13CO(2) peak value of L-[1-(13)C]phenylalanine breath test reflects hepatopathy

[13C]Methionine breath test to assess intestinal failure-associated liver disease

Oxidation of L[1-C]methionine ([C]-Met) in liver mitochondria can be quantified by measuring exhaled CO2. We hypothesized that CO2 recovery after i.v. administered [C]-Met would provide a noninvasive measure of liver function in pediatric intestinal failure-associated liver disease (IFALD). After Institutional Review Board (IRB) approval, 27 patients underwent L[1-C]-Met breath tests ([C]-MBTs), five of whom underwent repeat testing after clinical changes in liver function. Sterile, pyrogen-free [C]-Met was given i.v. Six breath samples collected during 120 min were analyzed for CO2 enrichment using isotope ratio mass spectrometry. Pediatric end-stage liver disease (PELD) scores were recorded, and total carbon dioxide (CO2) production was measured by indirect calorimetry. Twenty-seven patients (median age = 5.3 mo) underwent a total of 34 [C]-MBTs without adverse events. Fourteen patients had documented liver biopsies (five with cirrhosis and nine with cholestasis or fibrosis). The [C]-MBT differentiated patients with and without cirrhosis (medians 210 and 350, respectively, p = 0.04). Serial [C]-MBTs in five patients reflected changing PELD scores. i.v. administering the stable isotope [C]-Met with serial breath sampling provides a useful, safe, and potentially clinically relevant evaluation of hepatic function in pediatric IFALD. The [C]-MBT may also help quantify progression or improvement of IFALD.

L-[1-13C]phenylalanine breath test in patients with chronic liver disease of different etiologies

The aim of this study was to compare the oxidation of L-[1-(13)C]phenylalanine ((13)C-PheOx) in patients with chronic liver failure due to different etiologies using L-[1-(13)C]phenylalanine breath test. Breath samples were collected before the administration of 100 mg L-[1-(13)C]phenylalanine, and every 10 min thereafter until completion of 1 h. Control subjects (n=9) presented a larger cumulative percentage of (13)C dose recovery (CPDR) than patients (n=124) with chronic liver disease, regardless of the etiology (7.5+/-0.7 vs. 4.2+/-0.2, p=0.001). No differences in CPDR were found considering the Child-Pugh (CP) class or etiology: alcoholic (CP A=7.7+/-0.7, CP B=4.1+/-0.5, CP C=2.0+/-0.3), hepatitis C virus (CP A=5.4+/-0.5, CP B=4.0+/-0.2, CP C=2.2+/-0.3), hepatocellular carcinoma (CP A=5.5+/-1.6, CP B=3.6+/-1.8, CP C=2.2+/-1.0); or cryptogenic cirrhotic patients (CP A=7.4+/-1.5, CP B=4.4+/-0.4, CP C=2.1+/-0.7). Results confirm that (13)C-PheOx decreases in patients with cirrhosis with respect to controls, notwithstanding the etiology.

A preliminary study of (13)c-phenylalanine and (13)c-dipeptide breath tests in horses

This study aimed to establish a standard dose and sample collection time for (13)C phenylalanine and (13)C-Dipeptide breath test in horses. To evaluate dose-dependent effects, healthy horses received 2.5 mg/kg, 5 mg/kg, and 10 mg/kg (13)C phenylalanine dissolved in 1 ml/kg distilled water and 1.25 mg/kg, 2.5 mg/kg, and 5 mg/kg (13)C dipeptide dissolved in 2 ml/ kg distilled water. Tmax was observed during the sample collection time. For (13)C phenylalanine, the standard deviation of Cmax at 5 mg/kg was lower than that of 10 mg/kg. For (13)C dipeptide, the standard deviation of Tmax was the lowest at 5 mg/kg. This study revealed that an optimal dose for breath tests with (13)C phenylalanine and (13)C dipeptide may be 5 mg/kg in horses.

