Kinetic Analysis of the Human Blood-Brain Barrier Transport of Lactate and its Influence by Hypercapnia

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Abstract
Blood–brain barrier permeability to L-lactate was studied in 18 patients with the double indicator technique. Venous outflow curves were obtained during normo- and hypercapnia and were analyzed by means of a model that takes tracer backflux and capillary heterogeneity of transit times into account. The average unidirectional extraction of L-lactate was 15%; the transport from the blood to the brain (PS1) was 0.081 ml g−1 min−1 and the transport from the brain to the blood (PS2) was on the same order of magnitude. In hypercapnia, arterial pH decreased from 7.39 to 7.26 and PS1 to L-lactate increased significantly by 110%. PS2 also increased although a statistically significant difference compared to the resting state was not reached. It is concluded that L-lactate is easily taken up by the human brain, and that the mechanism by which it crosses the blood–brain barrier is equilibrative. Furthermore, the brain permeability to lactate is enhanced by hypercapnia and the mechanism is believed to act through the decrease in pH.