1. Biochemistry of the Nervous System Transport through BBB Metabolism of Neurotransmitters Metabolism of CNS Biochemical Aspects of CNS diseases CSF chemical analysis

2. Biochemistry of the Nervous System
Transport of substances through the blood-brain barrier (BBB)
Metabolism of neurotransmitters
Synthesis (precursors – role of vitamins)
Release
Effect
Termination
Metabolism of CNS :
Energy Metabolism of CNS
Lipid Metabolism in CNS
Myelin sheath
Biochemical aspects of CNS diseases
Hypoglycemia
Cerebral ischemia
CSF chemical analysis

3. Transport through Blood-Brain Barrier (BBB)
Large number of compounds are transported through endothelial capillaries by facilitated diffusion
1- Fuels
Glucose:
The principal fuel of the brain
Transported through endothelial membranes by facilitated diffusion via GLUT-1
At blood glucose of 60 m/dl, glucose is reduced to below Km of GLUT-1 leading to
appearance of symptoms of hypoglycemia
2- Others: as ketone bodies by another transport system
When blood levels of KB are elevated (during starvation)
KBs are important fuels for brain during prolonged starvation
Non-essential fatty acids (of diet or lipolysis) do not cross BBB
Essential fatty acids (linoleic & linolenic) can pass BBB

4. Transport through Blood-Brain Barrier (BBB)
2- Amino acids
Amino acids are transported by amino acid transporters
Amino acids are used in brain for synthesis of:
- Proteins of CNS
- Neurotransmitters (requires certain vitamins as B12, B6 & B1 …)
Types of transported amino acids:
1- Long neutral amino acids (by single amino acid transporters)
Essential: Phenylalanine , Leucine, Isoleucine, Valine, Tryptophan, Methionine
Non-essential: Tyrosine
Semi-essential: Histidine
2- Small neutral amino acids (entry is markedly restricted as their influx markedly
change content of neurotransmitters)
Nonessential: Alanine, Glycine, Proline
3- Vitamins: transported by special transporters

5. Metabolism of Neurotransmitters
Are chemicals released at synapses for transmission of nerve impulses
Generally, each neuron synthesizes only those neurotransmitters that it uses for transmission through synapses So, the neuronal tracts are often identified by their neurotransmitters
Structurally divided into two categories:
- Small nitrogen-containing neurotransmitters
- Neuropeptides: Targeted in CNS as endorphins OR Released to circulation as GH & TSH
Major small nitrogen containing neurotransmitters:
Glutamate
GABA
Glycine
Acetylcholine
Dopamine
Norepinephrine
Serotonin
Histamine
In addition to: epinephrine, aspartate, nitric oxide

6. Metabolism of Neurotransmitters
General features of neurotransmitters synthesis, release & termination
1- Most are synthesized in presynaptic terminal from : Amino acids
Intermediates of glycolysis
Intermediates of TCA
2- Once synthesized, they are stored in vesicles (by active uptake)
3- Released in response to nerve impulse:
1- Nerve impulse causes Ca2+ influx (through Ca2+ channels) to presynaptic terminal
2- Exocytosis of neurotransmitters into synaptic cleft
3- Neurotransmitter binds to receptors on postsynaptic membrane-----EFFECT
4- Termination: by: Reuptake of the neurotransmitter into presynaptic terminal (or by glial cells)
Or/ Enzymatic inactivation (in presynaptic terminal, postsynaptic terminal or in astrocyte)

7. Metabolism of Neurotransmitters

8. Neurotransmitters: Catecholamines & Serotonin
Phenylalanine Tyrosine
Tyrosine Hydroxylase
Cu-dependent
BH4
DOPA Melanin
DOPA Decarboxylase melanocytes
PLP
Dopamine
Dopamine Hydroxylase
Cu Monoamine Oxidases
Vit . C
MAO-A
Norepinephrine VMA
in Adrenal
Medulla Methyl transferase
(& few neurons) using SAM
Vit. B Epinephrine
Folate
Tryptophan
Hydroxylase
BH4
MAO-A
5 HIAA Serotonin
Melatonin
In URINE

9. Neurotransmitter: Histamine
Histamine is an excitatory neurotransmitter in CNS
Synthesized in CNS from the amino acid histidine by histidine decarboxylase (requires PLP)
Antihistaminic drugs (for treatment of allergy) cause drowsiness BUT new generations of antihistaminics do not pass BBB & so do not cause CNS effects

