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				BLOOD-BRAIN BARRIER 
										
										Electron microscope studies have shown 
										that capillaries in the brain have a 
										continuous capillary endothelium with 
										tight junctions and are therefore unlike 
										the more permeable capillaries found 
										elsewhere in the body. This effectively 
										excludes the passage of many materials 
										including proteins and molecules with 
										molecular weights as low as 2000. The 
										existence of the barrier was first 
										demonstrated by Paul Ehrlich and later 
										by Goldman, who in 1909 injected large 
										amounts of the dye trypan blue into the 
										vascular circulation and observed that 
										all tissues became intensely stained 
										while the brain remained "snow white." 
										We now know that trypan blue was 
										excluded from the brain because it 
										rapidly complexed with albumen in the 
				plasma and could not cross cerebral capillaries in this form. 
				Many materials do, however, cross the barrier from plasma to 
				brain. Nevertheless, it's a "selective" barrier where some 
				materials are excluded or cross with difficulty and others pass 
				quite freely. Because of the heavy dependence of the brain on a 
				steady supply of oxygen for cellular respiration and glucose for 
				energy metabolism, it is not surprising to find that they pass 
				freely into the brain with little hindrance. Similarly, 
				metabolic wastes and carbon dioxide readily pass across the 
				barrier from brain to plasma. On the other hand, free fatty 
				acids, an easily accessible alternate energy source for most 
				other cells of the body including muscle, are virtually excluded 
				from the brain. A summary of the permeability of the blood-brain 
				barrier to several different metabolic substances is illustrated 
				in Fig. -1 
					
						|  | Diffusion Across the Barrier 
 
						
						O2, CO2, N2O, Kr, and 
						Xe are gases which readily diffuse across the barrier. 
						The latter three have been used to calculate cerebral 
						blood flow. Water also readily diffuses into and out of 
						the brain. Its net movement is dictated solely by the 
						osmolality of the plasma. Thus an increase in the plasma 
						osmolality from its normal value of 290 mosmol/L can 
						draw water from the brain by osmosis, and actually 
						shrink its volume. This phenomenon has been employed 
						clinically to reduce intracranial pressure by using 
						plasma expanders such as mannitol to increase plasma 
						osmolality. Mannitol does not cross the blood-brain 
						barrier. 
						
						Lipid solubility is an important factor in diffusion 
						across the barrier. Generally the higher the lipid 
						solubility of a substance, the more readily it diffuses. 
						Thus alcohols like ethanol move freely into the brain. 
						Lipid-soluble thiobarbital equilibrates more rapidly 
						between plasma and brain than the slightly less soluble 
						barbital does. Salicylic acid is less soluble yet and 
						thus requires even more time to equilibrate. 
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						|  | Facilitated Transport across the Barrier 
						
						Carrier systems 
						appear to be involved in the transport of several 
						materials across the barrier. Glucose, ions, and certain 
						amino acids utilize this type of system. The carrier 
						system for glucose is stereospecific as n-glucose, but 
						not Lglucose, is readily transported into the brain. 
						Lactic, pyruvic, and acetic acids also utilize such 
						carriers.  
						While proteins are 
						virtually excluded from the brain, certain amino acids 
						 pass readily into it. Included are the essential amino 
						acids and those which are precursors for the production 
						of neurotransmitters. The latter include tyrosine 
						(required for norepinephrine and dopamine synthesis) and 
						tryptophan (for serotonin synthesis). Similarly, 
						neuroactive peptides whose amino acid sequences have 
						been clearly identified such as substance P, methionine 
						enkephalin and leucine enkephalin, ,B-endorphin, ACTH, 
						angiotensin II,
						
						oxytocin, vasopressin, 
						somatostatin, thyrotropin-releasing factor, and 
						luteinizing hormone-releasing factor rely on a steady 
						transport of these amino acids from plasma to brain for 
						their continued synthesis.  
						Ions cross the 
						barrier into brain but do so much more slowly than into 
						other body tissues. An intravenous K + administration 
						exchanges much more quickly with muscle tissue that it 
						does with brain. Ca2+ and Mg2+ transport is equally 
						slow, while N a + is somewhat faster. H+ ion transport 
						into the brain is very slow.  
						Certain areas of 
						the brain apparently contain no blood-brain barrier. 
						These include the neurohypophysis, median eminence of 
						the hypothalamus, the area postrema, and the pineal 
						gland. Because many circulating hormones control their 
						own release through negative feedback to the 
						hypothalamus, the importance of barrier lack in this 
						area is readily apparent. If such hormones are to 
						influence the hypothalamic output of releasing or 
						inhibiting factors to the anterior pituitary via the 
						hypothalamohypophyseal portal system, they must not be 
						barred from the hypothalamus by a barrier system. 
						Similarly, osmoreceptors of the hypothalamus must be 
						able to constantly and easily detect changes in the 
						osmolality of the plasma if the release of antidiuretic 
						hormone (ADH) is to proceed properly.
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