Prognostic value of 13C-phenylalanine breath test on predicting survival in patients with chronic liver failure

AIM: To evaluate the prognostic value of percentage of ¹³C-phenylalanine oxidation (¹³C-PheOx) obtained by ¹³C-phenylalanine breath test (¹³C-PheBT) on the survival of patients with chronic liver failure.

METHODS: The hepatic function was determined by standard liver blood tests and the percentage of ¹³C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox.

RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of ¹³C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of ¹³C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival.

CONCLUSION: Percentage of ¹³C-PheOx obtained by ¹³C-PheBT is a strong predictor of survival in patients with chronic liver disease.

13C-acetic acid is more sensitive than 13C-octanoic acid for evaluating gastric emptying of liquid enteral nutrient formula by breath test in conscious rats

Breath test using 13C-labeled compound has been used as a convenient method to evaluate gastric emptying. 13C-Labeled acetic acid or octanoic acid has been used in clinic. However, there is few report comparing two compounds. This study aimed to compare 13C-acetic acid and 13C-octanoic acid in newly-constituted breath test for monitoring gastric emptying in conscious rats. After fasting, rats were orally administered Racol (liquid enteral nutrient formula) containing 13C-labeled compound (same molar of 13C-acetic acid or 13C-octanoic acid) and housed in a chamber. The expired air in the chamber was collected in a breath-sampling bag using a tube and aspiration pump. The level of 13CO2 in the expired air was measured using an infrared spectrometer at appropriate intervals for 120 min. Expired 13CO2 air from 13C-acetic acid changed at significantly higher levels than that from 13C-octanoic acid. Cmax and AUC120 min values of expired 13CO2 from 13C-acetic acid were significantly higher than those from 13C-octanoic acid, but Tmax was not different between them. These results show that 13C-acetic acid is more sensitive for monitoring gastric emptying than 13C-octanoic acid in liquid test meal although both acids clearly monitored gastric emptying.

[Irinotecan and liver dysfunctions]

During last years, irinotecan has become registered as a major cytotoxic drug in several tumor types. Since the metabolism of this drug is predominantly made in the liver, administration to patients with liver dysfunctions remains a major problem. Hyperbilirubinemia has been shown to require dose reduction. In addition, gene polymorphism of UGT1A1 was shown to be associated with a higher risk of toxicity. However, studies are still required to optimise the use of irinotecan in patients with liver dysfunctions.

Phenylalanine breath test as a method to evaluate hepatic dysfunction in obstructive jaundice

BACKGROUND

The purpose of this study was to investigate whether the hepatic dysfunction associated with obstructive jaundice can be measured from changes in expiratory 13CO2 levels after intravenous administration of l-[1-(13)C]phenylalanine, using a rat model of obstructive jaundice.

MATERIALS AND METHODS

Under pentobarbital anesthesia, bile duct ligation (BDL) was performed (n=12). In the control group, simple laparotomy was performed (n=12). On postoperative day 7, 20 mg/kg l-[1-(13)C]phenylalanine was administered via the femoral vein. Phenylalanine breath test (PBT) was performed for 30 min. We compared single point of 13CO2 level (SPT: T: min) and sum of 13CO2 output (ST) values between BDL and control rats. We examined the correlation of SPT or ST with phenylalanine hydroxylase activity (PHA) and blood chemical parameters.

RESULTS

Both SPT and ST values decreased in BDL compared to control 3 min after the start of PBT (SP10; 103+/-12 (per thousand) versus 84+/-16 (per thousand) P=0.025). PHA/g liver in BDL was significantly decreased compared to control (40.81+/-4.80 (U) versus 28.93+/-9.60 (U) P=0.008). PHA/g liver was correlated with SPT with correlation coefficient of more than 0.715, 10 min after the start of PBT, and the maximum correlation was at SP20 (r=0.801). Blood chemical parameters were correlated with S15 (total bilirubin, r=-0.717; alkaline phosphatase, r=-0.841; gamma-glutamyl transpeptidase, r=-0.759; alanine aminotransferase, r=-0.776; albumin, r=0.819).

