Whole-body protein synthesis and breakdown rates in children before and after reconstructive surgery of the skin

Mass spectrometric analysis of PTM dynamics using stable isotope labeled metabolic precursors in cell culture

Biological organisms represent highly dynamic systems, which are continually exposed to environmental factors and always strive to restore steady-state homeostasis. Posttranslational modifications are key regulators with which biological systems respond to external stimuli. To understand how homeostasis is restored, it is important to study the kinetics of posttranslational modifications. In this review we discuss proteomic approaches using stable isotope labeled metabolic precursors to study dynamics of posttranslational modifications in cell culture.

Whole Body Protein Turnover and Net Protein Balance After Pediatric Thoracic Surgery: A Noninvasive Single-Dose 15 N Glycine Stable Isotope Protocol With End-Product Enrichment

BACKGROUND

We used the 15 N glycine urinary end-product enrichment technique to quantify whole body protein turnover following thoracic surgery.

MATERIALS AND METHODS

A single dose of 15 N glycine (2 mg/kg) was administered orally on postoperative day 1 to children (1-18 years) following thoracic surgery. 15 N enrichment of ammonia and urea was measured in mixed urine after 12 and 24 hours, respectively, and protein synthesis, breakdown, and net balance determined. Nitrogen balance (dietary intake minus urinary excretion) was calculated. Urinary 3-methylhistidine:creatinine ratio was measured as a marker of skeletal muscle protein breakdown.

RESULTS

We enrolled 19 subjects-median (interquartile range): age, 13.8 years (12.2-15.1); weight, 49.2 kg (38.4-60.8)-who underwent thoracotomy (n = 12) or thoracoscopic (n = 7) surgery. Protein synthesis and breakdown by 15 N enrichment were 7.1 (5.5-9) and 7.1 (5.6-9) g·kg-1 ·d-1 with ammonia (12 hours) as the end product, and 5.8 (3.8-6.7) and 6.7 (4.5-7.6) with urea (24 hours), respectively. Net protein balance by the 15 N glycine and urinary urea nitrogen methods were -0.34 (-0.47, -0.3) and -0.48 (-0.65, -0.28) g·kg-1 ·d-1 , respectively (rs = 0.828, P < .001). Postoperative change in 3-methylhistidine:creatinine ratio did not correlate significantly with protein breakdown or balance.

CONCLUSION

The single-dose oral administration of 15 N glycine stable isotope with measurement of urinary end-product enrichment is a feasible and noninvasive method to investigate whole body protein turnover in children. After major surgery, children manifest increased protein turnover and net negative balance due to increased protein breakdown.

Whole body protein kinetics measured with a non-invasive method in severely burned children

Persistent and extensive skeletal muscle catabolism is characteristic of severe burns. Whole body protein metabolism, an important component of this process, has not been measured in burned children during the long-term convalescent period. The aim of this study was to measure whole body protein turnover in burned children at discharge (95% healed) and in healthy controls by a non-invasive stable isotope method. Nine burned children (7 boys, 2 girls; 54±14 (S.D.)% total body area burned; 13±4 years; 45±20 kg; 154±14 cm) and 12 healthy children (8 boys, 4 girls; 12±3 years; 54±16 kg; 150±22 cm) were studied. A single oral dose of (15)N-alanine (16 mg/kg) was given, and thereafter urine was collected for 34 h. Whole body protein flux was calculated from labeling of urinary urea nitrogen. Then, protein synthesis was calculated as protein flux minus excretion, and protein breakdown as flux minus intake. At discharge, total protein turnover was 4.53±0.65 (S.E.)g kg body weight(-1) day(-1) in the burned children compared to 3.20±0.22 g kg(-1) day(-1) in controls (P=0.02). Expressed relative to lean body mass (LBM), the rates were 6.12±0.94 vs. 4.60±0.36 g kg LBM(-1) day(-1) in burn vs. healthy (P=0.06). Total protein synthesis was also elevated in burned vs. healthy children, and a tendency for elevated protein breakdown was observed.

CONCLUSION

Total protein turnover is elevated in burned children at discharge compared to age-matched controls, possibly reflecting the continued stress response to severe burn. The oral (15)N-alanine bolus method is a convenient, non-invasive, and no-risk method for measurement of total body protein turnover.

