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Ketogenic diet and ketone ester supplementation as an acute therapeutic for spinal cord injury Kolehmainen, Kathleen Liisa

Abstract

Spinal cord injury (SCI) is a debilitating condition with no curative treatment. In recent years metabolism has been suggested as a factor that could be altered to enhance recovery after SCI, and research from the Tetzlaff lab showed that a ketogenic diet (KD) can improve recovery after a cervical SCI in rodents. KDs are high fat, low carbohydrate diets that have been successfully used as a treatment for drug-resistant epilepsy in children. KDs produce high levels of the ketone body, beta-hydroxybutyrate (BHB), which can act as an energy source or bind and activate the cell surface receptor, hydroxycarboxylic acid receptor 2 (HCAR2). BHB levels can also be increased by oral ketone ester (KE) supplementation making KE a potential alternative to KD. In Chapter 2, the use of KD on recovery after a cervical forceps crush SCI in mice was assessed. In this injury model KD did not improve recovery of the mice. In Chapter 3, the effect of KD following a more clinically relevant T9 midline contusive SCI was investigated. We observed that KD could reduce pro-inflammatory cytokines CCL3 and CCL4 at 7 days post-injury and a scRNA-sequencing analysis of CD45+ cells at the injury site at 7 days after injury confirmed KD-mediated downregulation of many immune pathways. We also used the T9 contusion injury model with wild type and HCAR2₋/₋ mice to investigate the role of HCAR2 activation on KD-mediated effects. We found that KD could reduce the influx of CD45+CD11b+ myeloid cells into the injury site at 7 days post-injury, which required the HCAR2 receptor. Chapter 4 investigated the use of KE supplementation as a treatment following a C5 hemi-contusive injury in rats. Proteomic analysis at 2 weeks after injury showed that KE and KD appear to impact different cellular pathways. In this model, KE showed only minor improvements in behavioural recovery. Together these results suggest that KD can reduce inflammation at 7 days after injury in mice and that different paradigms of KE supplementation may be needed to see behavioral improvement following SCI in rats.

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