CONCLUSIONS

In the breath test with intravenously l-[1-(13)C]phenylalanine, hepatic dysfunction associated with obstructive jaundice could be measured in a short period.

[13C] phenylalanine breath test and hepatic phenylalanine metabolism enzymes in cirrhotic rats

BACKGROUND

Stable isotope 13C-labelled phenylalanine breath test has been applied to enable the quantitative evaluation of hepatic functional reserve, but the mechanism underlying the changes in function has not been resolved. This study evaluated the correlation between expression of the mRNA of key enzymes mediating phenylalanine metabolism and the metabolism of L-[1-13C] phenylalanine (13C-phe) assessed by the excretion of 13C-CO2 in the breath of rats with, and without, chronic hepatic injury induced by administration of carbon tetrachloride (CCl4).

MATERIALS AND METHODS

Male Sprague-Dawley (SD) rats (n = 29) were given subcutaneous injections of CCl4 to induce chronic hepatic injury. L-[1-13C] phenylalanine breath tests (PheBT) were then applied to the rats to assess hepatic function. Expression of phenylalanine hydroxylase (PHH) and tyrosine transaminase (TYT) mRNA in liver was detected by real-time fluorescence quantification RT-PCR, using TaqMan as the probe. It was then determined whether the PheBT results correlated with PHH and/or TYT mRNA expression. In addition, immunohistochemical labelling was used to visualize PHH protein expression in the control and injured liver tissue.

RESULTS

There were significant decreases in PheBT and PHH mRNA expression in the cirrhotic rats relative to the uninjured controls and these two measures of liver function were correlated. However, TYT mRNA expression was not changed by CCl4-induced liver injury. The immunohistochemical analysis revealed that PHH protein was expressed predominantly in the cytoplasm of liver cells.

CONCLUSIONS

The results of the PheBT were consistent with the changes in PHH gene expression following liver injury. The present findings indicate that decreased expression of the rate-limiting enzyme PHH, but not of TYT, might underlie the functional deficits detected as decreased PheBT. The 13C excretion rate constant per mass liver (PheBT-k/LW) was the most sensitive index that could be used to evaluate the PHH mRNA expression in the liver.

Ornithine breath test as a method to evaluate functional liver volume1

BACKGROUND

The purpose of this study was to investigate whether the functional liver volume can be measured from changes in expiratory 13CO2 levels after intravenous administration of L-[1, 2-13C] ornithine, using a rat model of hepatectomy.

MATERIALS AND METHODS

Under pentobarbital anesthesia, 30%, 70%, or 90% hepatectomy was performed. In the control group, simple laparotomy was performed. Then, 20 mg/kg L-[1, 2-13C] ornithine was administered to rats via the femoral vein. A breath test was conducted 20 min after laparotomy. We examined the correlation of the sum of 13CO2 output (S) or a single point of 13CO2 level (SP) with liver weight/body weight (LW/BW) (%) every 15 min.

RESULTS

In all of the groups, the ornithine breath test (OBT) graph reached a plateau level at about 6 min. The correlation coefficient between S15 and LW/BW was highest 0.952 (P <0.0001). The correlation coefficient between SP14 and LW/BW was highest, 0.944 (P <0.0001). The severity of hepatic injury could be evaluated, with significant differences in S5-15 and SP5-15 in all comparisons between groups.

CONCLUSION

In the breath test with intravenously administered L-[1, 2-13C] ornithine, functional liver volume could be evaluated accurately in a short period.

