Therapeutic Lub luag hauj lwm ntawm Ketogenic noj zaub mov nyob rau hauv Neurological Disorders Part 1

Abstract:

Kev noj zaub mov ketogenic (KD) yog cov rog rog, tsis muaj carbohydrates, thiab cov khoom noj muaj protein txaus uas tsis ntev los no tau muaj koob meej hauv cov ntsiab lus ntawm cov kab mob neurological (NDs).

Nrog rau kev hloov pauv hauv kev ua neej niaj hnub no, kev noj zaub mov muaj roj ntau dhau los ua kev xaiv txhua hnub rau ntau tus neeg. Ntau tus neeg txhawj xeeb tias kev noj zaub mov muaj roj ntau yuav ua rau kev nco, tab sis qhov tseeb, kev sib raug zoo ntawm kev noj zaub mov muaj rog thiab kev nco tsis yog xim dub thiab dawb.

Ua ntej, nws yuav tsum paub meej tias rog muaj qee yam cuam tshuam rau peb lub cev thiab lub hlwb. Cov rog muab lub zog, txhawb lub cev kev loj hlob, thiab tswj kev ncaj ncees ntawm cov cell membranes. Ntxiv mus, rog kuj tseem ceeb heev rau lub hlwb noj qab haus huv. Feem ntau ntawm lub paj hlwb yog ua los ntawm cov rog, uas tiv thaiv cov neurons los ntawm kev puas tsuaj thiab pab tswj cov neurotransmission zoo.

Txawm li cas los xij, kev noj zaub mov muaj roj ntau ua rau lub cev tsis zoo thiab tuaj yeem ua rau kev nco. Kev tshawb fawb qhia tau hais tias kev noj zaub mov muaj roj ntau tuaj yeem ua rau insulin tsis kam, uas cuam tshuam rau lub cev ua haujlwm ntawm cov ntshav qab zib thiab yog li cuam tshuam rau lub hlwb ua haujlwm. Tsis tas li ntawd, kev noj zaub mov muaj roj kuj tuaj yeem cuam tshuam rau cov ntshav khiav thiab cov pa oxygen, txo cov hlwb ua haujlwm, thiab yog li cuam tshuam rau kev xav thiab nco.

Txawm li cas los xij, qhov no tsis tau txhais hais tias peb yuav tsum tsis txhob rog tag nrho. Rog yog ib qho tseem ceeb hauv peb cov zaub mov noj txhua hnub, thiab kev noj zaub mov kom zoo pab tswj kev noj qab haus huv ntawm lub cev thiab lub hlwb. Yog li ntawd, peb yuav tsum ua raws li lub hauv paus ntsiab lus ntawm "qhov tsim nyog ua ntej", noj cov roj uas tsim nyog, thiab tsis txhob noj ntau dhau, tshwj xeeb tshaj yog cov zaub mov tsis zoo.

Tsis tas li ntawd, qee qhov kev tshawb fawb qhia tias qee cov fatty acids muaj txiaj ntsig zoo rau kev nco. Piv txwv li, omega -3 fatty acids tuaj yeem txhawb kev tsim thiab kho cov neurons, txhim kho lub hlwb kev txawj ntse thiab kev txawj ntse. Muaj qee cov khoom noj uas muaj omega -3 fatty acids, xws li ntses salmon, cod, flax noob, thiab lwm yam, thiab koj tuaj yeem nce koj cov khoom noj kom tsim nyog kom tau txais txiaj ntsig.

