Metabolism of glycosyl ureides by human intestinal brush border enzymes

Environmental Enteric Dysfunction and Growth Failure/Stunting in Global Child Health

Approximately 25% of the world's children aged <5 years have stunted growth, which is associated with increased mortality, cognitive dysfunction, and loss of productivity. Reducing by 40% the number of stunted children is a global target for 2030. The pathogenesis of stunting is poorly understood. Prenatal and postnatal nutritional deficits and enteric and systemic infections clearly contribute, but recent findings implicate a central role for environmental enteric dysfunction (EED), a generalized disturbance of small intestinal structure and function found at a high prevalence in children living under unsanitary conditions. Mechanisms contributing to growth failure in EED include intestinal leakiness and heightened permeability, gut inflammation, dysbiosis and bacterial translocation, systemic inflammation, and nutrient malabsorption. Because EED has multiple causal pathways, approaches to manage it need to be multifaceted. Potential interventions to tackle EED include: (1) reduction of exposure to feces and contact with animals through programs such as improved water, sanitation, and hygiene; (2) breastfeeding and enhanced dietary diversity; (3) probiotics and prebiotics; (4) nutrient supplements, including zinc, polyunsaturated fatty acids, and amino acids; (5) antiinflammatory agents such as 5-aminosalicyclic acid; and (6) antibiotics in the context of acute malnutrition and infection. Better understanding of the underlying causes of EED and development of noninvasive, practical, simple, and affordable point-of-care diagnostic tools remain key gaps. "Omics" technologies (genomics, epigenomics, transcriptomics, proteomics, and metabolomics) and stable isotope techniques (eg, ¹³C breath tests) targeted at children and their intestinal microbiota will enhance our ability to successfully identify, manage, and prevent this disorder.

Methods for the assessment of small-bowel and colonic transit

Transit assessment of the small intestine and colon is relevant in the study of physiology, pathophysiology, and pharmacodynamics, and there is increasing use of small-bowel and colonic transit measurements in clinical practice as well. The main methods that are applied in clinical practice are substrate-hydrogen breath tests for small-bowel transit and radiopaque markers for colonic transit. Over the past 2-3 decades, scintigraphy has become the preferred standard in research studies, particularly for studies of pathophysiology and pharmacodynamics. New approaches include experimental stable isotope measurement of orocecal transit and the recently approved method using a wireless motility capsule that is validated as an accurate measurement of small-bowel and colonic transit.

In vitro validation of the lactose 13C-ureide breath test for equine orocaecal transit time measurement

REASONS FOR PERFORMING STUDY

Validation of a reliable, noninvasive clinical test for quantification of equine orocaecal transit time (OCTT) is required. This would facilitate an evidence-based approach to investigation and treatment of equine small intestinal disorders.

OBJECTIVES

1) Comparison of the lactose (13) C-ureide breath test (LUBT) with the hydrogen breath test (H(2) BT) for OCTT measurement. 2) Identification of the characteristics of gastrointestinal microbial glycosylureide hydrolase activity in vitro. 3) Production of an optimised protocol for the LUBT for in vivo measurement of equine OCTT.

HYPOTHESIS

Significant lactose (13) C-ureide ((13) C-LU) hydrolase activity is restricted to the large bowel. The rate of expiratory (13) CO(2) production after ingestion of the isotope will provide an indirect quantifiable measure of orocaecal transit rate. Requisite bacterial activity may be enhanced by a primer dose of unlabelled substrate as shown in Man.

METHODS

Combined LUBT and H(2) BT were performed in 8 healthy individuals. Analysis of sequential end expiratory breath samples was used to calculate OCTT and results compared. Digestion of (13) C-LU was investigated in vitro using fresh faecal material or intestinal aliquots collected post mortem. Isotopic fermentation rate was measured by rate of appearance of (13) CO(2) .

RESULTS

Peaks in expiratory (13) CO(2) occurred in all individuals after ingestion of the labelled test meal, whereas H(2) expiration was variable. Both faecal and intestinal microbial digestion of (13) C-LU were maximised by prior exposure to (12) C-LU. Induced bacterial glucoseureide hydrolase activity was significantly greater in the caecum than in the small intestine (n = 10, P<0.05).

