Further evaluation of isotopic equilibration between labeled pyruvate and lactate

In vivo calibration of genetically encoded metabolite biosensors must account for metabolite metabolism during calibration and cellular volume

Isotopic assays of brain glucose utilization rates have been used for more than four decades to establish relationships between energetics, functional activity, and neurotransmitter cycling. Limitations of these methods include the relatively long time (1-60 min) for the determination of labeled metabolite levels and the lack of cellular resolution. Identification and quantification of fuels for neurons and astrocytes that support activation and higher brain functions are a major, unresolved issues. Glycolysis is preferentially up-regulated during activation even though oxygen level and supply are adequate, causing lactate concentrations to quickly rise during alerting, sensory processing, cognitive tasks, and memory consolidation. However, the fate of lactate (rapid release from brain or cell-cell shuttling coupled with local oxidation) is long disputed. Genetically encoded biosensors can determine intracellular metabolite concentrations and report real-time lactate level responses to sensory, behavioral, and biochemical challenges at the cellular level. Kinetics and time courses of cellular lactate concentration changes are informative, but accurate biosensor calibration is required for quantitative comparisons of lactate levels in astrocytes and neurons. An in vivo calibration procedure for the Laconic lactate biosensor involves intracellular lactate depletion by intravenous pyruvate-mediated trans-acceleration of lactate efflux followed by sensor saturation by intravenous infusion of high doses of lactate plus ammonium chloride. In the present paper, the validity of this procedure is questioned because rapid lactate-pyruvate interconversion in blood, preferential neuronal oxidation of both monocarboxylates, on-going glycolytic metabolism, and cellular volumes were not taken into account. Calibration pitfalls for the Laconic lactate biosensor also apply to other metabolite biosensors that are standardized in vivo by infusion of substrates that can be metabolized in peripheral tissues. We discuss how technical shortcomings negate the conclusion that Laconic sensor calibrations support the existence of an in vivo astrocyte-neuron lactate concentration gradient linked to lactate shuttling from astrocytes to neurons to fuel neuronal activity.

Triacylglycerol infusion does not improve hyperlactemia in resting patients with mitochondrial myopathy due to complex I deficiency

BACKGROUND

A high-fat diet has been recommended for correction of biochemical abnormalities and muscle energy state in patients with complex I (NADH dehydrogenase) deficiency (CID).

OBJECTIVE

This study evaluated the effects of intravenous infusion of isoenergetic amounts of triacylglycerol or glucose on substrate oxidation, glycolytic carbohydrate metabolism, and energy state in patients with CID.

DESIGN

Four CID patients and 15 matched control subjects were infused with triacylglycerol (1.85 mg x kg(-1) x min(-1)) or glucose (5 mg x kg(-1) x min(-1)) while at rest. Respiratory calorimetry was used to evaluate mitochondrial substrate oxidation. Metabolism of glycolytic carbohydrate was determined on the basis of the rates of appearance and concentrations of plasma lactate from dilution of [1-(13)C]lactate measurements. In addition, high-energy phosphate metabolism was measured in forearm muscle by (31)P magnetic resonance spectroscopy.

RESULTS

Whole-body oxygen consumption rates were higher in the patients than in the control subjects (P < 0.05). Oxygen consumption and high-energy phosphate metabolism in forearm muscle were not significantly different between the 2 infusion groups. The rates of appearance and concentrations of plasma lactate were higher in each of the 4 patients than in the control subjects (P < 0.05) and were lower during the triacylglycerol infusion than during the glucose infusion (P < 0.05); the differences were comparable in the patients and control subjects.

CONCLUSIONS

We conclude that triacylglycerol infusion, relative to glucose infusion, does not improve the oxidation of substrates or the energy state of skeletal muscle and does not lower the rates of appearance and concentrations of plasma lactate to normal values in CID patients at rest.

Triacylglycerol infusion improves exercise endurance in patients with mitochondrial myopathy due to complex I deficiency

BACKGROUND

A high-fat diet has been recommended for the treatment of patients with mitochondrial myopathy due to complex I (NADH dehydrogenase) deficiency (CID).

OBJECTIVE

This study evaluated the effects of intravenous infusion of isoenergetic amounts of triacylglycerol or glucose on substrate oxidation, glycolytic carbohydrate metabolism, and exercise endurance time and energy state of muscle in CID patients.

DESIGN

Four CID patients and 15 control subjects were infused with triacylglycerol (3.7 mg x kg(-1) x min(-1)) or glucose (10 mg x kg(-1) x min(-1)) during low-intensity leg exercise. Respiratory calorimetry was used to evaluate mitochondrial substrate oxidation. The concentration and rate of appearance of plasma lactate (from dilution of [1-(13)C]lactate) were used to evaluate glycolytic carbohydrate metabolism. (31)P magnetic resonance spectroscopy was used to determine ratios of phosphocreatine to inorganic o-phosphate in forearm muscle during exercise.