Zuag qhia tag nrho, kev sib raug zoo ntawm kev noj zaub mov muaj roj ntau thiab kev nco yog qhov nyuaj, thiab peb yuav tsum tsis txhob simplistically saib tag nrho cov zaub mov muaj roj ntau ua teeb meem. Kev noj zaub mov kom tsawg, ceev faj xaiv hom rog thiab ntau npaum li cas, thiab ntxiv qee cov khoom noj muaj txiaj ntsig tuaj yeem pab ua kom nco qab noj qab nyob zoo. Nws tuaj yeem pom tias peb yuav tsum txhim kho kev nco, thiab Cistanche deserticola tuaj yeem txhim kho kev nco zoo vim Cistanche deserticola yog cov khoom siv tshuaj hauv Suav teb uas muaj ntau yam teebmeem, ib qho ntawm kev txhim kho kev nco. Kev ua tau zoo ntawm Cistanche deserticola los ntawm ntau yam khoom xyaw uas nws muaj, suav nrog tannic acid, polysaccharides, flavonoid glycosides, thiab lwm yam. Cov khoom xyaw no tuaj yeem txhawb lub hlwb kev noj qab haus huv los ntawm ntau txoj hauv kev.

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Nyem Paub Txoj Kev Txhim Kho Kev Nco

Lub complexity ntawm pathogenesis ntawm cov kab mob no txhais tau hais tias cov ntaub ntawv zoo ntawm kev kho mob tseem tsis muaj. Conventionaltherapy feem ntau cuam tshuam nrog kev ua siab ntev thiab / lossis tshuaj tiv thaiv.

Yog li ntawd, cov tswv yim kho kom zoo dua yog nrhiav kom muaj txiaj ntsig zoo ntawm cov ntaub ntawv kho mob thiab txhim kho lub neej zoo ntawm cov neeg mob. Nyob rau lub sijhawm no, nws zoo li KD tuaj yeem muab cov txiaj ntsig kho mob rau cov neeg mob uas muaj teeb meem hauv lub paj hlwb los ntawm kev tswj hwm qhov sib npaug ntawm cov txheej txheem tshuaj tiv thaiv antioxidant thiab pro-excitatory thiab inhibitory neurotransmitters, thiab kho qhov mob lossis hloov cov kab mob hauv plab microbiome.

Hauv qhov kev tshuaj xyuas no, peb tau soj ntsuam cov txiaj ntsig kho tau zoo ntawm KD hauv kev mob vwm, kev nyuaj siab, migraine, Alzheimer's disease, thiab Parkinson's disease. Hauv peb lub tswv yim, KD yuav tsum raug suav hais tias yog kev kho mob ntxiv rau qee cov kab mob neurological.

Lo lus tseem ceeb: noj ketogenic; neurological mob; mob qaug dab peg; kev nyuaj siab; migraine; Alzheimer tus kab mob; Tus kab mob Parkinson.

1. Ketogenic noj zaub mov

Kev noj zaub mov ketogenic (KD) yog cov rog rog, cov protein txaus, cov zaub mov tsis muaj carbohydrate [1] .Qhov kev hloov pauv ntawm qhov kev faib ua feem ntawm macronutrients ua rau cov piam thaj-sparing thiab enhancedketogenesis [2]. Lub xeev metabolic no hu ua "nutritional ketosis".

Kev tshawb nrhiav ntau thiab ntau ntxiv qhia tau hais tias kev noj zaub mov ketogenic tuaj yeem muaj txiaj ntsig zoo rau lub hlwb kev ua haujlwm thiab cov kabmob peripheral, thiab yog li muab cov txiaj ntsig kho mob rau ntau yam ntawm cov kab mob neurological [3,4]. Txawm hais tias cov txheej txheem molecular ntawm kev ua ntawm ketogenic noj zaub mov tsis meej, kev tshawb fawb loj hlob qhia tias KD tuaj yeem yog ib qho tseem ceeb hauv kev kho mob hauv kev kho mob hauv nruab nrab paj hlwb (CNS) cov kab mob.

Tsis ntev los no, nws tau pom tias KD tuaj yeem cuam tshuam cov kab mob los ntawm kev hloov kho qhov mob [5–10], tswj qhov sib npaug ntawm cov txheej txheem pro- thiab antioxidant [11–14], thiab / lossis hloov cov kab mob hauv plab microbiome [15] .