Age-related changes of muscle and plasma amino acids in healthy children

The aim of the study was to explore if changes in muscle and plasma amino acid concentrations developed during growth and differed from levels seen in adults. The gradient and concentrations of free amino acids in muscle and plasma were investigated in relation to age in metabolic healthy children. Plasma and specimens from the abdominal muscle were obtained during elective surgery. The children were grouped into three groups (group 1: < 1 year, n = 8; group 2: 1-4 years, n = 13 and group 3: 5-15 years, n = 15). A reference group of healthy adults (21-38 years, n = 22) was included in their comparisons and reflected specific differences between children and adults. In muscle the concentrations of 8 out of 19 amino acids analysed increased with age, namely taurine, aspartate, threonine, alanine, valine, isoleucine, leucine, histidine, as well as the total sums of branched chain amino acids (BCAA), basic amino acids (BAA) and total sum of amino acids (P < 0.05). In plasma the concentrations of threonine, glutamine, valine, cysteine, methionine, leucine, lysine, tryptophane, arginine, BCAA, BAA and the essential amino acids correlated with age (P < 0.05). These results indicate that there is an age dependency of the amino acid pattern in skeletal muscle and plasma during growth.

Effect of surgical trauma on muscle protein synthesis in the rat

The rate of protein synthesis in skeletal muscle was measured in vivo in rats at various times during the first 2 days after abdominal surgery. Protein synthesis in abdominal muscle at the site of the wound was slightly reduced 2 h after operation, had returned to normal by 24 h and was massively increased by 48 h after surgery. In contrast, there was no change at any time in the rate of protein synthesis in either the gastrocnemius muscle or abdominal muscle distant from the wound site. Surgery had no effect on the weight or protein content of the gastrocnemius muscle, although urinary nitrogen excretion was increased relative to food intake, indicating the presence of a net catabolic response. Changes in whole-body protein turnover in response to uncomplicated abdominal surgery are thus likely to reflect the anabolic processes of wound healing and repair as well as any catabolic response in uninjured tissues.

Regulation of eukaryotic initiation factor-2 expression during sepsis

Protein synthesis is stimulated at the level of peptide chain initiation in livers from rats with a sterile or septic abscess. In contrast, peptide chain initiation is inhibited in fast-twitch skeletal muscles from septic rats. We investigated the possible mechanisms responsible for these differential changes in peptide chain initiation between liver and skeletal muscle during sepsis by measuring the cellular content of eukaryotic initiation factor-2 (eIF-2), the extent of phosphorylation of the alpha-subunit of eIF-2, and the activity of eIF-2B. In skeletal muscle, neither the eIF-2 content nor the extent of phosphorylation of eIF-2 alpha was altered during sepsis. However, a significant decrease (P < 0.001) in eIF-2B activity was observed in fast-twitch muscles. In liver, neither the extent of phosphorylation of eIF-2 alpha nor the activity of eIF-2B was different in rats with a sterile or septic abscess compared with control. However, the amount of eIF-2 in liver was increased in both sterile inflammation and sepsis. The relative abundance of eIF-2 alpha mRNA was not increased in either condition compared with control. Analysis of the distribution of eIF-2 alpha mRNA from control rats revealed that only approximately 40% of the message was associated with polysomes. Sterile inflammation or sepsis caused a 50% increase in the proportion of eIF-2 alpha mRNA associated with the polysomes compared with control.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolic basis for management of the septic surgical patient

The physiologic events accompanying postoperative septic complications in surgical patients represent a coordinated response to bacterial invasion, which is aimed at maintaining the function of key organ systems. When sepsis is prolonged or overwhelming, physiologic dysfunction and multiorgan failure develop. This review outlines the pathophysiologic response to sepsis and correlates it with recent therapeutic advances in the metabolic management of the postoperative septic patient.