10. Neurotransmitter: Acetylcholine
Synthesis in CNS (in presynapses)
Choline Acetyltransferase enzyme
Acetyl CoA + Choline Acetyl Choline
Choline:
1- From diet
2- From phosphatidylcholine (PC) in membrane lipids
PC is synthesized from PE utilizing methyl groups of S-adenosyl methionine (SAM)
Requires vitamins B12 & B6
Acetyl group
From glucose oxidation (requires oxygen) is the major source (little FA oxidation in CNS)
Thiamine (vit. B1)
Glucose Pyruvate Acetyl CoA ATP
Pyruvate Decarboxylase
N.B. In thiamine deficiency & hypoxia: no ATP & no acetylcholine neurotransmitter

11. Neurotransmitter: Glutamate & GABA
Glutamate is the main excitatory neurotransmitter in the CNS
Neurons that respond to glutamate are referred to as glutaminergic neurons
Sources of glutamate in nerve terminals:
1- Synthesized from glucose through glucose metabolism in neurons (main source)
Glucose --- a Ketoglutarate (a KG) glutamate (Requires PLP)
2- From glutamine (of glial cells) by glutaminase
2- From blood (few as no cross BBB)
Mechanism of action of glutamate as a neurotransmitter:
1- Synthesis from glucose metabolism & concentration in vesicles (in presynapses)
2- Release by exocytosis to synaptic cleft
3- Uptake by postsynaptic
4- Binding to glutaminergic receptors in postsynapses
5- Functional effect
6- Termination: glutamate reuptake by astrocytes (glial cells) .. REQUIRES ATP (ENERGY)
In astrocytes, glutamate is converted to glutamine (REQUIRES ATP)
Glutamine is released from astrocytes & is taken up by neurons
In neurons, glutamine is converted to glutamate by glutaminase

12. Neurotransmitter: Glutamate & GABA
GABA Is an inhibitory neurotransmitters in CNS
In presynaptic neurons, GABA is synthesized from glutamate by glutamate decarboxylase (GAD) by a reaction that requires PLP
Then, GABA is released to synaptic cleft. It is recognized by receptors on postsynaptic neurons.
Termination: GABA in synaptic cleft is uptaken by glial cells (as astrocytes) & converted to glutamate
Glutamate is converted to glutamine by glutamine synthetase (requires ATP)
Fate of glutamine of astrocytes:
1- A fraction of glutamine is released from astrocytes & is taken up by neurons.
In neurons, glutamine is deaminated to glutamate by glutaminase
2- Another fraction of glutamine is released to blood------to kidney --- ammonia
Tiagabine is used as an antiepileptic (anticonvulsant) as it inhibits the reuptake of GABA `

14. (hepatic encephalopathy)
Neurotransmitter: Glutamate & GABA
Glutamate metabolism in hyperammonemia:
During hyperammonemia, ammonia can diffuse into the brain from the blood to neurons.
The ammonia is able to inhibit the glutaminase in neurons, thereby decreasing formation of glutamate in presynaptic neurons (not regenerated)
This effect of ammonia might contribute to the lethargy associated with the hyperammonemia found in patients with hepatic disease.
(hepatic encephalopathy)

15. Neurotransmitter: Glutamate & GABA
Relation between glutamate synthesis & citric acid cycle:
In neurons, synthesis of glutamate removes a ketoglutarate from the citric acid cycle ending in a decrease in regeneration of oxalacetate
Regeneration of oxalacetate is necessary for oxidation of acetyl CoA & this is performed by two major anaplerotic pathways:
1- Degradation of isoleucine & valine amino acids to butyric succinyl CoA,
which yields oxalacetate.
This reaction requires vitamin B12 (coenzyme for methylmalonyl CoA mutase)
2- Pyruvate carboxylation to oxalacetate (by pyruvate carboxylase, requires
the vitamin biotin as a coenzyme).