1.1. Keeb kwm ntawm Ketogenic noj zaub mov

Kev noj haus ketogenic muaj nws lub hauv paus hauv kev yoo mov, uas tau siv txij li lub sijhawm qub los kho mob vwm. Xyoo 1921, Woodyatt pom tias kev tshaib kev nqhis thiab kev noj zaub mov muaj rog ua rau lub xeev ntawm ketosis.

Nyob rau hauv tib lub xyoo, KD tau siv nyob rau hauv Mayo Clinic raws li kev kho mob rau qaug dab peg los ntawm Russell Wilder [16]. Thaum lub sijhawm, nws tau txiav txim siab tias ntau tshaj li ib nrab ntawm cov menyuam yaus uas muaj mob vwm tau txhim kho lawv tus mob. Kev noj zaub mov no tau siv dav hauv cov neeg mob no, kom txog rau thaum kev tshawb pom thawj zaug ntawm kev mob vwm, diphenylhydantoin (1938) [16].

Thaum kawg ntawm lub xyoo pua xeem, cov kws tshawb fawb tau rov ua dua lawv txoj kev txaus siab rau KD rau nws txoj haujlwm tseem ceeb hauv kev puas hlwb. Vining et al. [17] tau kawm txog qhov ua tau zoo ntawm KD hauv kev txo qis qaug dab peg hauv cov menyuam yaus (hnub nyoog 1-8 xyoo) txog tam sim no tsis teb rau kev kho mob nrog ob hom tshuaj tiv thaiv kab mob.

Tom qab ib xyoos tom qab kev noj zaub mov, 40% ntawm cov neeg mob tau sau tseg tias txo qis kev qaug dab peg los ntawm ntau dua 50% thiab 10% ntawm cov neeg mob pom tias tsis muaj kev qaug dab peg.

Astudy ua los ntawm Freeman et al. [18] ntawm 150 tus neeg mob hnub nyoog 1-16 xyoo uas muaj tshuaj tiv thaiv kab mob qog noj ntshav tau lees paub cov teebmeem neuroprotective ntawm KD. Cov kws tshawb fawb tau pom tias tom qab ib xyoos tom qab kev noj zaub mov, 27% ntawm cov neeg mob tau ntsib kev qaug dab peg ntau dua 90%. Tom qab 10 xyoo, Neal et al. [19] tau ua ib qho kev sim tshuaj ntsuam xyuas uas tau lees paub lub luag haujlwm tseem ceeb ntawm KD hauv kev tswj hwm ntawm qaug dab peg.

Tom qab 3 lub hlis ntawm kev noj haus, kev qaug dab peg ntau dua 50% hauv 38% ntawm cov neeg mob hnub nyoog 2-16 xyoo tau pom. Tsis tas li ntawd, kev tshawb fawb tsis ntev los no qhia tias KD tuaj yeem muaj txiaj ntsig zoo rau kev kawm ntawm lwm yam kab mob neurological, suav nrog Alzheimer's disease (AD ) thiab Parkinson's Disease (PD) [20–22].

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1.2. Hom thiab yam ntxwv ntawm Ketogenic noj haus

Niaj hnub no, muaj ntau hom kev noj zaub mov ketogenic, sib txawv ntawm qhov sib npaug ntawm macronutrients, uas tso cai rau kev noj zaub mov kom haum rau cov kev xav tau tshwj xeeb ntawm tus neeg mob. Daim duab 1 qhia txog kev sib piv ntawm cov kev hloov pauv ntawm cov khoom noj ketogenic thiab lawv cov macronutrient piv.

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1.2.1. Classic Ketogenic noj zaub mov (CKD)

Kev noj zaub mov ketogenic classic yog tus cwj pwm los ntawm kev noj zaub mov muaj roj ntau, kev noj zaub mov muaj protein ntau, thiab kev noj zaub mov tsawg, nrog rau macronutrient piv ntawm 4: 1 [23]. Kev noj zaub mov Theketogenic txwv tsis pub noj carbohydrate rau 10% ntawm tag nrho cov calories noj txhua hnub. Nws ua raws li cov neeg uas xav tau lub zog txhua hnub ntawm 2000 kcal tuaj yeem haus txog 50 g ntawm carbohydrates.