Comparative effects of thermal and surgical trauma on rat muscle protein metabolism

A modified intraperitoneal pool flooding technique, employing L-3H-tyrosine, was developed for measuring muscle protein synthetic rates following traumatic injury. Sufficient radiolabeled tyrosine was injected intraperitoneally to effect a six-fold increase in plasma tyrosine concentration (124-800 microM) resulting in constant, sustained specific radioactivities in plasma- and intracellular-free tyrosine pools. Localized vs systemic effects of thermal and surgical trauma on gastrocnemius muscle protein turnover were assessed 2 and 4 days postinjury. Thermal trauma increased total, myofibrillar, and sarcoplasmic muscle protein synthesis (44%) and protein degradation (300%). Conversely, surgical trauma decreased synthesis of total (24%), myofibrillar (14%), and sarcoplasmic (43%) muscle proteins without altering protein degradation. Short-term restriction of pair-fed controls did not affect either aspect of protein turnover.

Advances in hospital nutrition

The General Clinical Research Center facilities have been largely responsible for expansion of knowledge in the field of hospital nutrition. Expansion of this knowledge base has led to major medical advances in this century. Without the meticulous attention necessary for metabolic balance studies many if not most of these advances would have been seriously delayed. The role that General Clinical Research Centers have played and will continue to play cannot be overestimated.

Leucine kinetics in surgical patients. I: A study of the effect of surgical 'stress'

At present there is no consensus about the effect of surgical and accidental trauma on protein metabolism. Leucine kinetics, an index of protein turnover, have been studied in ten patients before intra-abdominal surgery and on either the third (n = 5) or seventh (n = 5) postoperative day. Only small changes in leucine kinetics were noted in the early postoperative study but, by the seventh day, there was evidence of increased synthesis as part of an overall elevation of turnover rates. It is suggested that the previously expressed opinion that protein synthesis is reduced after surgery must be re-examined.

Metabolic response to sepsis and trauma

This review examines current knowledge regarding the metabolic responses to trauma and sepsis. The factors which may mediate the responses are discussed and the potential value of pharmacological or nutritional manipulation is reviewed.

The metabolic and nutritional effects of injury and sepsis

The existence of a co-ordinated response to stress of a variety of causes has clearly been established. Basically, this consists of an elevation in energy expenditure and an increased breakdown of skeletal muscle protein. In addition, glucose level in the plasma increases as a result of increased synthesis and decreased uptake of glucose into cells. Release of fatty acid into the plasma is also increased, and an elevation in the proportion of energy derived from oxidation of fatty acids is observed. This response is qualitatively very different from that seen in simple starvation, where a progressive reduction in energy expenditure and a reduction in the synthesis of glucose allows fat to become the major energy-producing substrate and also allows sparing of body protein stores. The mechanisms responsible for this altered pattern of metabolism are probably primarily hormonal in nature, with adrenaline, cortisol and glucagon being the major catabolic stimulants. Some evidence exists, however, for alteration in intracellular pathway metabolism. Within the past decade a new class of mediators of the stress response, the cytokines, has been recognized. These substances are protein products of circulating monocytes and the way in which they integrate into the control of the stress response has not been completely elucidated. At present there is evidence that they can stimulate production of catabolic hormones, and also they may well have direct effects in enhancing protein catabolism in muscle. At present the main method for modification of the stress response remains the provision of energy and amino acid, either intravenously or enterally. In the present state of our knowledge, 30-40 kcal kg-1 day-1 would appear to be adequate for most patients, with half provided as fat. Amino acids 3 g kg-1 day-1 will provide adequate nitrogen. It must be said, however, that the most effective method of modifying the stress response is removal of the source of stress by surgery, antibiotics or other primary therapy.