CONCLUSIONS

Significant (13) C-LU digestion is restricted to the equine large intestine under normal conditions, and is enhanced by prior exposure to (12) C-LU, making (13) C-LU a suitable noninvasive marker of equine OCTT. The LUBT is more reliable than the H(2) BT for measurement of equine OCTT.

Use of the lactose-[13C]ureide breath test for diagnosis of small bowel bacterial overgrowth: comparison to the glucose hydrogen breath test

PURPOSE

The glucose hydrogen breath test (GHBT) is commonly used as a noninvasive test to diagnose small bowel bacterial overgrowth (SBBO) but its validity has been questioned. Our aim was to evaluate the lactose-[(13)C]ureide breath test (LUBT) to diagnose SBBO and to compare it with the GHBT, using cultures of intestinal aspirates as a gold standard.

METHODS

In 22 patients with suspected SBBO (14 male, age range 18-73 years) aspirates were taken from the region of the ligament of Treitz under sterile conditions and cultured for bacterial growth. More than 10(6) colony-forming units/mL fluid or the presence of colonic flora was defined as culture positive (c+). After oral intake of 50 g glucose and 2 g of lactose-[(13)C]ureide, end-expiratory breath samples were obtained up to 120 min. The (13)C/(12)C ratio in breath CO(2) was determined by isotope ratio-mass spectrometry and hydrogen concentration in breath was analyzed electrochemically.

RESULTS

After analyzing receiver operating characteristic curves of the LUBT results, total label recovery of >0.88% at 120 min was considered positive. The test had a sensitivity of 66.7% and a specificity of 100% to predict c+. In the GHBT, an increase of the signal of > or =12 ppm from baseline was considered positive. The sensitivity and specificity of the test were 41.7 and 44.4%, respectively.

CONCLUSIONS

The new stable isotope-labeled LUBT has excellent specificity but suboptimal sensitivity. In contrast, the standard GHBT lacks both high sensitivity and specificity. The LUBT is superior to the GHBT for detecting SBBO.

Does the biomarker 15N-lactose ureide allow to estimate the site of fermentation of resistant starch?

We evaluated the effect of resistant starch (RS) and resistant starch with wheat bran (RS+WB) on the colonic ammonia metabolism in healthy volunteers using the biomarker (15)N-lactose ureide ((15)N-LU). Particularly, it was investigated whether this biomarker allowed to estimate differences in the site of fermentation. Ten volunteers were included in a placebo-controlled crossover study. They consumed in random order 2 x 15 g RS/day for 2 weeks and placebo for 2 weeks separated by 2 weeks wash-out. At baseline, on the first day of each intake period and after each intake period, they consumed a (15)N-labelled test meal and collected all urine in different fractions for 48 h. In ten other volunteers, the effect of 2 x 15 g RS/day and of 2 x 15 g RS + 2 x 6 g WB was compared. These volunteers collected urine and feces for 72 h. (15)N-content of urine and feces was measured using combustion-isotope ratio mass spectrometry. RS exerted a significant decrease in cumulative urinary (15)N-excretion which was different from placebo. The effect was most pronounced in the 6-24 h urine fraction which suggest fermentation in the proximal colon. The effect of RS+WB on cumulative urinary (15)N-excretion was not significantly different from the effect of RS. A less pronounced decrease in the 6-24 h fraction was observed suggesting less fermentation in the proximal colon whereas no indications for more distal fermentation were observed. Since about 80% of the cumulative urinary (15)N was recovered within 24 h, it was concluded that the biomarker (15)N-LU was useful to monitor processes in the proximal colon rather than in the distal colon.

