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Lara-Prado JI, Pazos-Pérez F, Méndez-Landa CE, Grajales-García DP, Feria-Ramírez JA, Salazar-González JJ, Cruz-Romero M, Treviño-Becerra A. Acute Kidney Injury and Organ Dysfunction: What Is the Role of Uremic Toxins? Toxins (Basel) 2021; 13:toxins13080551. [PMID: 34437422 PMCID: PMC8402563 DOI: 10.3390/toxins13080551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/04/2023] Open
Abstract
Acute kidney injury (AKI), defined as an abrupt increase in serum creatinine, a reduced urinary output, or both, is experiencing considerable evolution in terms of our understanding of the pathophysiological mechanisms and its impact on other organs. Oxidative stress and reactive oxygen species (ROS) are main contributors to organ dysfunction in AKI, but they are not alone. The precise mechanisms behind multi-organ dysfunction are not yet fully accounted for. The building up of uremic toxins specific to AKI might be a plausible explanation for these disturbances. However, controversies have arisen around their effects in organs other than the kidney, because animal models usually depict AKI as a kidney-specific injury. Meanwhile, humans present AKI frequently in association with multi-organ failure (MOF). Until now, medium-molecular-weight molecules, such as inflammatory cytokines, have been proven to play a role in endothelial and epithelial injury, leading to increased permeability and capillary leakage, mainly in pulmonary and intestinal tissues.
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Affiliation(s)
- Jesús Iván Lara-Prado
- Department of Nephrology, General Hospital No. 27, Mexican Social Security Institute, Mexico City 06900, Mexico; (J.I.L.-P.); (D.P.G.-G.)
| | - Fabiola Pazos-Pérez
- Department of Nephrology, Specialties Hospital, National Medical Center “21st Century”, Mexican Social Security Institute, Mexico City 06720, Mexico;
- Correspondence: ; Tel.: +52-55-2699-1941
| | - Carlos Enrique Méndez-Landa
- Department of Nephrology, General Hospital No. 48, Mexican Social Security Institute, Mexico City 02750, Mexico;
| | - Dulce Paola Grajales-García
- Department of Nephrology, General Hospital No. 27, Mexican Social Security Institute, Mexico City 06900, Mexico; (J.I.L.-P.); (D.P.G.-G.)
| | - José Alfredo Feria-Ramírez
- Department of Nephrology, General Hospital No. 29, Mexican Social Security Institute, Mexico City 07910, Mexico;
| | - Juan José Salazar-González
- Department of Nephrology, Regional Hospital No. 1, Mexican Social Security Institute, Mexico City 03100, Mexico;
| | - Mario Cruz-Romero
- Department of Nephrology, Specialties Hospital, National Medical Center “21st Century”, Mexican Social Security Institute, Mexico City 06720, Mexico;
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Clinical and biochemical characteristics of patients with ornithine transcarbamylase deficiency. Clin Biochem 2020; 84:63-72. [PMID: 32569589 DOI: 10.1016/j.clinbiochem.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/31/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ornithine transcarbamylase deficiency (OTCD) is pleomorphic congenital hyperammonemia, in which the prognosis of the patient is determined both by genotype and environmental factors. This study investigated the clinical and biochemical characteristics of OTCD patients with different prognosis. METHOD Of 35 OTCD patients, six males deceased at the first disease-onset, 17 males survived and had controllable ammonia levels after treatment, and 12 females survived through the first disease-onset but had intractable hyperammonemia and high mortality. Fasting blood samples from patients collected at three disease stages were used for the analysis of amino acid (AA) profile, acylcarnitine profile, and micronutrients. Differences in profiles between patients and healthy controls and within patient groups were studied. RESULTS All OTCD patients had accumulation of glutamine, homocitrulline, lysine, glutamate, cystathionine, and pipecolic acid, as well as deficiency of citrulline, tryptophan, threonine, and carnitine. For male non-survivors, most other AAs and long-chain acylcarnitines were elevated at disease onset, of which the levels of creatine, N-acetylaspartic acid, and homoarginine were remarkably high. Male survivors and female patients had most other AAs at low to normal levels. Compared with male survivors, female patients had much lower protein-intolerance, as indicated by significantly lower levels of protein consumption indicators, including essential AAs, 1-methylhistidine, acylcarnitines et al., but high levels of ammonia. Female patients still had significantly higher levels of citrulline, homocitrulline, and citrulline/arginine compared to male survivors. CONCLUSION Unique profiles were observed in each group of OTCD patients, indicating specific physiological changes that happened to them.
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Behaviour of plasma citrulline after bariatric surgery in the BARIASPERM cohort. Clin Nutr 2020; 40:505-510. [PMID: 32891457 DOI: 10.1016/j.clnu.2020.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Plasma citrulline is currently used in clinical practice as a marker of small bowel functional mass. Behaviour of plasma citrulline after bariatric surgery and its link with post-operative outcome are still poorly understood. OBJECTIVE Primary objective was to compare plasma citrulline 12 months after two types of bariatric surgery with pre-operative concentrations. Secondary objectives were to search for correlation between plasma citrulline variation and body weight and fat mass loss. DESIGN This is an ancillary study of the BARIASPERM study. Forty-six adult men (mean age 38.9 ± 7.9 years) who underwent gastric bypass (GB, n = 20) or sleeve gastrectomy (SG, n = 26) were included in this prospective study. Plasma citrulline was measured at baseline, 6 months and 12 months after surgery, as well as total body weight and fat mass measured by dual x-ray absorptiometry (DEXA). RESULTS Plasma citrulline increased significantly 12 months after surgery, both after gastric bypass and sleeve gastrectomy (respectively 30.2% [18.3-42.2] and 17.8% [5.8-29.7]). The increase was significantly higher after GB than after SG (p = 0.02) while total body weight and fat mass loss were not significantly different between GB and SG. The increase in plasma citrulline levels tended to be positively correlated with both weight and fat mass loss however the association did not reach statistical significance (p = 0.07 and p = 0.06 respectively). CONCLUSION These results confirm the increase in plasma citrulline after GB published in two previous small studies. Citrulline also significantly increased after SG, and in spite of similar weight loss obtained with both surgery types, citrulline increase was higher after GB than SG. This suggests different modifications of intestinal functional mass after these two different techniques.