Muscle protein metabolism of rats in surgical trauma

The effects of decreased food intake and degree of surgical trauma on total, myofibrillar and sarcoplasmic muscle protein synthesis and degradation were assessed in two experiments (A and B). Trauma consisted of an abdominal incision with or without hysterectomy. The degree of trauma in experiment B was increased relative to that in experiment A by extending the length of the incision, operative manipulation and time required to perform the surgery. To account for postoperative diminutions in food intake on protein turnover, a group of nonoperated rats were pair-fed to the level of food consumed by hysterectomized rats. Traumatized rats in experiment B lost more weight, ate less, and had a lower muscle total protein concentration than corresponding rats in experiment A, confirming a more severe trauma in experiment B. In both experiments, trauma depressed total protein content of muscle. Synthesis was measured by the incorporation of L-[U-14C] tyrosine from a single meal into total, sarcoplasmic and myofibrillar proteins of gastrocnemius muscle. Degradation was calculated as the difference between the growth rate and the synthetic rate. Synthetic rate (ks) of total protein was depressed by surgical trauma; the more severe the trauma, the greater the depression. In mild trauma, the depression in ks was due only to a decrease in sarcoplasmic protein synthesis (ke), whereas with more severe trauma, synthetic rates of both sarcoplasmic (kes) and myofibrillar (kem) proteins were decreased. Protein degradation (kd,) was increased on day 2 in experiments A and B, had returned to control values on day 4 in experiment A and had decreased below control values in experiment B.(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamics of the protein metabolic response to burn injury

The protein metabolic response to burn injury was assessed in 17 children aged 7.1 +/- 1.1 years (mean +/- SEM) and a mean burn size of 65 +/- 7% total body surface area (TBSA) during the acute, flow, convalescent, and recovery phases. Stable isotopes of leucine, valine, lysine, and urea were infused in postabsorptive patients in order to measure protein kinetics. The absolute rate of protein breakdown was assessed from the plasma flux of the essential amino acids (EAA), and the rate of urea production (Ra urea) was used as an index of net protein catabolism. Compared to values obtained in recovered patients, the plasma fluxes of all three EAAs were significantly increased (P less than .05), indicating an increased protein breakdown, during the acute, flow, and convalescent phases of injury. Ra urea, however, was only significantly increased during the flow phase (P less than .01), suggesting that protein breakdown was adequately counteracted in the acute and convalescent phases by elevations in protein synthesis but not in the flow phase. The protein kinetic response did not correlate with changes in the metabolic rate since resting energy expenditure (REE) was significantly increased above predicted levels during the acute and flow phases (by 40% and 50%, respectively), and returned to normal in convalescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of elective surgical procedures on tissue protein synthesis

The purpose of the study was to examine whether an early decrease in protein synthesis rates occurred in any tissues after abdominal surgery in postprandial rats. Leucine-specific radioactivity in mixed protein and on tRNA was determined after continuous infusion of L-[3H]leucine. Synthesis rates of mixed protein were significantly decreased in the gastrocnemius muscle, but not in the jejunum, liver, or heart, of rats 1-2 hr after splenectomy and ovariectomy or after combining the groups that had various types of abdominal surgery. These results suggest that a very early decrease in the protein synthesis rate of the gastrocnemius muscle occurs after laparotomy.

Close association of accelerated rates of whole body protein turnover (synthesis and breakdown) and energy expenditure in children with newly diagnosed acute lymphocytic leukemia

Using a single-dose [15N]glycine turnover technique, we studied protein metabolism in 15 children with newly diagnosed acute lymphocytic leukemia (ALL). As in our previous study, we observed increased rates of whole body protein synthesis (S) and breakdown (B) in comparison to healthy controls. In eight patients, we assessed basal metabolic rate (BMR). There was a significant linear regression between BMR (kcal/d) (Y) and S (g protein/d) (X): y = 3.7 X + 850 (R = 0.925, p less than 0.001). There was also a significant linear correlation between BMR, expressed as a percentage of the normal value, and S expressed as a percentage of the mean value in the healthy children (r = 0.79, p less than 0.05). There were also significant positive correlations between BMR and body weight (r = 0.75, p less than 0.05) or age (r = 0.83, p less than 0.05) and between S and weight or age (both, r = 0.86, p less than 0.01). BMR (kcal/d) also correlated with B (g protein/d) (r = 0.91, p less than 0.01). Multiple regression analysis revealed that BMR was much more highly related to S than to weight. These data suggest that increased rates of S are closely related to increased energy requirements in patients with ALL. Furthermore, these data provide evidence for the biological relevance of whole body protein kinetics.

