The capacity of ketone bodies to replace glucose in support of neuronal function is unresolved. Here, we determined the contributions of glucose and ketone bodies to neocortical oxidative metabolism over a large range of brain activity in rats fasted 36 hours and infused intravenously with [2,4-13 C 2 ]-D-b-hydroxybutyrate (BHB). Three animal groups and conditions were studied: awake ex vivo, pentobarbital-induced isoelectricity ex vivo, and halothane-anesthetized in vivo, the latter data reanalyzed from a recent study. Rates of neuronal acetyl-CoA oxidation from ketone bodies (V acCoA-kbN ) and pyruvate (V pdhN ), and the glutamateglutamine cycle (V cyc ) were determined by metabolic modeling of 13 C label trapped in major brain amino acid pools. V acCoA-kbN increased gradually with increasing activity, as compared with the steeper change in tricarboxylic acid (TCA) cycle rate (V tcaN ), supporting a decreasing percentage of neuronal ketone oxidation: B100% (isoelectricity), 56% (halothane anesthesia), 36% (awake) with the BHB plasma levels achieved in our experiments (6 to 13 mM). In awake animals ketone oxidation reached saturation for blood levels 417 mM, accounting for 62% of neuronal substrate oxidation, the remainder (38%) provided by glucose. We conclude that ketone bodies present at sufficient concentration to saturate metabolism provides full support of basal (housekeeping) energy needs and up to approximately half of the activity-dependent oxidative needs of neurons. Keywords: 13 C isotopes; glucose utilization; glutamate/glutamine cycle; ketone body utilization; neuroenergetics; nuclear magnetic resonance spectroscopy
INTRODUCTIONThe adult mammalian brain shows a remarkably high utilization of glucose compared with other potential fuel substrates, such as lactate or ketone bodies. Brain consumption of alternate substrates is limited by transport from the blood, and factors which alter membrane transport alter the rate of consumption. Under fasting conditions, starvation, or diets high in fats, blood ketone body levels rise, increasing their cerebral rate of consumption. The extent to which ketone bodies can support the different aspects of brain function, once transport is no longer limiting, has not been clearly established. Ketone bodies are metabolized by neurons and astrocytes in vitro and in vivo, 1-3 and like glucose, neuronal (glutamatergic) oxidation dominates quantitatively in vivo, 3,4 reflecting the relatively larger volume fraction of neurons compared with glial cells. Despite extensive study to ascertain the role of ketone bodies in neural function, basic unanswered questions persist about their involvement, and that of glucose, in the energy requirements associated with neurotransmission.Previous studies from our laboratory using 13 C magnetic resonance spectroscopy (MRS) with [1-13 C]glucose reported a linear relationship between neuronal oxidation of glucose in the tricarboxylic acid (TCA) cycle and glutamate (Glu)-glutamine (Gln) cycling flux over a large range of brain activity, 5-7...