Effect of carnitine and branched-chain acylcarnitines on the 2-oxo acid dehydrogenase activity in intact mitochondria of rat muscle

The role of carnitine in normal and altered fatty acid metabolism

Carnitine is a low-molecular-weight compound obtained from the diet that also is biosynthesized from the essential amino acids lysine and methionine. Carnitine has been identified in a variety of mammalian tissues and has an obligate role in the mitochondrial oxidation of long-chain fatty acids through the action of specialized acyltransferases. Other roles for carnitine include buffering of the acyl coenzyme A (CoA)-CoA ratio, branched-chain amino acid metabolism, removal of excess acyl groups, and peroxisomal fatty acid oxidation. The growing body of evidence about carnitine function has led to increased understanding and identification of disorders associated with altered carnitine metabolism. Disorders of fatty acid oxidation and metabolism typically are associated with primary and secondary forms of carnitine deficiency. These disorders, which include increased lipolysis, increased lipid peroxidation, accumulation of acylcarnitines, and altered membrane permeability, have significant consequences for patients with myocardial diseases and kidney failure. Therapeutic administration of carnitine shows promise in treating selected groups of patients who have altered carnitine homeostasis, resulting in improved cardiac function, increased exercise capacity, reduced muscle cramps, and reduced intradialytic complications.

Multicenter trial of L-carnitine in maintenance hemodialysis patients. II. Clinical and biochemical effects

Since carnitine deficiency has been reported in some patients undergoing maintenance hemodialysis, we studied the effects of intravenous infusion of L-carnitine or placebo at the end of each dialysis treatment. The trial, which lasted seven months (one month baseline, 6 months treatment) was multicenter, double blind, placebo controlled, and randomized. Eighty-two long-term hemodialysis patients, who were given either carnitine (N = 38) or placebo (N = 44), completed this study. In each group, clinical and biochemical parameters during treatment were compared with baseline values. Intra-dialytic hypotension and muscle cramps were reduced only in the carnitine treated group, while improvement in post-dialysis asthenia was noticed in both carnitine and placebo groups. Maximal oxygen consumption, measured during a progressive work exercise test, improved significantly in the carnitine group (111 +/- 50 ml/min. P less than 0.03) and was unchanged in the placebo group. L-carnitine treatment was associated with a significant drop in pre-dialysis concentrations of serum urea nitrogen, creatinine and phosphorus (means +/- SEM, 101 +/- 4.5 to 84 +/- 3.9, 16.7 +/- 0.67 to 14.7 +/- 0.64, and 6.4 +/- 0.3 to 5.5 +/- 0.4 mg/dl, respectively, P less than 0.004). No significant changes in any of these variables were noticed in the placebo group. Mid-arm circumference and triceps skinfold thickness were measured in 11 carnitine and 13 placebo treated patients. Calculated mid-arm muscle area increased in the carnitine patients (41.37 +/- 2.68 to 45.6 +/- 2.82 cm2, P = 0.05) and remained unchanged in the placebo patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Transamination and oxidative decarboxylation of L-isoleucine, L-alloisoleucine and related 2-oxo acids in perfused rat hind limb muscle

Metabolism of L-isoleucine, L-alloisoleucine and corresponding 2-oxo acids in rat hind limb muscle was comparatively studied under steady-state perfusion conditions. At 0.5 mM L-[1-14C]isoleucine, apparent transamination and 2-oxo acid decarboxylation rates amounted to about 17 and 4 nmol/min per g of muscle, respectively. With L-allo[1-14C]isoleucine, the corresponding rates were about 5- and 10-fold lower, respectively. After addition of dichloroacetate (1-5 mM), the portion of (S)- and (R)-methyl-2-oxopentanoate undergoing further oxidative decarboxylation within the tissue was similarly increased by over 40%. In perfusions with 0.5 mM (R,S)-3-methyl-2-oxopentanoate and tracer doses of 1-14C-labeled (S)- or (R)-enantiomer, the 14CO2 production was comparable (about 0.5 nmol/min per g of muscle). Dichloroacetate caused a several-fold increase in 14CO2 release from either enantiomer, apparent 2-oxo acid transamination rates remaining unaffected. Indications for a racemization of 2-oxo acid were not obtained in the experiments. The results are discussed with respect to the appearance/disappearance of L-alloisoleucine in vivo and to the fact that (R)-3-methyl-2-oxopentanoate, but not L-alloisoleucine, can support growth of rats on a diet deficient in L-isoleucine.