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Li X, Zheng S, Wu G. Amino Acid Metabolism in the Kidneys: Nutritional and Physiological Significance. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1265:71-95. [DOI: 10.1007/978-3-030-45328-2_5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hsu CN, Lu PC, Lo MH, Lin IC, Tain YL. The Association between Nitric Oxide Pathway, Blood Pressure Abnormalities, and Cardiovascular Risk Profile in Pediatric Chronic Kidney Disease. Int J Mol Sci 2019; 20:ijms20215301. [PMID: 31653115 PMCID: PMC6862290 DOI: 10.3390/ijms20215301] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/15/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease (CVD) is common in chronic kidney disease (CKD), while major CV events are rare in young CKD patients. In addition to nitric oxide (NO)-related biomarkers, several surrogate markers have been assessed to stratify CV risk in youth with CKD, including 24-h ambulatory blood pressure monitoring (ABPM), carotid artery intima-media thickness (cIMT), pulse wave velocity (PWV), ABPM-derived arterial stiffness index (AASI), flow-mediated dilatation (FMD), and left ventricular mass index (LVMI). The aim of this study was to identify subclinical CVD through the analysis of indices of CV risk in children and adolescents with CKD. Between 2016 and 2018, the prospective observational study enrolled 125 patients aged 3 to 18 years with G1–G4 CKD stages. Close to two-thirds of young patients with CKD exhibited blood pressure (BP) abnormalities on ABPM. CKD children with abnormal office BP showed lower plasma arginine levels and arginine-to-asymmetric dimethylarginine (ADMA) ratio, but higher ratios of ADMA-to-symmetric dimethylarginine (SDMA) and citrulline-to-arginine. High PWV and AASI, indices of arterial stiffness, both strongly correlated with high BP load. Additionally, LV mass and LVMI exhibited strong correlations with high BP load. Using an adjusted regression model, we observed the citrulline-to-arginine ratio was associated with 24-h systolic and diastolic BP, systolic blood pressure (SBP) load, and diastolic blood pressure (DBP) load. Early assessments of NO-related parameters, BP load abnormalities, arterial stiffness indices, and LV mass will aid in early preventative care toward decreasing CV risk later in life for children and adolescents with CKD.
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Affiliation(s)
- Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Pei-Chen Lu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
| | - Mao-Hung Lo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
| | - I-Chun Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
| | - You-Lin Tain
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
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Abdul Ghani ZDF, Ab Rashid AH, Shaari K, Chik Z. Urine NMR Metabolomic Study on Biochemical Activities to Investigate the Effect of P. betle Extract on Obese Rats. Appl Biochem Biotechnol 2019; 189:690-708. [DOI: 10.1007/s12010-019-03042-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
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Allerton TD, Proctor DN, Stephens JM, Dugas TR, Spielmann G, Irving BA. l-Citrulline Supplementation: Impact on Cardiometabolic Health. Nutrients 2018; 10:nu10070921. [PMID: 30029482 PMCID: PMC6073798 DOI: 10.3390/nu10070921] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 12/12/2022] Open
Abstract
Diminished bioavailability of nitric oxide (NO), the gaseous signaling molecule involved in the regulation of numerous vital biological functions, contributes to the development and progression of multiple age- and lifestyle-related diseases. While l-arginine is the precursor for the synthesis of NO by endothelial-nitric oxide synthase (eNOS), oral l-arginine supplementation is largely ineffective at increasing NO synthesis and/or bioavailability for a variety of reasons. l-citrulline, found in high concentrations in watermelon, is a neutral alpha-amino acid formed by enzymes in the mitochondria that also serves as a substrate for recycling l-arginine. Unlike l-arginine, l-citrulline is not quantitatively extracted from the gastrointestinal tract (i.e., enterocytes) or liver and its supplementation is therefore more effective at increasing l-arginine levels and NO synthesis. Supplementation with l-citrulline has shown promise as a blood pressure lowering intervention (both resting and stress-induced) in adults with pre-/hypertension, with pre-clinical (animal) evidence for atherogenic-endothelial protection. Preliminary evidence is also available for l-citrulline-induced benefits to muscle and metabolic health (via vascular and non-vascular pathways) in susceptible/older populations. In this review, we examine the impact of supplementing this important urea cycle intermediate on cardiovascular and metabolic health outcomes and identify future directions for investigating its therapeutic impact on cardiometabolic health.
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Affiliation(s)
| | - David N Proctor
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA.
| | | | - Tammy R Dugas
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA.
| | - Guillaume Spielmann
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA.
| | - Brian A Irving
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA.
