The blood-brain barrier (BBB) is formed by complex tight-junctions of the brain capillary endothelial cells (BCECs) and expresses various transport systems. These characteristics of the BBB make it possible to control selective transport across the BBB and to limit the non-selective brain distribution of drugs. Since understanding the mechanism of BBB transport is important for improving the BBB permeability of CNS-acting drugs, the molecular mechanism of the BBB transport has been analyzed mainly with respect to drug transport. At first, blood-to-brain influx transport was regarded as a system for transporting drugs and nutrients to the brain. This resulted in the discovery of transport systems for glucose and amino acids. 1) Subsequently, the importance of efflux transport at the BBB has been recognized after finding that P-glycoprotein (P-gp) is involved in the efflux transport of xenobiotics.2,3) Due to these studies, the BBB is now accepted as a complex transport system which is an important determinant of drug distribution to the brain.In addition to the drug permeability aspects, the physiological function of the BBB is important in the central nervous system (CNS). To date, the BBB transport system has been shown to supply nutrients, such as glucose, lactate, amino acids and nucleotides, to the brain. However, it is conceivable that the BBB have many other physiological functions involving regulation of the CNS milieu. For instance, the brain is a highly energy-consuming tissue and produces various metabolites. In particular, metabolism is essential for the inactivation of neurotransmitters after their secretion from the pre-synapses, as well as re-uptake. The metabolites produced in the brain must be removed in order to maintaine proper neural function. Therefore, the BBB can be thought to act as a clearance system to remove various metabolites from the CNS.Clarifying the physiological role of the BBB is also necessary to understand the role of the BBB in CNS disorders. This is because an alteration in BBB functions may result in a change in CNS conditions leading to CNS disorders. Furthermore, analyzing the BBB functions from a different point of view could result in the discovery of a new transport system that is involved in drug permeability. In this review, I shall introduce the recent advances in research into the molecular basis of BBB transport, focusing on its physiological functions.The BBB Supplies Creation to the Brain The brain consumes 18% of total body energy, while its weight is only 2% of the total body weight. The brain cannot store glucose for energy synthesis, and the BBB plays a crucial role in glucose supply to the brain by expressing glucose transporter 1 (GLUT1) (Fig. 1). 4) Besides energy synthesis, an energystoring system is necessary for maintain energy homeostasis in high energy-consuming tissues. We have shown that the BBB also plays an important role in the energy storing process (Fig. 1).
5)Creatine plays a key role in this energy-storing process. The phosphate-bound energy...