The in vivo use of the stable isotope-labelled biomarkers lactose-[15N]ureide and [2H4]tyrosine to assess the effects of pro- and prebiotics on the intestinal flora of healthy human volunteers

Amongst the various claimed beneficial effects of pro- and prebiotics for the human host, it has been hypothesised that functional foods are able to suppress the generation and accumulation of toxic fermentation metabolites (NH3, p-cresol). Direct evidence supporting this hypothesis is lacking mainly because of the unavailability of reliable biomarkers. Preliminary data indicate that lactose-[15N]ureide and [2H4]tyrosine may be potential biomarker candidates. The aim of the present study was to evaluate the effect of pro- and prebiotics on the colonic fate of these biomarkers in a randomised, placebo-controlled, cross-over study with nineteen healthy volunteers. At the start of the study and at the end of each 2-week study period, during which they were administered either a probiotic (n 10; 6·5×109Lactobacillus casei Shirota cells twice daily) or a prebiotic (n 9; lactulose 10 g twice daily), the volunteers consumed a test meal containing the two biomarkers. Urine was collected during 48 h. Results were expressed as percentage of the administered dose. As compared with the placebo, the decrease in the percentage dose of p-[2H4]cresol in the 24–48 h urine fraction was significantly higher after probiotic intake (P=0·042). Similar changes were observed for the 15N tracer (P=0·016). After prebiotic intake, a significantly higher decrease in the percentage dose of p-[2H4]cresol (P=0·005) and 15N tracer (P=0·029) was found in the 0–24 h urine collection. The present results demonstrate that suppression of the generation and accumulation of potentially toxic fermentation metabolites by pro- and prebiotics can reliably be monitored in vivo by the use of stable isotope-labelled biomarkers.

The duration of enzyme induction in orocaecal transit time measurements

OBJECTIVE

In this study, the duration of enzyme induction provoked by unlabelled lactose ureide (LU) in orocaecal transit time (OCTT) measurements with lactose-[(13)C]ureide ((13)C-LU) was evaluated.

DESIGN

Experimental study.

SETTING

University of Rostock, Children's Hospital, Research Laboratory.

SUBJECTS

Fifteen healthy adults aged 19-54 years.

INTERVENTION

One-half gram of (13)C-LU was administered together with a continental breakfast. After 1 week, the test was repeated after pre-dosing of 5 x 100 mg LU on the day before the study began. The (13)C-LU ingestion was repeated under identical conditions but without pre-dosing 1 and 3 weeks after pre-dosing. Expired air samples were taken over 14 h. (13)CO(2)-enrichment was measured by isotope ratio mass spectrometry (SerCon, Crewe, UK). The OCTT was calculated from the interval between (13)C-LU administration and the detection of a significant and sustained (13)C-rise of 2 delta over baseline in breath.

RESULTS

Without pre-dosing, an OCTT of 419+/-82 min was measured. The pre-dosing resulted in higher (13)C-enrichments and caused a significant OCTT shortening of 311+/-99 min (P=0.028). One and 3 weeks after pre-dosing, the measured OCTT again increased to 404+/-124 and 379+/-103 min, respectively.

CONCLUSIONS

Pre-dosing with LU before pulse labelling with (13)C-LU led to an induction of enzyme activity and resulted in a definitive estimation of the OCTT when using a threshold of 2 delta over baseline. After 1 and 3 weeks, respectively, the OCTT was no longer significantly different to those without pre-dosing, indicating the disappearance of enzyme induction. Therefore, a pre-dosing with LU on the day before (13)C-LU ingestion is essential for OCTT measurements.

Evaluation of the necessity of induction for lactose-[15N, 15N]-ureide to study the colonic ammonia metabolism

OBJECTIVE

Stable isotope labelled glycosyl ureides have been described as non-invasive markers for measurement of gastrointestinal processes. Lactose-[13C]-ureide is used for the evaluation of orocaecal transit time (OCTT), whereas lactose-[15N, 15N]-ureide is used to study the fate of the NH3 metabolism in the colon. Induction with unlabelled lactose ureide is necessary for the determination of the OCTT. In the present study, the effect of a preceding induction on the fate of 15NH3 in the colon was evaluated.