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da Silva DK, Jacinto JL, de Andrade WB, Roveratti MC, Estoche JM, Balvedi MCW, de Oliveira DB, da Silva RA, Aguiar AF. Citrulline Malate Does Not Improve Muscle Recovery after Resistance Exercise in Untrained Young Adult Men. Nutrients 2017; 9:E1132. [PMID: 29057836 PMCID: PMC5691748 DOI: 10.3390/nu9101132] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 01/21/2023] Open
Abstract
The effects of citrulline malate (CM) on muscle recovery from resistance exercise remains unknown. We aimed to determine if citrulline malate supplementation improves muscle recovery after a single session of high-intensity resistance exercise (RE) in untrained young adult men. Nine young adult men (24.0 ± 3.3 years) participated in a double-blind crossover study in which they received 6 g of CM and placebo (PL) on two occasions, separated by a seven-day washout period. Each occasion consisted of a single session of high-intensity RE (0 h) and three subsequent fatigue tests sessions (at 24, 48, and 72 h) to assess the time course of muscle recovery. During the tests sessions, we assessed the following variables: number of maximum repetitions, electromyographic signal (i.e., root mean square (RMS) and median frequency (MF)), muscle soreness and perceived exertion, as well as blood levels of creatine kinase (CK), lactate, insulin, and testosterone:cortisol ratio. CK levels increased at 24 h post-exercise and remained elevate at 48 and 72 h, with no difference between CM and PL conditions. Muscle soreness increased at 24 h post-exercise, which progressively returned to baseline at 72 h in both conditions. Lactate levels increased immediately post-exercise and remained elevated at 24, 48, and 72 h in both conditions. No significant treatment × time interaction was found for all dependents variables (maximum repetitions, perceived exertion, CK, lactate, RMS, MF, and testosterone:cortisol ratio) during the recovery period. In conclusion, our data indicate that CM supplementation (single 6 g dose pre-workout) does not improve the muscle recovery process following a high-intensity RE session in untrained young adult men.
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Affiliation(s)
- Douglas K da Silva
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - Jeferson L Jacinto
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - Walquiria B de Andrade
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - Mirela C Roveratti
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - José M Estoche
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - Mario C W Balvedi
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - Douglas B de Oliveira
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
| | - Rubens A da Silva
- Laboratory of Functional Evaluation and Human Motor Performance, LAFUP, Center for Research in Health Sciences, North Univeristy of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
- Département des Sciences de la Santé, Programme de Physiothérapie de L'université McGill Offert en Extension à L'UNIVERSITÉ du Québec à Chicoutimi (UQAC), 555 boul. De L'université, ville du Saguenay, Québec, QC G7H 5B8, Canada.
| | - Andreo F Aguiar
- Center for Research in Health Sciences, North University of Paraná (UNOPAR), 675 Paris Ave., Londrina 86041-120, Brazil.
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Li R, Dai J, Kang H. The construction of a panel of serum amino acids for the identification of early chronic kidney disease patients. J Clin Lab Anal 2017. [PMID: 28643348 DOI: 10.1002/jcla.22282] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Serum creatinine, urea, and cystatin-c are standardly used for the evaluation of renal function in the clinic. However, some patients have chronic kidney disease but still retain kidney function; a conventional serum index in these patients can be completely normal. Serum amino acid levels can reflect subtle changes in metabolism and are closely related to renal function. Here, we investigated how amino acids change as renal impairment increases. METHODS Subjects were divided into three groups by renal function glomerular filtration rate: healthy controls, patients with chronic kidney disease with normal kidney function, and patients with chronic kidney disease with decreased kidney function group. We identified 11 amino acids of interest using LC-MS/MS on MRM (+) mode. RESULTS Statistical analysis indicated that alanine (ALA), valine (VAL), and tyrosine (TYR) decrease with renal function impairment, whereas phenylalanine (PHE) and citrulline (CIT) increase. We tried to construct a diagnostic model utilizing a combination of amino acids capable of identifying early chronic kidney disease patients. The accuracy, specificity, and sensitivity of the combining predictors were 86.9%, 84.6%, and 90.9%, respectively, which is superior to the reported values for serum creatinine, urea, and cystatin-c. CONCLUSION Our data suggest that serum amino acid levels may supply important information for the early detection of chronic kidney disease. We are the first to establish a diagnostic model utilizing serum levels of multiple amino acids for the diagnosis of patients with early-stage chronic kidney disease.
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Affiliation(s)
- Rui Li
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jinna Dai
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hui Kang
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Posaconazole plasma exposure correlated to intestinal mucositis in allogeneic stem cell transplant patients. Eur J Clin Pharmacol 2016; 72:953-63. [PMID: 27066958 DOI: 10.1007/s00228-016-2057-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/31/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Low posaconazole plasma concentrations (PPCs) are frequently encountered in allogeneic hematopoietic stem cell transplant (HSCT) patients, due to variable gastrointestinal absorption. In this study, the impact of intestinal mucositis on posaconazole exposure is investigated. PATIENTS AND METHODS A prospective pharmacokinetic study was performed including allogeneic HSCT patients receiving posaconazole prophylaxis with the oral suspension or tablets. Steady state PPCs were determined using high-performance liquid chromatography-fluorescence detection at the day of transplantation (=day 0), day +7, and +14. Citrulline was measured using liquid chromatography-tandem mass spectrometry to evaluate severity of mucositis, at baseline (day -7 or -6), and at day 0, +7 and +14. Additionally, citrulline plasma concentrations and steady state trough PPCs were determined in hematological patients without HSCT or mucositis. RESULTS Thirty-four HSCT patients received posaconazole oral suspension together with 25 cL of Coca Cola, 6 HSCT patients received posaconazole tablets and 33 hematological patients not receiving HSCT received posaconazole oral suspension. The median (interquartile range) average PPC was 0.26 mg/L (0.17-0.43), 0.67 mg/L (0.27-1.38), and 1.08 mg/L (0.96-1.38), with suspension in HSCT patients, suspension in hematological patients and tablets in HSCT patients, respectively. A higher trough PPC was encountered with the oral suspension when citrulline plasma concentrations were above 10 μmol/L compared to values below 10 μmol/L (p < 0.001), whereas for tablets, average PPCs remained high with citrulline plasma concentrations below or above 10 μmol/L (p = 0.64). CONCLUSION Posaconazole tablets should be preferred to suspension in HSCT patients immediately after transplantation to prevent insufficient plasma exposure due to intestinal mucositis.