Whole body protein kinetics in severely septic patients. The response to glucose infusion and total parenteral nutrition

Rates of whole body protein synthesis and catabolism in normal volunteers and in a group of severely septic patients were isotopically determined. In addition, the effect in the patients of either glucose infusion or total parenteral nutrition (TPN) on protein dynamics was assessed. The basal rate of net protein catabolism (NPC) was significantly higher in the septic patients than in the volunteers (p less than 0.05). The values obtained in the volunteers and patients were 1.44 +/- 0.18 and 2.20 +/- 0.10 g/kg/day, respectively. This increase in NPC was primarily due to a major increase in whole body catabolism that was partially counteracted by a modest increase in protein synthesis. When the patients were infused with glucose (4 mg/kg/min), NPC decreased significantly (p less than 0.001) to 1.96 +/- 0.08 g/kg/day, and during TPN the value was significantly lower again (p less than 0.04) (0.63 +/- 0.28 g/kg/day). In each instance the conservation of host tissue was due to an increase in protein synthesis: the accelerated rate of whole body protein catabolism continued irrespective of the nutritional status. The following conclusions were reached from these data: severely ill septic patients have an accelerated rate of NPC compared with normal volunteers, and this is primarily due to a large increase in whole body protein catabolism; TPN is an effective means of conserving host tissue in severely septic patients via the promotion of whole body protein synthesis; despite the beneficial effect of TPN in these patients, whole body protein catabolism continues unabated, and as a result, protein losses still occur at approximately one fourth the rate seen in the absence of TPN; and there is no obvious advantage in terms of protein-sparing when protein is provided in amounts exceeding 1.5 g/kg/day.

Protein synthesis in skeletal muscle in relation to nitrogen balance after abdominal surgery: the effect of total parenteral nutrition

Protein synthesis in skeletal muscle was studied in patients after elective abdominal surgery, using the concentration and size distribution of ribosomes. The patients were given either an electrolyte solution or total parenteral nutrition postoperatively. The analyses were performed on muscle biopsy specimens taken prior to surgery and on days 1 and 3 following surgery. The percentage content of polyribosomes, total ribosome concentration and the polyribosome concentrations per milligram of tissue DNA were determined. Elective abdominal surgery caused a significant decrease (p less than 0.05) in the three variables. Total parenteral nutrition did not prevent the decrease. The negative nitrogen balance was significantly improved by total parenteral nutrition, but it did not reach equilibrium. The results show that total parenteral nutrition given postoperatively did not maintain protein synthesis activity in skeletal muscle. The improvement in nitrogen balance suggests that amino acids are utilized by tissues other than skeletal muscle.

Burn-induced stimulation of lysosomal enzyme activity in skeletal muscle

A localized burn injury to a rat hindlimb was used to investigate the proteolytic enzymes responsible for the burn-induced increase in muscle protein breakdown. In 10,000 x g pellets of muscle homogenates, burn stimulated (50% to 100%) protease activities with pH optima of 3, 5.5, and 7.8. Burn also stimulated acid protease activity in 27,000 x g supernatants derived from triton X100 treated extracts of muscle. Pretreatment of rats with compound 48/80 (to eliminate contaminating mast cells) eliminated 95% of the neutral protease activity in the particulate fraction. The Ca++-sensitive neutral protease was not affected by either burn or 48/80 treatment. However, muscle extracts from the burned leg always showed a 40% to 70% increase in acid protease activity. All of the acid protease activity could be inhibited by a combination of cathepsin inhibitors pepstatin (0.01 microgram/mL) and leupeptin (1 mumol/L) and leupeptin (1 mumol/L) or Ep475 (1 microgram/mL). Leupeptin and the lysosomotropic agent leucine methyl ester also inhibited the burn-induced proteolysis in intact muscle. A time course shows parallel increases in whole muscle proteolysis and acid protease activity of muscle homogenates. These findings support the conclusion that the increase in lysosomal cathepsins are sufficient to account for the burn-induced increase in protein breakdown in muscles from the injured leg.

Principles of burn dressings

Throughout history burn wounds have been treated by covering with dressings of many different materials. The successful application of a burn dressing remains an objective for biomaterial development. This paper examines how the burn wound differs from other skin injuries, the requirements of the ideal burn wound dressing, and reviews the type of dressings available. The dressings in common use in the treatment of burns are compared with the 'ideal' dressing, in so far as it can be defined.

