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Yang Y, Zhou T, Zhao X, Cai Y, Xu Y, Gang X, Wang G. Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review. Medicine (Baltimore) 2024; 103:e37916. [PMID: 38669419 PMCID: PMC11049756 DOI: 10.1097/md.0000000000037916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with diverse clinical presentations. Alterations in energy expenditure state are commonly observed in patients with PPGL. However, the reported prevalence of hypermetabolism varies significantly and the underlying mechanisms and implications of this presentation have not been well elucidated. This review discusses and analyzes the factors that contribute to energy consumption. Elevated catecholamine levels in patients can significantly affect substance and energy metabolism. Additionally, changes in the activation of brown adipose tissue (BAT), inflammation, and the inherent energy demands of the tumor can contribute to increased resting energy expenditure (REE) and other energy metabolism indicators. The PPGL biomarker, chromogranin A (CgA), and its fragments also influence energy metabolism. Chronic hypermetabolic states may be detrimental to these patients, with surgical tumor removal remaining the primary therapeutic intervention. The high energy expenditure of PPGL has not received the attention it deserves, and an accurate assessment of energy metabolism is the cornerstone for an adequate understanding and treatment of the disease.
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Affiliation(s)
- Yuqi Yang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Tong Zhou
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yunjia Cai
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yao Xu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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Saner FH, Raptis DA, Alghamdi SA, Malagó MM, Broering DC, Bezinover D. Navigating the Labyrinth: Intensive Care Challenges for Patients with Acute-on-Chronic Liver Failure. J Clin Med 2024; 13:506. [PMID: 38256640 PMCID: PMC10816826 DOI: 10.3390/jcm13020506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Acute-on-chronic liver failure (ACLF) refers to the deterioration of liver function in individuals who already have chronic liver disease. In the setting of ACLF, liver damage leads to the failure of other organs and is associated with increased short-term mortality. Optimal medical management of patients with ACLF requires implementing complex treatment strategies, often in an intensive care unit (ICU). Failure of organs other than the liver distinguishes ACLF from other critical illnesses. Although there is growing evidence supporting the current approach to ACLF management, the mortality associated with this condition remains unacceptably high. In this review, we discuss considerations for ICU care of patients with ACLF and highlight areas for further research.
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Affiliation(s)
- Fuat H. Saner
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Dimitri A. Raptis
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Saad A. Alghamdi
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Massimo M. Malagó
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Dieter C. Broering
- Organ Transplant Center of Excellence, King Faisal Specialized Hospital & Research Center, Riyadh 12111, Saudi Arabia; (D.A.R.); (S.A.A.); (M.M.M.); (D.C.B.)
| | - Dmitri Bezinover
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA;
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Beske RP, Obling LER, Bro-Jeppesen J, Nielsen N, Meyer MAS, Kjaergaard J, Johansson PI, Hassager C. The Effect of Targeted Temperature Management on the Metabolome Following Out-of-Hospital Cardiac Arrest. Ther Hypothermia Temp Manag 2023; 13:208-215. [PMID: 37219970 DOI: 10.1089/ther.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Targeted temperature management (TTM) may moderate the injury from out-of-hospital cardiac arrest. Slowing the metabolism has been a suggested effect. Nevertheless, studies have found higher lactate levels in patients cooled to 33°C compared with 36°C even days from TTM cessation. Larger studies have not been performed on the TTM's effect on the metabolome. Accordingly, to explore the effect of TTM, we used ultra-performance liquid-mass spectrometry in a substudy of 146 patients randomized in the TTM trial to either 33°C or 36°C for 24 hours and quantified 60 circulating metabolites at the time of hospital arrival (T0) and 48 hours later (T48). From T0 to T48, profound changes to the metabolome were observed: tricarboxylic acid (TCA) cycle metabolites, amino acids, uric acid, and carnitine species all decreased. TTM significantly modified these changes in nine metabolites (Benjamini-Hochberg corrected false discovery rate <0.05): branched amino acids valine and leucine levels dropped more in the 33°C arm (change [95% confidence interval]: -60.9 μM [-70.8 to -50.9] vs. -36.0 μM [-45.8 to -26.3] and -35.5 μM [-43.1 to -27.8] vs. -21.2 μM [-28.7 to -13.6], respectively), whereas the TCA metabolites including malic acid and 2-oxoglutaric acid remained higher for the first 48 hours (-7.7 μM [-9.7 to -5.7] vs. -10.4 μM [-12.4 to -8.4] and -3 μM [-4.3 to -1.7] vs. -3.7 μM [-5 to -2.3]). Prostaglandin E2 only dropped in the TTM 36°C group. The results show that TTM affects the metabolism hours after normothermia have been reached. Clinical Trial Number: NCT01020916.
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Affiliation(s)
- Rasmus Paulin Beske
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niklas Nielsen
- Department of Clinical Sciences at Helsingborg, Lund University, Lund, Sweden
| | | | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Pär Ingemar Johansson
- Department of Clinical Immunology, Center for Endotheliomics, CAG, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ni N, Yang LP, Lin X, Hong YL, Shen L. Studies on the mechanism of energy metabolism via AMPK/PGC-1α signaling pathway induced by compatibility of Ligusticum chuanxiong Hort and Gastrodia. Phytother Res 2022. [PMID: 36250265 DOI: 10.1002/ptr.7623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/25/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022]
Abstract
AMP-activated protein kinase (AMPK) regulates overall energy consumption and energy intake through cytokines. Ligusticum striatum DC (CX) combined with Gastrodia elata Blume (TM) has been used for migraine treatment for millennia. When used alone in clinical practice, CX causes symptoms of thirst, irritability, and yellow urine and has influenced the levels of cytokines such as AMP that activate the AMPK pathway of energy metabolism. However, relationships between this compatibility prescription, integral biological energy metabolism, and the AMPK pathway remain unclear. Studies were performed by treating normal rats with physiological saline, CX extract, CX coupled TM extract, and TM extracts separately for 4 weeks. Food intake, water intake, urine output, stool output, and body weight were monitored once a week by the metabolic cage method. Values of FBG, BUN, TP, TC and TG in blood samples were detected approaching the whole blood automatic detector from 1 to 4 weeks. Na+ -K+ -ATPase, Ca2+ -Mg2+ -ATPase, cAMP, and cGMP activity were determined by the enzyme-linked immunosorbent assay (ELISA); the biological samples that were obtained at 1, 2, 3, and 4 weeks after drug administration were tested by GC-TOF-MS. Then real-time PCR and Western Blot were applied to detect changes in expression of some substances involved in energy metabolism. The results demonstrated that administering CX alone increased energy input, mobility, and respiratory exchange ratio, accelerated energy consumption, and caused inflammatory infiltration in the liver. CX coupled with TM led to lower energy metabolism and liver damage in comparison with CX used alone. Moreover, CX-treated rats harbored higher levels of differential metabolites (including pyrophosphate, oxaloacetic acid, and galactinol). Glycerophospholipid metabolism and the citrate cycle are closely related to the differential metabolites above. In addition, CX-induced unbalanced energy metabolism depends on cAMP activation mediated by the AMPK/PGC-1α pathway in rats. Our findings suggest that CX-induced energy metabolism imbalance was corrected after coupling with TM by mediating the AMPK/PGC-1α pathway.
