Role of Glutamate Transport in Alcohol Withdrawal

Glutamate is the major excitatory neurotransmitter in the brain. However, excessive glutamate can lead to neurotoxicity. Evidence suggests that a hyperglutamatergic brain state is the core pathology behind alcohol withdrawal syndrome (AWS). This hyperglutamatergic state results from upregulation of glutamate receptors, dysregulation of glutamate metabolism, and reduction of synaptic glutamate clearance. Numerous genetic factors along this pathway could modulate the vulnerability or severity of AWS. Benzodiazepines, which facilitate inhibitory neurotransmission, are standard therapeutic agents for acute AWS. While effective in reducing withdrawal severity, benzodiazepines carry risks of sedation, respiratory suppression, and dependence, and they do not correct the persistent hyperglutamatergic state associated with relapse. Data show that ceftriaxone, a β-lactam antibiotic, upregulates excitatory amino acid transporter 2 (EAAT2) and attenuates withdrawal manifestations in preclinical models. These findings underscore the importance of glutamatergic mechanisms in AWS and suggest that glutamate reuptake may represent a novel target for acute withdrawal and relapse prevention.