Differential effects of isoleucine deprivation on cell motility, membrane transport and DNA synthesis in NIL 8 hamster cells

Review article: hyperammonaemic and catabolic consequences of upper gastrointestinal bleeding in cirrhosis

BACKGROUND

Upper gastrointestinal (UGI) bleeding in patients with cirrhosis of the liver induces hyperammonaemia and leads to a catabolic cascade that precipitates life-threatening complications. The haemoglobin molecule is unique because it lacks the essential amino acid isoleucine and contains high amounts of leucine and valine. UGI bleed therefore presents the gut with protein of very low biologic value, which may be the stimulus to induce net catabolism.

AIM

To describe the hyperammonaemic and catabolic consequences of UGI bleeding in cirrhosis.

METHODS

A semi-structured literature search was performed using PubMed and article references.

RESULTS

It has recently been proven that ('simulation of ') a UGI bleed in patients with cirrhosis leads to impaired protein synthesis that can be restored by intravenous infusion of isoleucine. This may have therapeutic implications for the function of rapidly dividing cells and short half-life proteins such as clotting factors. Renal and small bowel ammoniagenesis were shown to be the most prominent causes for the hyperammonaemia that resulted from a UGI bleed. This provides an explanation for the therapeutic failure of the current clinical therapies that are aimed at large bowel-derived ammonia production. Isoleucine infusion did not diminish renal ammoniagenesis.

CONCLUSIONS

New pharmacological therapies to diminish postbleeding hyperammonaemia should target the altered inter-organ ammonia metabolism and promote ammonia excretion and/or increase the excretion of precursors of ammoniagenesis, e.g. l-ornithine-phenylacetate.

Protein synthesis is severely diminished following a simulated upper GI bleed in patients with cirrhosis

BACKGROUND/AIMS

An upper gastrointestinal (GI) bleed in cirrhotic patients has been hypothesised to induce catabolism due to the absence of the essential branched chain amino acid (BCAA) isoleucine and an abundance of the BCAA leucine in haemoglobin. We tested whether an upper GI bleed produces hypoisoleucinemia via BCAA antagonism and impairs protein synthesis.

METHODS

Isoleucine turnover and oxidation was studied in 5 metabolically stable patients with cirrhosis during a 4-h period of intragastric saline infusion followed by a 4-h period in which an upper GI bleed was simulated by an amino acid solution mimicking haemoglobin.

RESULTS

The simulated upper GI bleed induced hypoisoleucinemia (26% of initial values) and an increase in leucine (400%) and valine (350%) concentrations. Isoleucine flux and isoleucine oxidation decreased to a third of initial values following a simulated bleed, but the fraction of isoleucine flux used for oxidation did not change. Consequently, the non-oxidative portion of isoleucine flux, representing protein synthesis, decreased similarly.

CONCLUSIONS

The present study shows that a simulated upper GI bleed induces hypoisoleucinemia and decreases protein synthesis markedly. The fact that the percentage of isoleucine flux that was oxidized was not influenced by the hypoisoleucinemic state can only be explained by BCAA antagonism.

Isoleucine infusion during "simulated" upper gastrointestinal bleeding improves liver and muscle protein synthesis in cirrhotic patients

Upper gastrointestinal (GI) bleeding in cirrhotic patients has a high incidence of mortality and morbidity. Postbleeding catabolism has been hypothesized to be partly due to the low biological value of hemoglobin, which lacks the essential amino acid isoleucine. The aims were to study the metabolic consequences of a "simulated" upper GI bleed in patients with cirrhosis of the liver and the effects of intravenous infusion of isoleucine. Portal drained viscera, liver, muscle, and kidney protein kinetics were quantified using a multicatheterization technique during routine portography. Sixteen overnight-fasted, metabolically stable patients who received an intragastric infusion of an amino acid solution mimicking hemoglobin every 4 hours were randomized to saline or isoleucine infusion and received a mixture of stable isotopes (L-[ring-2H5]phenylalanine, L-[ring-2H4]tyrosine, and L-[ring-2H2]tyrosine) to determine organ protein kinetics. This simulated bleed resulted in hypoisoleucinemia that was attenuated by isoleucine infusion. Isoleucine infusion during the bleed resulted in a positive net balance of phenylalanine across liver and muscle, whereas renal and portal drained viscera protein kinetics were unaffected. In the control group, no significant effect was shown.