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Affiliation(s)
- Ni Ni
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu-Ping Yang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Lin
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Long Hong
- Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lan Shen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Wepler M, Preuss JM, Tilp C, Keck M, Blender J, Wachter U, Merz T, Vogt J, Kress S, Gröger M, Hoffmann A, Fink M, Calzia E, Burret U, Radermacher P, Tuckermann JP, Vettorazzi S. Cigarette smoke exposure reduces hemorrhagic shock induced circulatory dysfunction in mice with attenuated glucocorticoid receptor function. Front Immunol 2022; 13:980707. [PMID: 36172380 PMCID: PMC9510589 DOI: 10.3389/fimmu.2022.980707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionWe previously showed that attenuated glucocorticoid receptor (GR) function in mice (GRdim/dim) aggravates systemic hypotension and impairs organ function during endotoxic shock. Hemorrhagic shock (HS) causes impaired organ perfusion, which leads to tissue hypoxia and inflammation with risk of organ failure. Lung co-morbidities like chronic obstructive pulmonary disease (COPD) can aggravate tissue hypoxia via alveolar hypoxia. The most common cause for COPD is cigarette smoke (CS) exposure. Therefore, we hypothesized that affecting GR function in mice (GRdim/dim) and pre-traumatic CS exposure would further impair hemodynamic stability and organ function after HS.MethodsAfter 3 weeks of CS exposure, anesthetized and mechanically ventilated GRdim/dim and GR+/+ mice underwent pressure-controlled HS for 1h via blood withdrawal (mean arterial pressure (MAP) 35mmHg), followed by 4h of resuscitation with re-transfusion of shed blood, colloid fluid infusion and, if necessary, continuous intravenous norepinephrine. Acid–base status and organ function were assessed together with metabolic pathways. Blood and organs were collected at the end of the experiment for analysis of cytokines, corticosterone level, and mitochondrial respiratory capacity. Data is presented as median and interquartile range.ResultsNor CS exposure neither attenuated GR function affected survival. Non-CS GRdim/dim mice had a higher need of norepinephrine to keep target hemodynamics compared to GR+/+ mice. In contrast, after CS exposure norepinephrine need did not differ significantly between GRdim/dim and GR+/+ mice. Non-CS GRdim/dim mice presented with a lower pH and increased blood lactate levels compared to GR+/+ mice, but not CS exposed mice. Also, higher plasma concentrations of some pro-inflammatory cytokines were observed in non-CS GRdim/dim compared to GR+/+ mice, but not in the CS group. With regards to metabolic measurements, CS exposure led to an increased lipolysis in GRdim/dim compared to GR+/+ mice, but not in non-CS exposed animals.ConclusionWhether less metabolic acidosis or increased lipolysis is the reason or the consequence for the trend towards lower catecholamine need in CS exposed GRdim/dim mice warrants further investigation.
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Affiliation(s)
- Martin Wepler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Ulm, Germany
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
- *Correspondence: Martin Wepler, ; Sabine Vettorazzi,
| | - Jonathan M. Preuss
- Institute of Comparative Molecular Endocrinology (CME), Ulm University, Ulm, Germany
| | - Cornelia Tilp
- Immunology and Respiratory, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Martina Keck
- Immunology and Respiratory, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Jochen Blender
- Immunology and Respiratory, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Ulrich Wachter
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Tamara Merz
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Josef Vogt
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Sandra Kress
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Michael Gröger
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Andrea Hoffmann
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Marina Fink
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Enrico Calzia
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Ute Burret
- Institute of Comparative Molecular Endocrinology (CME), Ulm University, Ulm, Germany
| | - Peter Radermacher
- Institute for Anesthesiologic Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | - Jan P. Tuckermann
- Institute of Comparative Molecular Endocrinology (CME), Ulm University, Ulm, Germany
| | - Sabine Vettorazzi
- Institute of Comparative Molecular Endocrinology (CME), Ulm University, Ulm, Germany
- *Correspondence: Martin Wepler, ; Sabine Vettorazzi,
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Hypermetabolism and Substrate Utilization Rates in Pheochromocytoma and Functional Paraganglioma. Biomedicines 2022; 10:biomedicines10081980. [PMID: 36009527 PMCID: PMC9406117 DOI: 10.3390/biomedicines10081980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
The overproduction of catecholamines in pheochromocytoma/paraganglioma (PPGL) induces a hypermetabolic state. The aim of this study was to evaluate the incidence of a hypermetabolic state and differences in substrate metabolism in consecutive PPGL patients divided by catecholamine phenotype. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured in 108 consecutive PPGL patients and 70 controls by indirect calorimetry. Hypermetabolic state was defined according to the Mifflin St. Jeor Equation as a ratio above 110%. Hypermetabolic state was confirmed in 70% of PPGL patients, regardless of phenotype. Older age, prevalence of diabetes mellitus and arterial hypertension were correlated with hypermetabolic PPGL as compared to normometabolic form. Analysis according to overproduced catecholamine showed differences in VCO2 (p < 0.05) and RQ (p < 0.01) and thus different substate metabolism between phenotypes in hypermetabolic form of PPGL. Lipid utilization was higher in the adrenergic phenotype (p = 0.001) and positively associated with the percentage of REE ratio (R = 0.48, p < 0.001), whereas the noradrenergic phenotype preferentially oxidizes carbohydrates (P = 0.001) and is correlated with the percentage of REE ratio (R = 0.60, p < 0.001). Hypermetabolic state in PPGL is a common finding in both catecholamine phenotypes. Hypermetabolic PPGL patients are older and suffer more from diabetes mellitus and arterial hypertension. Under basal conditions, the noradrenergic type preferentially metabolizes carbohydrates, whereas the adrenergic phenotype preferentially metabolizes lipids.
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Thomsen HH, Olesen JF, Aagaard R, Nielsen BRR, Voss TS, Svart MV, Johannsen M, Jessen N, Jørgensen JOL, Rittig N, Bach E, Møller N. Investigating effects of sodium beta-hydroxybutyrate on metabolism in placebo-controlled, bilaterally infused human leg with focus on skeletal muscle protein dynamics. Physiol Rep 2022; 10:e15399. [PMID: 35986508 PMCID: PMC9391664 DOI: 10.14814/phy2.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023] Open
Abstract
Systemic administration of beta-hydroxybutyrate (BHB) decreases whole-body protein oxidation and muscle protein breakdown in humans. We aimed to determine any direct effect of BHB on skeletal muscle protein turnover when administered locally in the femoral artery. Paired design with each subject being investigated on one single occasion with one leg being infused with BHB and the opposing leg acting as a control. We studied 10 healthy male volunteers once with bilateral femoral vein and artery catheters. One artery was perfused with saline (Placebo) and one with sodium-BHB. Labelled phenylalanine and palmitate were used to assess local leg fluxes. Femoral vein concentrations of BHB were significantly higher in the intervention leg (3.4 (3.2, 3.6) mM) compared with the placebo-controlled leg (1.9 (1.8, 2.1) mM) with a peak difference of 1.4 (1.1, 1.7) mM, p < 0.0005. Net loss of phenylalanine for BHB vs Placebo -6.7(-10.8, -2.7) nmol/min vs -8.7(-13.8, -3.7) nmol/min, p = 0.52. Palmitate flux and arterio-venous difference of glucose did not differ between legs. Under these experimental conditions, we failed to observe the direct effects of BHB on skeletal muscle protein turnover. This may relate to a combination of high concentrations of BHB (close to 2 mM) imposed systemically by spillover leading to high BHB concentrations in the saline-infused leg and a lack of major differences in concentration gradients between the two sides-implying that observations were made on the upper part of the dose-response curve for BHB and the relatively small number of subjects studied.
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Affiliation(s)
- Henrik Holm Thomsen
- Department of Internal Medicine, Clinic for Diabetes and EndocrinologyViborg Regional HospitalViborgDenmark
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
- Research Unit for MultimorbidityViborg Regional HospitalViborgDenmark
| | - Jonas Franck Olesen
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
| | - Rasmus Aagaard
- Department of AnesthesiologyRanders Regional HospitalRandersDenmark
| | | | | | - Mads Vandsted Svart
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Mogens Johannsen
- Department of Forensic Medicine, Bioanalytical UnitAarhus UniversityAarhusDenmark
| | - Niels Jessen
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Department of BiomedicineAarhus UniversityAarhusDenmark
| | - Jens Otto L. Jørgensen
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
| | - Nikolaj Rittig
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Ermina Bach
- Department of Internal Medicine, Clinic for Diabetes and EndocrinologyViborg Regional HospitalViborgDenmark
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Niels Møller
- Department of Internal Medicine and EndocrinologyAarhus University HospitalAarhusDenmark
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
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Hyppönen V, Stenroos P, Nivajärvi R, Ardenkjaer-Larsen JH, Gröhn O, Paasonen J, Kettunen MI. Metabolism of hyperpolarised [1- 13 C]pyruvate in awake and anaesthetised rat brains. NMR IN BIOMEDICINE 2022; 35:e4635. [PMID: 34672399 DOI: 10.1002/nbm.4635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
The use of hyperpolarised 13 C pyruvate for nononcological neurological applications has not been widespread so far, possibly due to delivery issues limiting the visibility of metabolites. First proof-of-concept results have indicated that metabolism can be detected in human brain, and this may supersede the results obtained in preclinical settings. One major difference between the experimental setups is that preclinical MRI/MRS routinely uses anaesthesia, which alters both haemodynamics and metabolism. Here, we used hyperpolarised [1-13 C]pyruvate to compare brain metabolism in awake rats and under isoflurane, urethane or medetomidine anaesthesia. Spectroscopic [1-13 C]pyruvate time courses measured sequentially showed that pyruvate-to-bicarbonate and pyruvate-to-lactate labelling rates were lower in isoflurane animals than awake animals. An increased bicarbonate-to-lactate ratio was observed in the medetomidine group compared with other groups. The study shows that hyperpolarised [1-13 C]pyruvate experiments can be performed in awake rats, thus avoiding anaesthesia-related issues. The results suggest that haemodynamics probably dominate the observed pyruvate-to-metabolite labelling rates and area-under-time course ratios of referenced to pyruvate. On the other hand, the results obtained with medetomidine suggest that the ratios are also modulated by the underlying cerebral metabolism. However, the ratios between intracellular metabolites were unchanged in awake compared with isoflurane-anaesthetised rats.
