One of the nagging unresolved questions regarding ketone bodies is whether they correlate with seizure control. Recent studies have suggested that under certain conditions and in specific models, blood levels of ketones do not in fact correlate well with anticonvulsant effects (Hartman & Vining, 2007). However, ketone levels are known to vary considerably during the circadian cycle, mostly as a consequence of feeding schedules and subsequent metabolism of foodstuffs (DeGasquet et al., 1977). Despite numerous studies highlighting ketonemia following KD treatment, we still do not know what the true brain concentrations are, especially in the microenvironment of the highly metabolically active synapse. Moreover, there are other studies suggesting that high ketone body levels are not necessary for clinical efficacy of a high-fat diet against medically refractory epilepsies (Pfeifer & Thiele, 2005).
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Over the past decade, much progress has been made in understanding the mechanisms of ketogenic diet (KD) action. From the complex systemic and metabolic changes induced by the KD have emerged innovative hypotheses attempting to link biochemical adaptations to its clinical effects. Despite such developments, the fundamental question of how the KD works remains as elusive as ever. At present, it is unclear which of many potential mechanisms proposed thus far are directly relevant to the clinical effects of the KD. It is unlikely that these numerous hypotheses can be unified into a single mechanism (or a final common pathway). Nevertheless, it may be instructive to consider each of these putative mechanisms in turn and ask the following question: If the mechanism or target in question is a critical determinant of the anticonvulsant efficacy of the KD, then would a similar intervention known to be based on that mechanism yield a comparable effect? Perhaps answering this question for each mechanistic speculation might help substantiate (or invalidate) that particular hypothesis. Can the KD be packaged into a pill? At present, the answer is likely “no.” We have yet to discover a “magic bullet” that completely mirrors the anticonvulsant (and potential neuroprotective) effects of the KD. However, without a clearer understanding of the mechanistic elements comprising the complex metabolic puzzle posed by the KD, we would be left only with empiric observations, and to wonder curiously how a high-fat diet can exert such profound clinical effects.
Polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA, C22: 6ω-3), arachidonic acid (AA, C20: 4ω-3), or eicosapentaenoic acid (EPA, C20: 5ω-3) have been reported to suppress voltage-gated sodium channels and L-type calcium channels in seizure-prone structures such as the hippocampus (Vreugdenhil et al., 1996). The KD produces elevations of both AA and DHA in serum (Fraser et al., 2003; Cunnane et al., 2002) and brain (Taha et al., 2005) of patients and animals, respectively, suggesting that these substrates might exert anticonvulsant effects by inhibiting sodium and calcium channels, like many anticonvulsant drugs (Xiao et al., 1997, 1998).
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Historically, many anticonvulsant medications have resulted from structural modifications of lead compounds that had themselves been discovered serendipitously. The mechanistic bases for their effectiveness have typically been elucidated post-hoc. At present, it is unclear which of many potential mechanisms reviewed in this supplement are relevant to the clinical effects of the KD. It would be far too difficult to integrate these numerous possibilities into a single unifying hypothesis (or a final common pathway), or to consider them simultaneously. Nevertheless, it might be instructive to consider each of these putative mechanisms one by one and ask a simple comparative question. If the mechanism or target in question is a critical determinant of the anticonvulsant efficacy of the KD, then would a similar intervention known to be based on that mechanism yield a comparable effect? Perhaps answering this question for each mechanistic speculation might help substantiate (or perhaps invalidate) that particular hypothesis.
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Furthermore, if the KD increases GABA levels in the brain, then such an effect is approximated by vigabatrin, an irreversible inhibitor of the degradative enzyme GABA-transaminase, as well as by tiagabine, a GABA re-uptake blocker that interferes with presnaptic GABA transporters (White et al., 2007). Yet, the anticonvulsant profile of the KD is distinct from that of vigabatrin and tiagabine (Hartman et al., 2007). The general approach of deriving another pill that enhances brain GABA levels may not be relevant or viable, since many seizure types seem to be exacerbated by agents that contribute to enhanced tonic inhibition, and extrasynaptic GABA receptors that mediate tonic inhibition are more sensitive to elevated ambient GABA concentrations (Sazgar & Bourgeois, 2005). Indeed, increased GABAergic inhibition in the cortex appears to underlie the mechanism of synchronization and seizure generation in two mouse models of autosomal dominant nocturnal frontal lobe epilepsy (Klassen et al, 2006)
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Resep Tumis Bunga Pepaya Kangkung Khas Manado ini kesukaan saya dan suami. Di awal-awal mencoba menbuat sendiri, saya tidak tahu caranya agar bunga pepaya tidak pahit. Saya pikir sama caranya dengan mengolah pare, agar tidak pahit diremas-remas dengan garam terlebih dahulu. Meskipun pahitnya berkurang, tapi bentuk bunga pepaya jadi tidak bagus. Ternyata ada cara yang …
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Berapa banyak keton harus dalam urin untuk ketosis
One highly studied mechanism implicated in the clinical benefits of calorie restriction involves sirtuins, a large and diverse family of enzymes that regulate gene expression. The first sirtuin, silent information regulator 2 (Sir2), was described in yeast. Sir2 is a class III histone deacetylase that uses the cofactor nicotinamide adenine dinucleotide (NAD+) in a catalytic reaction that releases nicotinamide (a feedback inhibitor) and O-acetyl ADP ribose (Imai et al. 2000; Marmorstein 2004; Sauve et al. 2006). It has been reported that increased Sir2 activity lengthens life span, and that calorie restriction increases Sir2 levels and does not promote longevity in SIR2 knockouts (Kaeberlein et al. 1999; Lin et al. 2000, 2004; Tissenbaum and Guarente 2001; Rogina and Helfand 2004). In mammals, calorie restriction increases the expression of Sirt1, the Sir2 mammalian ortholog, in various tissues, including brain. Resveratrol, a natural Sirt1 activator found in red wine, lengthens the life span of mice and prevents the age-related deterioration of their motor function (Cohen et al. 2004; Baur et al. 2006). Additionally, resveratrol stimulates AMP kinase activity in neurons (Dasgupta & Milbrandt, 2007), and more importantly, protects against kainic acid-induced seizures and oxidative stress in rats (Gupta et al., 2002).