16. Metabolism of CNS Glucose & Energy Metabolism
Energy source of the brain
The mass of the brain is only 2% of the total body mass, yet its energy requirement is more than seven times than that of the other organs
Thus for brain metabolism, there is a high requirement for glucose and oxygen at steady rate.
The main source of energy is the generation of ATP by the aerobic metabolism of glucose
Aerobic Glycolysis
In Cytosol Mitochondria & Oxygen
Glucose ---- Pyruvate Acetyl CoA ---- With oxalacetate in CAC ATP

17. Glucose Metabolism & Neurotransmitter Synthesis
Metabolism of CNS Glucose & Energy Metabolism
Glucose metabolism & neurotransmitters
(in CNS)
There is a relationship between the oxidation of
glucose in glycolysis and the supply of precursors
for the synthesis of neurotransmitters in neurons
within CNS.
Accordingly, deficiencies of either glucose or oxygen
(hypoglycemia or hypoxia) affect brain
function because they influence:
1- ATP production for CNS neurons
2- Supply of precursors for neurotransmitter
synthesis.
Glucose Metabolism & Neurotransmitter Synthesis

18. Metabolism of CNS Brain Lipids Synthesis & Oxidation
Sources of lipids to CNS:
BBB significantly inhibits entry of certain fatty acids & lipids into CNS. So, all lipids found in CNS must be synthesized within CNS
(e.g. non-essential fatty acids, cholesterol, sphingolipids, glycosphingolipids &
cerebrosides)
All these are needed for neurological functions & synthesis of myelin by glial cells (non-
neuronal cells)
EXCEPTION is:
Essential fatty acids (linoleic & linolenic FAs) can enter the brain
Within CNS, these two FAs are elongated & desaturated to yield the very-long chain
fatty acids required for synthesis of myelin sheath.
Fatty acid oxidation as a source of energy:
Intake of fatty acids (coming from diet and/or lipolysis of TG ) to CNS is insufficient to meet the energy demands of CNS (by FA oxidation) & hence the requirement for aerobic glucose metabolism
Recall that ketone bodies are sources of energy to brain during prolonged starvation as they can pass BBB easily….

19. Metabolism of CNS Brain Lipids Synthesis & Oxidation
Peroxisomal fatty acid oxidation is important in the brain as the brain contains very-long-chain fatty acids & branched-chain fatty acids as phytanic acid (of diet)
Both are oxidized by a oxidation in the peroxisomes
Refsumes disease: a disorder that affects the peroxisomes –
severely affects the brain due to inability to metabolize both
very long chain & branched chain fatty acids

20. Myelin Synthesis Multiple sclerosis (MS)
Rapid rate of nerve conduction in PNS & CNS depends on the formation of myelin.
Myelin is a multilayered lipid (sphingolipids) & protein structure that is formed by the plasma membrane of glial cells to wrap around the axon.
In PNS, myelin is synthesized by Schwan cells
In CNS, myelin is synthesized by oligodendrocytes
Multiple sclerosis (MS)
Progressive demyelination of CNS neurons
May be due to an event that triggers the formation of autoimmune antibodies directed against components of the nervous system (as viral or bacterial infection)
Loss of myelin (insulator) in the white matter of the brain that interferes with nerve conduction along demyelinated area
CNS compensates by stimulating the oligodendrocytes to remyelinate the damaged axon(& hence remission is activated)
Remyelination is accompanied by slowing in conduction (speed is proportional to myelin thickness)

21. Clinical Manifestation Hypoglycemic Encephalopathy
Clinical manifestations of hypoglycemia:
Early clinical signs in hypoglycemia initiated by hypothalamic sensory nuclei as sweating, palpitations, anxiety and hunger.
In late stages, these symptoms give way to serious manifestations of CNS disorders as confusion, lethargy, seizures & coma

22. SO, GLUTAMATE METABOLIDSM HAS TO BE UNDERSTOOD
Biochemistry of Hypoglycemic Encephalopathy
As blood glucose falls below 45 mg/dL
the brain attempts to use internal substrates such as glutamate and TCA cycle intermediates
as fuels for ATP production.
Because the pool size of these substrates is quite small, they are quickly depleted.
As the blood glucose drops from 45 to 36 mg/dL
NO EEG changes are observed
Symptoms appear to arise from decreased synthesis of neurotransmitters in particular
regions of the brain (hippocampal & cortical structures)
If blood glucose levels continue to fall below 18 mg/dL
EEG becomes isoelectric
Neuronal cell death ensues that may be caused by glutamate excitotoxicity ?? (as result of
ATP depletion)
SO, GLUTAMATE METABOLIDSM HAS TO BE UNDERSTOOD

23. Glutamate as a neurotransmitter
Role of glutamate as a transmitter in CNS:
Within the CNS, glutaminergic neurons are responsible for the mediation of many vital processes such as the encoding of information, the formation and retrieval of memories, spatial recognition and the maintenance of consciousness.
Postsynaptic glutaminergic neurons perform their roles through:
1- Ionotropic receptors that bind glutamate released from presynaptic neurons
referred to as kainate, 2-amino-3-hydroxy-5-methyl-4-isoxalone propionic
acid (AMPA) and N-methyl-D-aspartate (NMDA) receptors.
2- Metabotropic glutamate receptors that are members of the G-protein coupled
receptor (GPCR) family.