CONCLUSION

The present study investigated hepatic and portal drained viscera protein metabolism selectively in humans. The data show that hepatic and muscle protein synthesis is stimulated by improving the amino acid composition of the upper GI bleed by simultaneous intravenous isoleucine administration.

The pathophysiological basis of acute-on-chronic liver failure

The vast majority of patients that are referred to a specialist hepatological centre suffer from acute deterioration of their chronic liver disease. Yet, this entity of acute-on-chronic liver failure remains poorly defined. With the emergence of newer liver support strategies, it has become necessary to define this entity, its pathophysiology and the short and long-term prognosis. This review focuses upon how a precipitant such as an episode of gastrointestinal bleeding or sepsis may start a cascade of events that culminate in end-organ dysfunction and liver failure. We briefly review the pathophysiological basis of the therapeutic modalities that are available. Our current strategy for the management of liver failure involves supportive therapy for the end-organs with the hope that the liver function would recover if sufficient time for such a recovery is allowed. Because liver failure, whether of the acute or acute-on-chronic variety, is potentially reversible, the stage is set for the application of newer liver support strategies to enhance the recovery process.

Upper gastrointestinal bleeding: an ammoniagenic and catabolic event due to the total absence of isoleucine in the haemoglobin molecule

Upper gastrointestinal bleeding causes increased urea concentrations in patients with normal liver function and high ammonia concentrations in patients with impaired liver function. This ammoniagenesis may precipitate encephalopathy. The haemoglobin molecule is unique because it lacks the essential amino acid isoleucine and has high amounts of leucine and valine. Upper gastrointestinal bleeding therefore presents the gut with protein of very low biologic value, which may be the stimulus to induce a cascade of events culminating in net catabolism. This may influence the function of rapidly dividing cells and short half-life proteins. We hypothesize that, following a variceal bleed in a cirrhotic patient, the lack of isoleucine in blood protein is the cause of the exaggerated ammoniagenesis and catabolism. We propose that intravenous administration of isoleucine may serve as a simple therapeutic that transforms blood protein in a balanced protein, resulting in only a short-lived rise in ammonia and urea production, and preventing interference with protein synthesis.

Decreased plasma isoleucine concentrations after upper gastrointestinal haemorrhage in humans

BACKGROUND

A decrease in arterial isoleucine values after intragastric blood administration in pigs has been observed. This contrasted with increased values of most other amino acids, ammonia, and urea. After an isonitrogenous control meal in these pigs all amino acids including isoleucine increased, and urea increased to a lesser extent, suggesting a relation between the arterial isoleucine decrease and uraemia after gastrointestinal haemorrhage.

METHODS

To extend these findings to humans, plasma amino acids were determined after gastrointestinal haemorrhage in patients with peptic ulcers (n = 9) or oesophageal varices induced by liver cirrhosis (n = 4) and compared with preoperative patients (n = 106).

RESULTS

After gastrointestinal haemorrhage, isoleucine decreased in all patients by more than 60% and normalised within 48 hours. Most other amino acids increased and also normalised within 48 hours. Uraemia occurred in both groups, hyperammonaemia was seen in patients with liver cirrhosis.

CONCLUSIONS

These results confirm previous findings in animals and healthy volunteers that plasma isoleucine decreases after simulated upper gastrointestinal haemorrhage. This supports the hypothesis that the absence of isoleucine in blood protein causes decreased plasma isoleucine values after gastrointestinal haemorrhage, and may be a contributory factor to uraemia and hyperammonaemia in patients with normal and impaired liver function, respectively. Intravenous isoleucine administration after gastrointestinal haemorrhage could be beneficial and will be the subject of further research.

Sequential change of DNA synthesis in cultured aortic smooth muscle cells stimulated by hyperlipidemic serum

Smooth muscle cells from monkey aorta quiescent in 5% calf serum have been shown to be stimulated to renewed proliferation by hyperlipidemic serum or LDL from such serum. This proliferative response evidently is not dependent on platelet-derived growth factor present in our system in large quantities. The least exposure time required for reaction between the mitogen and the cells in order to initiate maximal DNA synthesis by this mechanism was studied using autoradiography. Stationary primary cultures and subcultures from monkey aortic media required at least 4 and 8 hr of contact with hyperlipidemic serum or LDL so that a significant number of cells reentered the mitotic cycle. Compared to the primary culture system, subcultures needed a slightly longer time of contact with serum to initiate DNA synthesis. Since there was no significant difference in labeling index between the primary cultures stimulated by serum for 8 and 48 hr and the subcultures exposed between 6 and 48 hr, it is concluded that a relatively brief stimulation commits the majority of responsive cells to reenter the cycle and initiate DNA synthesis.