Simple and Noninvasive Breath Test Using 13C-Acetic Acid to Evaluate Gastric Emptying in Conscious Rats and Its Validation by Metoclopramide

The (13)C-breath test has been used to clinically evaluate gastric emptying. However, this method has not been sufficiently validated in experimental animals. The present study aimed to establish a simple and noninvasive (13)C-breath-test system in Sprague-Dawley male rats. After fasting, rats were orally administered Racol containing (13)C-acetic acid and housed in a desiccator. The expired air in the chamber was collected in a breath-sampling bag using a tube and aspiration pump. The level of (13)CO2 in the expired air was measured using an infrared spectrometer at appropriate intervals for 120 min. During this period, the rate of (13)CO2 excretion increased, peaked, and decreased thereafter. The maximum concentration (Cmax) and area under the curve (AUC120 min) of (13)CO2 excretion increased in volume- and dose-dependent manners. The time taken to reach the maximum concentration (Tmax) of (13)CO2 excretion increased as the volume increased, but was not affected by the dose of (13)C-labeled acetic acid. Metoclopramide dose-dependently increased the Cmax and shortened Tmax of (13)CO2 excretion compared with those of the control rats, whereas the AUC120 min was not affected. These results confirm that this simple method can successfully evaluate gastric emptying. Moreover, this system is suitable for investigating additional physiological functions using other labeled compounds.

Current and future uses of breath analysis as a diagnostic tool

The analysis of exhaled breath is a potentially useful method for application in veterinary diagnostics. Breath samples can be easily collected from animals by means of a face mask or collection chamber with minimal disturbance to the animal. After the administration of a 13C-labelled compound the recovery of 13C in breath can be used to investigate gastrointestinal and digestive functions. Exhaled hydrogen can be used to assess orocaecal transit time and malabsorption, and exhaled nitric oxide, carbon monoxide and pentane can be used to assess oxidative stress and inflammation. The analysis of compounds dissolved in the aqueous phase of breath (the exhaled breath condensate) can be used to assess airway inflammation. This review summarises the current status of breath analysis in veterinary medicine, and analyses its potential for assessing animal health and disease.

L-[1-13C] phenylalanine breath test reflects histological changes in the liver

OBJECTIVE

Compared with healthy individuals, patients with chronic liver disease reportedly have lower L-[1-13C] phenylalanine breath test (PBT) values. However, there is no report detailing the relationship between the results of PBT and pathological data in liver disease patients. This study was designed to investigate the degree of histological changes in the liver that induce PBT changes and the time of measurement that reflects the histological change.

MATERIALS AND METHODS

PBT was performed in 47 patients (10 with a normal liver, and 37 with chronic hepatitis C). After administering 10 mg/kg L-[1-13C] phenylalanine, 300 mL of expired air was collected over 90 min at 15-min intervals. The rate of hepatic phenylalanine oxidation (%13C dose h(-1)) at each time point was calculated from the amount of 13CO(2) in the exhaled air, assuming a CO(2) production rate of 300 mmol m(-2) body surface area per hour. Subsequently, we examined the relationship between the results of PBT and METAVIR pathological scoring.

RESULTS

The highest correlation coefficients between the fibrosis score and %13C dose h(-1) and between the fibrosis score and %13C cumulative excretion were obtained at 45 min (r = -0.779, R(2) = 0.607; P < 0.0001) and 75 min (r = -0.768, R(2) = 0.590; P < 0.0001), respectively.

CONCLUSION

PBT is a useful adjunct for detecting histological changes in the liver. The %13C dose h(-1) value at 45 min and the %13C cumulative excretion value at 75 min of PBT are useful for detecting hepatic histological change.

L-[1-13C] phenylalanine breath test reflects phenylalanine hydroxylase activity of the whole liver

OBJECT

The purpose of this study was to perform L-[1-13C] phenylalanine breath test (PBT), measure phenylalanine hydroxylase (PAH) activity in liver tissue biopsies from patients, analyze the relationship between PBT results and PAH activity, and determine the time point at which measurements best reflect PAH activity in liver tissue.

METHODS

PBT was performed in 25 patients (10 with normal liver and 15 with liver cirrhosis). After administering 10 mg/kg L-[1-13C] phenylalanine, 300 ml of expired air was collected over 90 min at 15-min intervals. The rate of hepatic phenylalanine oxidation (%13C dose h(-1)) at each time point was calculated from the amount of 13CO(2) in the breath, assuming a CO(2) production rate of 300 mmol m(-2) body surface area per hour. Subsequently, we examined the relationship between the results of PBT and PAH activity.

