Sclerosing cholangitis associated with chronic cryptosporidiosis in a child with a congenital immunodeficiency disorder

Primary sclerosing cholangitis (PSC) in children is a rare and incurable disorder of unknown etiology. We report an immunodeficient child with chronic cryptosporidiosis of the biliary tract leading to clinical, pathological, and radiographic findings consistent with PSC. This case documents the ability of Cryptosporidium to disseminate to extraintestinal organs, and suggests that chronic cryptosporidial infection of the biliary tract may be one etiological mechanism producing sclerosing cholangitis in immunodeficient children. The increased incidence of PSC in immunodeficient children may in part be due to their inability to resolve infections of the biliary tract, which may result in sclerosing cholangitis mimicking PSC. We submit that an aggressive diagnostic workup should be performed to rule out an infectious etiology of sclerosing cholangitis in immunodeficient patients who have findings of PSC, because specific chemotherapy against the infecting organism would potentially arrest progressive biliary obliteration.

Pivampicillin-promoted excretion of pivaloylcarnitine in humans

Pivampicillin treatment of seven children (five boys and two girls) for 7 days significantly reduced the amounts of total acid-soluble carnitine, free carnitine, and long-chain acylcarnitines and increased the amounts of acid-soluble acylcarnitine in plasma. The fasting plasma levels of 3-hydroxybutyrate at the end of treatment were 15% of the control value. The levels of free fatty acids were decreased, whereas triglyceride levels were unaffected, indicating impaired fat metabolism. Daily urinary excretion of total carnitine was four to five times higher than controls after the first day of treatment, although the amounts of free carnitine and acetylcarnitine were decreased. The urinary acylcarnitines were isolated and characterized by gas chromatography/electron impact mass spectrometry and fast-atom bombardment mass spectrometry. Pivaloylcarnitine was the predominant urinary acylcarnitine; it represented greater than 96% of the increased excretion of total carnitine and 75-80% of the total conjugated pivalic acid. The renal clearance of acylcarnitines was comparable to that of creatinine, indicating no reabsorption of pivaloylcarnitine. These data suggest a detoxification function of carnitine for pivalic acid in humans.

Energy balance in rats with obesity-producing hypothalamic knife cuts: effects of adrenalectomy

Rats with obesity-producing, hypothalamic knife cuts (KC) were fed a purified high fat diet for 9 wk. KC rats consumed more energy (+70-100%) and retained energy with a much higher efficiency than control rats. Adrenalectomy of KC rats 1 wk (before gross obesity was evident) or 5 wk (when KC rats were 70% overweight) after KC surgery caused a reduction in energy intake to levels approximating those of control rats. Furthermore, energy retention in adrenalectomized KC rats was depressed more than could be explained on the basis of the reduction in energy intake. Two factors associated with the reduction in energy retention, urinary excretion of norepinephrine, an indicator of sympathetic nervous system activity, and GDP binding to brown adipose tissue mitochondria, an indicator of the thermogenic capacity of the tissue, were higher in vadrenalectomized KC rats than in pair-fed KC rats. Removal of the adrenals not only suppressed hyperphagia in KC rats fed a high fat diet, but also increased energy expenditure per kilocalorie consumed.

Effects of oral L-carnitine supplementation in low-birth-weight premature infants maintained on human milk

Effects of oral L-carnitine supplementation on fat and protein metabolism have been studied in 20 low-birth-weight premature infants (mean weight at birth 1.519 g, range 1,200-1,880 g) fed with pooled pasteurized human milk. Throughout 7 consecutive days, started at various postnatal ages (range 10-33 days) infants were fed exclusively with milk containing 300 nmol/ml L-carnitine as added supplement. The amount of extra carnitine intake ranged from 42.6 to 72.0 mumol/kg/day. Until day 5 of supplementation there was a continuous increase in the daily urinary excretion of total carnitine, which levelled off thereafter, corresponding approximately to 50% of the extra L-carnitine intake, indicating that a part of the supplement was retained by the body. Total, free and esterified carnitine levels were significantly elevated in the plasma at the end of the study period. The increased levels of acylcarnitines in plasma and urine indicate that the carnitine supplement was taken up by tissues and entered the intermediary metabolism. Plasma triglyceride level was decreased, whereas 3-hydroxybutyrate level was increased at the end of supplementation, indicating an enhanced fat utilization. Plasma and urine analysis also revealed an altered nitrogen handling. There was a marked decrease in plasma urea level as well as a significant fall in the urea and total N excretion, with a trend of decrease in excretion of 3-methylhistidine, suggesting a reduced amino acid and protein catabolism during L-carnitine supplementation.