Effects of L-carnitine loading on the aerobic and anaerobic performance of endurance athletes

L-Carnitine (L-C), a well known physiological carrier across the inner mitochondrial membrane of activated long chain fatty acids and acceptor of acyl groups from acyl-CoA, has been recently synthesised industrially. This has made it possible to study the effects of L-C loading (4 g X d(-1) by mouth over a period of 2 weeks) on the aerobic and anaerobic performance of 6 long distance competitive walkers. As a result of the treatment: 1) mean total, free and esterified serum L-C both at rest and shortly after completing a 120 min walk at about 65% of the individual maximal aerobic power (VO2max) were significantly increased; 2) VO2max increased 6%, from 54.5 +/- 3.7 (S.D.) to 57.8 +/- 4.7 m1O2 X kg(-1) X min(-1) (P less than 0.02); 3) blood lactate concentration (Lab) as a consequence of short bouts repeated exercise (series of 10, 15 and 20 jumps off both feet on a force platform) was unchanged; 4) heart rate, pulmonary ventilation, oxygen consumption, and respiratory quotient in the same conditions as for 1) were unchanged. It is concluded that, in trained athletes, as a consequence of L-C loading VO2max is slightly but significantly raised, probably as a result of an activation of substrate flow through the TCA cycle, whereas the lipid contribution to metabolism in prolonged submaximal exercise remains unchanged.

Plasma carnitine levels and urinary carnitine excretion during sepsis

Carnitine is an indispensable factor for the beta-oxidation of medium- and long-chain fatty acids, and it plays a possible role in the oxidation of branched-chain amino acids. Plasma and urinary levels of free carnitine and short-chain acyl-carnitines were studied in 67 surgical patients, after non-septic surgical procedures or during sepsis. The septic state was associated with increased urinary excretion of free carnitine (p less than 0.001), as well as with lower plasma levels of short-chain acyl-carnitines (p less than 0.001); the latter feature correlated with the level of hypermetabolism, as evaluated by the metabolic rate and by the arterial-mixed venous O2 difference. In 26 patients during total parenteral nutrition D, L-acetyl-carnitine was administered (100 mg/kg/24 hrs, in continuous iv infusion) and was associated, in septic patients only, with a significant decrease in the respiratory quotient, suggesting enhanced oxidation of low respiratory quotient substrates (fatty acids and/or branched-chain amino acids). Carnitine supplementation during total parenteral nutrition might be of theoretical benefit in some clinical conditions, such as sepsis, in which the following conditions coexist enhanced utilization of substrates whose oxidation is partially or totally carnitine dependent; prolonged absence of exogenous intake of carnitine (as in long-term total parenteral nutrition); eventual impairment of carnitine synthesis due to hepatic dysfunction; increased, massive urinary loss of carnitine.

Interaction of short-chain and branched-chain fatty acids and their carnitine and CoA esters and of various metabolites and agents with branched-chain 2-oxo acid oxidation in rat muscle and liver mitochondria

Interaction of various compounds with the 14CO2 production from [1-14C]-labelled branched-chain 2-oxo acids was studied in intact rat quadriceps muscle and liver mitochrondria. In the absence of carnitine, CoA esters of short-chain and branched-chain fatty acids, CoA and acetyl-L-carnitine stimulated oxidation of 4-methyl-2-oxopentanoate and 3-methyl-2-oxobutanoate in muscle mitochondria. Octanoyl-L-carnitine inhibited oxidation of the latter, but stimulated that of the former substrate. Isovaleryl-L-carnitine was inhibitory with both substrates. Carnitine stimulates markedly 3-methyl-2-oxobutanoate oxidation in liver mitochondria at substrate concentrations higher than 0.1 mM, in contrast to 4-methyl-2-oxopentanoate oxidation. In the presence of carnitine, 3-methyl-2-oxobutanoate oxidation was inhibited in muscle and liver mitochondria by octanoate, octanoyl-L-carnitine and isovaleryl-L-carnitine. The latter ester and octanoyl-D-carnitine inhibited also 4-methyl-2-oxopentanoate oxidation in muscle mitochondria. Branched-chain 2-oxo acids inhibited mutaly their oxidation, except that 3-methyl-2-oxobutanoate did not inhibit 4-methyl-2-oxopentanoate oxidation in liver mitochondria. Their degradation products, isovalerate, 3-methylcrotonate, isobutyrate and 3-hydroxyisobutyrate inhibited to a different extent 2-oxo acid oxidation in liver mitochondria. The effect of CoA esters was studied in permeabilized and with cofactors reinforced mitochondria. Acetyl-CoA and isovaleryl-CoA inhibited only 3-methyl-2-oxobutanoate oxidation in muscle mitochondria. Octanoyl-CoA inhibited oxidation of both 2-oxo acids in muscle and 4-methyl-2-oxopentanoate oxidation in liver mitochondria.(ABSTRACT TRUNCATED AT 250 WORDS)

The metabolic fate of branched-chain amino acids and 2-oxo acids in rat muscle homogenates and diaphragms