Leupeptin's effect on organ weight, RNA, DNA, and protein content after long bone fracture in the rat

Long bone fracture in the rat is accompanied by enhanced urinary nitrogen loss reflecting changes in protein synthesis and breakdown. The effects of leupeptin, an inhibitor of lysosomal proteases, were assessed on organ weights, RNA, DNA, and protein content after injury in the rat. Two groups of 8-week-old rats were studied: The first group received left femoral fracture. Half of these received leupeptin (25 mumole ip/day), and the remainder received saline. The second group served as uninjured pair-fed controls, with half receiving leupeptin and half receiving saline. On Days 0, 1, 2, 4, and 7 after injury, animals were sacrificed and organs were removed for determination of weight, RNA, DNA, and protein content. All injured rats lost weight, with maximum loss occurring on Day 4. Food intake was also reduced. Pair-fed rats lost the same amount of weight as injured ones, and leupeptin could not prevent whole body weight loss. Expressed as percentage of total body weight, livers from leupeptin-treated injured rats weighed 10% greater than saline-treated ones on Days 2, 4, and 7 after injury (P less than 0.05). No differences occurred in RNA, DNA, or protein contents. Diaphragms similarly weighed 10, 20, and 30% greater on Days 2, 4, and 7 after injury, respectively, in leupeptin-treated rats (P less than 0.05). In addition, the RNA and DNA contents of diaphragms were 96 and 88% greater, respectively, in treated rats than in controls (P less than 0.05) on Day 4. It is concluded that leupeptin causes a relative increase in the weights of livers and diaphragms after injury, and causes a marked increase in the RNA and DNA contents of diaphragms.

Effect of parenteral nutrition on muscle amino acid output and 3-methylhistidine excretion in septic patients

The effects of adequate total parenteral nutrition (TPN) on nitrogen excretion, urea N percentage, 3-methylhistidine excretion, and leg amino acid output, were studied during the ten-day period following abdominal surgery for generalized peritonitis in nine patients. The first two postoperative days were without nutritional intake, TPN was started on the third postoperative day (57 cal/KgBW--40% as Intralipid--0.30 g of N/KgBW). Leg amino acid outputs were done before TPN (DO), then two days (D2) and eight days (D8) after TPN. Total nitrogen and urea N percentage did not significantly differ before and after TPN. Between DO and D2 there was a significant reduction of urinary 3-methylhistidine (467 +/- 37 to 280 +/- 29 mumol/24 h-P less than 0.001) and leg amino acid release (604 +/- 103 to 254 +/- 87 nmol/mn/100 g of calf muscle--P less than 0.01) reflecting reduction in muscle hypercatabolism despite the persistence of the septic state. Between D2 and D8, 3-methylhistidine remained stable while leg amino acid release continued to decrease (254 +/- 87 to 68 +/- 40 nmol/mn/100 g--P less than 0.05). This association suggests an increased muscle protein synthesis. A closer examination of the clinical evolution of these patients, especially concerning their septic evolution, shows that only improved patients with recovery from sepsis increased their muscle protein synthesis. Thus, in septic hypercatabolic patients TPN seems to be able to reduce muscle catabolism while the increase in protein synthesis is mainly the consequence of recovery from the septic state. In such patients TPN should be used as a preventive therapeutic measure.

Urinary excretion and efflux from the leg of 3-methylhistidine before and after major surgical operation

Changes in the effluxes from the leg of 3-methylhistidine and tyrosine were studied in relation to alterations in the 24-hour excretion of 3-methylhistidine and total nitrogen in 11 patients before and after undergoing major surgical operation. On the first day after operation, efflux of 3-methylhistidine from the leg was significantly decreased by 40% compared to preoperative values. In contrast, tyrosine efflux was doubled at the same time as a transient 20% increase in oxygen uptake of the leg and a marked increase in catecholamine excretion were observed. These changes coincided with a 40% elevation in the excretion of both 3-methylhistidine and nitrogen. Leg metabolism returned to the preoperative pattern within a week. These results suggest that the loss of amino acids from the lean tissues of the leg is the result of a fall in protein synthesis accompanied by an adaptive fall in protein breakdown. Although the increase in nitrogen excretion in response to major surgical trauma reflects the negative amino acid balance of skeletal muscle, the changes in urinary 3-methylhistidine do not correlate with changes in efflux of 3-methylhistidine from the leg. These results suggest that the use of 3-methylhistidine excretion as a specific index of skeletal muscle protein breakdown in postoperative patients may be invalid. Tissues other than skeletal muscle appear to make a substantial contribution to the 3-methylhistidine excretion postoperatively.

