Sprengell Marie, Kubera Britta, Peters Achim
Center of Brain, Behavior and Metabolism (CBBM), Medical Clinic 1, University of Lübeck, Lübeck, Germany.
Front Neurosci. 2021 Nov 4;15:740502. doi: 10.3389/fnins.2021.740502. eCollection 2021.
Cerebral energy supply is determined by the energy content of the blood. Accordingly, the brain is undersupplied during hypoglycaemia. Whether or not there is an additional cerebral energy demand that depends upon the energy content of the brain is considered differently in two opposing theoretical approaches. The Selfish-Brain theory postulates that the brain actively demands energy from the body when needed, while long-held theories, the gluco-lipostatic theory and its variants, deny such active brain involvement and view the brain as purely passively supplied. Here we put the competing theories to the test. We conducted a systematic review of a condition in which the rival theories make opposite predictions, i.e., experimental T1DM. The Selfish-Brain theory predicts that induction of experimental type 1 diabetes causes minor mass (energy) changes in the brain as opposed to major glucose changes in the blood. This prediction becomes our hypothesis to be tested here. A total of 608 works were screened by title and abstract, and 64 were analysed in full text. According to strict selection criteria defined in our PROSPERO preannouncement and complying with PRISMA guidelines, 18 studies met all inclusion criteria. Thirteen studies provided sufficient data to test our hypothesis. The 13 evaluable studies (15 experiments) showed that the diabetic groups had blood glucose concentrations that differed from controls by +294 ± 96% (mean ± standard deviation) and brain mass (energy) that differed from controls by -4 ± 13%, such that blood changes were an order of magnitude greater than brain changes ( = 11.5, df = 14, < 0.001). This finding confirms not only our hypothesis but also the prediction of the Selfish-Brain theory, while the predictions of the gluco-lipostatic theory and its variants were violated. The current paper completes a three-part series of systematic reviews, the two previous papers deal with a distal and a proximal bottleneck in the cerebral brain supply, i.e., caloric restriction and cerebral artery occlusion. All three papers demonstrate that accurate predictions are only possible if one regards the brain as an organ that regulates its energy concentrations independently and occupies a primary position in a hierarchically organised energy metabolism. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156816, PROSPERO, identifier: CRD42020156816.
脑能量供应取决于血液中的能量含量。因此,低血糖期间大脑会出现供应不足。关于是否存在额外的脑能量需求(该需求取决于大脑的能量含量),两种相反的理论方法有不同的看法。“自私脑”理论假定,大脑在需要时会主动从身体获取能量,而长期以来的理论,即糖脂稳态理论及其变体,则否认大脑有这种主动参与,认为大脑完全是被动接受供应的。在此,我们对相互竞争的理论进行检验。我们对一种情况进行了系统综述,在这种情况下,相互竞争的理论会做出相反的预测,即实验性1型糖尿病。“自私脑”理论预测,诱导实验性1型糖尿病会导致大脑质量(能量)变化较小,而血液中的葡萄糖变化较大。这一预测成为我们在此要检验的假设。通过标题和摘要共筛选出608篇文献,对其中64篇进行了全文分析。根据我们在PROSPERO预公告中定义并符合PRISMA指南的严格选择标准,18项研究符合所有纳入标准。13项研究提供了足够的数据来检验我们的假设。这13项可评估的研究(15个实验)表明,糖尿病组的血糖浓度与对照组相比相差+294±96%(平均值±标准差),大脑质量(能量)与对照组相比相差-4±13%,因此血液变化比大脑变化大一个数量级(F = 11.5,自由度 = 14,P < 0.001)。这一发现不仅证实了我们这一假设,也证实了“自私脑”理论的预测,同时违背了糖脂稳态理论及其变体的预测。本文完成了一个由三篇组成的系统综述系列,前两篇论文分别探讨了脑能量供应中的一个远端瓶颈和一个近端瓶颈,即热量限制和脑动脉闭塞。这三篇论文均表明,只有将大脑视为一个能独立调节其能量浓度并在分级组织的能量代谢中占据首要位置的器官,才有可能做出准确的预测。https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156816,PROSPERO,标识符:CRD42020156816。
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