Effects of acute metabolic acidosis on renal, gut, liver, and muscle metabolism of glutamine and ammonia in the dog

Origin and Roles of Alanine and Glutamine in Gluconeogenesis in the Liver, Kidneys, and Small Intestine under Physiological and Pathological Conditions

Alanine and glutamine are the principal glucogenic amino acids. Most originate from muscles, where branched-chain amino acids (valine, leucine, and isoleucine) are nitrogen donors and, under exceptional circumstances, a source of carbons for glutamate synthesis. Glutamate is a nitrogen source for alanine synthesis from pyruvate and a substrate for glutamine synthesis by glutamine synthetase. The following differences between alanine and glutamine, which can play a role in their use in gluconeogenesis, are shown: (i) glutamine appearance in circulation is higher than that of alanine; (ii) the conversion to oxaloacetate, the starting substance for glucose synthesis, is an ATP-consuming reaction for alanine, which is energetically beneficial for glutamine; (iii) most alanine carbons, but not glutamine carbons, originate from glucose; and (iv) glutamine acts a substrate for gluconeogenesis in the liver, kidneys, and intestine, whereas alanine does so only in the liver. Alanine plays a significant role during early starvation, exposure to high-fat and high-protein diets, and diabetes. Glutamine plays a dominant role in gluconeogenesis in prolonged starvation, acidosis, liver cirrhosis, and severe illnesses like sepsis and acts as a substrate for alanine synthesis in the small intestine. Interactions among muscles and the liver, kidneys, and intestine ensuring optimal alanine and glutamine supply for gluconeogenesis are suggested.

Renohepatic crosstalk: a review of the effects of acute kidney injury on the liver

Several theories regarding acute kidney injury (AKI)-related mortality have been entertained, although mounting evidence supports the paradigm that impaired kidney function directly and adversely affects the function of several remote organs. The kidneys and liver are fundamental to human metabolism and detoxification, and it is therefore hardly surprising that critical illness complicated by hepatorenal dysfunction portends a poor prognosis. Several diseases can simultaneously impact the proper functioning of the liver and kidneys, although this review will address the impact of AKI on liver function. While evidence for this relationship in humans remains sparse, we present supportive studies and then discuss the most likely mechanisms by which AKI can cause liver dysfunction. These include 'traditional' complications of AKI (uremia, volume overload and acute metabolic acidosis, among others) as well as systemic inflammation, hepatic leukocyte infiltration, cytokine-mediated liver injury and hepatic oxidative stress. We conclude by addressing the therapeutic implications of these findings to clinical medicine.

Metabolism of D-Lactate in the Dog and in Man

Peritoneal fluid contains equimolar amounts of D and L isomers of lactate. Controversy exists as to whether D-Iactate is metabolized as effectively as the L isomer. D and L-Iactate were infused into the portal circulation of dogs and net hepatic uptake of both isomers measured by A-V sampling, blood flows being measured by flow probes. Hepatic extractions of both isomers were not significantly different. In three patients on intermittent peritoneal dialysis (IPD), and three patients on continuous ambulatory peritoneal dialysis (CAPD), arterial D-Iactate was less than 15% of the concentration of Llactate at the end of treatment. In conclusion, D-Iactate is metabolized as effectively as L-Iactate.

Effect of glutamine on acute lung injury in rats with endotoxemia

We administered endotoxin to rats to produce an acute lung injury model, and assessed the effect on respiratory function when glutamine was added to the solution for total parenteral nutrition. Rats given total parenteral nutrition with glutamine as 33% of the amino acid content were compared with rats given no glutamine. Endotoxin (500 microg/kg) was administered intravenously after 72 h of total parenteral nutrition. The survival rate and the nitrogen balance were significantly improved (P < 0.05) at 48 h after endotoxin administration as a result of glutamine treatment. In addition, the arterial oxygen partial pressure was significantly increased (P < 0.01) and the wet: dry lung weight ratio was decreased (P < 0.05) by glutamine. These results suggested that glutamine improved endotoxin-induced acute lung injury in rats.

Complexity of glutamine metabolism in kidney tubules from fed and fasted rats

Glutamine is an important renal glucose precursor and energy provider. In order to advance our understanding of the underlying metabolic processes, we studied the metabolism of variously labelled [13C]glutamine and [14C]glutamine molecules and the effects of fasting in isolated rat renal proximal tubules. Absolute fluxes through the enzymes involved, including enzymes of four different cycles operating concomitantly, were assessed by combining mainly the 13C NMR data with an appropriate model of glutamine metabolism. In both nutritional states, unidirectional glutamine removal by glutaminase was partially masked by the concomitant operation of glutamine synthetase; fasting accelerated glutamine removal by increasing flux solely through glutaminase, without changing that through glutamine synthetase. Fasting stimulated net glutamate degradation only by decreasing flux through glutamate dehydrogenase in the reductive amination direction, but surprisingly did not significantly alter complete oxidation of the glutamine carbon skeleton. Finally, gluconeogenesis from glutamine involved not only substantial recycling through the tricarboxylic acid cycle, but also an important anaplerotic flux through pyruvate carboxylase that was accelerated dramatically by fasting. Thus renal glutamine metabolism follows an unexpectedly complex route that is precisely regulated during fasting.