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Pironi L, Guidetti M, Lauro A, Zanfi C, Agostini F, D'Errico A, Altimari A, Pinna AD. Plasma citrulline after small bowel transplantation: effect of time from transplantation, acute cellular rejection, and renal failure. Clin Transplant 2015; 29:1039-1046. [DOI: 10.1111/ctr.12630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure; Department of Gastroenterology; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Mariacristina Guidetti
- Center for Chronic Intestinal Failure; Department of Gastroenterology; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Augusto Lauro
- Transplantation Surgical Unit; Department of Organ Failure and Transplantation; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Chiara Zanfi
- Transplantation Surgical Unit; Department of Organ Failure and Transplantation; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Federica Agostini
- Center for Chronic Intestinal Failure; Department of Gastroenterology; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
- PhD on Medical Sciences; University of Bologna; Bologna Italy
| | - Antonietta D'Errico
- Center for Histopathological and Molecular Diagnostic of Solid Organ Transplantation; Department of Organ Failure and Transplantation; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Annalisa Altimari
- Center for Histopathological and Molecular Diagnostic of Solid Organ Transplantation; Department of Organ Failure and Transplantation; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Antonio D. Pinna
- Transplantation Surgical Unit; Department of Organ Failure and Transplantation; Sant'Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
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Odewunmi NA, Umoren SA, Gasem ZM, Ganiyu SA, Muhammad Q. l-Citrulline: An active corrosion inhibitor component of watermelon rind extract for mild steel in HCl medium. J Taiwan Inst Chem Eng 2015. [DOI: 10.1016/j.jtice.2015.01.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Wijnands KAP, Castermans TMR, Hommen MPJ, Meesters DM, Poeze M. Arginine and citrulline and the immune response in sepsis. Nutrients 2015; 7:1426-63. [PMID: 25699985 PMCID: PMC4377861 DOI: 10.3390/nu7031426] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/15/2015] [Accepted: 01/26/2015] [Indexed: 01/01/2023] Open
Abstract
Arginine, a semi-essential amino acid is an important initiator of the immune response. Arginine serves as a precursor in several metabolic pathways in different organs. In the immune response, arginine metabolism and availability is determined by the nitric oxide synthases and the arginase enzymes, which convert arginine into nitric oxide (NO) and ornithine, respectively. Limitations in arginine availability during inflammatory conditions regulate macrophages and T-lymfocyte activation. Furthermore, over the past years more evidence has been gathered which showed that arginine and citrulline deficiencies may underlie the detrimental outcome of inflammatory conditions, such as sepsis and endotoxemia. Not only does the immune response contribute to the arginine deficiency, also the impaired arginine de novo synthesis in the kidney has a key role in the eventual observed arginine deficiency. The complex interplay between the immune response and the arginine-NO metabolism is further underscored by recent data of our group. In this review we give an overview of physiological arginine and citrulline metabolism and we address the experimental and clinical studies in which the arginine-citrulline NO pathway plays an essential role in the immune response, as initiator and therapeutic target.
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Affiliation(s)
- Karolina A P Wijnands
- Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht 6200 MD, The Netherlands.
| | - Tessy M R Castermans
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200MD, The Netherlands.
| | - Merel P J Hommen
- Department of Surgery, Maastricht University Medical Center, Maastricht 6200MD, The Netherlands.
| | - Dennis M Meesters
- Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht 6200 MD, The Netherlands.
| | - Martijn Poeze
- Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht 6200 MD, The Netherlands.
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Poole A, Deane A, Summers M, Fletcher J, Chapman M. The relationship between fasting plasma citrulline concentration and small intestinal function in the critically ill. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:16. [PMID: 25599966 PMCID: PMC4355456 DOI: 10.1186/s13054-014-0725-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/18/2014] [Indexed: 01/21/2023]
Abstract
Introduction In this study, we aimed to evaluate whether fasting plasma citrulline concentration predicts subsequent glucose absorption in critically ill patients. Methods In a prospective observational study involving 15 healthy and 20 critically ill subjects, fasting plasma citrulline concentrations were assayed in blood samples immediately prior to the administration of a liquid test meal (1 kcal/ml; containing 3 g of 3-O-methylglucose (3-OMG)) that was infused directly into the small intestine. Serum 3-OMG concentrations were measured over the following 4 hours, with the area under the 3-OMG concentration curve (AUC) calculated as an index of glucose absorption. Results The groups were well matched in terms of age, sex and body mass index (BMI) (healthy subjects versus patients, mean (range) values: age, 47 (18 to 88) versus 49 (21 to 77) years; sex ratio, 60% versus 80% male; BMI, 25.2 (18.8 to 30.0) versus 25.5 (19.4 to 32.2) kg/m2). Compared to the healthy subjects, patients who were critically ill had reduced fasting citrulline concentration (26.5 (13.9 to 43.0) versus 15.2 (5.7 to 28.6) μmol/L; P < 0.01) and glucose absorption (3-OMG AUC, 79.7 (28.6 to 117.8) versus 61.0 (4.5 to 97.1) mmol/L/240 min; P = 0.05). There was no relationship between fasting citrulline concentration and subsequent glucose absorption (r = 0.28; P = 0.12). Conclusions Whereas both plasma citrulline concentrations and glucose absorption were reduced in critical illness, fasting plasma citrulline concentrations were not predictive of subsequent glucose absorption. These data suggest that fasting citrulline concentration does not appear to be a marker of small intestinal absorptive function in patients who are critically ill.