RESULTS

PAH activity of the whole liver was significantly decreased in hepatic cirrhosis patients (P < 0.05). The results of PBT %13C dose h(-1) correlated with the PAH activity/liver, with correlation coefficients at 30, 45, and 60 min of more than 0.7, and the maximum correlation was at 30 min (r = 0.821, P < 0.0001). %13C cumulative excretion correlated with the PAH activity/liver with correlation coefficients of more than 0.7 after 45 min. The maximum correlation was at 90 min (r = 0.770, P = 0.001).

CONCLUSION

PBT values reflect PAH activity in the whole liver and, in particular, the % dose h(-1) at 30 min after oral administration highly correlates with PAH activity, providing an important indicator for monitoring changes in whole liver PAH activity.

Phenylalanine kinetics in healthy volunteers and liver cirrhotics: implications for the phenylalanine breath test

Expired 13CO2 recovery from an oral l-[1-13C]phenylalanine ([13C]Phe) dose has been used to quantify liver function. This parameter, however, does not depend solely on liver function but also on total CO2 production, Phe turnover, and initial tracer distribution. Therefore, we evaluated the impact of these factors on breath test values. Nine ethyl-toxic cirrhotic patients and nine control subjects received intravenously 2 mg/kg of [13C]Phe, and breath and blood samples were collected over 4 h. CO2 production was measured by indirect calorimetry. The exhaled 13CO2 enrichments were analyzed by isotope ratio mass spectrometry and the [13C]Phe and l-[1-13C]tyrosine enrichments by gas chromatography-mass spectrometry. The cumulative 13CO2 recovery was significantly lower in cirrhotic patients (7 vs. 12%; P < 0.01), in part due to lower total CO2 production rates. Phe turnover in cirrhotic patients was significantly lower (33 vs. 44 micro mol. kg(-1). h(-1); P < 0.05). When these extrahepatic factors were considered in the calculation of the Phe oxidation rate, the intergroup differences were even more pronounced (3 vs. 7 micro mol. kg(-1). h(-1)) than those for 13CO2 recovery data. Also, the Phe-to-Tyr conversion rate, another indicator of Phe oxidation, was significantly reduced (0.7 vs. 3.0 micro mol. kg(-1). h(-1)).

Recovery of liver function in two-third partial hepatectomized rats evaluated by L-[1-13C]phenylalanine breath test

BACKGROUND

We have previously reported that by means of a breath test with intravenously administered L-[1-13C] phenylalanine (13Cphe), hepatopathy could be quantitatively evaluated by measuring expiratory 13CO2 levels in a short period. It is known that phenylalanine hydroxylase activity (PAHA) plays an important role in phenylalanine metabolism. We examined the relationship between changes in PAHA and the results of the 13Cphe breath test during hepatic regeneration in a rat model of 70% hepatectomy, to assess their usefulness for evaluating hepatic regeneration.

METHODS

Male Wistar rats (Shizvoka Laboratory Animal Center, Hamamatsu, Japan) weighing 230 to 290 g were subjected to 70% hepatectomy under anesthesia with sodium pentobarbital. One, 2, 3, 5, 7, and 14 days postoperatively, 30 mg/kg 13Cphe was intravenously injected into the femoral vein, and the increase in exhaled 13CO2 (Delta 13CO2) was measured for 15 minutes. Simple laparotomy was performed in control rats. After the breath test, the regenerated liver was removed and weighed. The amount of DNA, amount of hepatic tissue total protein (TP), and PAHA were determined.

RESULTS

The r between liver weight/body weight and PAHA, between DNA and PAHA, and between TP and PAHA were 0.832, 0.720, and 0.758, respectively. Breath test graphs revealed that liver weight/body weight, DNA, and TP showed the best correlations with the peak value of Delta 13CO2 (liver weight/body weight percentage, r = 0.801; DNA, r = 0.660; TP, r = 0.706), and r between PAHA and peak value was 0.638.

