Plasma protein turnover (albumin, transferrin, IgG, IgM) in Ménétrier's disease (giant hypertrophic gastritis): evidence of non-selective protein loss

Ten cases of Ménétrier's disease (;giant hypertrophic gastritis') have been studied with radioiodine-labelled albumin (all 10 cases), IgG (eight cases), transferrin (two cases), and IgM (six cases). Abnormal gastric loss of plasma protein was present in all cases as demonstrated by (59)Fe-iron dextran (eight cases), (51)Cr-albumin (one case), and (131)I-polyvinylpyrrolidone (one case). None of the patients had more distal gastrointestinal lesions. The synthetic rate of the proteins studied was normal or slightly elevated. The fractional catabolic rate of the proteins was increased. The increase above the normal mean was similar for albumin, transferrin, and IgG. Since the molecular weight of IgG is more than twice that of albumin and transferrin, it is concluded that the protein loss in Ménétrier's disease is nonselective in the sense that it affects a similar fraction of the intravascular masses of all plasma proteins. IgM catabolism was strongly accelerated. Simultaneous studies with (50)Fe-iron dextran, radioiodine-labelled albumin or IgG showed that IgM hypercatabolism could only partly be due to abnormal gastric protein loss, since IgM catabolism was significantly more raised than that of albumin and IgG. Faecal radioiodine excretion was normal in most patients after the injection of radioiodine-labelled proteins. It confirms a previous observation that increased gastrointestinal (59)Fe clearance after injection of (59)Fe-iron dextran associated with normal faecal radioiodine excretion after the injection of radioiodine-labelled proteins permits of a diagnosis of protein loss in the stomach.

IgM turnover in Crohn's disease

Simultaneous turnover studies with radioiodine-labelled IgM and IgG were made in 12 patients with Crohn's disease. Intestinal protein loss was estimated by means of (59)Fe-labelled iron dextran. The serum levels of IgM, IgG, and IgA were normal in most cases. The catabolic rate of IgM was increased in all but one case. A positive correlation was present between the catabolic rate and serum concentration of IgM, an observation which, so far, has been made only in Crohn's disease. The synthetic rate of IgM was raised or high normal in four cases with an intraabdominal abscess. It was normal in the remaining cases. A strong positive correlation was found between the synthetic rates of IgM and IgG. The size of the protein loss was unrelated to the raised catabolic rates of IgM and IgG.Faecal radioiodine excretion from labelled IgM and IgG bore no relation to faecal (59)Fe excretion, nor did it indicate the site of the intestinal lesion. However, a close correlation was observed between faecal excretion of the labels from IgM and IgG.

Glycerol metabolism in the human liver: inhibition by ethanol

Glycerol is metabolized predominantly in the liver, the first step presumably being phosphorylation to alpha-glycerophosphate. When ethanol is present in the blood the rate of glycerol uptake by the splanchnic organs is reduced to about one-third of the control value. At the same time glycerophosphate accumulates in the liver. Hepatic blood flow and oxygen consumption are not influenced by the combined infusion of glycerol and ethanol. The phenomenon may be connected with the increased concentration of the reduced form of diphosphopyridine nucleotide present in the liver during ethanol metabolism.