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Affiliation(s)
- Viivi Hyppönen
- Kuopio Biomedical Imaging Unit, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Petteri Stenroos
- Kuopio Biomedical Imaging Unit, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riikka Nivajärvi
- Kuopio Biomedical Imaging Unit, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jan Henrik Ardenkjaer-Larsen
- Center for Hyperpolarization in Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Olli Gröhn
- Kuopio Biomedical Imaging Unit, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Paasonen
- Kuopio Biomedical Imaging Unit, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mikko I Kettunen
- Kuopio Biomedical Imaging Unit, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
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Bengtsen MB, Hansen ESS, Tougaard RS, Lyhne MD, Rittig NF, Støy J, Jessen N, Mariager CØ, Stødkilde-Jørgensen H, Møller N, Laustsen C. Hyperpolarized [1- 13 C]pyruvate combined with the hyperinsulinaemic euglycaemic and hypoglycaemic clamp technique in skeletal muscle in a large animal model. Exp Physiol 2021; 106:2412-2422. [PMID: 34705304 PMCID: PMC9298727 DOI: 10.1113/ep089782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022]
Abstract
New Findings What is the central question of this study? Is it possible to combine the hyperpolarized magnetic resonance technique and the hyperinsulinaemic clamp method in order to evaluate skeletal muscle metabolism in a large animal model? What is the main finding and its importance? The logistical set‐up is possible, and we found substantial increments in glucose infusion rates representing skeletal muscle glucose uptake but no differences in ratios of [1‐13C]lactate to [1‐13C]pyruvate, [1‐13C]alanine to [1‐13C]pyruvate, and 13C‐bicarbonate to [1‐13C]pyruvate, implying that the hyperpolarization technique might not be optimal for detecting effects of insulin in skeletal muscle of anaesthetized animals, which is of significance for future studies.
Abstract In skeletal muscle, glucose metabolism is tightly regulated by the reciprocal relationship between insulin and adrenaline, with pyruvate being at the intersection of both pathways. Hyperpolarized magnetic resonance (hMR) is a new approach to gain insights into these pathways, and human trials involving hMR and skeletal muscle metabolism are imminent. We aimed to combine the hyperinsulinaemic clamp technique and hMR in a large animal model resembling human physiology. Fifteen anaesthetized pigs were randomized to saline (control group), hyperinsulinaemic euglycaemic clamp technique (HE group) or hyperinsulinaemic hypoglycaemic clamp technique (HH group). Skeletal muscle metabolism was evaluated by hyperpolarized [1‐13C]pyruvate injection and hMR at baseline and after intervention. The glucose infusion rate per kilogram increased by a statistically significant amount in the HE and HH groups (P < 0.001). Hyperpolarized magnetic resonance showed no statistically significant changes in metabolite ratios: [1‐13C]lactate to [1‐13C]pyruvate in the HH group versus control group (P = 0.19); and 13C‐bicarbonate to [1‐13C]pyruvate ratio in the HE group versus the control group (P = 0.12). We found evidence of profound increments in glucose infusion rates representing skeletal muscle glucose uptake, but interestingly, no signs of significant changes in aerobic and anaerobic metabolism using hMR. These results imply that hyperpolarized [1‐13C]pyruvate might not be optimally suited to detect effects of insulin in anaesthetized resting skeletal muscle, which is of significance for future studies.
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Affiliation(s)
- Mads Bisgaard Bengtsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Mads Dam Lyhne
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Nikolaj Fibiger Rittig
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Julie Støy
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Jessen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Niels Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Bernal W, Karvellas C, Saliba F, Saner FH, Meersseman P. Intensive care management of acute-on-chronic liver failure. J Hepatol 2021; 75 Suppl 1:S163-S177. [PMID: 34039487 DOI: 10.1016/j.jhep.2020.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
The syndrome of acute-on-chronic liver failure combines deterioration of liver function in a patient with chronic liver disease, with the development of extrahepatic organ failure and high short-term mortality. Its successful management demands a rapid and coherent response to the development of dysfunction and failure of multiple organ systems in an intensive care unit setting. This response recognises the features that distinguish it from other critical illness and addresses the complex interplay between the precipitating insult, the many organ systems involved and the disordered physiology of underlying chronic liver disease. An evidence base is building to support the approaches currently adopted and outcomes for patients with this condition are improving, but mortality remains unacceptably high. Herein, we review practical considerations in critical care management, as well as discussing key knowledge gaps and areas of controversy that require further focussed research.
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Affiliation(s)
- William Bernal
- Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
| | - Constantine Karvellas
- Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, Alberta T6G-2X8, Canada
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris SACLAY, INSERM Unit 1193, Villejuif, France
| | - Fuat H Saner
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie Universitätsklinikum Essen Hufelandstr. 55 45 147, Essen, Germany
| | - Philippe Meersseman
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
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11
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Jeffries O, Hill J, Patterson SD, Waldron M. Energy Drink Doses of Caffeine and Taurine Have a Null or Negative Effect on Sprint Performance. J Strength Cond Res 2021; 34:3475-3481. [PMID: 29065052 DOI: 10.1519/jsc.0000000000002299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Jeffries, O, Hill, J, Patterson, SD, and Waldron, M. Energy drink doses of caffeine and taurine have a null or negative effect on sprint performance. J Strength Cond Res 34(12): 3475-3481, 2020-This study investigated the effects of caffeine and taurine coingestion on repeat-sprint cycling performance and associated physiological and perceptual responses. In a double-blind, cross-over, repeated measures study, 11 male subjects (age 21 ± 2 years; stature 178 ± 7 cm; body mass 80 ± 13 kg) completed 10 × 6-second sprints on a cycle ergometer, each separated by 24 seconds, one hour after ingesting: caffeine (80 mg) and taurine (1 g), equivalent to the amount observed in popular commercial energy drinks, or placebo (maltodextrin ∼1 g) in a gelatine capsule. Performance was measured on a cycle ergometer, whereas blood lactate concentration (B[la]), rating of perceived exertion (RPE), and heart rate (HR) were measured at baseline (pre-exercise) and after sprints 5 and 10. Magnitude-based inferences revealed likely, trivial differences in peak power and unclear, trivial intersprint fatigue index after ingestion of the caffeine and taurine supplement. Intrasprint fatigue was greater in the caffeine and taurine condition at sprint 10 (likely, small) and possibly smaller in sprints 6-9. The caffeine and taurine supplement had a likely large effect on HR at baseline (effect size = 0.94) and increases in B[la] after sprints 5 (likely small) and 10 (possibly small). There was no effect of the supplement on RPE (unclear, trivial). Administration of caffeine and taurine at doses equivalent to commercial energy drinks did not improve repeat-sprint cycling performance and seemed to induce greater fatigue within selected sprints, particularly at the end of the trial. This undesirable performance effect occurs in parallel with increased HR and glycolytic metabolic bi-products.
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Affiliation(s)
- Owen Jeffries
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, United Kingdom; and
| | - Jessica Hill
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, United Kingdom; and
| | - Stephen D Patterson
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, United Kingdom; and
| | - Mark Waldron
- School of Sport, Health and Applied Science, St Mary's University, Twickenham, United Kingdom; and.,School of Science and Technology, University of New England, Armidale, New South Wales, Australia
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12
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Bengtsen MB, Støy J, Rittig NF, Voss TS, Magnusson NE, Svart MV, Jessen N, Møller N. A Human Randomized Controlled Trial Comparing Metabolic Responses to Single and Repeated Hypoglycemia in Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:5905590. [PMID: 32927476 DOI: 10.1210/clinem/dgaa645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
AIMS Hypoglycemia hinders optimal glycemic management in type 1 diabetes (T1D). Long diabetes duration and hypoglycemia impair hormonal counter-regulatory responses to hypoglycemia. Our study was designed to test whether (1) the metabolic responses and insulin sensitivity are impaired, and (2) whether they are affected by short-lived antecedent hypoglycemia in participants with T1D. MATERIALS AND METHODS In a randomized, crossover, 2x2 factorial design, 9 male participants with T1D and 9 comparable control participants underwent 30 minutes of hypoglycemia (p-glucose < 2.9 mmol/L) followed by a euglycemic clamp on 2 separate interventions: with and without 30 minutes of hypoglycemia the day before the study day. RESULTS During both interventions insulin sensitivity was consistently lower, while counter-regulatory hormones were reduced, with 75% lower glucagon and 50% lower epinephrine during hypoglycemia in participants with T1D, who also displayed 40% lower lactate and 5- to 10-fold increased ketone body concentrations following hypoglycemia, whereas palmitate and glucose turnover, forearm glucose uptake, and substrate oxidation did not differ between the groups. In participants with T1D, adipose tissue phosphatase and tensin homolog (PTEN) content, hormone-sensitive lipase (HSL) phosphorylation, and muscle glucose transporter type 4 (GLUT4) content were decreased compared with controls. And antecedent hypoglycemic episodes lasting 30 minutes did not affect counter-regulation or insulin sensitivity. CONCLUSIONS Participants with T1D displayed insulin resistance and impaired hormonal counter-regulation during hypoglycemia, whereas glucose and fatty acid fluxes were intact and ketogenic responses were amplified. We observed subtle alterations of intracellular signaling and no effect of short-lived antecedent hypoglycemia on subsequent counter-regulation. This plausibly reflects the presence of insulin resistance and implies that T1D is a condition with defective hormonal but preserved metabolic responsiveness to short-lived hypoglycemia.