CONCLUSIONS

These results suggest that measurement of PAHA in regenerated liver is an effective method for following up liver function after hepatic resection. Moreover, the 13Cphe breath test may also be useful to evaluate liver function after partial hepatectomy.

[Evaluation of liver function with 13C-labelled amino acid using hepatectomized rat model]

Using a rat model of hepatectomy, we investigated whether the severity of hepatopathy could be quantitatively measured from changes in expiratory 13CO2 levels after intravenous administration of L-[1-(13)C]phenylalanine, L-[1-(13)C]methionine or L-[1-(13)C]alanine.

MATERIALS AND METHODS

Under nembutal anesthesia, 30 mg/kg L-[1-(13)C]phenylalanine, 40 mg/kg L-[1-(13)C]methionine or 20 mg/kg L-[1-(13)C]alanine was administered to rats through the femoral vein, and expiratory 13CO2 levels were measured for 15 min. Thirty percent, 70% or 90% hepatectomy was performed. In the control group, simple laparotomy was performed.

RESULTS

The correlation coefficient between total 13CO2 output over 15 min after L-[1-(13)C]phenylalanine administration and liver weight/body weight was 0.883 (P < 0.001). The correlation coefficient between total 13CO2 output over 15 min after L-[1-(13)C]methionine administration and liver weight/body weight was 0.922 (P < 0.001). The correlation coefficient between total 13CO2 output over 15 min after L-[1-(13)C]alanine administration and liver weight/body weight was 0.902 (P < 0.0001).

CONCLUSION

In the breath test with intravenously administered L-[1-(13)C]phenylalanine, L-[1-(13)C]methionine, or L-[1-(13)C]alanine, hepatopathy could be quantitatively evaluated by measuring expiratory 13CO2 levels over 15 min.

The 13C-octanoic acid breath test: validation of a new noninvasive method of measuring gastric emptying in rats

Currently available rat models for measuring gastric emptying are hampered by the necessity to kill the animals at the end of each experiment, which makes repetitive testing impossible. We have developed and validated a noninvasive test model, adapted from the 13C-octanoic breath test in humans, for repetitive measurements of gastric emptying in rats. Male Wistar rats were trained on a fixed protocol to eat a piece of pancake doped with 1 microg 13C-octanoic acid after 12 h fasting, and to stay thereafter in cylindrical glass cages. Breath tests were performed by a fully automated system of computer-guided switching valves, which collected consecutive breath samples. All breath samples were analysed by gas chromatography and isotope mass spectrometry. The area under the curve (AUC) from the cumulative 13CO2 excretion from 0 to 6 h was determined by the trapezium method to calculate the gastric half-emptying times (t(1/2)). Inter-day variability was determined. The effect of subcutaneous or intraperitoneal injection of saline was studied. The test was further validated for pharmacological interventions by oral administration of cisapride and parenteral administration of atropine, to induce, respectively. acceleration and delay of gastric emptying. Mean gastric emptying times +/- SD of 24 rats were 119.3 +/- 28.2 min, 138.7 +/- 26.0 min, and 124.5 +/- 30.9 min on three different test days. The mean coefficient of variation of three repeated measurements in the same 24 rats was 17.5%. No significant differences were observed after subcutaneous or intraperitoneal injection of saline. In a second test series of eight rats, cisapride significantly accelerated gastric emptying (mean t(1/2) 112.7 +/- 33.1 min, P < 0.05), while atropine caused a significant delay (mean t(1/2) 205.9 +/- 24.9 min, P < 0.05) when compared to control test results (mean t(1/2) 140.7 +/- 16.7 min) in the same rats. We validated the 13C-octanoic breath test to study gastric emptying in rats. This test method obviates the necessity to kill laboratory animals and allows repetitive measurements of gastric emptying to study its physiology or pathophysiology as well as the effect of pharmacological agents.

l-[1-(13)C]Alanine is a useful substance for the evaluation of liver function

BACKGROUND

Using a rat model of hepatectomy, we investigated whether the severity of hepatopathy could be quantitatively measured from changes in expiratory (13)CO(2) levels after intravenous administration of l-[1-(13)C]alanine.