RESULTS

In 3 patients, leg exercise endurance time was better during the triacylglycerol infusion than during the glucose infusion. In all 4 patients, whole-body oxygen consumption rates during exercise were higher during triacylglycerol infusion than during the glucose infusion. In 3 patients, the concentration and rate of appearance of plasma lactate were lower during triacylglycerol infusion than during the glucose infusion. Ratios of phosphocreatine to inorganic o-phosphate during exercise were not significantly different between the 2 infusion studies or between the patients and control subjects.

CONCLUSIONS

Triacylglycerol infusion is associated with a greater oxidation of substrates, lower rates of appearance and concentrations of plasma lactate, and greater leg exercise endurance time in myopathic CID patients than is glucose infusion. The energy state of muscle during exercise, however, was not significantly different after infusion of triacylglycerol or glucose.

Lactate as a fuel for mitochondrial respiration

Lactate production in skeletal muscle has now been studied for nearly two centuries and still its production and functional role at rest and during muscle contraction is a subject of debate. Historically, skeletal muscle was seen mainly as the site of lactate production during contraction and lactate production associated with a lack of muscle oxygenation and fatigue. Later, it was recognized that skeletal muscle not only plays an important role in lactate production but also in lactate clearance and this in turn has led to a renewed interest in the metabolic fate of lactate in skeletal muscle and also in other tissues. Studies using lactate isotopes have shown that skeletal muscle extracts lactate from the circulation despite a substantial net lactate release, and that skeletal muscle has a large capacity for lactate oxidation; these processes being enhanced with exercise. Lactate dehydrogenase (LDH) controls the formation of lactate and may regulate the turnover of lactate in the muscle cell. Skeletal muscle contains five LDH isoforms (LDH1-5). Of the five LDH isoforms, the heart-specific LDH1, 2 is generally suggested to favour the reaction of lactate to pyruvate whereas the muscle-specific LDH4,5 isoform favours lactate formation. However, in this paper, it is argued that compartmentalization of the muscle cell and LDH association with cell structures may play a more predominant role in whether the LDH reaction proceeds towards lactate or pyruvate formation. The model for skeletal muscle lactate metabolism presented is in essence based on a synthesis of old and more recent studies on skeletal muscle lactate transport, uptake, release, oxidation, and the role of LDH at rest and during exercise.

A study of lactate metabolism without tracer during passive and active postexercise recovery in humans

Tracers have been used extensively to study lactate metabolism in humans during rest and exercise. Nevertheless, quantification of in vivo lactate kinetics as measured by lactate tracers remains controversial and new data are necessary to clarify the issue. The present study has developed a simple kinetic model which does not require labelled molecules and which yields proportional and quantitative information on lactate metabolism in humans during postexercise recovery performed at different levels of intensity. Five subjects took part in six experiments each of which began with the same strenuous exercise (StrEx; 1 min, 385 W, 110 rpm). The StrEx of each session was followed by a different intensity of recovery: passive recovery (PR) and active recoveries (AR) with power outputs of 60, 90, 120, 150 and 180 W, respectively. Blood lactate concentration was measured prior to and immediately after StrEX and regularly during the 1st h of recovery. Oxygen uptake (VO2) was measured every 30 s during the whole session. The results showed that the disappearance rate constant (ke) increases abruptly from PR [0.080 (SEM 0.004) min-1] to moderate AR [60 W: 0.189 (SEM 0.039) min-1] and decreases slowly during more intense AR [180 W: 0.125 (SEM 0.027) min-1]. The lactate apparent clearance (Cl.F-1) was calculated from the area under the lactate concentration-time curve. The Cl.F-1 increased 1.81 (SEM 0.17) fold from PR to moderate AR (60 W) and only 1.31 (SEM 0.14) from PR to the most intense AR (180 W). Using the model, the apparent lactate production (F"K0) was also calculated. The F"K0 increased regularly following a slightly curvilinear function of VO2 and was 2.61 (SEM 0.53) fold greater during the most intense AR (180 W) than during PR. Because of the lack of data concerning the size of apparent lactate distribution volume (Vd), the apparent turnover rate (Rbl) has been presented here related to Vd. The Rbl.Vd-1 increased also following a slightly curvilinear function of VO2. The Rbl.Vd-1 was 85.90 (SEM 14.42) mumol.min-1.l-1 during PR and reached 314.09 (SEM 153.95) mumol.min-1.l-1 during the most intense AR (180 W). In conclusion the model presented here does not require labelled molecules and firstly makes it possible to follow the proportional change of apparent lactate clearance and apparent lactate production during active postexercise recovery in comparison with passive recovery conditions and secondly to estimate the blood lactate turnover.