Impaired thermoregulation in cold-exposed rats with hypothalamic obesity

Rats with obesity-producing, hypothalamic knife cuts were fed a high fat diet and placed in the cold (2 degrees C) for six days starting 3, 11, or 24 days after surgery. Between surgery and cold exposure, knife-cut rats consumed 90% to 122% more energy and gained more weight (32 +/- 4, 112 +/- 5, and 241 +/- 9 g) than sham-operated rats (15 +/- 2, 34 +/- 2, and 58 +/- 3 g). When exposed to cold, sham-operated rats increased (22% to 30%) energy intake whereas knife-cut rats decreased (5% to 51%) intake. After 24 hours at 2 degrees C body temperatures of knife-cut rats were 1.2, 0.7, and 0.7 degrees less than those of control rats; body temperatures continued to decrease to 2.9, 3.0 and 2.5 degrees less than control rats after six days at 2 degrees C. Fasting for 12 hours at 2 degrees C caused a further reduction in body temperature to 4.9, 4.8, and 5.9 degrees less than in control rats. Cold exposure increased urinary excretion of norepinephrine and epinephrine (indicators of sympathoadrenal activity) in all rats. Guanosine diphosphate (GDP) binding to brown adipose tissue (BAT) mitochondria (an indicator of the thermogenic capacity of the tissue) was similar in cold-exposed, knife-cut, and sham-operated rats. Cold acclimation before hypothalamic knife-cut surgery prevented the cold-induced decrease in body temperatures of knife-cut rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation and identification of alpha-methyloctanylcarnitines from human urine

Medium-chain acylcarnitines were isolated from human urine using a combination of chloroform-methanol extraction, silicic acid column and molecular sieving chromatography and preparative HPLC. Three purified acylcarnitines were analyzed by fast atom bombardment mass spectrometry and were also saponified and the free fatty acids analyzed by gas chromatography and mass spectrometry. Combined electron impact mass spectrometry and fast atom bombardment mass spectrometry and periodate oxidation for location of double bonds, demonstrated the occurrence of delta 6-octenylcarnitine, 2-methyloctanylcarnitine and 2-methyl-delta 6-octenylcarnitine. These acylcarnitines were present in the thirteen urines obtained from normal humans, but were not detected in urines from three individuals who had been on total parenteral nutrition for more than a year. The occurrence of alpha-methyl medium-chain acylcarnitines in human urine indicates a role for carnitine in excretion (detoxification) of these acyl derivatives.

Hypothalamic obesity, brown adipose tissue, and sympathoadrenal activity in rats

Obesity-producing, hypothalamic knife cuts and ventromedial hypothalamic (VMH) lesions in ad libitum-fed adult rats increased intake of a high-fat diet (123 and 130%) and energy retention (880 and 1,099%) during the 4-wk period postsurgery; even when pair fed to control rats, energy retention of the knife-cut and lesioned rats was still elevated (105 and 155%). Thermogenic capacity of brown adipose tissue (BAT), estimated from guanosine diphosphate (GDP) binding to BAT mitochondria, was unchanged in hyperphagic knife-cut and VMH-lesioned rats and was reduced approximately 50% when these rats were pair fed to controls. Urinary excretion of norepinephrine (NE) was approximately twofold higher in ad libitum-fed, knife-cut, and lesioned rats than in control rats; restriction of energy intake decreased NE excretion to control values. Rates of NE turnover in heart paralleled urinary NE excretion, whereas NE turnover in BAT was generally not increased in the hyperphagic rats. Urinary epinephrine excretion, an index of adrenal medullary activity, was depressed in all knife-cut and VMH-lesioned rats. Hyperphagia coupled with a lack of increased heat production in BAT causes gross obesity in ad libitum-fed, knife-cut, and VMH-lesioned rats, whereas obesity in pair-fed rats develops in part at least as a result of reduced heat production by BAT.

Effect of hypoxia on pig heart short-chain acylcarnitines

The right ventricles of pig heart were perfused with hypoxic blood and the left ventricles were perfused with normally ventilated arterial blood. Free carnitine and short-chain acylcarnitines in hypoxic ventricles were lower than in perfused controls, and much lower than in non-perfused heart. Acetylcarnitine levels decreased and the branched-chain acylcarnitines and propionylcarnitine were elevated in the hypoxic perfused ventricles. These data indicate that both hypoxia and anaesthesia caused loss of carnitine and short-chain acylcarnitines from the heart and hypoxia also changed the distribution of short-chain acylcarnitines in the heart.