Leukocyte endogenous mediator alters protein dynamics in rats

Leukocyte endogenous mediator (LEM), a low-molecular-weight peptide synthesized by monocytic cells during phagocytosis, has been implicated as the host's initiator of the protein metabolic response to infection and inflammation. To determine whether administration of LEM would alter protein kinetics, appearance and oxidation of plasma tyrosine as well as the rates of protein synthesis in liver and skeletal muscle were determined in fasted rats that received a 30-hour continuous infusion of either physiologic saline, LEM, or heat-inactivated LEM. The LEM was obtained from rabbit peritoneal exudate and the treatment solutions supplied 2.8 X 10(8) cell equivalents/100 g of body weight (BW) per day. Endogenous tyrosine oxidation increased from 4.0 +/- 0.4 mumol/100 g BW/h to 5.4 +/- 0.7 mumol/100 g BW/h in animals infused with heat-inactivated LEM and to 7.5 +/- 1.5 mumol/100 g BW/h in rats receiving LEM (P less than 0.01). Nonsecretory protein synthesis in the liver was greatest in rats administered LEM (2239 +/- 325 mg/d) when compared with control groups receiving physiologic saline (1122 +/- 195 mg/d) or heat-inactivated LEM (1374 +/- 62 mg/d; P less than 0.01), whereas skeletal protein synthetic rates were unchanged. Rates of muscle and collagen protein breakdown were estimated from the urinary excretion rate of Nt-methylhistidine and hydroxyproline, respectively, and their excretion rose by 30% (P less than 0.05) and 42% (P less than 0.05) with LEM administration. These results suggest that administration of LEM stimulates a mobilization of amino acids from peripheral tissues to support increased visceral protein anabolism while whole body amino acid oxidation is also enhanced. Since similar effects follow fever and infection, these results suggest that LEM may play an underlying role in the protein metabolic response to infection and inflammation.

Urinary excretion of 3-methylhistidine: an assessment of muscle protein catabolism in adult normal subjects and during malnutrition, sepsis, and skeletal trauma

The urinary excretion of 3-methylhistidine (3 MEH) has been shown to be a reliable index of muscle protein breakdown. It is decreased in protein-calorie malnutrition and increased during the hypercatabolic phase of sepsis and thermal trauma. Losses of 3 MEH after moderate to severe skeletal trauma in man and animals are reported as increased or unchanged. To clarify this response, 24 male and 6 female skeletal trauma patients were evaluated for 24 hr urinary losses of 3 MEH, nitrogen and creatinine. Eight of the 24 males also received a catabolic steroid for treatment of a head injury. In addition, 3 male and 1 female septic patients were similarly evaluated. Controls consisted of 10 volunteers on a meat free diet for 4 days and of 8 volunteers who were given only intravenous 5% dextrose in water for 3 days. The 3 MEH excretion for all control males was 3.6 mumole/Kg/day and for females was 2.8 Skeletal trauma produced a 280% increase for the males and a 225% increase for the females. Trauma with steroids caused a 325% increase. Sepsis induced a 227% increase in 3 MEH losses for males and 292% for females during the febrile episode. Creatinine excretion also increased significantly in response to trauma and sepsis but the magnitude of the increase was less than for 3 MEH. This was reflected in the 3 MEH to creatinine molar ratio increase from 0.018 for controls to 0.030-0.040 in sepsis and trauma. Patients with extensive body weight loss showed decreases in 3 MEH and creatinine excretion and a molar ratio similar to controls. The calculated contribution of muscle protein to whole body protein breakdown in the trauma and septic groups showed a twofold increase compared to the control group. The data indicate that the increased muscle protein catabolic response following stress of skeletal trauma and sepsis provides an insight on the origin of the large urinary nitrogen losses following such insults.