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Affiliation(s)
- Alexis Poole
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Adam Deane
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Matthew Summers
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Janice Fletcher
- Genetics and Molecular Pathology, SA Pathology, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Marianne Chapman
- Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia. .,Discipline of Acute Care Medicine, University of Adelaide, Frome Road, Adelaide, South Australia, 5000, Australia.
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15
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Forteschi M, Sotgia S, Pintus G, Zinellu A, Carru C. Simultaneous determination of citrulline and arginine in human blood plasma by capillary electrophoresis with ultraviolet absorption detection. J Sep Sci 2014; 37:2418-23. [DOI: 10.1002/jssc.201400177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Mauro Forteschi
- Department of Biomedical Sciences; University of Sassari; Italy
| | | | | | - Angelo Zinellu
- Department of Biomedical Sciences; University of Sassari; Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences; University of Sassari; Italy
- Quality Control Unit; Hospital University of Sassari (AOU); Sassari Italy
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Marini JC, Didelija IC, Fiorotto ML. Extrarenal citrulline disposal in mice with impaired renal function. Am J Physiol Renal Physiol 2014; 307:F660-5. [PMID: 25056350 DOI: 10.1152/ajprenal.00289.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The endogenous synthesis of arginine, a semiessential amino acid, relies on the production of citrulline by the gut and its conversion into arginine by the kidney in what has been called the "intestinal-renal axis" for arginine synthesis. Although the kidney is the main site for citrulline disposal, it only accounts for ~60-70% of the citrulline produced. Because the only known fate for citrulline is arginine synthesis and the enzymes that catalyze this reaction are widespread among body tissues, we hypothesized that citrulline can be utilized directly by tissues to meet, at least partially, their arginine needs. To test this hypothesis, we used stable and radioactive tracers in conscious, partially nephrectomized (½ and ⅚) and anesthetized acutely kidney-ligated mouse models. Nephrectomy increased plasma citrulline concentration but did not affect citrulline synthesis rates, thus reducing its clearance. Nephrectomy (⅚) reduced the amount of citrulline accounted for as plasma arginine from 88 to 42%. Acute kidney ligation increased the half-life and mean retention time of citrulline. Whereas the rate of citrulline conversion into plasma arginine was reduced, it was not eliminated. In addition, we observed direct utilization of citrulline for arginine synthesis and further incorporation into tissue protein in kidney-ligated mice. These observations indicate that a fraction of the citrulline produced is utilized directly by multiple tissues to meet their arginine needs and that extrarenal sites contribute to plasma arginine. Furthermore, when the interorgan synthesis of arginine is impaired, these extrarenal sites are able to increase their rate of citrulline utilization.
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Affiliation(s)
- Juan C Marini
- Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Inka C Didelija
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Marta L Fiorotto
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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17
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Sailer M, Dahlhoff C, Giesbertz P, Eidens MK, de Wit N, Rubio-Aliaga I, Boekschoten MV, Müller M, Daniel H. Increased plasma citrulline in mice marks diet-induced obesity and may predict the development of the metabolic syndrome. PLoS One 2013; 8:e63950. [PMID: 23691124 PMCID: PMC3653803 DOI: 10.1371/journal.pone.0063950] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/10/2013] [Indexed: 12/31/2022] Open
Abstract
In humans, plasma amino acid concentrations of branched-chain amino acids (BCAA) and aromatic amino acids (AAA) increase in states of obesity, insulin resistance and diabetes. We here assessed whether these putative biomarkers can also be identified in two different obesity and diabetic mouse models. C57BL/6 mice with diet-induced obesity (DIO) mimic the metabolic impairments of obesity in humans characterized by hyperglycemia, hyperinsulinemia and hepatic triglyceride accumulation. Mice treated with streptozotocin (STZ) to induce insulin deficiency were used as a type 1 diabetes model. Plasma amino acid profiling of two high fat (HF) feeding trials revealed that citrulline and ornithine concentrations are elevated in obese mice, while systemic arginine bioavailability (ratio of plasma arginine to ornithine + citrulline) is reduced. In skeletal muscle, HF feeding induced a reduction of arginine levels while citrulline levels were elevated. However, arginine or citrulline remained unchanged in their key metabolic organs, intestine and kidney. Moreover, the intestinal conversion of labeled arginine to ornithine and citrulline in vitro remained unaffected by HF feeding excluding the intestine as prime site of these alterations. In liver, citrulline is mainly derived from ornithine in the urea cycle and DIO mice displayed reduced hepatic ornithine levels. Since both amino acids share an antiport mechanism for mitochondrial import and export, elevated plasma citrulline may indicate impaired hepatic amino acid handling in DIO mice. In the insulin deficient mice, plasma citrulline and ornithine levels also increased and additionally these animals displayed elevated BCAA and AAA levels like insulin resistant and diabetic patients. Therefore, type 1 diabetic mice but not DIO mice show the “diabetic fingerprint” of plasma amino acid changes observed in humans. Additionally, citrulline may serve as an early indicator of the obesity-dependent metabolic impairments.