After incubation of muscle preparations with [U-14C]branched-chain amino acids or 2-oxo acids, radioactive metabolites were separated, identified and quantified. Homogenates of rat heart and skeletal muscle incubated with 4-methyl-2-oxopentanoate accumulated isovalerate, 3-hydroxyisovalerate and the corresponding carnitine esters. Incubation with 3-methyl-2-oxobutanoate resulted in the production of isobutyrate, 3-hydroxyisobutyrate and their carnitine esters. Addition of L-carnitine increased the production of the esters. The enzymes 3-methylcrotonyl-CoA carboxylase and 3-hydroxyisobutyric acid dehydrogenase apparently are inactive during incubation of muscle homogenates. With liver homogenates the degradation of both 2-oxo acids was more complete. Rat hemidiaphragms incubated with leucine, valine and isoleucine accumulated the corresponding branched-chain 2-oxo acids, fatty acids and hydroxylated fatty acids. The degradation of valine was markedly limited by the release of these metabolites. Considerable amounts (relatively smaller for valine) of radioactivity were also recovered in CO2 and glutamine and glutamate. Incubations with branched-chain 2-oxo acids gave the same radioactive products, except for glutamine and glutamate. Radioactivity was never found in lactate, pyruvate or alanine. These data indicate that the carbon-chains of amino acids entering the citric acid cycle in muscle, are not used for oxidation or for alanine synthesis, but are converted exclusively to glutamine.

The activity state of the branched-chain 2-oxo acid dehydrogenase complex in rat tissues

An assay is described to define the proportion of the branched-chain 2-oxo acid dehydrogenase complex that is present in the active state in rat tissues. Activities are measured in homogenates in two ways: actual activities, present in tissues, by blocking both the kinase and phosphatase of the enzyme complex during homogenization, preincubation, and incubation with 1-14C-labelled branched-chain 2-oxo acid, and total activities by blocking only the kinase during the 5 min preincubation (necessary for activation). The kinase is blocked by 5 mM-ADP and absence of Mg2+ and the phosphatase by the simultaneous presence of 50 mM-NaF. About 6% of the enzyme is active in skeletal muscle of fed rats, 7% in heart, 20% in diaphragm, 47% in kidney, 60% in brain and 98% in liver. An entirely different assay, which measures activities in crude tissue extracts before and after treatment with a broad-specificity protein phosphatase, gave similar results for heart, liver and kidney. Advantages of our assay with homogenates are the presence of intact mitochondria, the simplicity, the short duration and the high sensitivity. The actual activities measured indicate that the degradation of branched-chain 2-oxo acids predominantly occurs in liver and kidney and is limited in skeletal muscle in the fed state.

Interaction of octanoate with branched-chain 2-oxo acid oxidation in rat and human muscle in vitro

Acetate and butanoate inhibited and hexanoate and octanoate increased the 14CO2 production from 0.1 mM [1-14C]-labelled 2-oxoisocaproate (KIC) and 2-oxoisovalerate (KIV) in rat hemidiaphragms. Octanoate increased KIC and KIV oxidation in rat soleus muscle, too, inhibited it in human skeletal muscle and had a divergent effect in rat and human heart slices. In rat hemidiaphragms octanoate primarily affected the process of oxidative decarboxylation. No effect was found on transamination rates of branched-chain amino acids and on the CO2 production beyond alpha-decarboxylation. The reverse transamination of branched-chain 2-oxo acids and their incorporation into protein decreased in the presence of octanoate. Octanoate had no effect on KIC and KIV oxidation at higher 2-oxo acid concentrations and in hemidiaphragms from 3-day-starved rats. The observed interactions are discussed and related to regulatory mechanisms, which are known to affect the branched-chain 2-oxo acid dehydrogenase complex.

Interaction of various metabolites and agents with branched-chain 2-oxo acid oxidation in rat and human muscle in vitro

The interaction of various metabolites and agents with the 14CO2 production from 0.1 mM [1-14C]-labelled 2-oxoisocaproate (KIC) and 2-oxoisovalerate (KIV) was studied in rat and human heart and skeletal muscle preparations. Glucose and carnitine had no effect in any of the studied systems; palmitate gave a small increase of KIC oxidation only in soleus muscle. With rat hemidiaphragms a considerable decrease was found in the presence of high concentrations of a competitive branched-chain 2-oxo acid and of pyruvate, and in the presence of ketone bodies. A considerable increase was found in the presence of the branched-chain 2-oxo acid dehydrogenase kinase inhibitor 2-chloroisocaproate and the transminase inhibitor amino-oxyacetate. 2-Oxoglutarate increased and clofibric acid decreased only KIC oxidation. Divergent effects were given by intermediates of the degradation route of KIC and KIV and by monocarboxylate translocator inhibitors. The observed interactions are discussed and related to regulatory mechanisms which are known to affect the branched-chain 2-oxo acid dehydrogenase complex.

Enzymatic and pharmacokinetic studies on the metabolism of branched chain alpha-keto acids in the rat

Michaelis-constants and enzyme activities for dehydrogenation and transamination of the three branched chain alpha-keto acids in liver, kidney, skeletal muscle, and brain of rats are reported. After oral load only 11-22% of the keto acids pass the liver unchanged. Blood levels in pharmacokinetic and absorption studies are related to the Michaelis-constants. At the low keto-acid concentrations after oral application, dehydrogenation in the non-hepatic tissues is supposed to prevail over transamination. Data on feed efficiency of branched chain alpha-keto acids reported in the literature support this view. The chance for transamination is better after intravenous administration. The transferability of our data to humans, and various factors influencing the efficiency of branched chain alpha-keto acids are discussed in connection with data reported in the literature.