Rb+ influxes differentiate between growth arrest of cells by different agents

The effect of cell cycle on Rb+ (K+) fluxes was studied in NIH 3T3 mouse fibroblasts. Serum starvation or isoleucine deprivation resulted in cell arrest at an early G1/G0 phase, accompanied by a marked decrease in both ouabain-sensitive and ouabain-resistant Rb+ influx. On the other hand, cells arrested at late G1/G0 phase by hydroxyurea treatment have high ouabain-sensitive and ouabain-resistant Rb+ influx. Butyric acid treatment resulted in cell arrest at an early G1/G0 phase, but in contrast to serum or isoleucine starvation did not decrease Rb+ influxes. It is thus shown that quiescent cells may have Rb+ influx rates as high as that of logarithmically growing cells. The results are consistent with the hypothesis that an increased ion permeability of the cell is initiated at a critical stage in G1/G0 phase, and that butyric acid may arrest the cell beyond that stage.

The centriolar antigen expression in TC7 cells is dependent on growth conditions and occurs at a particular time point in G1

The correlation between growth conditions and centriolar antigen (Cag) expression in TC7 cells, a subline of African green monkey kidney cells, was studied. TC7 cells became quiescent when their number reached a high cell density, or when serum factors were depleted from media containing a low concentration of fetal bovine serum (FBS). There was a stoichiometric relationship between the concentration of serum present and the number of new cells produced. During proliferation, the projected cell area decreased as a function of cell density with two abrupt transitions. The first transition appeared to be independent of cell-cell contact. However, the second transition seemed to occur mainly as a result of the limitation of the available substratum surface on which the cells could grow. The appearance of Cag in TC7 cells was found to be associated with the cells' growth conditions as well as with the particular phase in cell cycle. In an exponentially growing culture of cells with 10% FBS and in cells that were growth restricted due to a high density (above 2-3 X 10(5) cells/cm2), the incidence of cells with Cag-positive staining was about 10-20%. It increased, however, to about 40-60% at cell densities between 2 X 10(4) cells/cm2 and 1 X 10(5) cells/cm2. The frequency of cells with positive Cag staining was as high as 80% in TC7 cells that were growth restricted by depletion of serum factor(s). Thus, the quiescent states attained by the two different growth restrictions seem to be different in their ability to express Cag. The frequency of Cag could be further increased by stimulating the quiescent cell population by FBS. In mitotically selected TC7 cells, Cag staining appeared about 4 hr after mitosis and about 2-4 hr before the onset of DNA synthesis. Thus, expression of Cag in TC7 cells is related to their growth conditions, and is characteristic of a part of the G1 phase of the cell cycle.

Glutamine and the regulation of DNA replication and cell multiplication in fibroblasts

Several studies indicate that glutamine is a critical requirement for cell growth in vitro. Growing and quiescent (serum-starved) 3T3-fibroblasts were exposed to media (Dulbecco's modified Eagle's minimal essential medium) in which the concentration of the 13 essential amino acids had been lowered to 1/100 or 1/1,000 of that in DMEM - either all together or one by one. The effects on DNa synthesis were measured by autoradiographic determinations of the percentage of labeled cells after 24 hours exposure to 3H-thymidine. a reduction of all 13 essential amino acids to 1/100 or 1/1,000 of the normal concentration in the medium resulted only in a minor growth inhibitory effect during the first cell cycle. A similar growth inhibitory effect was caused by the depletion of one of the 13 essential amino acids (except glutamine) from the medium. However, a depletion of glutamine from the medium resulted in a marked inhibition of growth. Conversely, a relative excess of glutamine, when the other 12 amino acids were lowered to 1/1,000 of the normal concentration, counteracted the growth inhibitory effect of serum starvation. It was even possible to stimulate quiescent cells to undergo DNa synthesis by exposing them to a serum-depleted (0.5% serum) medium with a relative excess of glutamine.

