Amelioration of ischemic brain damage by peritoneal dialysis

J Clin Invest. 2013 Oct;123(10):4359-63. doi: 10.1172/JCI67284. Epub 2013 Sep 3.

Abstract

Ischemic stroke is a devastating condition, for which there is still no effective therapy. Acute ischemic stroke is associated with high concentrations of glutamate in the blood and interstitial brain fluid. The inability of the tissue to retain glutamate within the cells of the brain ultimately provokes neuronal death. Increased concentrations of interstitial glutamate exert further excitotoxic effects on healthy tissue surrounding the infarct zone. We developed a strategy based on peritoneal dialysis to reduce blood glutamate levels, thereby accelerating brain-to-blood glutamate clearance. In a rat model of stroke, this simple procedure reduced the transient increase in glutamate, consequently decreasing the size of the infarct area. Functional magnetic resonance imaging demonstrated that the rescued brain tissue remained functional. Moreover, in patients with kidney failure, peritoneal dialysis significantly decreased glutamate concentrations. Our results suggest that peritoneal dialysis may represent a simple and effective intervention for human stroke patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Cerebral Cortex / blood supply
  • Cerebral Cortex / pathology
  • Cerebral Cortex / physiopathology
  • Corpus Callosum / physiopathology
  • Electric Stimulation
  • Glutamic Acid / blood*
  • Humans
  • Infarction, Middle Cerebral Artery / blood
  • Infarction, Middle Cerebral Artery / pathology
  • Infarction, Middle Cerebral Artery / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Peritoneal Dialysis*
  • Rats
  • Rats, Sprague-Dawley
  • Recovery of Function
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / therapy
  • Stroke / blood
  • Stroke / pathology
  • Stroke / therapy*

Substances

  • Glutamic Acid