24. Ionotropic Glutamate Receptors
Non- NMDA
NMDA
NMDA receptors allows the passage of both Na+ and Ca++ ions. (More permeable to Ca++ )
AMPA
KAINATE
AMPA and Kainate receptors generally allow the passage of Na+ and K+

25. Glutamate Excitotoxicity
Exciotoxicity is the pathological process by which nerve cells are damaged and killed by glutamate (and similar substances).
This occurs when receptors for glutamate such as the NMDA & AMPA receptor are over activated (overstimulated).
Excessive excitation of glutamate receptors has been associated with
hypoglycemia & stroke
(cases in which there is lack of glucose and/or oxygen ending in lack of energy production in CNS)

26. Glutamate Excitotoxicity
occurs when the cellular energy reserves are depleted (as in hypoglycemia or stroke, etc ) Failure of the energy-dependent reuptake pumps of glutamate Accumulation of glutamate in the synaptic cleft Overstimulation of the postsynaptic glutamate receptors Prolonged glutamate receptor activation leads to prolonged opening of the receptor ion channel and the influx of lethal amounts of Ca2 ions, which can activate cytotoxic intracellular pathways in the postsynaptic neurons

27. Biochemistry of Cerebral Ischemia
It is the potentially reversible altered state of brain physiology and biochemistry that occurs when substrate delivery is cut off or substantially reduced by vascular stenosis or occlusion
Stroke
is defined as “an acute neurologic dysfunction of vascular origin with sudden (within seconds) or at least rapid (within hours) occurence of symptoms and signs corresponding to the involvement of focal areas in the brain”
(Goldstein et al, 1989)

28. Pathophysiology of Cerebral Ischemia
↓↓ ATP
Induction
Amplification
Expression

29. Lack of oxygen supply to ischemic neurones
The cell switches to anaerobic metabolism, producing lactic acid.
ATP depletion
malfunctioning of membrane ion system
Induction
Phase
Depolarisation of neurones
Influx of calcium
Release of neurotransmitters as glutamate
(causing glutamate excitotoxicity)
Lactic acidosis :While it is clearly not the sole or even the major source of injury in ischemia, lactic acidosis does apparently contribute to the pathophysiology of ischemia It has been shown, for instance, that lactate levels above a threshold of micromol/g result in currently irreversible neuronal injury Decrease in pH as a consequence of lactic acidosis has been shown to injure and inactivate mitochondria. Lactic acid degradation of NADH (which is needed for ATP synthesis) may also interfere with adequate recovery of ATP levels post ischemically [69]. Lactic acid can also increase iron decompartmentalization, thus increasing the amount of free-radical mediated injury
So  Lactic acid in neurons  acidosis  promotes the pro-oxidant effect  ↑ the rate of conversion of O2- to H2O2 or to hydroxyperoxyl radical
Amplification
Phase
Accumulation of more intracellular levels of Ca2+ which causes additional release of glutamate (viscious cycle)

30. The cell's membrane is broken down by phospholipases
Expression Phase
Ca2+
1-overexcites cells and causes the generation of harmful chemicals like
free radicals ( causing oxidative stress)
2- Activation of calcium-dependent enzymes such as:
calpain ( causing apoptosis)
phospholipases (causing membrane breakdown)
3- Calcium can also cause the release of more glutamate (glutamate excitotoxicity)
The cell's membrane is broken down by phospholipases
Cell membrane becomes more permeable, and more ions and harmful chemicals flow into the cell. +
Mitochondria membrane break down, releasing toxins and apoptotic factors into the cell