Txawm li cas los xij, hauv thawj theem ntawm kev noj zaub mov, carbohydrates yuav tsum txwv tsis pub tshaj 20 g ib hnub. Xws li cov khoom noj uas tsis muaj carbohydrate ua kom lub cev hloov pauv thiab hloov pauv cov metabolism hauv kev siv fatty acids los ua lub zog tseem ceeb.

1.2.2. Kev hloov pauv ntawm Classic Ketogenic noj zaub mov

High-Protein Ketogenic noj zaub mov (MAD)

Kev noj zaub mov muaj protein ntau ketogenic tseem hu ua Modified Atkins Diet (MAD) [24] .Lub induction theem yuav kav ntev li ntev tau thiab thaum lub sij hawm no, cov carbohydrate kom tsawg tsis ntau tshaj 20 g ib hnub twg. MAD xav tias qhov piv ntawm cov rog rau carbohydrates thiab cov protein ua ke yog 1-2: 1 [24,25]. Cov zaub mov no tsis cuam tshuam nrog kev txwv cov protein lossis calories noj, ua kom yooj yim rau kev tswj hwm thiab tswj tau yooj yim dua [25].

Medium-Chain Triglycerides Noj Zaub Mov (MCTD)

MTCD yog ib hom KD qhov nruab nrab-chain triglycerides (MTC) yog qhov tseem ceeb [26] .MTCD muab kev nqus sai ntawm triglycerides rau hauv cov hlab ntsha. Kev hloov pauv ntawm cov saw hlau ntev fatty acids rau cov saw hlau luv fatty acids, uas yog metabolized sai dua, ua rau kom tau txais ntau lub cev ketone ib kilocalories.

Kev ua haujlwm siab dua ntawm cov txheej txheem no ua rau muaj kev xav tau qis dua rau cov rog, yog li ua rau nws muaj peev xwm haus cov carbohydrates thiab cov protein ntau dua [27]. Qhov no yog qhov sib txawv tseem ceeb uas txiav txim siab txog kev noj qab haus huv mus sij hawm ntev, vim nws tsis nruj dua li classic KD [28,29]. Tsis tas li ntawd, hom kev noj haus no txhim kho mitochondrial muaj nuj nqi [30].

Medium-Chain Triglycerides Noj Zaub Mov (MCTD)

Tsawg-calorie Ketogenic noj zaub mov (VLCKD)

Kev noj zaub mov carbohydrate ntawm cov zaub mov no txawv ntawm 20-50 g ib hnub lossis tej zaum tsawg dua 10% ntawm 2000 kcal ib hnub [31]. Vim muaj qhov sib txawv ntawm tus kheej, tsis yog txhua tus neeg mob tuaj yeem ua tiav ketones nrog cov macronutrient piv. Qhov kev hloov kho no tuaj yeem siv los ua cov khoom noj induction toketogenic nrog cov ntsiab lus protein ntau dua.

Kev Kho Mob Tsawg Glycemic Index (LGIT)

Low Glycemic Index Treatment (LGIT) yog ib qho kev xaiv rau kev noj haus ketogenic. Nws yog kev noj zaub mov muaj rog uas hloov cov khoom noj glycemic siab (GI) nrog cov khoom noj GI tsawg yog qhov tseem ceeb.

GI qhia tias cov zaub mov nce ntshav qabzib ntau npaum li cas piv rau tib yam ntawm cov khoom siv carbohydrates [32]. Txawm hais tias qhov kev noj haus no tsis ua rau ketosis tas li, nws muaj txiaj ntsig zoo rau cov metabolism hauv carbohydrate. Nws yooj yim dua rau cov neeg mob kom tswj tau thiab yog li nrov nrog cov neeg mob hluas thaum mus pw hauv tsev kho mob [1].

