Glucose transport kinetics at the blood–brain barrier
Transport of glucose into and out of the brain is clearly more complex than that into and out of red blood cells. Firstly GLUT1 is needed in both membranes of the endothelial cells of the blood–brain barrier to allow the glucose to enter on one side and leave on the other. However, because the endothelial cells are very thin and correspondingly contain very little glucose, provided that the properties of the transport in the two membranes are similar, it is thought that the transport can still be described, at least qualitatively, as transport across a single barrier [331–333]. Secondly once across the blood–brain barrier, glucose is metabolized at a rate comparable to the rates of influx and efflux across the barrier while in red blood cells transport is much faster than metabolism. Thirdly there is also the technical difficulty that, with the important exception of the study in 1975 by Betz et al. [327], it has not proved possible to manipulate interstitial fluid glucose concentrations during the experiments. In most studies all that has been done is either to measure the extraction of glucose (total or labelled) from blood as described above or to measure the variation in the total amount of glucose present in the parenchyma with time as a function of glucose concentration in plasma. Mason et al. [334] compare the results obtained in many studies performed prior to 1992 but with the surprising omission of reference to studies from Betz’s group. Also in 1992, Gjedde [335] reviewed results obtained for glucose transport in rat and man. Glucose transport into and within the brain has been analyzed and reviewed by Simpson et al. [315], Barros et al. [314] and, more recently, by Patching [336].
In one of the first attempts to establish the mechanism of glucose transport at the blood–brain barrier, Buschiazzo et al. [319] found that 3-O-methyl-d-glucose, a non-metabolizable derivative of glucose, competes with glucose for transport, and furthermore that an inward gradient of glucose could drive 3-O-methyl-d-glucose uphill out of the brain, i.e. there is counter-transport for GLUT1 at the blood–brain barrier just as in red blood cells. Further evidence that GLUT1 behaves in a similar manner in the two environments was obtained by Betz et al. [327] who found that the rate of glucose influx was increased by increasing the concentration of glucose within the brain, i.e. there is trans-stimulation (see Appendix D).
Buschiazzo et al. [319] and Betz et al. [327] determined the total glucose in the parenchyma for different glucose concentrations in plasma (see Fig. 14). Subsequently NMR has been used to measure glucose content in conscious humans and lightly anaesthetized rats [334, 337–341]. The NMR results for humans and rats confirm under nearly physiological conditions (see Fig. 14) that brain glucose content continues to increase with plasma concentration for plasma concentrations up to at least 30 mM well above a typical resting value, 6 mM. They also confirm that the rates of glucose influx and efflux are respectively larger than and not much smaller than the rate of metabolism. Because influx and efflux substantially exceed the expected efflux via the perivascular route, the net flux across the blood–brain barrier is normally taken to be equal to CMRglc at steady-state.
Fig. 14 Four studies of brain glucose content versus glucose concentration in blood. In two studies glucose content was measured by chemical assay, a in anaesthetized rats by Buschiazzo et al. [319] and b in isolated perfused brains from dogs by Betz et al. [327]. In the latter it was assumed that brain water was 0.75 mL g−1. In the other two studies glucose content was determined by magnetic resonance spectroscopy, c in conscious humans by Gruetter et al. [337] and d in lightly anaesthetized rats by Choi et al. [338]. In all studies the glucose content continues to increase with plasma concentration even though it is known that the influx of glucose shows saturation. The explanation is that efflux also saturates and the increase in content must parallel the increase in plasma concentration in order for efflux to increase so that it is equal to influx minus the constant rate of glucose metabolism (see Appendix D)
In the results reported by Duarte et al. (see Figure 3 in [341]) using rats, following a step change in cplasma from 4 to 20 mM the brain content of glucose increased from about 0.5 to 4.5 µmol g−1 with a half life of about 16 min which indicates a net rate of accumulation of 0.122 µmol g−1 min−1, i.e. using their value of CMRglc, 0.52 µmol g−1 min−1, there is an influx of 0.64 µmol g−1 min−1 which is similar to that reported by Betz et al. in 1974 [302] for the dog.
It has so far not proved possible to analyse glucose efflux directly after injection of glucose into the brain. Any such measurements face major challenges including separating efflux from metabolism and avoiding disturbance of the efflux processes by the injection or infusion. The study by Ball et al. [85] established that during a 5 min, 0.1 µL min−1 infusion into the inferior colliculus glucose can move, presumably by a perivascular route, to the adjacent meninges strongly suggesting that as expected there is perivascular efflux of glucose. However, estimating the normal rate of this process to see if the perivascular clearance notably exceeds the 1 µL g−1 min−1 found in other regions would require measurement of the time course of the appearance of glucose in the meninges after the end of the infusion.15
The glucose efflux across the blood–brain barrier can be calculated if the influx and net flux are both known as indicated earlier in this discussion of glucose. Furthermore if it can be assumed that the fluxes are described by the expressions of the form derived from the carrier model, the rate of efflux can be calculated from the measured rates of influx versus the concentrations in plasma and ISF. An example of this using the data from Betz et al. [327] for the isolated perfused dog brain is given in Appendix D and Additional file 1. These data remain the only measurements of glucose influx versus plasma concentration for a range of known concentrations within the brain. Hence the calculated results in Appendix D are the only available results for efflux as a function of both plasma and ISF concentrations.
The fits to the data of Betz et al. [327] (see Additional file 1) indicate that the net flux = CMRglc for cplasma = 6 mM is 0.65 µmol g−1 min−1 with cisf = 1.2 mM. This value of CMRglc is close to those expected for rats but about twice that for humans. The fits also predict that glucose consumption, CMRglc, could increase to about 0.9 µmol g−1 min−1 with cisf approaching 0 without any change in transport capacity. However, larger increases in glucose consumption are required in order to support nervous activity. Changes in transport capacity are considered in Sect. 6.2.
Both neurons and astrocytes have transporters that will allow uptake of glucose and both can use it as a substrate for energy production. The proportions of glucose metabolism that occur in astrocytes and neurons remain controversial [315, 342–346] (see next section).