MATERIAL AND METHODS

Ten healthy volunteers performed two tests: the first test without induction, the second test one week later with induction, i.e. administration of 1 g lactose ureide the evening before the test. Each test consisted of a fractionated 24-h urine collection after the subjects had received a pancake test meal labelled with 75 mg lactose-[15N, 15N]-ureide. All samples were analysed for [15N]-content by combustion IRMS (isotope ratio mass spectrometry) and results were expressed as a percentage of the administered dose.

RESULTS

No significant differences were found in the percentage dose 15N excreted in the different urine fractions between the test without and with preceding induction. The cumulative excretion rates of the 15N-isotope after 24 h were 44.35% without induction and 44.27% with induction.

CONCLUSIONS

The results in this study show that predosing with unlabelled lactose ureide is unnecessary for the evaluation of the ammonia metabolism in the colon by means of lactose-[15N, 15N]-ureide.

Effect of lactulose and Saccharomyces boulardii administration on the colonic urea-nitrogen metabolism and the bifidobacteria concentration in healthy human subjects

BACKGROUND

Protein fermentation products, especially ammonia, are implicated in the pathogenesis of certain diseases.

AIM

To investigate the influence of lactulose and Saccharomyces boulardii cells on the composition of the intestinal microbiota and on the metabolic fate of ammonia by means of lactose-[(15)N, (15)N]-ureide.

METHODS

An at random, placebo-controlled, crossover study was performed in 43 healthy volunteers to evaluate the influence of lactulose and/or S. boulardii cells either administered as a single dose or after a 4-week intake period. Urine and faeces were collected. All samples were analysed for (15)N-content by combustion-isotope ratio mass spectrometry. Real-time polymerase chain reaction was applied to determine the composition of the predominant faecal microbiota.

RESULTS

A single administration of lactulose significantly decreased urinary (15)N-excretion in a dose-dependent way. After long-term administration of lactulose, a significant reduction of the urinary (15)N-excretion was observed, which was accompanied with a significant increase in the faecal (15)N-output, more specifically more (15)N was found in the bacterial fraction. A significant rise in the Bifidobacterium population was found after lactulose intake. No significant effects were observed after S. boulardii intake.

CONCLUSION

Dietary addition of lactulose can exert a bifidogenic effect accompanied by a favourable effect on the colonic NH(3)-metabolism.

Selective pressure on the allantoicase gene during vertebrate evolution

During vertebrate evolution, the uric acid degradation pathway has been modified and several enzymes have been lost. Consequently, the end product of purine catabolism varies from species to species. In the past few years, we have focused our attention on vertebrate allantoicase (an uricolytic pathway enzyme), whose activity is present in certain fish and amphibians only, but whose mRNA we detected also in mammals. As allantoicase activity disappeared in amniotes, we wonder why these sequences not only remain present in the mammalian genome, but are still transcribed. To elucidate this issue, we have cloned and analyzed comparable cDNA sequences of different organisms from ascidians to mammals. The analysis of the nonsynonymous-synonymous substitution rate that we performed on the coding region comprising exons 3 to 8 by means of maximum likelihood suggested that a certain amount of purifying selection is acting on the allantoicase sequences. Some implications of the preservation of an apparently unnecessary gene in higher vertebrates are discussed.

The use of 13C-labelled glycosyl ureides for evaluation of orocaecal transit time

OBJECTIVE

In the present study, cellobiose-[13C]ureide and glucose-[13C]ureide were synthesized and tested as alternative substrates for noninvasive evaluation of the orocaecal transit time (OCTT).

DESIGN

Experimental study.

INTERVENTION

In total, 1 g cellobiose-[13C]ureide was administered together with a continental breakfast either without or after predosing of 5 x 1 g unlabelled cellobiose ureide on the day prior to study commencement. After 2 weeks, the same subjects ingested glucose-[13C]ureide (dosage: 0.57 g) either without or after predosing of the respective unlabelled ureide under identical conditions. Expired air samples were taken over 10 h. 13CO2-enrichment was measured by isotope ratio mass spectrometry (PDZ Europa, Sandbach, UK). The OCTT was calculated from the interval between 13C-ureide administration and the detection of a significant and sustained 13C-rise of 2 delta over baseline in breath.