Cyclical Ketogenic noj zaub mov (CKD)

Qhov no suav nrog lub sijhawm ua haujlwm ntawm cov khoom noj ketogenic classic thiab cov carbohydrates ntau (nrog 45-65% carbohydrates). Lub tom kawg yog tsom rau kev ntxiv cov khw muag khoom glycogen hauv cov leeg [33].

Targeted Ketogenic noj zaub mov (TKD)

Hom kev noj haus ketogenic no tso cai rau ib tus neeg kom haus ntau cov carbohydrates ib ncig ntawm lub cev ua haujlwm kom tswj tau qhov kev ua tau zoo thaum tsis cuam tshuam rau lub xeev ntawm ketosis [33].

2. Metabolic Alterations nyob rau hauv lub hlwb txuam nrog Ketogenic noj

Txawm hais tias lub paj hlwb tsuas yog kwv yees li 2% ntawm lub cev hnyav, nws yog lub cev muaj zog tshaj plaws hauv lub cev. Nws paub tias tsis yog tsuas yog qabzib tuaj yeem ua lub zog rau lub hlwb, tab sis kuj tseem muaj ketones uas tuaj yeem ua tau raws li 60% ntawm lub hlwb xav tau lub zog tag nrho [34].

Kev tshawb fawb ntau ntxiv qhia tau hais tias kev noj zaub mov ketogenic los ntawm kev hloov pauv biochemical tuaj yeem muaj txiaj ntsig zoo rau lub hlwb kev ua haujlwm thiab tuaj yeem xa cov txiaj ntsig kho mob rau ntau yam mob paj hlwb. Kev noj zaub mov muaj roj ntau lub hom phiaj txhawm rau ua kom muaj lub xeev ntawm ketosis hauv lub cev, ua kom muaj lipolysis ntxiv nrog rau ketogenesis [35].

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Raws li pom nyob rau hauv daim duab 2 cov fatty acids yog intensive oxidized nyob rau hauv lub siab, uas ua rau tsim ib tug loj npaum li cas ntawm ketone lub cev (KBs), xws li acetoacetate (ACA), D(-)3-hydroxybutyrate (D- HB, - HB) thiab acetone. Thawj ob tuaj yeem nkag mus rau lub voj voog citric acid (tricarboxylic acid voj voog, TCA voj voog) thiab siv tau ATP los ntawm cov neurons.

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Leino et al. [36] pom tau hais tias theem ntawm monocarboxylate transporter (MCT), uas yog lub luag haujlwm rau KBs thauj hla cov ntshav-hlwb barrier (BBB), yog nce inanimals pub KD noj zaub mov piv rau kev tswj hwm noj cov zaub mov carbohydrate feem ntau. Kev nce ntxiv ntawm ketone lub cev kuj tau lees paub los ntawm Bentourkia li al. [37] siv positronemission tomography (PET) thiab 11C-labeled ACA.

Txoj kev tshawb no pom tau hais tias qhov nce ntawm xya mus rau yim npaug ntawm 11C-ACA lub hlwb nce siab hauv lub xeev ntawm ketosis tshwm sim los ntawm KD lossis kev tshaib plab, piv rau kev tswj hwm noj zaub mov muaj carbohydrate. Tom qab ntawd, cov tsim KBs raug hloov mus rau acetyl-CoA hauv cov ntaub so ntswg extrahepatic thiab koom nrog citric acidcycle ua lub zog [38].

Raws li pom hauv cov kev sim tsiaj, qhov tau txais lub zog los ntawm ketone lub cev muaj ntau yam txiaj ntsig uas cuam tshuam rau lub paj hlwb ua haujlwm. Ntawm qhov tod tes, lawv qhov kev hloov pauv nce ntxiv tag nrho lub zog lub pas dej, uas yog siv los ntawm cov neurons los tsim cov neurotransmitters [39] .Interestingly, -HB inhibits lipolysis, yog li tswj hemostasis thiab ketogenesis [5], los ntawm kev ua kom muaj hydroxycarboxylic acid receptor 2 (HCA2, PUMA-G). , PIB 109A).