A study of the acylcarnitine content of sows' colostrum, milk and newborn piglet tissues: demonstration of high amounts of isovalerylcarnitine in colostrum and milk

As part of a project to determine if newborn piglets contain less than optimal amounts of carnitine, the carnitine and acylcarnitine content of colostrum, milk and serum of sows and of serum, liver, heart and muscle of newborn and 2-day-old piglets was measured. Colostrum contained high amounts (370 nmol/ml) total carnitine, with greater than 95% being acylated. The principal acylcarnitines (approx. 45% each) were acetyl- and isovalerylcarnitine . In contrast, serum from lactating or nonpregnant nonlactating sows and from piglets all contained primarily free carnitine and some acetylcarnitine but only traces of isovalerylcarnitine . At birth, the blood and liver of piglets contained very low amounts of total carnitine, which increased two- and fourfold, respectively, after 2 days of suckling. These data show that newborn piglet liver and blood are carnitine poor and indicate that the high levels in colostrum and milk are a source of tissue carnitine. The large amounts of acetyl- and isovalerylcarnitine in colostrum and milk might facilitate secretion of available carnitine.

A radioisotopic-exchange method for quantitation of short-chain (acid-soluble) acylcarnitines

A reliable and sensitive method for the quantitation of picomole amounts of acetylcarnitine, propionylcarnitine, aliphatic 4-carbon, and 5-carbon acylcarnitines has been developed. The procedure requires the measurement of the amounts of carnitine and acid-soluble carnitine and then the enzymatic exchange of 3H- or 14C-labeled L-carnitine into the acylcarnitine pool using commercial carnitine acetyltransferase, essentially free of acyl-CoA hydrolase activity. After isotopic equilibrium is obtained, the radioactive acylcarnitines are separated using either HPLC or thin-layer chromatography. Procedures for both are described. After separation, the amounts of radioactivity in the acylcarnitines are determined and the amount of individual acylcarnitines can be calculated from the specific activity of the initial total carnitine pool or from the ratio of dpm in the acylcarnitine fraction/dpm in free carnitine X (nanomoles L-carnitine) in the sample. The method has several advantages over current procedures, including rapidity, use of small sample sizes, simplicity, and reliability.

Combined effect of ascorbic acid deficiency and underfeeding on the hepatic carnitine level in guinea-pigs

Liver carnitine level decreased from 249 +/- 16.1 nmoles/g (mean +/- SEM) control value to 148 +/- 9.8 nmoles/g (59.4%) in ascorbic acid deficient guinea-pigs, while in the underfed ('pair-fed') group it decreased to 181 +/- 14.1 nmoles/g (72.6%). Underfeeding also resulted in lower ascorbic acid levels; the depression of carnitine in the underfed animals could be prevented by an overdose (200 mg daily) of ascorbic acid.

The effect of electrical stimulation, fasting and anesthesia on the carnitine(s) and acyl-carnitines of rat white and red skeletal muscle fibres

Time courses for the effect of electrical stimulation, fasting and sampling mode (anesthesia vs decapitation) on the quantitative distribution of carnitine and its esters in fast white and fast red skeletal muscle fibres of rats were determined. Both fibre types responded similarly to electrical stimulation with respect to changes in acetyl- and propionylcarnitine, but the time course was very different. The proportion of esterified carnitine decreased with fasting and anesthesia in both fibres compared to the fed decapitated group. This shift in the acylation state of carnitine was mainly due to the decrease of acetylcarnitine levels. The data show that the use of anesthetics may induce significant quantitative changes in specific acylcarnitine levels, presumably reflecting changes in specific acylcoenzyme A levels.

On carnitine content of the human breast milk

The concentration of total carnitine in human breast milk remained at a constant mean level near 62.9 range: 56.0-69.8/nmoles/ml during the first 21 days postpartum. The carnitine level fell significantly to 35.2 +/- 1.26 nmoles/ml until the 40-50th day. The carnitine concentrations did not depend on the secreted volume of milk. In comparison, fresh and commercial pasteurized cow's milk contained 206.2 (range: 192-269) nmoles/ml and 160.0 (range: 158-200) nmoles/ml carnitine, respectively. In the sera of nursing mothers, the concentration of total carnitine was lower on the first day after delivery (27.2 +/- 1.19 nmoles/ml) but returned to normal by the 21st day postpartum (38.8 +/- 2.97 nmoles/ml).

Concurrent occurrence of elevated ketone body and depressed carnitine level in underfed guinea-pigs

Food ingestion of male guinea-pigs was restricted to 10 g/day. Total carnitine content of liver of the underfed animals fell to 3.75 mumoles per liver (46.1% of control). Serum level of total carnitine was 35.0 nmoles/ml (64.4%) in the underfed animals while they developed high ketonemia, 384.2 nmoles/ml (555.2%). In "restricted' animals the carnitine levels also decreased in the muscles.

An alternative birth center in a community teaching hospital

The hospital-based alternative birth center answers the needs of many low-risk patients. At the same time, it provides safety factors that cannot be approached by home delivery. A home-like environment facilitates labor, simplifies delivery, and strengthens the family unit.