31. lactic acid is produced in excess in ischemia
In cerebral ischemia, lack of oxygen switches metabolism of glucose to the anaerobic pathway & lactic acid production Lactic acid contribute to the pathophysiology of ischemia as: 1- It decreases pH that may injure and inactivate mitochondria. 2- Lactic acid degradation of NADH (which is needed for ATP synthesis) may also interfere with adequate post-ischemic recovery of ATP levels. 3- Lactic acid increase the amount of free-radical mediated injury.  Lactic acid in neurons  acidosis  promotes the pro-oxidant effect  ↑ the rate of conversion of O2- to H2O2 or to hydroxyperoxyl radical

32. Oxidative stress is caused by ischemia
What is meant by ROS?
Reactive oxygen species (ROS) are formed from partial reduction of molecular O2 i.e. adding electrons to oxygen leading to the formation of superoxide, hydrogen peroxide & hydroxyl radical.
Generally, ROS cause damage to DNA, protein and unsaturated lipids of the cells.
What is meant by oxidative stress
A condition in which cells are subjected to excessive levels of ROS (free radicals) & they are unable to counterbalance their deleterious effects with antioxidants

33. Oxidative stress is caused by ischemia
Cellular Effects of Reactive Oxygen Species (ROS) in CNS
Nitric oxide is over produced and turns to be a neurotoxic mediator as it reacts with superoxide anions to generate toxic peroxynitrite which leads to production of more potent neurotoxin such as hydroxyl radicals
Lipid peroxidation
Inactivation of enzymes
Nucleic acid (DNA & RNA) damage
Release of calcium ions from intracellular stores with more damage to neurons
Damage to cytoskeleton

34. Apoptosis & necrosis are caused by ischemia
is commonly observed early after severe ischemic insults
Apoptosis:
occurs with more mild insults and with longer survival periods
The mechanism of cell death involves calcium-induced calpain-mediated proteolysis of brain tissue
Substrates for calpain include:
Cytoskeletal proteins
Membrane proteins
Regulatory and signaling proteins

35. Apoptosis Broughton et al., 2009; Stroke
Mitochondria break down, releasing toxins and apoptotic factors into the cell.
The caspase-dependent apoptosis cascade is initiated, causing cells to "commit suicide."
Apoptosis can be initiated by internal events involving the disruption of mitochondria and activation of caspases.
Alternatively, specific ligands that bind to “death receptors” (ie, “Extrinsic Pathway”).
Broughton et al., 2009; Stroke 35

36. Broughton et al., 2009; Stroke
Caplains are cytosolic proteinases
Whose irreversible proteolytic activity
is against cytoskeleton
and regulatory proteins
Increased intracellular calcium activates calpains > cleavage of Bid to truncated Bid (tBid) > interacts with apoptotic proteins such as Bad and Bax > mitochondrial transition pores (MTP) are opened > releasing cytochrome c (Cytc) or apoptosis-inducing factor (AIF). Once released into the cytosol, Cytc binds with apoptotic protein-activating factor-1 (Apaf-1) and procaspase-9 to form an “apoptosome,” which activates caspase-9 and subsequently caspase-3. Activated caspase-3 cleaves nDNA repair enzymes, such as poly (ADP-ribose) polymerase (PARP), which leads to nDNA damage and apoptosis. By contrast, AIF translocates rapidly to the nucleus where it mediates large-scale DNA fragmentation and cell death in a caspase-independent manner. In addition, nuclear pathways of neuronal apoptosis are activated in response to DNA damage, for example, through phosphorylation and activation of p53. Furthermore, cerebral ischemia and reperfusion generate superoxide anions (O2-), which causes DNA damage.
Broughton et al., 2009; Stroke 36

37. Broughton et al., 2009; Stroke
The extracellular Fas ligand (FasL) binds to Fas death receptors (FasR), which triggers the recruitment of the Fas-associated death domain protein (FADD). FADD binds to procaspase-8 to create a death-inducing signaling complex (DISC), which activates caspase-8. Activated caspase-8 either mediates cleavage of Bid to truncated Bid (tBid), which integrates the different death pathways at the mitochondrial checkpoint of apoptosis, or directly activates caspase-3. At the mitochondrial membrane tBid interacts with Bax, which is usually neutralized by antiapoptotic B-cell leukemia/lymphoma 2 (Bcl-2) family proteins Bcl-2 or Bcl-xL. Dimerization of tBid and Bax leads to the opening of mitochondrial transition pores (MTP), thereby releasing cytochrome c (Cytc), which execute caspase 3-dependent cell death.
Broughton et al., 2009; Stroke 37