SETTING

University of Rostock, Children's Hospital, Research Laboratory.

SUBJECTS

Eight healthy adults aged 22-55 y.

RESULTS

After application of cellobiose-[13C]ureide and glucose-[13C]ureide OCTTs of 401 and 415 min, respectively, were measured. The predosing resulted in higher and steeper 13C-enrichments and caused a significant shortening of OCTTs of 265 and 287 min, respectively (P=0.012 and 0.017).

CONCLUSIONS

The onset of 13CO2-enrichment reflected the degradation of glycosyl-[13C]ureides by glucose ureide hydrolase. The predosing with unlabelled ureides prior to pulse labelling with cellobiose-[13C]ureide and glucose-[13C]ureide (the latter is the key substance of the enzymatic sugar-ureide degradation) led to an induction of enzyme activity and resulted in a more precise and similar estimation of the OCTT when using both 13C-labelled ureides.

Gastrointestinal handling of glycosyl [13C]ureides

OBJECTIVES

Lactose [(13)C]ureide has been proposed as a noninvasive marker for oro-caecal transit time in adults and children. The present study investigates the handling of lactose [(13)C]ureide ((13)C LU) and glucose [(13)C]ureide ((13)C GU) by the gastrointestinal tract and describes the metabolic fates of these substrates and describes the extent of tracer excretion by different routes.

STUDY DESIGN AND SUBJECTS

Four subjects underwent five studies in which they ingested a test meal plus (1) no substrate, (2) (13)C LU, (3) (13)C GU, (4) (13)C LU after predosing with unlabelled lactose ureide and (5) (13)C LU after predosing with glucose ureide. Subjects were studied at home with at least 1 week between tests and they all completed the study. Breath was analysed for (13)CO(2) recovery and urine was analysed for total (13)C recovery, (13)C urea recovery and (13)C GU recovery.

RESULTS

The profiles and extent of tracer recovery in breath and urine were similar when either (13)C GU or (13)C LU was used, suggesting similar handling of these substrates by the gut. (13)C GU was the major (13)C-enriched species recovered in the urine even when (13)C LU was consumed. Predosing with either lactose ureide or glucose ureide increased the rate of appearance of tracer, but did not alter transit times.

CONCLUSIONS

(13)C LU is hydrolysed to (13)C GU in the small intestine with the fraction of (13)C GU appearing in the urine probably limited by small intestinal permeability. Either (13)C LU or (13)C GU can be used to measure oro-caecal transit time.

Rapid quality control analysis of (13)C-enriched substrate synthesis by isotope ratio mass spectrometry

There is a growing interest in the use of (13)C-enriched substrates to investigate metabolic processes in humans. The non-invasive nature of (13)C breath tests makes them attractive to clinicians, particularly because they can be safely used in children. The availability of suitable (13)C-enriched substrates can limit the application of this biotechnology. We have used isotope ratio mass spectrometry to assay the chemical purity and isotopic enrichment of substrates that were synthesised to study gut transit and colonic fermentation. Lactose ureide and lactose [(13)C]ureide were synthesised by acid-catalysed condensation of lactose and urea or (13)C urea, respectively. Glucose ureide and glucose [(13)C]ureide were synthesised by similar methods but required an additional purification step to remove urea of crystallisation. Substrates were analysed by standard analytical techniques and combustion isotope ratio mass spectrometry for carbon and nitrogen content and (13)C-enrichment. Monitoring the C/N ratio proved to be a sensitive assay of chemical purity. Analysis of the percentage composition of C and N (and hence O + H) suggested that lactose ureide crystallises as the dihydrate. It was synthesised with approximately 99% chemical purity and with the theoretical enrichment. Glucose ureide was synthesised with approximately 98% chemical purity but with lower than theoretical enrichment.