Micelacking cov receptor no qhia tau tias muaj kev siv ntau dua ntawm lipolysis thiab ketogenesis, qhia tias qhov receptor no yog qhov tseem ceeb rau inhibition ntawm lipolysis los ntawm -HB [40].Cov kev tshawb fawb tshiab qhia tau hais tias KD tuaj yeem hloov qhov piv ntawm NAD + / NADH, nce qhov muaj NAD +. nyob rau hauv lub hlwb, uas muaj kev cuam tshuam tseem ceeb ntawm cellularpathways koom nrog inflammatory teb, DNA puas kho, thiab circadian rhythmregulation [14,41].

Qhov no ua rau kev noj zaub mov ketogenic muaj peev xwm txo tau cov tsos mob ntawm cov kab mob ntawm cov kab mob uas cuam tshuam nrog cov txheej txheem yav dhau los.

2.1. Qhov cuam tshuam ntawm Ketogenic noj zaub mov ntawm Glucose Metabolism]

Thaum cov khoom noj carbohydrates los ntawm kev noj zaub mov tsis txaus, lub paj hlwb tau txais txiaj ntsig los ntawm ketogenesis. Ntau qhov kev tshawb fawb qhia tau hais tias kev hloov pauv ntawm lub hlwb metabolism los ntawm cov piam thaj oxidation mus rau ketone lub cev siv yuav tsum tau hloov kho [42-44].

Thaum cov kab mob tau hloov mus rau kev siv KBs ua lub hauv paus ntawm lub zog, nws tuaj yeem npog txog li 60-70% ntawm lub zog xav tau rau kev ua haujlwm ntawm lub hlwb [34,45]. Ib txoj kev tshawb fawb thiab kev tshuaj ntsuam meta-ua los ntawm Zhang li al. [46] ua pov thawj tias tus nqi ntawm lub hlwb hloov pauv nyob ntawm lub sijhawm thiab qhov hnyav ntawm ketosis.The Zilberter li al. [2] kev soj ntsuam tau xaus lus tias KBs ua los ntawm sparing qabzib ntau dua li inhibiting glycolysis.

Vim yog cov txheej txheem no, cov piam thaj ua lwm yam haujlwm uas nws tsis tuaj yeem hloov pauv, piv txwv li, biosynthesis ntawm lwm cov tebchaw, xws li alanine [47] andglutamate [48], glycogenesis, thiab tiv thaiv antioxidant [2].Glucose raug thauj hauv lub hlwb los ntawm peb. isoforms ntawm glucose transporters (GLUT): (1) 55 kDa GLUT 1, qhia los ntawm endothelial hlwb, (2) 45 kDa GLUT 1, qhia byastrocytes, (3) GLUT 3, tsim los ntawm neurons [49].

Leino et al. [36] qhia tias GLUT1levels tau nce siab hauv cov hlwb endothelial thiab neuropil ntawm nas muab tso rau hauv ketosis, piv rau ib pab pawg tau noj cov zaub mov carbohydrate siab. Kev txhim kho cov piam thaj mus rau lub hlwb kuj tseem tuaj yeem cuam tshuam nrog kev ua ntawm insulin zoo li kev loj hlob zoo (IGF1).

Cov nas noj ketogenicdiet nrog kev txwv lub zog tau pom muaj kev nthuav qhia ntau ntxiv ntawm (1) zoo li insulin-zoo li kev loj hlob factorIGF1 receptors nyob rau hauv txhua feem ntawm lub hlwb, (2) IGF1 binding protein, uas inhibits IGF1proteolysis, hauv Purkinje hlwb, thiab (3) GLUT 1, GLUT. 3 mRNA [50].

