Review Lactate as a supplemental fuel for synaptic transmission and neuronal network oscillations: Potentials and limitations, 2023, Kann

Andy

Retired committee member
Abstract

Lactate shuttled from the blood circulation, astrocytes, oligodendrocytes or even activated microglia (resident macrophages) to neurons has been hypothesized to represent a major source of pyruvate compared to what is normally produced endogenously by neuronal glucose metabolism. However, the role of lactate oxidation in fueling neuronal signaling associated with complex cortex function, such as perception, motor activity, and memory formation, is widely unclear.

This issue has been experimentally addressed using electrophysiology in hippocampal slice preparations (ex vivo) that permit the induction of different neural network activation states by electrical stimulation, optogenetic tools or receptor ligand application. Collectively, these studies suggest that lactate in the absence of glucose (lactate only) impairs gamma (30–70 Hz) and theta-gamma oscillations, which feature high energy demand revealed by the cerebral metabolic rate of oxygen (CMRO2, set to 100%). The impairment comprises oscillation attenuation or moderate neural bursts (excitation–inhibition imbalance). The bursting is suppressed by elevating the glucose fraction in energy substrate supply.

By contrast, lactate can retain certain electric stimulus-induced neural population responses and intermittent sharp wave-ripple activity that features lower energy expenditure (CMRO2 of about 65%). Lactate utilization increases the oxygen consumption by about 9% during sharp wave-ripples reflecting enhanced adenosine-5′-triphosphate (ATP) synthesis by oxidative phosphorylation in mitochondria. Moreover, lactate attenuates neurotransmission in glutamatergic pyramidal cells and fast-spiking, γ-aminobutyric acid (GABA)ergic interneurons by reducing neurotransmitter release from presynaptic terminals.

By contrast, the generation and propagation of action potentials in the axon is regular. In conclusion, lactate is less effective than glucose and potentially detrimental during neural network rhythms featuring high energetic costs, likely through the lack of some obligatory ATP synthesis by aerobic glycolysis at excitatory and inhibitory synapses. High lactate/glucose ratios might contribute to central fatigue, cognitive impairment, and epileptic seizures partially seen, for instance, during exhaustive physical exercise, hypoglycemia and neuroinflammation.

Open access, https://onlinelibrary.wiley.com/doi/10.1111/jnc.15867
 
Reformatting for ease of reading —

The impairments of gamma and theta-gamma oscillations induced by lactate might result from diverse effects such as
(1) attenuation of intrinsic neuronal excitability,
(2) reduced neurotransmitter release, and
(3) altered activation of postsynaptic glutamatergic and GABAergic receptors.

These effects might be mediated by
(4) local shortage of ATP by drop out of glycolysis and limitations in transport, conversion and oxidation of lactate,
(5) increased production of NO by the Ca2+ -sensitive neuronal NO synthase partially inhibiting mitochondrial respiration,
(6) intracellular acidification by ATP hydrolysis and the H+ -coupled neuronal MCT2,
(7) shift in the cytosolic NAD+ /NADH ratio,
(8) activation of the HCAR1 by lactate, and/ or
(9) activation of purinergic (P2X) and adenosine (A1) receptors by extracellular ATP and adenosine.

The lactate-induced disturbances of gamma oscillations are likely caused by transient ATP shortages in presynaptic terminals, particularly in those lacking mitochondria. During neuronal stimulation, presynaptic terminals of central neurons increase glucose uptake through glucose transporters (GLUT3, GLUT4) and upregulate glycolysis by formation of glycolytic enzyme clusters. This rapid way of glycolytic ATP synthesis is necessary for regular presynaptic action potential waveform and Ca 2+ influx as well as for maintenance of the vesicle cycle, including vesicle transport. Endocytosis and the vacuolar H + ATPase that energizes transmitter filling into vesicles are major consumers of glycolytic ATP.

Lactate can provide adequate fuel for network activity states under low energy demand. During network activity states with high energetic costs, however, lactate can only serve as a supplemental fuel, in addition to glucose. The outcomes of high lactate/glucose ratios on disturbances of synaptic transmission, network oscillations, cognition and behavior appear to depend on the pathophysiological context. Whereas concomitant activation of HCAR1, purinergic and adenosine receptors may contribute to balanced attenuation of synaptic transmission, concomitant hypoxia and high NO levels may contribute to excitation–inhibition imbalance and hence promote the initiation of epileptic seizures, especially during high network activity states.

Detailed knowledge about the energetic properties of dendrites, axons and presynaptic terminals, particularly in the different types of excitatory and inhibitory cortical neurons, however, is widely lacking. This exciting fundamental topic requires comprehensive morphological, biochemical, electrophysiological and imaging studies in different cortical networks in the future.

Sounds like a potentially fruitful area of investigation for those trying to understand the mechanisms behind Functional Neurological Disorder...
 
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