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Affiliation(s)
- Mads Bisgaard Bengtsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Julie Støy
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | | | | | - Nils Erik Magnusson
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Mads Vadsted Svart
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Jessen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Møller
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
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13
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Kim IY, Park S, Jang J, Wolfe RR. Quantifications of Lipid Kinetics In Vivo Using Stable Isotope Tracer Methodology. J Lipid Atheroscler 2020; 9:110-123. [PMID: 32821725 PMCID: PMC7379070 DOI: 10.12997/jla.2020.9.1.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/19/2019] [Accepted: 12/29/2019] [Indexed: 12/16/2022] Open
Abstract
Like other bodily materials, lipids such as plasma triacylglycerol, cholesterols, and free fatty acids are in a dynamic state of constant turnover (i.e., synthesis, breakdown, oxidation, and/or conversion to other compounds) as essential processes for achieving dynamic homeostasis in the body. However, dysregulation of lipid turnover can lead to clinical conditions such as obesity, fatty liver disease, and dyslipidemia. Assessment of “snap-shot” information on lipid metabolism (e.g., tissue contents of lipids, abundance of mRNA and protein and/or signaling molecules) are often used in clinical and research settings, and can help to understand one's health and disease status. However, such “snapshots” do not provide critical information on dynamic nature of lipid metabolism, and therefore may miss “true” origin of the dysregulation implicated in related diseases. In this regard, stable isotope tracer methodology can provide the in vivo kinetic information of lipid metabolism. Combining with “static” information, knowledge of lipid kinetics can enable the acquisition of in depth understanding of lipid metabolism in relation to various health and disease status. This in turn facilitates the development of effective therapeutic approaches (e.g., exercise, nutrition, and/or drugs). In this review we will discuss 1) the importance of obtaining kinetic information for a better understanding of lipid metabolism, 2) basic principles of stable isotope tracer methodologies that enable exploration of “lipid kinetics” in vivo, and 3) quantification of some aspects of lipid kinetics in vivo with numerical examples.
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Affiliation(s)
- Il-Young Kim
- Department of Molecular Medicine, Lee Gil Ya Cancer and Diabetes Institute, College of Medicine, Gachon University, Incheon, Korea
| | - Sanghee Park
- Department of Molecular Medicine, Lee Gil Ya Cancer and Diabetes Institute, College of Medicine, Gachon University, Incheon, Korea
| | - Jiwoong Jang
- Department of Molecular Medicine, Lee Gil Ya Cancer and Diabetes Institute, College of Medicine, Gachon University, Incheon, Korea
| | - Robert R Wolfe
- Department of Geriatrics, Center for Translational Research in Aging & Longevity, Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Determinants of prehospital lactate in trauma patients: a retrospective cohort study. BMC Emerg Med 2020; 20:18. [PMID: 32160880 PMCID: PMC7066760 DOI: 10.1186/s12873-020-00314-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Point of care serum lactate measurement is emerging as an adjunct to prehospital clinical assessment and has the potential to guide triage and advanced treatment decision-making. In this study we aimed to assess which factors potentially affect prehospital lactate levels. Methods We performed a retrospective cohort study of all trauma patients attended by the Air Ambulance, Kent, Surrey & Sussex (AAKSS) between July 2017 and April 2018 in whom a pre-hospital lactate was measured. Lactate was measured before AAKSS treatments were commenced, but generally after prehospital treatment by ground ambulance crews was initiated. Primary endpoint of interest was the association of various patient- and treatment characteristics with prehospital lactate levels. Results During the study period, lactate was measured in 156 trauma patients. Median lactate was 3.0 [2.0–4.1] mmol/l. Patients with an elevated lactate more often had deranged indices of end organ perfusion- and oxygenation (shock index 0.80 [0.58–1.03] vs 0.61 [0.40–0.82], p < 0.001, SpO2 96 [89–100%] vs 98 [96–100%], p = 0.025). They more often suffered from head injuries (62% vs 41%, p = 0.008), and received less analgesia prior to arrival of the AAKSS team (51.6% vs 67.2%, p = 0.03). In multivariate analysis, indices of end organ perfusion- and oxygenation only explained 15% of the variation in lactate levels. Conclusions Prehospital lactate levels are not solely associated with indices of end organ perfusion- and oxygenation. Injury type, treatments given on scene and many other (unmeasured) factors likely play an important role as well. This should be taken into account when lactate is used in clinical algorithms to guide prehospital triage or treatment.
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15
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Haugen ØP, Vallenari EM, Belhaj I, Småstuen MC, Storm-Mathisen J, Bergersen LH, Åmellem I. Blood lactate dynamics in awake and anaesthetized mice after intraperitoneal and subcutaneous injections of lactate-sex matters. PeerJ 2020; 8:e8328. [PMID: 31934509 PMCID: PMC6951280 DOI: 10.7717/peerj.8328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 11/20/2022] Open
Abstract
Lactate treatment has shown a therapeutic potential for several neurological diseases, including Alzheimer's disease. In order to optimize the administration of lactate for studies in mouse models, we compared blood lactate dynamics after intraperitoneal (IP) and subcutaneous (SC) injections. We used the 5xFAD mouse model for familial Alzheimer's disease and performed the experiments in both awake and anaesthetized mice. Blood glucose was used as an indication of the hepatic conversion of lactate. In awake mice, both injection routes resulted in high blood lactate levels, mimicking levels reached during high-intensity training. In anaesthetized mice, SC injections resulted in significantly lower lactate levels compared to IP injections. Interestingly, we observed that awake males had significantly higher lactate levels than awake females, while the opposite sex difference was observed during anaesthesia. We did not find any significant difference between transgenic and wild-type mice and therefore believe that our results can be generalized to other mouse models. These results should be considered when planning experiments using lactate treatment in mice.
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Affiliation(s)
- Øyvind P Haugen
- The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Evan M Vallenari
- The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Imen Belhaj
- The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway.,Amino Acid Transporter Laboratory, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, SERTA: Healthy Brain Ageing Centre, University of Oslo, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Jon Storm-Mathisen
- Amino Acid Transporter Laboratory, Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, SERTA: Healthy Brain Ageing Centre, University of Oslo, Oslo, Norway
| | - Linda H Bergersen
- The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Ingrid Åmellem
- The Brain and Muscle Energy Group, Electron Microscopy Laboratory, Institute of Oral Biology, University of Oslo, Oslo, Norway
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16
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Dunkel B, Mason CJ, Chang YM. Retrospective evaluation of the association between admission blood glucose and l-lactate concentrations in ponies and horses with gastrointestinal disease (2008-2016): 545 cases. J Vet Emerg Crit Care (San Antonio) 2019; 29:418-423. [PMID: 31215733 DOI: 10.1111/vec.12851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/27/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A recent study described increased l-lactate concentrations in ponies with gastrointestinal disease compared to horses, but blood glucose (BG) concentrations were not considered. The study tested the hypothesis that BG and l-lactate concentrations are correlated in horses and ponies with gastrointestinal disease and that BG concentrations, not equid type (pony vs horse), are an independent predictor of L-lactate concentrations. It was further hypothesized that equid type was an independent predictor of BG concentrations. DESIGN Retrospective study 2008-2016. SETTING University teaching hospital. ANIMALS Admission data from 545 animals (384 horses and 161 ponies) with gastrointestinal disease. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data collected included signalment, clinicopathological findings on admission, and nature and location of the gastrointestinal lesion (strangulating vs non-strangulating and large vs small intestinal lesion). The association between admission blood l-lactate concentrations, equid type (pony or horse) and BG concentrations was investigated in a multivariable model. Admission l-lactate and BG concentrations were strongly correlated (n = 522; r = 0.63; P < 0.001). Ponies had significantly higher l-lactate (2.7 mmol/L (0.5-18.0 mmol/L) vs 1.4 mmol/L (0.3-19 mmol/L); P < 0.001) and BG concentrations than horses (8.4 mmol/L (4.2-24.4 mmol/L); 151 mg/dL (76-439 mg/dL) vs 6.9 mmol/L (3.4-26.8 mmol/L); 124 mg/dL (61-482 mg/dL); P < 0.001). In the multivariable analysis, l-lactate concentrations were significantly and positively associated with admission BG concentrations in all animals and also with equid type. For each millimole per liter (18 mg/dL) increase in BG, l-lactate concentrations increased by 7.9% (5.9, 9.9); P < 0.001. In comparison to ponies, l-lactate concentrations were decreased by 27.7% (37.4, 16.5); P < 0.001 in horses. Admission BG concentrations were significantly and positively associated with l-lactate concentrations in all animals. For each millimole per liter increase in l-lactate concentration, BG concentration increased by 6.2% (4.7, 7.6; P < 0.001). Admission BG concentrations were not associated with equid type. CONCLUSION Admission BG concentrations and equid type are independent predictors of blood l-lactate concentrations in equids with gastrointestinal disease, but their relationship requires further investigation.
