Animal studies have demonstrated a disturbance in oxidative and glucose metabolism after traumatic brain injury (TBI), with depression of metabolism being a significant feature. Our recent human studies have demonstrated two related findings: 1) There is a prolonged period of metabolic depression after brain injury and 2) extracellular glucose concentrations are frequently low during this metabolic depression. The duration and extent of low extracellular glucose concentration are independent predictors of neurologic outcome. At the same time, many experimental and clinical studies have demonstrated that systemic hyperglycemia adversely affects outcome after human TBI. Hence, the current standard of care requires the use of insulin to maintain nomoglycemia. However, little is known about the effects of glycemic control on brain metabolism nor the potential adverse effects of limiting glucose supply through strict glycemic control after TBI. We have demonstrated that insulin results in reduction in extracellular glucose and an increase in extracellular glutamate (Vespa, 2006) suggesting a possible adverse effect. Thus, there exists a controversy about on how best to manage systemic glucose concentrations in TBI. Given the potential therapeutic implications, there is a profound need to better understand the effects of glycemic control on brain metabolism after TBI. This project proposes to study the null hypothesis that limitation of glucose availability (serum glucose concentrations) reduces the rates of cerebral glucose and oxidative metabolism, by using a controlled insulin infusion to achieve normal serum glucose concentrations (80-110 mg/dl). In addition, we propose to test a secondary hypothesis that reduction of serum glucose to normal concentrations will result in microdialysis markers of metabolic distress in post-traumatic brain injured patients using a combined within-subjects and randomized cross over study design. This project is intricately inter-related with projects 1, 2 and 4 of this PPG.

Public Health Relevance

Critical Care for traumatic brain injury is extremely important for healthcare. Glycemic control is one of the top three therapeutic targets of critical care for traumatic brain injury. This research direct addresses this important issue.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Program Projects (P01)
Project #
5P01NS058489-05
Application #
8460077
Study Section
National Institute of Neurological Disorders and Stroke Initial Review Group (NSD)
Project Start
Project End
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
5
Fiscal Year
2013
Total Cost
$228,813
Indirect Cost
$66,014
Name
University of California Los Angeles
Department
Type
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Wolahan, Stephanie M; Prins, Mayumi L; McArthur, David L et al. (2016) Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury. Neurocrit Care :
Prins, Mayumi L; Matsumoto, Joyce (2016) Metabolic Response of Pediatric Traumatic Brain Injury. J Child Neurol 31:28-34
Moro, Nobuhiro; Ghavim, Sima S; Harris, Neil G et al. (2016) Pyruvate treatment attenuates cerebral metabolic depression and neuronal loss after experimental traumatic brain injury. Brain Res 1642:270-7
Wong, Koon-Pong; Bergsneider, Marvin; Glenn, Thomas C et al. (2016) A semi-automated workflow solution for multimodal neuroimaging: application to patients with traumatic brain injury. Brain Inform 3:1-15
Shijo, Katsunori; Sutton, Richard L; Ghavim, Sima S et al. (2016) Metabolic fate of glucose in rats with traumatic brain injury and pyruvate or glucose treatments: A NMR spectroscopy study. Neurochem Int 102:66-78
Vespa, Paul; Tubi, Meral; Claassen, Jan et al. (2016) Metabolic crisis occurs with seizures and periodic discharges after brain trauma. Ann Neurol 79:579-90
Goh, S Y Matthew; Irimia, Andrei; Torgerson, Carinna M et al. (2015) Longitudinal quantification and visualization of intracerebral haemorrhage using multimodal magnetic resonance and diffusion tensor imaging. Brain Inj 29:438-45
Glenn, Thomas C; Martin, Neil A; Horning, Michael A et al. (2015) Lactate: brain fuel in human traumatic brain injury: a comparison with normal healthy control subjects. J Neurotrauma 32:820-32
Chmayssani, Mohamad; Stein, Nathan R; McArthur, David L et al. (2015) Therapeutic intravascular normothermia reduces the burden of metabolic crisis. Neurocrit Care 22:265-72
Glenn, Thomas C; Martin, Neil A; McArthur, David L et al. (2015) Endogenous Nutritive Support after Traumatic Brain Injury: Peripheral Lactate Production for Glucose Supply via Gluconeogenesis. J Neurotrauma 32:811-9

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