Urinary excretion of 3-methylhistidine as an index of muscle protein catabolism in postoperative trauma: the effect of parenteral nutrition

The effect of different intravenous nutritional regimens on nitrogen balance and 3-methylhistidine (3-MeHIS) excretion were studied during a 6-day period following major elective surgery in 28 patients. All patients were kept on a synthetic diet 4 days prior to surgery and were given 0.1 g amino acid N and 120 kJ/kg . day. Postoperatively, all patients received parenteral nutrition with approximately 170 kJ/kg . day. Postoperatively, all patients received parenteral nutrition with approximately 170 kJ/kg . day. Three groups of patients were given varying amounts and proportions of amino acids while in one group no amino acids were administered. Preoperatively, urinary 3-MeHIS excretion (determined by a newly developed automatic analyzer) was 240.3 mumole/day +/- 9.2, nitrogen balance was -1.8 g N +/- 0.19. Postoperatively, nitrogen balance was less negative when amino acids were given. The degree of improvement depended on the amount, but not on the composition of nitrogen administered. In all four groups, 3-MeHIS outputs were elevated when compared with preoperative excretion. The 3-MeHIS excretion (mumole/day) was increased more in patients on high amino acid supply than in patients with low or no nitrogen supply. In each of the groups the 3-MeHIS excretion was negatively correlated to the nitrogen balance. Regression analyses suggest that postoperative muscle protein breakdown occurs in relation to the body protein loss. Amino acid administration seems not to decrease muscle protein breakdown, but rather, appears to stimulate protein synthesis, resulting in less net protein loss. The mean rate of muscle protein breakdown in the postoperative state was estimated to be 80 g/day, assuming 4.2 mumole 3-MeHIS per g mixed human muscle protein. This exceeded the mean preoperative breakdown by about 23 g muscle protein per day. This increase might be due to the metabolic response to the trauma and also in part to tissue damage by the surgical procedure.

Effects of dietary intake and hemodialysis on protein turnover in uremic children

The dynamic aspects of protein metabolism in uremic children were studied by using newly developed gas chromatography and mass spectrometry micromethods for determining nitrogen-15 enrichment in plasma lysine during a continuous i.v. infusion of 15N-lysine. Protein flux in uremic children was low and varied directly with protein and energy intake, which themselves were closely related in the diets consumed by the study subjects. Hemodialysis did not alter acutely protein flux. Protein flux in children undergoing chronic hemodialysis was still reduced below normal but was higher than that in nondialyzed uremic children at each level of protein-energy intake. The ratio of protein flux to protein intake was 0.05 +/- 0.003 g of protein x kg-1 x day-1 x kcal ingested in the nondialyzed uremic children, but it increased to a normal vaue of 0.11 +/- 0.03 g x kg-1 x day-1 x kcal in those on longterm hemodialysis. We conclude that the low protein turnover rates in our uremic population reflect the decreased protein-energy intake commonly found in such patients and that reduction of azotemia by chronic hemodialysis may improve whole body transport at a given energy intake.

In vivo demonstration of nitrogen-sparing mechanisms for glucose and amino acids in the injured rat

Changes in protein metabolism 8 hr after anesthesia and femur fracture were studied in healthy rats fasted or receiving either intravenous glucose or crystalline amino acids. Whole body rates of amino acid turnover (flux) and release from protein (breakdown) as well as fractional synthetic rates of mixed muscle, liver, and plasma protein were measured using the constant infusion of L-(I-14C)-leucine. Injury resulted in a 24% increase in the synthesis of liver (p less than 0.05) and plasma proteins (p less than 0.01), respectively. Amino acid infusions in the injured animals further increased the synthesis of liver protein (from 36.6% to 44.3%/day, p less than 0.05) and increased muscle protein synthesis (from 7.0% to 9.3%/day, p less than 0.05) without altering rates of protein breakdown. Glucose infusions, in contrast, reduced whole body protein breakdown 36% (p less than 0.05) when compared to fasting, and depleted the plasma essential amino acid pool (p less than 0.05). The usual increases in liver protein synthesis observed in fasted rats following injury were not seen when the animals were receiving intravenous glucose. The nitrogen-sparing mechanism of these two infusions are different. Protein-free glucose infusions impair the normal response to injury aimed at increasing visceral protein synthesis and maintaining plasma essential amino acid concentrations.