Human allantoicase gene: cDNA cloning, genomic organization and chromosome localization

Uric-acid-degrading enzymes (uricase, allantoinase, allantoicase, ureidoglycolate lyase and urease) were lost during vertebrate evolution and the causes for this loss are still unclear. We have recently cloned the first vertebrate allantoicase cDNA from the amphibian Xenopus laevis. Surprisingly, we have found some mammalian expressed sequence tags (ESTs) that show high similarity with Xenopus allantoicase cDNA. From a human fetal spleen cDNA library and adult kidney EST clone, we have obtained a 1790 nucleotide long cDNA. The 3' end of this sequence reveals a substantial high identity with the corresponding portion of Xenopus allantoicase cDNA. In contrast, at the 5' end the human sequence diverges from that of Xenopus; since no continuous open reading frame can be found in this region, the hypothetical human protein appears truncated at its N-terminus. We proposed that such a transcript could be due to an incorrect splicing mechanism that introduces an intron portion at the 5' end of human cDNA. Allantoicase cDNA is expressed in adult testis, prostate, kidney and fetal spleen. By comparison with available genomic sequences deposited in database, we have determined that the human allantoicase gene consists of five exons and spans 8kb. We have also mapped the gene in chromosome 2.

Xenopus allantoicase: molecular cloning, enzymatic activity and developmental expression

Allantoicase is one of the enzymes of the purine degradation pathway and, interestingly, it appears to be lost, together with uricase and allantoinase, during mammalian evolution. Only allantoicases from the ascomycetes S. pombe, S. cerevisiae, and N. crassa have already been cloned, although the activity has been reported also in fishes and amphibians. By screening a cDNA expression library of Xenopus liver, we have cloned a 1491-bp-length cDNA coding for a 389 amino acid protein that shows an high similarity with the enzyme allantoicase. We have found that allantoicase mRNA is abundantly expressed in kidney and liver, but at much lower level is also present in brain, testis, intestine, and lung. We have detected enzymatic activity in crude extract from kidney, liver, and lung; we have also determined kinetic parameters (K(m) = 8.44 mM, V(max) = 6. 94 micromol min(-1) per mg protein) in kidney. During embryo development, we have detected allantoicase transcript and activity starting from 1 and 5 days after fertilization, respectively.

Clostridium innocuum: a glucoseureide-splitting inhabitant of the human intestinal tract

Glycosylureides were recently described as non-invasive markers of intestinal transit time. The underlying principle is an enzymatic splitting of (13)C-labelled ureides by intestinal bacteria. The (13)CO(2) released from the urea moiety of the glycosylureides can be measured in breath samples when the ingested tracer substrate reaches the caecum that is colonised with microbes. To date, the microbes that degrade glycosylureides are unknown. In order to identify the glucoseureide (GU)-splitting bacteria, 174 different strains of intestinal microbes obtained from five healthy adults were checked for their ability to degrade GU. The results of the microbial cultures and thin layer chromatography revealed that GU was exclusively degraded by Clostridium innocuum, belonging to the normal human intestinal microflora. C. innocuum probably synthesises a yet unknown enzyme that splits the glucose-urea bond. We suggest that the term glucoseureidehydrolase is the appropriate designation for this enzyme.

Measurement of urinary total 13C and 13C urea by isotope ratio mass spectrometry after administration of lactose [13C]-ureide

A method of measuring total 13C excreted in urine after oral administration of lactose [13C]-ureide was developed using isotope ratio mass spectrometry. Furthermore, a method to measure 13C urea excreted in the urine was developed. Each urine sample collected over a 24 hour period, after administration of the tracer dose, was analysed for both total 13C and 13C urea. Combustion of the dried urine samples allowed measurement of the total 13C content. Treatment of urine samples with urease (EC 3.5.1.5) and analysis by isotope ratio mass spectrometry of the CO2 evolved allowed measurement of 13C urea in the urine sample. The total 13C and 13C urea content of each urine sample, obtained throughout the protocol, were compared to total 13C and 13C urea contents of a urine sample taken before the test. This allowed calculation of the fraction of tracer incorporated into urea and the fraction of tracer excreted in total. Analyses showed that approximately 15% of the dose administered, in terms of 13C, was recovered in the urine over the sampling period. Further analysis for urinary 13C urea showed that less than 1% of the label was incorporated into urea excreted over the sampling period.