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Affiliation(s)
- Bettina Dunkel
- Department of Clinical Science and Services, The Royal Veterinary College, Herts, UK
| | - Charlotte Jane Mason
- Department of Clinical Science and Services, The Royal Veterinary College, Herts, UK
| | - Yu-Mei Chang
- Research Support Office, The Royal Veterinary College, Herts, UK
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17
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Chebl RB, Tamim H, Dagher GA, Sadat M, Enezi FA, Arabi YM. Serum Lactate as an Independent Predictor of In-Hospital Mortality in Intensive Care Patients. J Intensive Care Med 2019; 35:1257-1264. [PMID: 31179840 DOI: 10.1177/0885066619854355] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study was to check if serum lactate was independently associated with mortality among critically ill patients. MATERIALS AND METHODS This was a single-center, retrospective cohort study. All adult patients (>18 years of age) who had at least 1 measurement of lactate within 24 hours of admission to intensive care unit (ICU) between January 2002 and December 2017 were included in the analysis. Patients were stratified into 3 groups: those with a serum lactate of <2 mmol/L (normal level), 2 to 4 mmol/L (intermediate level), and >4 mmol/L (high level). The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital lengths of stay and mechanical ventilation duration. To determine the association between lactate level and hospital mortality, bivariate and multivariate logistic regression analyses were performed. RESULTS Of the 16,447 patients admitted to the ICU, 8167 (49.65%) had normal levels, 4648 (28.26%) had an intermediate, and 3632 (22.09%) had high lactate levels. Hospital mortality was the highest in high lactate level, followed by the intermediate and the normal level group (47.4% vs 26.5% vs 19.6%; P < .0001). Intermediate and high lactate levels were independent predictors of hospital mortality (odds ratio [OR], 1.32; 95% confidence interval [CI]: 1.20-1.46, and 1.94; 95% CI, 1.75-2.16, respectively) as well as ICU mortality (OR, 1.47; 95% CI, 1.30-1.66 and 2.56; 95% CI, 2.27-2.88, respectively). CONCLUSIONS Intensive care unit serum lactate is associated with increased ICU and hospital mortality, independent of comorbidities, organ dysfunction, or hemodynamic status.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, 11238American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Emergency Medicine, 11238American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, 11238American University of Beirut, Beirut, Lebanon
| | - Musharaf Sadat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 48168King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Farhan Al Enezi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 48168King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 48168King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Abstract
Circulatory shock is defined as an imbalance between tissue oxygen supply and demand, and mostly results from a loss of blood volume, cardiac pump failure, and/or reduction of vasomotor tone. The clinical hallmarks of circulatory shock are arterial hypotension and lactate acidosis. Since the degree and duration of hypotension are major determinants of outcome, vasopressor administration represents a cornerstone therapy to treat these patients. Current guidelines recommend the use of catecholamines as the drug of first choice. However, apart from their hemodynamic effects, which depend on the different receptor profile, receptor affinity, receptor density, and the relative potency of the individual molecule, catecholamines have numerous other biological effects as a result of the ubiquitous presence of their receptors. In shock states, catecholamines aggravate hypermetabolism by promoting hyperglycemia and hyperlactatemia, and further increase oxygen demands, which can contribute to further organ damage. In the mitochondria, catecholamines may promote mitochondrial uncoupling, and aggravate oxidative stress, thereby contributing to the progression of mitochondrial dysfunction. Immunological side effects have also gained specific attention. Although both pro- and anti-inflammatory effects have been described, current evidence strongly indicates an immunosuppressive effect, thereby making patients potentially vulnerable to secondary infections. Catecholamines may not only decrease splanchnic perfusion due to their vasoconstrictor properties, but can also directly impair gastrointestinal motility. This article reviews the non-hemodynamic effects of different catecholamines, both under physiologic and pathophysiologic conditions, with a special focus on energy metabolism, mitochondrial function, immune response, and the gastrointestinal system.
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Son HW, Park SH, Cho HO, Shin YJ, Son JH. Epinephrine-induced lactic acidosis in orthognathic surgery: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2016; 42:295-300. [PMID: 27847739 PMCID: PMC5104873 DOI: 10.5125/jkaoms.2016.42.5.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/22/2016] [Accepted: 08/17/2016] [Indexed: 11/07/2022] Open
Abstract
Submucosal infiltration and the topical application of epinephrine as a vasoconstrictor produce excellent hemostasis during surgery. The hemodynamic effects of epinephrine have been documented in numerous studies. However, its metabolic effects (especially during surgery) have been seldom recognized clinically. We report two cases of significant metabolic effects (including lactic acidosis and hyperglycemia) as well as hemodynamic effects in healthy patients undergoing orthognathic surgery with general anesthesia. Epinephrine can induce glycolysis and pyruvate generation, which result in lactic acidosis, via β2-adrenergic receptors. Therefore, careful perioperative observation for changes in plasma lactate and glucose levels along with intensive monitoring of vital signs should be carried out when epinephrine is excessively used as a vasoconstrictor during surgery.