Regulation of the spatiotemporal pattern of expression of the glutamine synthetase gene

Glutamine synthetase, the enzyme that catalyzes the ATP-dependent conversion of glutamate and ammonia into glutamine, is expressed in a tissue-specific and developmentally controlled manner. The first part of this review focuses on its spatiotemporal pattern of expression, the factors that regulate its levels under (patho)physiological conditions, and its role in glutamine, glutamate, and ammonia metabolism in mammals. Glutamine synthetase protein stability is more than 10-fold reduced by its product glutamine and by covalent modifications. During late fetal development, translational efficiency increases more than 10-fold. Glutamine synthetase mRNA stability is negatively affected by cAMP, whereas glucocorticoids, growth hormone, insulin (all positive), and cAMP (negative) regulate its rate of transcription. The signal transduction pathways by which these factors may regulate the expression of glutamine synthetase are briefly discussed. The second part of the review focuses on the evolution, structure, and transcriptional regulation of the glutamine synthetase gene in rat and chicken. Two enhancers (at -6.5 and -2.5 kb) were identified in the upstream region and two enhancers (between +156 and +857 bp) in the first intron of the rat glutamine synthetase gene. In addition, sequence analysis suggests a regulatory role for regions in the 3' untranslated region of the gene. The immediate-upstream region of the chicken glutamine synthetase gene is responsible for its cell-specific expression, whereas the glucocorticoid-induced developmental appearance in the neural retina is governed by its far-upstream region.

The transport of L-glutamine into cultured human fibroblasts

The transport of L-glutamine has been studied in diploid human fibroblasts in culture. Mathematical discrimination by nonlinear regression, competition analysis, and conditions varying the relative contribution of the various mediations have been used to characterize the systems engaged in the inward transport of this amino acid. The adopted criteria showed that L-glutamine enters the fibroblast by the Na(+)-dependent systems ASC and A and by a Na(+)-independent route identified as system L. The relative contribution of these agencies to the total saturable uptake of glutamine varied with the concentration of the amino acid and with the nutritional state of the cell. At amino acid concentrations approaching those encountered in human plasma: (1) system ASC represented the primary mediation for entry of L-glutamine in human fibroblasts; (2) the contribution of system A was lower, though significant, in unstarved repressed cells and became predominant in starved derepressed cells; (3) the Na(+)-dependent system L accounted for less than one-fifth of glutamine uptake in either nutritional condition. The changes in the relative contribution of the various systems to the uptake of glutamine as a function of its concentration may have implications in pathophysiology under conditions associated with enhanced glutamine concentrations in the extracellular fluids.

Importance of ammonium ions in regulating hepatic glutamine synthesis during fasting

Four-day fasting in the conscious dog is associated with enhanced ammoniagenesis in both the gut and kidneys and a switch in the hepatic glutamine balance from net uptake to that of net production. In the present study we examined the role that the rise in portal venous ammonium ions plays in regulating nitrogen metabolism in vivo. Three groups of 18- to 24-h fasted conscious dogs with catheters surgically implanted in the femoral artery and in the hepatic, portal, and renal veins for 17-21 days were studied. On the day of the study, one group (n = 6) received intraportal ammonium acetate at 3.0 mumol.kg-1.min-1 intended to result in portal venous ammonium ion levels slightly above those seen in the 4-day fasted dog. Another group (n = 5) received an equimolar infusion of sodium acetate, and a third group (n = 6) received saline (0.9%) and acted as controls. Organ balances across the liver, extrahepatic splanchnic tissues (gut), and kidneys were estimated by the arteriovenous differences multiplied by blood flows. All of the load of ammonium acetate infused intraportally was taken up by the liver. As a result there was an immediate switch in hepatic glutamine balance from that of net uptake to net production similar to that seen in the 4-day fasted dog. Simultaneously, net hepatic production of urea nitrogen doubled. These occurred with no change in acid-base balance or no change in circulating arterial or portal venous levels of insulin and glucagon.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of hyperthermia on the peripheral metabolism of ammonia and glutamine

Although there are a number of physiological states associated with an increase in body temperature, eg, nonseptic and septic fever or exercise, the effects of hyperthermia on intermediary metabolism in vivo have received little attention. The current study was undertaken to examine the peripheral metabolism of ammonia and ammonia-related amino acids using a model of exogenously induced mild hyperthermia in nonfebrile subjects. Arteriovenous levels of metabolites were measured in subjects with known cerebrovascular insufficiency. Peripheral exchange of these metabolites was monitored before, during, and after hyperthermia to an average temperature of 38.5 degrees C. All subjects showed an increase in plasma ammonia and glutamate. There was also an associated peripheral production of ammonia and an uptake of glutamine and alanine by the skeletal muscle tissues. The exchange of glutamate was not affected. These findings indicate that hyperthermia is associated with a nitrogen-sparing effect, the mechanism of which is yet unknown.

