AMPK-dependent brain-wide norepinephrine release promotes recovery from metabolic coma in mice

Summary Coma is a pathological brain state characterized by loss of consciousness. How the brain recovers from coma remains largely unknown. Using mouse models of metabolic coma, we identified an endogenous neuromodulatory pathway that actively promotes coma recovery. In mice subjected to hypoglycemic coma, hypoglycemia triggered AMPK-dependent excitation of nucleus tractus solitarius (NTS) neurons, which activated locus coeruleus (LC) norepinephrine neurons through a glutamatergic NTS-LC circuit. LC activation drives widespread norepinephrine release across cortical and subcortical regions, thereby promoting post-coma arousal. Notably, coma-associated brain-wide norepinephrine release was unconventional in both scale and duration, with a magnitude approximately 10-fold higher than physiological norepinephrine release during sleep-wake cycles. This neuromodulatory process also operated during hypercapnic coma. Vagus nerve stimulation accelerated coma recovery by engaging this endogenous anti-coma mechanism. Our findings uncover an AMPK-dependent brainstem circuit that actively restores arousal from metabolic coma, revealing a neural defense strategy against profound metabolic stress.