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Affiliation(s)
- Hee-Won Son
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Se-Hun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyun-Oh Cho
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong-Joon Shin
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jang-Ho Son
- Department of Oral and Maxillofacial Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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20
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Gerdle B, Ernberg M, Mannerkorpi K, Larsson B, Kosek E, Christidis N, Ghafouri B. Increased Interstitial Concentrations of Glutamate and Pyruvate in Vastus Lateralis of Women with Fibromyalgia Syndrome Are Normalized after an Exercise Intervention - A Case-Control Study. PLoS One 2016; 11:e0162010. [PMID: 27695113 PMCID: PMC5047648 DOI: 10.1371/journal.pone.0162010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 08/12/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is associated with central alterations, but controversies exist regarding the presence and role of peripheral factors. Microdialysis (MD) can be used in vivo to study muscle alterations in FMS. Furthermore for chronic pain conditions such as FMS, the mechanisms for the positive effects of exercise are unclear. This study investigates the interstitial concentrations of algesics and metabolites in the vastus lateralis muscle of 29 women with FMS and 28 healthy women before and after an exercise intervention. METHODS All the participants went through a clinical examination and completed a questionnaire. In addition, their pressure pain thresholds (PPTs) in their upper and lower extremities were determined. For both groups, MD was conducted in the vastus lateralis muscle before and after a 15-week exercise intervention of mainly resistance training of the lower limbs. Muscle blood flow and interstitial muscle concentrations of lactate, pyruvate, glutamate, glucose, and glycerol were determined. RESULTS FMS was associated with significantly increased interstitial concentrations of glutamate, pyruvate, and lactate. After the exercise intervention, the FMS group exhibited significant decreases in pain intensity and in mean interstitial concentrations of glutamate, pyruvate, and glucose. The decrease in pain intensity in FMS correlated significantly with the decreases in pyruvate and glucose. In addition, the FMS group increased their strength and endurance. CONCLUSION This study supports the suggestion that peripheral metabolic and algesic muscle alterations are present in FMS patients and that these alterations contribute to pain. After an exercise intervention, alterations normalized, pain intensity decreased (but not abolished), and strength and endurance improved, all findings that suggest the effects of exercise are partially peripheral.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Malin Ernberg
- Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function and Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden
| | - Kaisa Mannerkorpi
- Section of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, Gothenburg, Sweden
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience and Osher Centre for Integrative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Nikolaos Christidis
- Karolinska Institute, Department of Dental Medicine, Section of Orofacial Pain and Jaw Function and Scandinavian Centre for Orofacial Neuroscience (SCON), Stockholm, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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21
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Early Circulating Lactate and Glucose Levels After Aneurysmal Subarachnoid Hemorrhage Correlate With Poor Outcome and Delayed Cerebral Ischemia: A Two-Center Cohort Study. Crit Care Med 2016; 44:966-72. [PMID: 26751612 DOI: 10.1097/ccm.0000000000001569] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In critically ill patients, elevated blood lactate at admission is associated with poor outcome, but after aneurysmal subarachnoid hemorrhage, this has not been investigated. We studied the association between early circulating lactate and glucose with delayed cerebral ischemia and poor outcome. Lactate and glucose were both studied, hypothesizing that both may be increased due to sympathetic activation after subarachnoid hemorrhage similar to critically ill patients. DESIGN Retrospective cohort study. SETTING ICUs of two academic hospitals in the Netherlands. PATIENTS Patients with aneurysmal subarachnoid hemorrhage admitted to the ICU within 24 hours after the bleed surviving beyond 48 hours after ICU admission and who had at least one lactate measurement within 24 hours after admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS In 285 patients, maximal lactate and glucose levels within the first 24 hours after admission were determined. Early lactate and glucose were related with delayed cerebral ischemia-related infarction and poor outcome (a modified Rankin Scale score of 4, 5, or death at 3 mo). Delayed cerebral ischemia occurred in 84 patients (29%), and 106 patients (39%) had poor outcome. Multivariable analyses were performed with adjustment of established predictors for delayed cerebral ischemia and outcome: age, sex, World Federation of Neurological Surgeons grade at admission and Hijdra sum scores. Early lactate and glucose were strongly related (Spearman ρ = 0.55; p < 0.001). Lactate and glucose were both independently associated with delayed cerebral ischemia and poor outcome in multivariable analyses with either lactate or glucose as covariates. When both lactate and glucose were included, only glucose showed an independent association with delayed cerebral ischemia (odds ratio, 1.14; 95% CI, 1.01-1.28) and only lactate showed an independent association with poor outcome (odds ratio, 1.42; 95% CI, 1.11-1.81). CONCLUSIONS Early lactate and glucose levels after aneurysmal subarachnoid hemorrhage are associated with delayed cerebral ischemia and poor outcome, suggesting that they may be considered in conjunction with other parameters for future prognostic models.
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Sanfilippo F, Chiarenza F, Cassisi C, Santonocito C, Tsoutsouras T, Trivella M, Gerry S, Astuto M, George S, Taggart DP. The Effects of On-Pump and Off-Pump Coronary Artery Bypass Surgery on Metabolic Profiles in the Early Postoperative Period. J Cardiothorac Vasc Anesth 2016; 30:909-16. [PMID: 27241767 DOI: 10.1053/j.jvca.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hyperlactatemia and base deficit (BD) are markers of adverse outcome after cardiac surgery, and their derangement can be influenced by the use of extracorporeal circulation. The authors hypothesized a better postoperative metabolic profile in off-pump coronary artery bypass grafting (OPCABG) compared with "on-pump" coronary artery bypass grafting (ONCABG). DESIGN This was a retrospective study, with consecutive data collected for 1 year from electronic medical records. SETTING Cardiothoracic intensive care unit at a tertiary university hospital. PARTICIPANTS The study comprised 339 patients who underwent elective coronary artery bypass grafting (ONCABG [n = 215], OPCABG [n = 124]). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The metabolic (arterial lactatemia, pH, and BD) and hemodynamic (inotropic/vasopressor support) parameters of OPCABG and ONCABG patients were compared at 7 predefined time points (intensive care admission and the 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). For each output of interest, mixed-effects linear regression models were used (with time as random-effect to allow for clustering of repeated measures) and adjusted for a predetermined set of covariates. Arterial lactatemia and pH were comparable at all time points; BD was worse in the ONCABG group overall (p = 0.01) and at most time points (except at the 1st and 24th postoperative hours). For the whole period, inotropic support was more common in ONCABG patients (p<0.05), whereas vasopressor use was more frequent in the OPCABG group (p< 0.05). CONCLUSIONS Improved postoperative BD values were demonstrated in the OPCABG group, although pH and lactatemia were similar between groups. Inotropic support was less common in the OPCABG group at the expense of more frequent vasopressor support.
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Affiliation(s)
- Filippo Sanfilippo
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - Federica Chiarenza
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Cesare Cassisi
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Cristina Santonocito
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Theodoros Tsoutsouras
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
| | - Marialena Trivella
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephen Gerry
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Marinella Astuto
- School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Shane George
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
| | - David P Taggart
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom; Nuffield Department of Surgery, John Radcliffe Hospital-University of Oxford,Oxford, United Kingdom
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Smith GI, Patterson BW, Klein SJ, Mittendorfer B. Effect of hyperinsulinaemia-hyperaminoacidaemia on leg muscle protein synthesis and breakdown: reassessment of the two-pool arterio-venous balance model. J Physiol 2015; 593:4245-57. [PMID: 26150260 DOI: 10.1113/jp270774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/19/2015] [Accepted: 06/07/2015] [Indexed: 11/08/2022] Open
Abstract
Accurate measurement of muscle protein turnover is critical for understanding the physiological processes underlying muscle atrophy and hypertrophy. Several mathematical approaches, used in conjunction with a tracer amino acid infusion, have been described to derive protein synthesis and breakdown rates from a two-pool (artery-vein) model. Despite apparently common underlying principles, these approaches differ significantly (some seem to not take into account arterio-venous shunting of amino acids, which comprises ∼80-90% of amino acids appearing in the vein) and most do not specify how tracer enrichment (i.e. mole percent excess (MPE) or tracer-to-tracee ratio (TTR)) and amino acid concentration (i.e. unlabelled only or total labelled plus unlabelled) should be expressed, which could have a significant impact on the outcome when using stable isotope labelled tracers. We developed equations that avoid these uncertainties and used them to calculate leg phenylalanine (Phe) kinetics in subjects who received a [(2) H5 ]Phe tracer infusion during postabsorptive conditions and during a hyperinsulinaemic-euglycaemic clamp with concomitant protein ingestion. These results were compared with those obtained by analysing the same data with previously reported equations. Only some of them computed the results correctly when used with MPE as the enrichment measure and total (tracer+tracee) Phe concentrations; errors up to several-fold in magnitude were noted when the same approaches were used in conjunction with TTR and/or unlabelled concentration only, or when using the other approaches (irrespective of how concentration and enrichment are expressed). Our newly developed equations should facilitate accurate calculation of protein synthesis and breakdown rates.
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Affiliation(s)
- Gordon I Smith
- Department of Medicine, Center for Human Nutrition, and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Bruce W Patterson
- Department of Medicine, Center for Human Nutrition, and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Seth J Klein
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Bettina Mittendorfer
- Department of Medicine, Center for Human Nutrition, and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
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Lactate kinetics and mitochondrial respiration in skeletal muscle of healthy humans under influence of adrenaline. Clin Sci (Lond) 2015; 129:375-84. [PMID: 25828264 DOI: 10.1042/cs20140448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Plasma lactate is widely used as a biomarker in critical illness. The aims of the present study were to elucidate the usefulness of a three-compartment model for muscle lactate kinetics in humans and to characterize the response to an exogenous adrenaline challenge. Repeated blood samples from artery and femoral vein together with blood flow measurements and muscle biopsies were obtained from healthy male volunteers (n=8) at baseline and during an adrenaline infusion. Concentrations of lactate and enrichment of [13C]lactate were measured and kinetics calculated. Mitochondrial activity, glycogen concentration, oxygen uptake and CO2 release were assessed. The adrenaline challenge increased plasma lactate 4-fold as a result of a greater increase in the rate of appearance (R(a)) than the increase in the rate of disappearance (R(d)). Leg muscle net release of lactate increased 3.5-fold, whereas intramuscular production had a high variation but did not change. Mitochondrial state 3 respiration increased by 30%. Glycogen concentration, oxygen uptake and CO2 production remained unchanged. In conclusion a three-compartment model gives additional information to the two-compartment model but, due to its larger variation and invasive muscle biopsy, it is less likely to become a regularly used tool in clinical research. Hyperlactataemia in response to adrenergic stimuli was driven by an elevated lactate release from skeletal muscle most probably due to a redirection of a high intramuscular turnover rather than an increased production.