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Affiliation(s)
- Manuela Sailer
- Molecular Nutrition Unit, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
| | - Christoph Dahlhoff
- Molecular Nutrition Unit, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
- PhD Graduate School ‘Epigenetics, Imprinting and Nutrition’, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
| | - Pieter Giesbertz
- Molecular Nutrition Unit, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
| | - Mena K. Eidens
- Molecular Nutrition Unit, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
| | - Nicole de Wit
- Netherlands Nutrigenomics Centre, TI Food & Nutrition, Wageningen University, Wageningen, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Isabel Rubio-Aliaga
- Molecular Nutrition Unit, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
| | - Mark V. Boekschoten
- Netherlands Nutrigenomics Centre, TI Food & Nutrition, Wageningen University, Wageningen, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Michael Müller
- Netherlands Nutrigenomics Centre, TI Food & Nutrition, Wageningen University, Wageningen, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Hannelore Daniel
- Molecular Nutrition Unit, Research Center for Nutrition and Food Sciences, Technische Universität München, Freising-Weihenstephan, Germany
- * E-mail:
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Chiarla C, Giovannini I. Citrulline and metabolomics in acute kidney injury. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 913-914:137. [PMID: 23291289 DOI: 10.1016/j.jchromb.2012.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
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Mochida T, Tanaka T, Shiraki Y, Tajiri H, Matsumoto S, Shimbo K, Ando T, Nakamura K, Okamoto M, Endo F. Time-dependent changes in the plasma amino acid concentration in diabetes mellitus. Mol Genet Metab 2011; 103:406-9. [PMID: 21636301 DOI: 10.1016/j.ymgme.2011.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/01/2011] [Accepted: 05/01/2011] [Indexed: 02/07/2023]
Abstract
We investigated longitudinal change in the amino acid (AA) profile in type 1 diabetes mellitus (DM) using AKITA mice, which develop DM as a result of insulin deficiency. The plasma concentrations of valine, leucine, isoleucine, as well as the total branched chain amino acids, alanine, citrulline and proline, were significantly higher in the diabetic mice. We show that the degree and timing of the changes were different among the plasma amino acid concentrations (pAAs) during the development of type 1 DM.
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Affiliation(s)
- Taiga Mochida
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Kumamoto 860-8556, Japan
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Smith PA, Villa V, King GL. Artifacts related to N-methyl-N-(tert-butyldimethylsilyl)trifluoroacetamide derivatization of citrulline revealed by gas chromatography–mass spectrometry using both electron and chemical ionization. J Chromatogr A 2010; 1217:5444-8. [DOI: 10.1016/j.chroma.2010.06.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 11/30/2022]
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Nakakariya M, Shima Y, Shirasaka Y, Mitsuoka K, Nakanishi T, Tamai I. Organic anion transporter OAT1 is involved in renal handling of citrulline. Am J Physiol Renal Physiol 2009; 297:F71-9. [DOI: 10.1152/ajprenal.90662.2008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Because citrulline plasma concentration is elevated in kidney failure, citrulline could be a biomarker of renal insufficiency, although the mechanism regulating its disposition in the kidney has not been clarified. In rat kidney slices, citrulline uptake was apparently Na+ dependent, saturable with Km 556 μM, and significantly inhibited by anionic (PAH) and cationic (TEA) compounds, but not by probenecid at 1 mM. Preincubation of kidney slices with glutarate increased citrulline uptake, while such an increase was not observed after preincubation of the slices in Na+-free buffer. This result suggested that a sodium-dependent dicarboxylate cotransporter is involved in citrulline uptake by rat kidney slices. In studies using transporter-overexpressing cells, human organic anion transporter 1 (OAT1) and rat Oat1 exhibited citrulline transport activity with Km values of 238 and 373 μM, respectively, while other OATs and organic cation transporters (OCTs) did not transport citrulline. Based on the relative activity factor method, the contribution of rat Oat1 to the overall uptake of citrulline in rat kidney slices was ∼70%. Moreover, the interaction among citrulline, PAH, and probenecid uptakes via rat Oat1 suggested that there are multiple functional sites on Oat1 and that the citrulline site may be distinct from the PAH and probenecid site. Thus OAT1/Oat1 appears to be one of the major contributors to renal basolateral uptake of citrulline, and impaired activities of these transporters may contribute substantially to the increase in plasma citrulline in renal failure. Accordingly, citrulline may be useful for diagnosis of kidney function as is creatinine.
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Mitsuoka K, Shirasaka Y, Fukushi A, Sato M, Nakamura T, Nakanishi T, Tamai I. Transport characteristics of L-citrulline in renal apical membrane of proximal tubular cells. Biopharm Drug Dispos 2009; 30:126-37. [DOI: 10.1002/bdd.653] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Rougé C, Des Robert C, Robins A, Le Bacquer O, Volteau C, De La Cochetière MF, Darmaun D. Manipulation of citrulline availability in humans. Am J Physiol Gastrointest Liver Physiol 2007; 293:G1061-7. [PMID: 17901164 DOI: 10.1152/ajpgi.00289.2007] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To determine whether circulating citrulline can be manipulated in vivo in humans, and, if so, whether citrulline availability affects the levels of related amino acids, nitric oxide, urinary citrulline, and urea nitrogen, 10 healthy volunteers were studied on 3 separate days: 1) under baseline conditions; 2) after a 24-h treatment with phenylbutyrate (0.36 g.kg(-1).day(-1)), a glutamine "trapping" agent; and 3) during oral L-citrulline supplementation (0.18 g.kg(-1).day(-1)), in randomized order. Plasma, erythrocyte (RBC), and urinary citrulline concentrations were determined by gas chromatography-mass spectrometry at 3-h intervals between 1100 and 2000 on each study day. Regardless of treatment, RBC citrulline was lower than plasma citrulline, with an RBC-to-plasma ratio of 0.60 +/- 0.04, and urinary citrulline excretion accounted for <1% of the citrulline load filtered by kidney. Phenylbutyrate induced an approximately 7% drop in plasma glutamine (P = 0.013), and 18 +/- 14% (P < 0.0001) and 19 +/- 17% (P < 0.01) declines in plasma and urine citrulline, respectively, with no alteration in RBC citrulline. Oral L-citrulline administration was associated with 1) a rise in plasma, urine, and RBC citrulline (39 +/- 4 vs. 225 +/- 44 micromol/l, 0.9 +/- 0.3 vs. 6.2 +/- 3.8 micromol/mmol creatinine, and 23 +/- 1 vs. 52 +/- 9 micromol/l, respectively); and 2) a doubling in plasma arginine level, without altering blood urea or urinary urea nitrogen excretion, and thus enhanced nitrogen balance. We conclude that 1) depletion of glutamine, the main precursor of citrulline, depletes plasma citrulline; 2) oral citrulline can be used to enhance systemic citrulline and arginine availability, because citrulline is bioavailable and very little citrulline is lost in urine; and 3) further studies are warranted to determine the mechanisms by which citrulline may enhance nitrogen balance in vivo in humans.