MATERIALS AND METHODS

Under nembutal anesthesia, 20 mg/kg l-[1-(13)C]alanine was administered to rats via the femoral vein, and expiratory (13)CO(2) levels were measured for 15 min. Then, 30, 70, or 90% hepatectomy was performed. In the control group, simple laparotomy was performed. A breath test was conducted 20 min after laparotomy. We examined the correlation of total (13)CO(2) output (S) or single point (13)CO(2) level (SP) every 1 min for 15 min with liver weight/body weight (LW/BW) (%).

RESULTS

In the control group, the breath test graph showed a specific peak level about 3 min after administration, but in all groups undergoing hepatectomy, it did not show any peak level during measurement. The correlation coefficient between S(12--15) after l-[1-(13)C]alanine administration and LW/BW was 0.902 (P < 0.0001). The correlation coefficient between SP(7) after l-[1-(13)C]alanine administration and LW/BW was highest, 0.908 (P < 0.0001). The severity of hepatopathy could also be evaluated, with significant differences in S(12-14) compared to control when the volume of resected liver was 30% or greater, but there was no significant difference between the groups undergoing 70 and 90% hepatectomy. However, the severity of hepatopathy could be evaluated, with significant differences in S(15) and SP(7) in all comparisons between groups.

CONCLUSION

In the breath test with intravenously administered l-[1-(13)C]alanine, the severity of hepatopathy could be quantitatively evaluated in a short period by measuring S(15) and SP(7).

Hepatic phenylalanine metabolism measured by the [13C]phenylalanine breath test

BACKGROUND

The amino acid clearance test including phenylalanine is known to reflect liver functional reserve, which correlates with surgical outcome; however, the procedure is not clinically useful because of its laborious and time-consuming nature. This study evaluates whether phenylalanine oxidation capacity measured by a breath test could reflect liver functional reserve.

DESIGN

We determined phenylalanine oxidation capacity in 42 subjects using the L-[1-13C]phenylalanine breath test (PBT). The 13CO2 breath enrichment was measured at 10-min intervals for 120 min after oral administration of 100 mg of L-[1-13C]phenylalanine. Subjects were divided into the following three groups according to their plasma retention rate of indocyanine green at 15 min (ICG R15): Group I (ICG R15 < 10%), Group II (ICG R15 10--20%), and Group III (ICG R15 > 20%). First, we determined the parameters of the phenylalanine oxidation capacity that differentiated these groups and then, using these parameters, we compared the PBT with the ICG clearance test, Child-Pugh classification score and standard liver blood tests.

RESULTS

The %13C dose h(-1) at 30 min and cumulative excretion at 80 min were significantly different among the three groups (P < 0.05). These two parameters significantly correlated with the ICG R15, Child-Pugh classification score (P < 0.0001) and results of standard liver blood tests (P < 0.05).

CONCLUSIONS

Phenylalanine oxidation capacity measured by the PBT was reduced according to the severity of liver injury assessed by the ICG clearance test, Child-Pugh classification, and standard liver blood tests. These results indicate that the PBT can be used as a noninvasive method to determine liver functional reserve.

[1-(13)C] breath test of galactose and fructose for quantitative liver function

BACKGROUND

Using a rat model of hepatectomy, we investigated whether the severity of hepatopathy could be quantitatively measured from changes in expiratory (13)CO(2) levels after intravenous administration of [1-(13)C]fructose or [1-(13)C]galactose.

