Abstract
The classic ketogenic diet (KD) can be used successfully to treat medically refractory epilepsy. However, the KD reduces seizures in 50–70% of patients with medically refractory epilepsy, and its antiseizure effect is limited. In the current study, we developed a new modified KD containing leucine (Leu)-enriched essential amino acids. Compared with a normal KD, the Leu-enriched essential amino acid-supplemented KD did not change the levels of ketosis and glucose but enhanced the inhibition of bicuculline-induced seizure-like bursting in extracellular recordings of acute hippocampal slices from rats. The enhancement of antiseizure effects induced by the addition of Leu-enriched essential amino acids to the KD was almost completely suppressed by a selective antagonist of adenosine A1 receptors or a selective dose of pannexin channel blocker. The addition of Leu-enriched essential amino acids to a normal diet did not induce any antiseizure effects. These findings indicate that the enhancement of the antiseizure effects of the KD is mediated by the pannexin channel-adenosine A1 receptor pathway. We also analyzed amino acid profiles in the plasma and hippocampus. A normal KD altered the levels of many amino acids in both the plasma and hippocampus. The addition of Leu-enriched essential amino acids to a KD further increased and decreased the levels of several amino acids, such as threonine, histidine, and serine, suggesting that altered metabolism and utilization of amino acids may play a role in its antiseizure effects. A KD supplemented with Leu-enriched essential amino acids may be a new therapeutic option for patients with epilepsy, including medically refractory epilepsy.
Highlights
The classic ketogenic diet (KD) is a high-fat low-carbohydrate diet therapy designed in the 1920s (Wilder, 1921)
All KD groups exhibited a deceleration of weight gain compared with control diet (CD) (Figures 1A,B), which is similar to previous findings (Ruskin et al, 2009)
The liver weights corrected for body weight of the normal KD, KD + CA, or KD + 2.5% AL group were not different from those of the CD group (Figure 1E), indicating that the reduction in liver weight might have been caused by the deceleration of weight gain
Summary
The classic ketogenic diet (KD) is a high-fat low-carbohydrate diet therapy designed in the 1920s (Wilder, 1921). The KD induces ketosis and alters metabolism in the brain. This alteration in brain metabolism induces antiseizure effects, and KD can be used successfully to treat patients with pediatric epilepsy. The KD has been identified as a useful therapy for antiepileptic drugresistant epilepsy (Hallbook et al, 2007). Despite almost 100 years of clinical use, the mechanisms underlying the antiseizure effects of the KD are not fully understood (Rho and Stafstrom, 2012; Danial et al, 2013; Simeone et al, 2018).
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