Deletion of the BH3-only protein Noxa alters electrographic seizures but does not protect against hippocampal damage after status epilepticus in mice. Cell Death Dis 2017; 8:e2556. [PMID: 28079889 PMCID: PMC5457684 DOI: 10.1038/cddis.2016.301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/19/2022]
Abstract
Several members of the Bcl-2 gene family are dysregulated in human temporal lobe epilepsy and animal studies show that genetic deletion of some of these proteins influence electrographic seizure responses to chemoconvulsants and associated brain damage. The BH3-only proteins form a subgroup comprising direct activators of Bax–Bak that are potently proapoptotic and a number of weaker proapoptotic BH3-only proteins that act as sensitizers by neutralization of antiapoptotic Bcl-2 family members. Noxa was originally characterized as a weaker proapoptotic, ‘sensitizer' BH3-only protein, although recent evidence suggests it too may be potently proapoptotic. Expression of Noxa is under p53 control, a known seizure-activated pathway, although Noxa has been linked to energetic stress and autophagy. Here we characterized the response of Noxa to prolonged seizures and the phenotype of mice lacking Noxa. Status epilepticus induced by intra-amygdala kainic acid caused a rapid increase in expression of noxa in the damaged CA3 subfield of the hippocampus but not undamaged CA1 region. In vivo upregulation of noxa was reduced by pifithrin-α, suggesting transcription may be partly p53-dependent. Mice lacking noxa developed less severe electrographic seizures during status epilepticus in the model but, surprisingly, displayed equivalent hippocampal damage to wild-type animals. The present findings indicate Noxa does not serve as a proapoptotic BH3-only protein during seizure-induced neuronal death in vivo. This study extends the comprehensive phenotyping of seizure and damage responses in mice lacking specific Bcl-2 gene family members and provides further evidence that these proteins may serve roles beyond control of cell death in the brain.
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Affiliation(s)
- Naoki Ichikawa
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.,Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mariana Alves
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Shona Pfeiffer
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Elena Langa
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Yasmina E Hernández-Santana
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Jochen Hm Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Tobias Engel
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - David C Henshall
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
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Velíšek L. Taming the rAMPAnt Fire with Fat. Epilepsy Curr 2017; 17:54-56. [PMID: 28331475 PMCID: PMC5340561 DOI: 10.5698/1535-7511-17.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
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