Gut-liver interaction in glutamine homeostasis: portal ammonia role in uptake and metabolism

The role of ammonia released by the gut on hepatic glutamine handling and metabolism was studied in postabsorptive anesthesized male Sprague-Dawley rats at spontaneous and elevated arterial glutamine concentrations. Glutamine handling and metabolite release across both organ beds were studied using arteriovenous concentration differences and simultaneously measured portal and hepatic venous plasma flows. At the spontaneous arterial glutamine load, fractional glutamine extraction, FE-Gln, by the gut and the liver was 24 and 10%, respectively. At the elevated glutamine load, gut glutamine uptake doubled, while FE-Gln remained at 24%; however, portal ammonia and alanine increased and decreased, respectively. In response, hepatic FE-Gln increased to 28% with a large release of glutamate and urea. The role of portal ammonia in modulating hepatic glutamine uptake was studied by infusing NH4HCO3 directly into the portal vein. Increasing the portal load promptly stimulated hepatic glutamine uptake and glutamate and urea release. Mitochondria isolated from these livers produced more glutamate from glutamine, suggesting ammonia activation of hepatic glutaminase flux; in addition, citrulline formation increased, suggesting a coupling of glutaminase flux to urea synthesis. The results are consistent with portal ammonia release acting as a key informational molecule in interorgan glutamine flow.

Role of acidosis in regulating hepatic nitrogen metabolism during fasting in conscious dog

This study was designed to investigate the role that acidosis plays in the metabolic responses to fasting. Eighteen conscious dogs with surgically implanted catheters in the femoral artery and in the hepatic, portal, and renal veins were studied. Six were fasted for 24 h and 12 were fasted for 4 days (96 h). On the day of the study, six 4-day fasted dogs were infused intravenously with NaHCO3 (10 mumol X kg-1 X min-1) for 3 h, while the rest received saline and acted as controls. Splanchnic balances of glutamine, alanine, blood urea nitrogen, ammonia, lactate, beta-hydroxybutyrate, and acetoacetate were estimated using the Fick principle. Blood flow to the splanchnic and renal beds were estimated using indocyanine green and p-aminohippurate extraction methods, respectively. The infusion of NaHCO3 nearly abolished the base deficit associated with fasting and normalized arterial bicarbonate levels but did not alter blood pH. It suppressed but did not abolish hepatic glutamine output by 60%. This was associated with a shift in cytoplasmic and mitochondrial redox potentials of the hepatocyte as evident by a decrease in hepatic production of beta-hydroxybutyrate and an increase in hepatic production of acetoacetate and a decrease in hepatic lactate utilization. Concomitantly, renal glutamine uptake decreased. Glutamine release of skeletal muscle was unchanged. The data suggest that hepatic glutamine synthesis and release seen with 4-day fasting has two components: a bicarbonate-dependent component that is influenced by the redox potential of the hepatocyte and a bicarbonate-independent component, the nature of which is not yet clear.(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial ammonemia changes of renal origin induced in the rat by acid and alkaline diets

The aim of this study was to investigate the influence of acid and alkali food supplementation on systemic ammonemia to explain the hyperammonemia previously observed in rats fed a high protein diet. In normal rats, arterial ammonia concentration significantly increases after 4 days of HCl-supplemented diet. Following a NaHCO3-enriched food, there is only a slight but not significant decrease in arterial ammonia level. These changes occur before any variation in arterial acid-base status and are of renal origin. Indeed, there is a positive linear correlation (r = 0.946; P less than 0.001) between arterial ammonia level and the ammonia concentration difference between the renal vein and artery (which varies proportionally to the urinary ammonium excretion). Hindquarter uptake and intestinal release of ammonia do not significantly participate in the arterial ammonia changes observed. Following HCl-enriched diets, increased renal glutamine uptake, enhanced hindquarter glutamine release, and perhaps decreased intestinal glutamine uptake occur simultaneously. In conclusion, acid and alkali food supplementation intervenes on the renal ammonia release into the circulation with concomitant arterial ammonemia changes.