MATERIALS AND METHODS

Under nembutal anesthesia, 100 mg/kg of [1-(13)C]fructose or [1-(13)C]galactose was administered to rats via the femoral vein, and expiratory (13)CO(2) levels were measured for 120 min. Then, 30, 70, or 90% hepatectomy was performed. In the control group, simple laparotomy was performed. A breath test was conducted 20 min after laparotomy. We examined the correlation of a single point (13)CO(2) level (SP) every 5 min until 30 min, and at 45 and 60 min with liver wt/body wt (LW/BW) (%).

RESULTS

In the control group and all groups undergoing hepatectomy, the [1-(13)C]fructose breath test graph reached a plateau level at about 25 min. In the control group, the [1-(13)C]galactose breath test graph reached a plateau level, but in all groups undergoing hepatectomy a plateau level was not reached during measurement. The correlation coefficient between SP(5) after [1-(13)C]fructose administration and LW/BW was the highest, 0.656 (P = 0.0017). The correlation coefficient between SP(25) after [1-(13)C]galactose administration and LW/BW was the highest, 0.923 (P < 0.0001).

CONCLUSION

In the breath test with intravenously administered [1-(13)C]fructose, hepatopathy could not be quantitatively evaluated accurately. However, hepatopathy could be quantitatively evaluated accurately by measuring SP(25) in the breath test with intravenously administered [1-(13)C]galactose over a short period.

Evaluation of liver regeneration using the L-[1-13C]methionine breath test

BACKGROUND

We examined the relationship between changes in the liver weight/body weight percentage, amount of hepatic tissue total DNA, and the results of the [1-(13)C]methionine ((13)Cmet) breath test during hepatic regeneration in a rat model of 70% hepatectomy, to assess their usefulness for evaluating hepatic regeneration.

MATERIALS AND METHODS

Male Wistar rats (230-290 g) were subjected to 70% hepatectomy under anesthesia with Nembutal. One, 2, 3, 7, and 14 days postoperatively, 40 mg/kg (13)Cmet was intravenously injected into the femoral vein, and the increase in exhaled (13)CO(2) (Delta(13)CO(2)) was measured for 15 min. Simple laparotomy was performed in control rats. Following the breath test, the regenerated liver was removed and weighed. The amount of DNA was determined.

RESULTS

The correlation coefficients (r) between liver weight/body weight (LW/BW) and results of the (13)Cmet breath test, and between DNA and results of the (13)Cmet breath test were 0.892 and 0.800, respectively.

CONCLUSIONS

The (13)Cmet breath test is considered to be very useful for assessing liver regeneration, and total (13)CO(2) output over 15 min in the (13)Cmet breath test graph seems to be an effective indicator for evaluating liver regeneration.

Metabolism 2000: the emperor needs new clothes

Metabolism is one of the corner stones of nutritional science. As biology enters the post-genomic era and with functional genomics beginning to takeoff, we anticipate that the study of metabolism will play an increasingly important role in helping to link advances made via the reductionist paradigm, that has been so successful in molecular and cellular biology, with those emerging from observational studies in animals and human subjects. A reconstructive metabolically-focused approach offers a timely paradigm for enhancing the elegance of nutritional science. Here we give particular attention to the use of tracers as phenotyping tools and discuss the application of our metaprobe concepts with respect to some novel features of metabolism, including 'underground metabolism', 'metabolic hijacking', 'catalytic promiscuity' and 'moonlighting proteins'. The opportunities for enhancing the study of metabolism by new and emerging technologies, and the importance of the interdisciplinary research enterprise are also touched upon. We conclude that: (1) the metaprobe concepts and approach, discussed herein, potentially yield a quantitative physiological (metabolic) phenotype against which to elaborate partial or focused genotypes; (2) physiological (metabolic) phenotypes which have a whole-body or kinetically-discernible inter-organ tissue-directed metabolic signature are an ideal target for this directed tracer-based definition of the 'functional' genotype; (3) metabolism, probed with tracer tool kits suitable for measuring rates of turnover, change and conversion, becomes in the current sociology of the 'Net', like AOL, Yahoo. Alta Vista, Lycos or Ask Jeeves, the portal for an exploration of the metabolic characteristics of the 'Genomics Internet'.