Kev sim tshawb fawb txog qhov cuam tshuam ntawm IGF1 ntawm lub hlwb nas tau pom tias nws ua haujlwm sib koom ua ke nrog insulinon kev hloov pauv ntawm cov piam thaj thauj mus rau GLUT1 mus rau astrocyte cell membrane, pab txhawb kev thauj cov piam thaj mus rau lub hlwb [51].

Nyob rau tib lub sijhawm, astrocyte metabolism yog augmented los ntawm KD [52] .Astrocytes qhib glycolysis thiab glycogenolysis, uas muab lub zog los tswj cov haujlwm tseem ceeb ntawm cov hlwb, xws li tshem tawm glutamate thiab K + ions los ntawm thesynaptic cleft [53].

2.2. Qhov cuam tshuam ntawm Ketogenic noj zaub mov ntawm Amino Acid Metabolism thiab Neurotransmitter Synthesis; Glutamate-Glutamine Cycle

Glutamate yog ib qho excitatory amino acid thiab yog li ntawd nws cov concentration hauv synapticgap yuav tsum tau khaws cia nyob rau theem qis. Nws yog thauj los ntawm vesicular glutamate transporters (VGLUTs). Lawv qhov kev txiav txim yog nyob ntawm Cl- ions, uas ua raws li allosteric modulators.

Qhov tsis muaj cov ions no inhibits glutamatergic thauj [54]. Yog et al. [55] pom tau hais tias ketone lub cev ua rau thim rov qab inhibition ntawm glutamate thauj hauv hippocampal neuronsby khi rau Cl- ion site. ACA tau nthuav tawm cov txiaj ntsig zoo dua li lwm cov khoom nruab nrab ntawm cov cell metabolism, xws li -HB thiab pyruvate.

Kev noj zaub mov kom ntev ntev nrog kev txo qis hauv cov carbohydrates ua rau nce qhov ntws los ntawm TCA lub voj voog los ntawm kev tsim tawm ntawm acetyl-CoA, thiab txhim kho kev ua haujlwm ntawm acetyl-CoA cov tshuaj tiv thaiv nrog oxaloacetate [52].

Txoj hauv kev kom tau txais glutamate kuj tseem muaj zog ntxiv vim qhov txo qis ntawm oxaloacetate piv rau lub cev lub cev, vim yog kev siv ntau ntxiv ntawm cov tshuaj no hauv cov tshuaj tiv thaiv nrog acetyl-CoA hauv lub voj voog citric acid [52].

Qhov no ua rau txo qis kev hloov pauv ntawm glutamate mus rau aspartate hauv cov tshuaj tiv thaiv glutamate + oxaloacetate=aspartate + -ketoglutarate [56] (saib daim duab 3). Kev tshawb fawb ntawm cov nas ketonic tau pom tias leucine ntau dua hauv cov ntshav thiab forebrain ntawm cov tsiaj no, thaum glutamate thiab glutamine concentrations tsis txawv piv rau cov tswj tau noj cov zaub mov carbohydrate feem ntau [56].

Qhov no yuav ua rau muaj kev thauj mus los ntawm glutamate los ntawm astrocytes mus rau cov neurons, uas yuav tsum tau xa cov ammonia molecule [57], feem ntau tsim los ntawm leucine [58]. Cov kev tshawb fawb no qhia txog qhov loj ntawm lub pas dej glutamate uas tuaj yeem nyiam cov synthesis ntawm inhibitory neurotransmitter gamma-aminobutyric acid (GABA), raws li tau lees paub los ntawm kev tshawb fawb ntawm synaptosomes siv cov concentration ntawm ACA [59].

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Ntxiv mus, cov kev tshawb fawb siv 13C-labeled qabzib thiab acetate tau qhia tias cov pa roj carbon monoxide muaj nyob hauv GABA hauv lub xeev ketosis tau muab los ntawm acetate [52]. Ib qho ntxiv GABA / glutamine piv kuj tau pom.

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