Effect of metabolic acidosis on hindquarter glutamine and alanine release

The relationship between hindquarter glutamine release and renal glutamine extraction was studied in rats undergoing chronic metabolic acidosis. Metabolic acidosis was induced by maintaining rats on NH4CL for four days; controls were pair-fed NH4HCO3. Metabolic acidosis increased renal glutamine extraction 8-fold and decreased arterial plasma glutamine concentration 40%. Hindquarter glutamine release rose 5-fold in acidosis due to an increased arteriovenous glutamine concentration difference and a significant rise in blood flow through the hindquarters. Both ammonia and glutamate extraction in the hindquarter increased in acidosis and could account for 25% of the glutamine nitrogen released. Alanine release by hindquarters, which exceeded glutamine release in the control animals, was greatly depressed in metabolic acidosis. The reduction in alanine nitrogen release during acidosis could account for 25% of the glutamine nitrogen released. Consequently, metabolic acidosis stimulates hindquarter glutamine release at the expense of alanine and is also supported by greater extraction of ammonia and glutamate. However, other N sources must supply nearly 50% of the glutamine nitrogen released based on balance studies.

Regulation of interorganal glutamine flow in metabolic acidosis

Metabolic acidosis redirects interorgan glutamine flow from hepatic utilization to renal ammoniagenesis at the expense of ureagenesis. The roles of arterial glutamine load and organ glutaminase capacity in the regulation of glutamine balance across the gut, liver, and kidneys were studied in control and chronically acidotic rats. In control rats these organs combined to remove 733 nmol glutamine X min-1 X 100 g-1 in agreement with their respective glutaminase content, gut greater than liver greater than kidneys. In chronic metabolic acidosis renal glutamine extraction alone increased to 1,158 nmol X min-1 X 100 g-1 associated with an increased glutaminase capacity. However, the total glutamine deficit across these organs rose to only 1,043 nmol glutamine consumed X min-1 X 100 g-1 as a consequence of hepatic glutamine uptake reversing to net release. This reversal was not dependent on increased hepatic glutamine synthetase capacity, but rather appears to be dependent on the combined effect of reduced portal venous glutamine load and increased ammonia load. The reduction in portal glutamine load is, in turn, a consequence of renal glutamine extraction and reduced arterial glutamine concentration in metabolic acidosis as well as maintained gut glutamine extraction. Elevating arterial glutamine concentration in metabolic acidosis has no effect on renal uptake, but enhances splanchnic bed extraction with the restoration of ureagenesis. Thus the interorgan flow of glutamine and deposition of N into either urea or ammonia appears to be dependent on arterial glutamine concentration and hence glutamine availability in chronic metabolic acidosis in the rat.

Release of lactate by the liver in metabolic acidosis in vivo

Chronic metabolic acidosis was induced in dogs by HCl. Pyruvate and lactate production and extractions were studied by arteriovenous sampling and electromagnetic flow probe measurements of gut and hepatic blood flows. The following results were obtained: (1) In control, overnight-fasted dogs, no net lactate or pyruvate was extracted by the liver. (2) In chronic acidosis, large amounts of lactate were produced. (3) Reduced tissue pyruvate levels and reduced activity of pyruvate dehydrogenase were found in the liver of these dogs compared with normal. These results demonstrate an unexpected effect of acidosis on hepatic lactate metabolism.

Lactate, alanine and glutamine metabolism in isolated canine pup liver cells

The metabolism of lactate, alanine and glutamine was studied in isolated canine liver cells. Lactate proved a better gluconeogenic precursor than alanine and glutamine. Glucose was synthesized at similar rates from both amino acids and ureogenesis from glutamine was double that from alanine. As in isolated rat liver cells, glucose and urea represented the main carbon and nitrogenous end-products of lactate, alanine and glutamine metabolism. Taken with the known levels of hepatic uptake of glutamine and alanine, these findings suggest that in the fasted dog, unlike in the fasted rat, glutamine and not alanine is the main transporter of nitrogen and carbon from muscle to liver for urea synthesis and gluconeogenesis.

Ammonia and acid-base homeostasis

The metabolic pathways involved in renal ammonia production have been considered and potential sites of regulatory control have been delineated. New information that acute acidosis stimulates renal ammonia production and that chronic respiratory acidosis does not result in an adaptive increase in the renal capacity to produce ammonia has been emphasized. The effect of potassium on renal ammonia production and the physiologic and pathophysiologic implication of this relationship have been detailed. Finally, the mechanism of urinary ammonium excretion and the impact of altered ammoniagenesis on urinary acidification, and the interpretation of clinical acidification tests have been discussed.

Preliminary report: the effects of acute acidosis on alanine and glucose metabolism across the liver, gut, kidney, and muscle in the dog

Acute metabolic acidosis (AMA) in the dog results in a 48% increase in arterial alanine concentration and an 11% fall in blood glucose. Extraction/production of glucose and alanine were studied by A/V sampling and electromagnetic blood flow probe measurements. Alanine and total amino-N release by muscle increased in acidosis Hepatic glucose release was reduced. More marked changes in metabolism occur in AMA in the dog than previously considered.