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Scherbakov N, Bauer M, Sandek A, Szabó T, Töpper A, Jankowska EA, Springer J, von Haehling S, Anker SD, Lainscak M, Engeli S, Düngen HD, Doehner W. Insulin resistance in heart failure: differences between patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 2015. [DOI: 10.1002/ejhf.317] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nadja Scherbakov
- Center for Stroke Research Berlin; Charite Universitätsmedizin Berlin; Germany
- German Centre for Cardiovascular Research (DZHK); partner site Berlin Germany
| | - Maximiliane Bauer
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Anja Sandek
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Tibor Szabó
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Agnieszka Töpper
- Working Group on Cardiovascular Magnetic Resonance; Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine Berlin; Germany
- HELIOS Klinikum Berlin Buch; Department of Cardiology and Nephrology; Berlin Germany
| | - Ewa A. Jankowska
- Cardiology Department, Centre for Heart Diseases; Military Hospital; Wroclaw Poland
- Department of Heart Diseases; Wroclaw Medical University, Wroclaw; Poland
| | - Jochen Springer
- Innovative Clinical Trials, Dept of Cardiology and Pneumology; University Medicine Göttingen (UMG); Göttingen Germany
| | | | - Stefan D. Anker
- Department of Heart Diseases; Wroclaw Medical University, Wroclaw; Poland
| | - Mitja Lainscak
- Division of Cardiology; General Hospital Celje; Slovenia
| | - Stefan Engeli
- Institute of Clinical Pharmacology; Hannover Medical School; Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin; Charite Universitätsmedizin Berlin; Germany
- German Centre for Cardiovascular Research (DZHK); partner site Berlin Germany
- Department of Cardiology, Campus Virchow; Charite Universitätsmedizin Berlin; Germany
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26
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VASSAL O, BONNET JM, BARTHELEMY A, ALLAOUCHICHE B, GOY-THOLLOT I, LOUZIER V, PAQUET C, AYOUB JY, DAUWALDER O, JACQUET-LAGRÈZE M, JUNOT S. Renal haemodynamic response to amino acids infusion in an experimental porcine model of septic shock. Acta Anaesthesiol Scand 2015; 59:598-608. [PMID: 25782071 DOI: 10.1111/aas.12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in sepsis. Treatments allowing maintenance of renal blood flow (RBF) could help to prevent AKI associated with renal hypoperfusion. Amino acids (AA) have been associated with an increase of RBF and glomerular filtration rate (GFR) in several species. The aim of this study was to evaluate the effects of an AA infusion on RBF and GFR in a porcine model of septic shock. METHODS A total of 17 piglets were randomly assigned into three groups: Sham (Sham, n = 5), sepsis without AA (S-NAA, n = 6), sepsis treated with AA (S-AA, n = 6). Piglets preparation included the placement of ultrasonic transit time flow probes around left renal artery for continuous RBF measurement; ureteral catheters for GFR and urine output evaluation; pulmonary artery catheter for cardiac output (CO) and pulmonary arterial pressure measurements. Mean arterial pressure (MAP) and renal vascular resistance (RVR) were also determined. Septic shock was induced with a live Pseudomonas aeruginosa infusion. Crystalloids, colloids and epinephrine infusion were used to maintain and restore MAP > 60 mmHg and CO > 80% from baseline. RESULTS Renal haemodynamic did not change significantly in the Sham group, whereas RBF increased slightly in the S-NAA group. Conversely, a significant increase in RVR and a decrease in RBF and GFR were observed in the S-AA group. AA infusion was associated with a higher requirement of epinephrine [340.0 (141.2; 542.5) mg vs. 32.5 (3.8; 65.0) mg in the S-NAA group P = 0.044]. CONCLUSION An infusion of amino acids impaired renal haemodynamics in this experimental model of septic shock.
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Affiliation(s)
- O. VASSAL
- Service d'Anesthésie-Réanimation; Hospices Civils de Lyon; Hôpital Edouard-Herriot; Lyon France
- Université Claude-Bernard; Lyon France
| | - J.-M. BONNET
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - A. BARTHELEMY
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - B. ALLAOUCHICHE
- Service d'Anesthésie-Réanimation; Hospices Civils de Lyon; Hôpital Edouard-Herriot; Lyon France
- Université Claude-Bernard; Lyon France
| | - I. GOY-THOLLOT
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - V. LOUZIER
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - C. PAQUET
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - J.-Y. AYOUB
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
| | - O. DAUWALDER
- Université de Lyon; Laboratory of Microbiology; Groupement Hospitalier Est; Lyon France
| | - M. JACQUET-LAGRÈZE
- Service d'Anesthésie-Réanimation; Hospices Civils de Lyon; Hôpital Edouard-Herriot; Lyon France
- Université Claude-Bernard; Lyon France
| | - S. JUNOT
- Université de Lyon; EA 4174 Hémostase Inflammation Sepsis; VetAgro Sup - Campus Vétérinaire de Lyon; Marcy l'Etoile France
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Nordsborg NB, Robach P, Boushel R, Calbet JAL, Lundby C. Erythropoietin does not reduce plasma lactate, H+, and K+during intense exercise. Scand J Med Sci Sports 2014; 25:e566-75. [DOI: 10.1111/sms.12374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. B. Nordsborg
- Department of Nutrition, Exercise and Sport (NEXS); University of Copenhagen; Copenhagen Denmark
| | - P. Robach
- Site de l'Ecole Nationale de Ski et d'Alpinisme; Ecole Nationale des Sports de Montagne; Chamonix France
| | - R. Boushel
- Åstrand Laboratory; The Swedish School of Sport and Health Sciences; Stockholm Sweden
| | - J. A. L. Calbet
- Department of Physical Education; University of Las Palmas de Gran Canaria; Las Palmas Spain
| | - C. Lundby
- Institute of Physiology and Center for Integrative Human Physiology; University of Zürich; Zurich Switzerland
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Zhang Z, Chen K, Ni H, Fan H. Predictive value of lactate in unselected critically ill patients: an analysis using fractional polynomials. J Thorac Dis 2014; 6:995-1003. [PMID: 25093098 PMCID: PMC4120171 DOI: 10.3978/j.issn.2072-1439.2014.07.01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/17/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Hyperlactatemia has long been associated with poor clinical outcome in varieties of intensive care unit (ICU) patients. However, the impact of temporal changes in lactate has not been well established and there are some shortcomings in model building in previous studies. The present study aims to investigate the association of initial lactate and normalization time with hazard by using fractional polynomial Cox proportional hazard model. METHODS A large clinical database named Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) was employed for analysis. Demographics, comorbidities, laboratory findings were extracted and were compared between survivors and non-survivors by using univariable analysis. Cox proportional hazard model was built by purposeful selection of covariate with initial lactate (L0) and normalization time (T) remaining in the model. Best fit model was selected by using deviance difference test and comparisons between fractional polynomial regression models of different degrees were performed by using closed test procedure. MAIN RESULTS A total of 6,291 ICU patients were identified to be eligible for the present study, including 1,675 non-survivors and 4,616 survivors (mortality rate: 26.6%). Patients with lactate normalization had significantly reduced hazard rate as compared to those without normalization (log-rank test: P<0.05). The best powers of L0 in the model were -2 and -1 with the deviance of 19,944.51, and the best powers of T were 0.5 and 3 with the deviance of 7,965.63. The adjusted hazard ratio for the terms L0(-2) and L0(-1) were 1.13 (95% CI: 1.09-1.18) and 0.43 (95% CI: 0.34-0.54); and the adjusted hazard ratio for the terms T(0.5) and T(3) were 7.42 (95% CI: 2.85-19.36) and 3.06×10(-6) (95% CI: 3.01×10(-11)-0.31). CONCLUSIONS Initial lactate on ICU admission is associated with death hazard and the relationship follows a fractional polynomial pattern with the power of -2 and -1. Delayed normalization of lactate is predictive of high risk of death when it is measured within 150 hours after ICU admission.