The control of growth of mouse mastocytoma cells by N6,O2'-dibutyryladenosine cyclic 3',5'-monophosphate

Addition of N6,O2'-Dibutyryladenosine cyclic 3',5'-monophosphate (DB cyclic AMP) plus theophylline or transfer to medium containing 0.2% serum slowed the growth of cultured mouse mastocytoma cells and eventually arrested their growth in G1 phase. Examination of the properties of cells arrested by either procedure suggested that the drugs arrested cells in G1 phase 1.5-2 h after the point of low serum arrest. Cycloheximide prevented the recovery of cell growth after low serum or drug-induced arrest demonstrating that protein synthesis was necessary to pass either growth restriction point. Cordycepin also prevented drug-arrested cells from progressing into cycle indicating a requirement for RNA synthesis to overcome the drug-induced growth arrest. Evidence is also presented that DB cyclic AMP prevented the cells receiving a pulse of calcium necessary to proceed past the DB cyclic AMP-sensitive growth restriction point. It is suggested that high cyclic AMP levels prevent mastocytoma cells from receiving a surge of calcium in G1 phase that is necessary if the cells are to proceed to S phase and eventually divide.

Growth arrest of AKR-2B cells maintained in the presence of epidermal growth factor or 12-O-tetradecanoylphorbol-13 acetate: evidence for two separate G1 arrest points

Nontransformed mouse embryo derived AKR-2B cells stop growing in the G1 phase of the cell cycle at saturation density due to depletion of serum growth factors, whereas a chemically transformed derivative line (AKR-MCA) arrests growth in G1 at a higher saturation density due to depletion of amino acids and glucose. Stimulation of DNA synthesis is inhibited in the AKR-2B cells, but not in the AKR-MCA cells, by two inhibitors of RNA metabolism, alpha-amanitin and 5-fluorouridine (5-FU). To determine whether the AKR-MCA cells growth arrest at a unique point in G1 or whether they arrest in a physiologic state which can also be achieved by the nontransformed cells, AKR-2B cells were maintained in medium with 10% serum containing the mitogens, epidermal growth factor (EGF) or 12-O-tetradecanoylphorbol-13-acetate (TPA), until they reached saturation density or were arrested at subconfluence by artificial deletion of amino acids from the medium. The AKR-2B cells maintained in EGF or TPA stopped growing in G1 at a higher saturation density, due to depletion of amino acids. Cells arrested in EGF or TPA or in amino acid deficient medium had a shortened interval between stimulation and the onset of DNA synthesis, and the stimulation of DNA synthesis was not inhibited by alpha-amanitin or 5-FU. The data show that the nontransformed AKR-2B cells have two different arrest states which may represent two separate and distinct G1 arrest points--a growth factor deficiency arrest point and a nutrient deficiency arrest point. The nutrient deficiency arrested cells were very similar to the G1 arrested transformed AKR-MCA cells.

Effect of amino acid deprivation on DNA synthesis in BHK-21/C13 cells

Removal of serum from BHK-21/C13 cells in culture results in a decline in thymidine incorporation extending over five days. Additional removal of any of several amino acids results in a rapid decrease in incorporation of thymidine to negligible levels by 24 hours. Replacement by complete medium then provokes a synchronous wave of DNA synthesis after only ten hours with DNA synthesis first increased at six hours. Starvation for glutamine results in a rapid decline in protein synthesis over the 24 hour period when DNA synthesis is falling. However, there is considerable degradation of total protein during this period, and RNA degradation is also greatly increased. Concurrently, synthesis of RNA falls to less than 10% of that in control cells.

Responses of proliferating and non-proliferating Chinese hamster cells to cytotoxic agents

The effects of various cytotoxic chemicals, as measured by viable cell counts, colony-forming ability and proliferative capacity, have been studied using Chinese hamster cells in exponential and plateau (stationary) phases of growth. The proliferating cells were altogether more sensitive to the action of the drugs than non-proliferating cells. However, imuran (azathioprine) a purine antimetabolite, was more effective against the plateau-phase cells. The observed response of cells to imuran could be detected at a wide range of concentrations (1-100 microgram/ml). These findings are discussed in view of the possible ability of imuran to interfere with active metabolic processes in non-proliferating cells.

Cells regulate their proliferation through alterations in transition probability

The proliferation of 3T3, 3T6 and SV3T3 cells was examined by time lapse cinephotography under a number of different growth conditions. It was found that the frequency distributions of intermitotic times of cells with widely different proliferation rates are qualitatively and quantitatively explained by the transition probability model of the cell cycle (Smith and Martin, '73). The behaviour of quiescent cells was characterized by very low values of the transition probability. No "out of cycle" or GO compartment of cells was detectable. From a consideration of these results and those in the literature it appears that the rate of cell proliferation is determined by the value of the "transition probability" (P), and that it is the biochemical manifestation of this parameter that regulates cell growth in vitro and in vivo.