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Affiliation(s)
- Carole Rougé
- UMR 1280, Physiologie des Adaptations Nutritionnelles, Centre de Recherche en Nutrition Humaine, Hotel-Dieu Hospital, Nantes Cedex 1, France
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Dose-ranging effects of citrulline administration on plasma amino acids and hormonal patterns in healthy subjects: the Citrudose pharmacokinetic study. Br J Nutr 2007; 99:855-62. [PMID: 17953788 DOI: 10.1017/s0007114507841110] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous experimental studies have highlighted that citrulline (CIT) could be a promising pharmaconutrient. However, its pharmacokinetic characteristics and tolerance to loading have not been studied to date. The objective was to characterise the plasma kinetics of CIT in a multiple-dosing study design and to assess the effect of CIT intake on the concentrations of other plasma amino acids (AA). The effects of CIT loading on anabolic hormones were also determined. Eight fasting healthy males underwent four separate oral loading tests (2, 5, 10 or 15 g CIT) in random order. Blood was drawn ten times over an 8 h period for measurement of plasma AA, insulin and growth hormone (Gh). Urine samples were collected before CIT administration and over the next 24 h. None of the subjects experienced side effects whatever the CIT dose. Concerning AA, only CIT, ornithine (ORN) and arginine (ARG) plasma concentrations were affected (maximum concentration 146 (sem 8) to 303 (sem 11) micromol/l (ARG) and 81 (sem 4) to 179 (sem 10) micromol/l (ORN); time to reach maximum concentration 1.17 (sem 0.26) to 2.29 (sem 0.20) h (ARG) and 1.38 (sem 0.25) to 1.79 (sem 0.11) h (ORN) according to CIT dose). Even at high doses, urinary excretion of CIT remained low ( < 5 %). Plasma insulin and Gh were not affected by CIT administration. Short-term CIT administration is safe and well-tolerated. CIT is a potent precursor of ARG. However, at the highest doses, CIT accumulated in plasma while plasma ARG levels increased less than expected. This may be due to saturation of the renal conversion of CIT into ARG.
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Lutgens L, Lambin P. Biomarkers for radiation-induced small bowel epithelial damage: An emerging role for plasma Citrulline. World J Gastroenterol 2007; 13:3033-42. [PMID: 17589917 PMCID: PMC4172608 DOI: 10.3748/wjg.v13.i22.3033] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Reduction of cancer treatment-induced mucosal injury has been recognized as an important target for improving the therapeutic ratio as well as reducing the economic burden associated with these treatment related sequellae. Clinical studies addressing this issue are hampered by the fact that specific objective parameters, which enable monitoring of damage in routine clinical practice, are lacking. This review summarizes pros and cons of currently available endpoints for intestinal injury. The metabolic background and characteristics of plasma citrulline, a recently investigated biomarker specifically for small intestinal injury, are discussed in more detail.
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Affiliation(s)
- Ludy Lutgens
- Department of Radiation Oncology (Maastro), GROW Research Institute, University of Maastricht, Tanslaan 12, 6202 AZ Maastricht, The Netherlands.
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Abstract
Citrulline (CIT) is an amino acid that is not involved in protein synthesis but that is tightly linked to arginine (ARG) metabolism. CIT displays a very specific metabolism: In the 1980s, Windmuller demonstrated that the small intestine releases CIT, which is mainly taken up by the kidney and metabolized into ARG. Because CIT is not taken up by the liver, this ARG-CIT-ARG cycle can be seen as a means of protecting dietary ARG from liver degradation and of sustaining protein homeostasis. These observations have led to the concept that plasma CIT concentration would be a good marker of intestinal failure in short bowel syndrome. Hence, in massive intestinal resection, citrullinemia is greatly reduced, and this is proportional to the severity of the intestinal disease. This concept was then extended to other situations in which the intestinal function is compromised. The data strongly suggest that CIT may be a conditionally essential amino acid in situations where the intestinal function is compromised. Recent data support this idea. Thus, CIT supplementation is able to restore nitrogen balance, generate large amounts of ARG in rats with short bowel syndrome, and increase muscle protein content (+20%) as well as muscle protein synthesis (+90%) in elderly malnourished rats. Finally, recent data indicate that CIT per se could be able to stimulate muscle protein synthesis. Hence, CIT could play a pivotal role in maintaining protein homeostasis, and the determination of the underlying mechanisms involved in its action should be important for the development of new nutritional strategies in malnourished patients with compromised intestinal functions.
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Affiliation(s)
- Christophe Moinard
- Laboratoire de Biologie de la Nutrition, EA 2498, Faculté de Pharmacie, Université Paris Descartes, and Laboratoire Biochimie, Hôtel-Dieu, AP-HP, Paris 75004, France.