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Affiliation(s)
- Zhongheng Zhang
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Kun Chen
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Hongying Ni
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
| | - Haozhe Fan
- Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, China
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Bach E, Nielsen RR, Vendelbo MH, Møller AB, Jessen N, Buhl M, K- Hafstrøm T, Holm L, Pedersen SB, Pilegaard H, Biensø RS, Jørgensen JO, Møller N. Direct effects of TNF-α on local fuel metabolism and cytokine levels in the placebo-controlled, bilaterally infused human leg: increased insulin sensitivity, increased net protein breakdown, and increased IL-6 release. Diabetes 2013; 62:4023-9. [PMID: 23835341 PMCID: PMC3837036 DOI: 10.2337/db13-0138] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tumor necrosis factor-α (TNF-α) has widespread metabolic actions. Systemic TNF-α administration, however, generates a complex hormonal and metabolic response. Our study was designed to test whether regional, placebo-controlled TNF-α infusion directly affects insulin resistance and protein breakdown. We studied eight healthy volunteers once with bilateral femoral vein and artery catheters during a 3-h basal period and a 3-h hyperinsulinemic-euglycemic clamp. One artery was perfused with saline and one with TNF-α. During the clamp, TNF-α perfusion increased glucose arteriovenous differences (0.91 ± 0.17 vs. 0.74 ± 0.15 mmol/L, P = 0.012) and leg glucose uptake rates. Net phenylalanine release was increased by TNF-α perfusion with concomitant increases in appearance and disappearance rates. Free fatty acid kinetics was not affected by TNF-α, whereas interleukin-6 (IL-6) release increased. Insulin and protein signaling in muscle biopsies was not affected by TNF-α. TNF-α directly increased net muscle protein loss, which may contribute to cachexia and general protein loss during severe illness. The finding of increased insulin sensitivity, which could relate to IL-6, is of major clinical interest and may concurrently act to provide adequate tissue fuel supply and contribute to the occurrence of systemic hypoglycemia. This distinct metabolic feature places TNF-α among the rare insulin mimetics of human origin.
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Affiliation(s)
- Ermina Bach
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Roni R. Nielsen
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel H. Vendelbo
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas B. Møller
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Jessen
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Buhl
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas K- Hafstrøm
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Holm
- Institute of Sports Medicine and Department of Orthopedic Surgery M, Bispebjerg Hospital, and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steen B. Pedersen
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Rasmus S. Biensø
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jens O.L. Jørgensen
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Møller
- Medical Research Laboratories, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Corresponding author: Niels Møller,
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Vestergaard ET, Møller N, Jørgensen JOL. Acute peripheral tissue effects of ghrelin on interstitial levels of glucose, glycerol, and lactate: a microdialysis study in healthy human subjects. Am J Physiol Endocrinol Metab 2013; 304:E1273-80. [PMID: 23592479 DOI: 10.1152/ajpendo.00662.2012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ghrelin is a gut-derived peptide and an endogenous ligand for the ghrelin receptor. Intravenous infusion of ghrelin induces insulin resistance and hyperglycemia and increases circulating levels of nonesterified free fatty acids. Our objective was to investigate whether the metabolic effects are mediated directly by ghrelin in skeletal muscle and adipose (peripheral and central) tissues. Ten healthy men (24.9 ± 1.3 yr) received 300 min of supraphysiological ghrelin administration by microdialysis catheters in skeletal muscle and adipose tissues in a randomized, single-blind, and placebo-controlled study. Microdialysis perfusates were analyzed every 30 min for glucose, glycerol, and lactate during both a basal period and a hyperinsulinemic euglycemic clamp. The primary outcome measures were interstitial concentrations of glucose, glycerol, and lactate in skeletal muscle and adipose tissues. Interstitial concentrations of glucose were similar in skeletal muscle, peripheral, and central adipose tissue in the basal period. During hyperinsulinemia, interstitial concentrations of glucose in skeletal muscle decreased in response to ghrelin exposure [2.84 ± 0.25 (ghrelin) vs. 3.06 ± 0.26 mmol/l (placebo), P = 0.04]. Ghrelin exposure did not impact on interstitial concentrations of glycerol and lactate. We conclude that ghrelin administration into skeletal muscle decreases interstitial concentrations of glucose during euglycemic hyperinsulinemia, which is indicative of increased insulin sensitivity without any effects on interstitial glycerol levels in either muscle or adipose tissue. These data contrast with the metabolic effects of ghrelin observed after systemic exposure and suggest the existence of a second messenger that remains to be identified.
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Buhl M, Bosnjak E, Vendelbo MH, Gjedsted J, Nielsen RR, K-Hafstrøm T, Vestergaard ET, Jessen N, Tønnesen E, Møller AB, Pedersen SB, Pilegaard H, Biensø RS, Jørgensen JOL, Møller N. Direct effects of locally administered lipopolysaccharide on glucose, lipid, and protein metabolism in the placebo-controlled, bilaterally infused human leg. J Clin Endocrinol Metab 2013; 98:2090-9. [PMID: 23543661 DOI: 10.1210/jc.2012-3836] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT Accumulating evidence suggests that chronic exposure to lipopolysaccharide (LPS, endotoxin) may create a constant low-grade inflammation, leading to insulin resistance and diabetes. All previous human studies assessing the metabolic actions of LPS have used systemic administration, making discrimination between direct and indirect effects impossible. OBJECTIVE We sought to define the direct, placebo-controlled effects of LPS on insulin resistance and protein and lipid metabolism in the infused human leg without systemic interference from cytokines and stress hormones. DESIGN This was a randomized, placebo-controlled, single-blinded study. PARTICIPANTS AND INTERVENTION We studied 8 healthy volunteers with bilateral femoral vein and artery catheters during a 3-hour basal and 3-hour hyperinsulinemic-euglycemic clamp period with bilateral muscle biopsies in each period during infusion with saline and LPS. RESULTS Overall, LPS perfusion significantly decreased leg glucose uptake, and during the clamp LPS decreased glucose arteriovenous differences (0.65 ± 0.07 mmol/L vs 0.73 ± 0.08 mmol/L). Net palmitate release was increased by LPS, and secondary post hoc testing indicated increased palmitate isotopic dilution, although primary ANOVA tests did not reveal significant dilution. Leg blood flows, phenylalanine, lactate kinetics, cytokines, and intramyocellular insulin signaling were not affected by LPS. LPS thus directly inhibits insulin-stimulated glucose uptake and increases palmitate release in the perfused human leg without detectable effects on amino acid metabolism. CONCLUSIONS These data strongly suggest that the primary metabolic effect of LPS is increased lipolysis and muscle insulin resistance, which, together with secondary insulin resistance, caused by systemic cytokine and stress hormone release may lead to overt glucose intolerance and diabetes.
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Affiliation(s)
- Mads Buhl
- Medical Research Laboratories, Clinical Institute, Aarhus University, DK-8000, Aarhus, Denmark
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Jensen J, Rustad PI, Kolnes AJ, Lai YC. The role of skeletal muscle glycogen breakdown for regulation of insulin sensitivity by exercise. Front Physiol 2011; 2:112. [PMID: 22232606 PMCID: PMC3248697 DOI: 10.3389/fphys.2011.00112] [Citation(s) in RCA: 219] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/09/2011] [Indexed: 12/12/2022] Open
Abstract
Glycogen is the storage form of carbohydrates in mammals. In humans the majority of glycogen is stored in skeletal muscles (∼500 g) and the liver (∼100 g). Food is supplied in larger meals, but the blood glucose concentration has to be kept within narrow limits to survive and stay healthy. Therefore, the body has to cope with periods of excess carbohydrates and periods without supplementation. Healthy persons remove blood glucose rapidly when glucose is in excess, but insulin-stimulated glucose disposal is reduced in insulin resistant and type 2 diabetic subjects. During a hyperinsulinemic euglycemic clamp, 70-90% of glucose disposal will be stored as muscle glycogen in healthy subjects. The glycogen stores in skeletal muscles are limited because an efficient feedback-mediated inhibition of glycogen synthase prevents accumulation. De novo lipid synthesis can contribute to glucose disposal when glycogen stores are filled. Exercise physiologists normally consider glycogen's main function as energy substrate. Glycogen is the main energy substrate during exercise intensity above 70% of maximal oxygen uptake ([Formula: see text]) and fatigue develops when the glycogen stores are depleted in the active muscles. After exercise, the rate of glycogen synthesis is increased to replete glycogen stores, and blood glucose is the substrate. Indeed insulin-stimulated glucose uptake and glycogen synthesis is elevated after exercise, which, from an evolutional point of view, will favor glycogen repletion and preparation for new "fight or flight" events. In the modern society, the reduced glycogen stores in skeletal muscles after exercise allows carbohydrates to be stored as muscle glycogen and prevents that glucose is channeled to de novo lipid synthesis, which over time will causes ectopic fat accumulation and insulin resistance. The reduction of skeletal muscle glycogen after exercise allows a healthy storage of carbohydrates after meals and prevents development of type 2 diabetes.
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Affiliation(s)
- Jørgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences Oslo, Norway
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