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Curis E, Nicolis I, Moinard C, Osowska S, Zerrouk N, Bénazeth S, Cynober L. Almost all about citrulline in mammals. Amino Acids 2005; 29:177-205. [PMID: 16082501 DOI: 10.1007/s00726-005-0235-4] [Citation(s) in RCA: 368] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Accepted: 06/04/2005] [Indexed: 01/05/2023]
Abstract
Citrulline (Cit, C6H13N3O3), which is a ubiquitous amino acid in mammals, is strongly related to arginine. Citrulline metabolism in mammals is divided into two fields: free citrulline and citrullinated proteins. Free citrulline metabolism involves three key enzymes: NO synthase (NOS) and ornithine carbamoyltransferase (OCT) which produce citrulline, and argininosuccinate synthetase (ASS) that converts it into argininosuccinate. The tissue distribution of these enzymes distinguishes three "orthogonal" metabolic pathways for citrulline. Firstly, in the liver, citrulline is locally synthesized by OCT and metabolized by ASS for urea production. Secondly, in most of the tissues producing NO, citrulline is recycled into arginine via ASS to increase arginine availability for NO production. Thirdly, citrulline is synthesized in the gut from glutamine (with OCT), released into the blood and converted back into arginine in the kidneys (by ASS); in this pathway, circulating citrulline is in fact a masked form of arginine to avoid liver captation. Each of these pathways has related pathologies and, even more interestingly, citrulline could potentially be used to monitor or treat some of these pathologies. Citrulline has long been administered in the treatment of inherited urea cycle disorders, and recent studies suggest that citrulline may be used to control the production of NO. Recently, citrulline was demonstrated as a potentially useful marker of short bowel function in a wide range of pathologies. One of the most promising research directions deals with the administration of citrulline as a more efficient alternative to arginine, especially against underlying splanchnic sequestration of amino acids. Protein citrullination results from post-translational modification of arginine; that occurs mainly in keratinization-related proteins and myelins, and insufficiencies in this citrullination occur in some auto-immune diseases such as rheumatoid arthritis, psoriasis or multiple sclerosis.
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Affiliation(s)
- E Curis
- Laboratoire de Biomathématiques, E.A. 2498, Faculté de Pharmacie, Université René Descartes, Paris, France.
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Héliès-Toussaint C, Moinard C, Rasmusen C, Tabbi-Anneni I, Cynober L, Grynberg A. Aortic banding in rat as a model to investigate malnutrition associated with heart failure. Am J Physiol Regul Integr Comp Physiol 2005; 288:R1325-31. [PMID: 15637166 DOI: 10.1152/ajpregu.00320.2004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Heart failure is a severe pathology, which has displayed a dramatic increase in the occurrence of patients with chronic heart disease in developed countries, as a result of increases in the population's average age and in survival time. This pathology is associated with severe malnutrition, which worsens the prognosis. Although the cachexia associated with chronic heart failure is a well-known complication, there is no reference animal model of malnutrition related to heart failure. This study was designed to evaluate the nutritional status of rats in a model of loss of cardiac function obtained by ascending aortic banding. Cardiac overload led to the development of cardiac hypertrophy, which decompensates to heart failure, with increased brain natriuretic peptide levels. The rats displayed hepatic dysfunction and an associated renal hypotrophy and renal failure, evidenced by the alteration in renal function markers such as citrullinemia, creatininemia, and uremia. Malnutrition has been evidenced by the alteration of protein and amino acid metabolism. A muscular atrophy with decreased protein content and increased amino acid concentrations in both plasma and muscle was observed. These rats with heart failure displayed a multiorgan failure and malnutrition, which reflected the clinical situation of human chronic heart failure.
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Affiliation(s)
- Cécile Héliès-Toussaint
- INRA UR 1154 LMFC, Faculté de pharmacie, 5, rue J. B. Clément, F-92290 Châtenay Malabry France.
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Moinard C, Neveux N, Royo N, Genthon C, Marchand-Verrecchia C, Plotkine M, Cynober L. Characterization of the alteration of nutritional state in brain injury induced by fluid percussion in rats. Intensive Care Med 2004; 31:281-8. [PMID: 15703899 DOI: 10.1007/s00134-004-2489-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 10/06/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Patients suffering from traumatic brain injury (TBI) undergo rapid weight loss with negative nitrogen balance and enhanced whole-body protein breakdown, with protein wasting causing morbidity and increased mortality. Many experimental models of TBI have been used to evaluate strategies to improve the outcome of these patients, but nutritional status has not been considered in experiments published to date, although this may have great importance and influence the results obtained with TBI models. This study characterized the hypercatabolism level and nutritional status of TBI rats. DESIGN Twenty-four male Wistar rats were randomized into three groups. Rats from the TBI group were anesthetized and fluid percussion was applied. The pair-fed (PF) group was healthy but was pair-fed to the TBI group. The ad libitum (AL) group was healthy and fed ad libitum. The study was performed over 10 days post-TBI. MEASUREMENTS AND RESULTS TBI in rats was characterized by remarkable long-lasting anorexia, renal failure (creatinine clearance: AL 1.8+/-0.2 and PF 1.5+/-0.1 vs. TBI 0.9+/-0.1 l/24 hour), anorexia (appetite depressed throughout the study), increased myofibrillar proteolysis (3-methylhistidine/creatinine ratio (day 2: AL 36+/-1 and PF 38+/-2 vs. TBI 54+/-5 micromol/mmol), and intestinal atrophy (ileum: AL 29.3+/-2.5 and PF 28.7+/-1.1 vs. TBI 22.5+/-1.4 mg/cm). In addition, anorexia led to muscular atrophy and decreased nitrogen balance. The metabolic alterations described above can increase morbidity and mortality. CONCLUSIONS TBI by fluid percussion in rats is a model reproducing the metabolic and nutritional alterations observed in clinical practice and is suitable for further studies exploring the efficacy of optimized nutritional support.
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Affiliation(s)
- Christophe Moinard
- Laboratoire de Biologie de la Nutrition EA 2498, Faculté de Pharmacie, 4 avenue de l'Observatoire, 75270 Paris Cedex 06, France.
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31
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Owen W, Young VR, Ajami A, Castillo L. Authors' reply:. Am J Kidney Dis 2002. [DOI: 10.1053/ajkd.2002.29917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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