Interactive effects of insulin and corticosterone on myofibrillar protein turnover in rats as determined by N tau-methylhistidine excretion

Muscle Toxicity of Drugs: When Drugs Turn Physiology into Pathophysiology

Drugs are prescribed to manage or prevent symptoms and diseases, but may sometimes cause unexpected toxicity to muscles. The symptomatology and clinical manifestations of the myotoxic reaction can vary significantly between drugs and between patients on the same drug. This poses a challenge on how to recognize and prevent the occurrence of drug-induced muscle toxicity. The key to appropriate management of myotoxicity is prompt recognition that symptoms of patients may be drug related and to be aware that inter-individual differences in susceptibility to drug-induced toxicity exist. The most prevalent and well-documented drug class with unintended myotoxicity are the statins, but even today new classes of drugs with unintended myotoxicity are being discovered. This review will start off by explaining the principles of drug-induced myotoxicity and the different terminologies used to distinguish between grades of toxicity. The main part of the review will focus on the most important pathogenic mechanisms by which drugs can cause muscle toxicity, which will be exemplified by drugs with high risk of muscle toxicity. This will be done by providing information on key clinical and laboratory aspects, muscle electromyography patterns and biopsy results, and pathological mechanism and management for a specific drug from each pathogenic classification. In addition, rather new classes of drugs with unintended myotoxicity will be highlighted. Furthermore, we will explain why it is so difficult to diagnose drug-induced myotoxicity, and which tests can be used as a diagnostic aid. Lastly, a brief description will be given of how to manage and treat drug-induced myotoxicity.

Excessive glucocorticoid-induced muscle MuRF1 overexpression is independent of Akt/FoXO1 pathway

The ubiquitin-proteasome system (UPS)-dependent proteolysis plays a major role in the muscle catabolic action of glucocorticoids (GCs). Atrogin-1 and muscle-specific RING finger protein 1 (MuRF1), two E3 ubiquitin ligases, are uniquely expressed in muscle. It has been previously demonstrated that GC treatment induced MuRF1 and atrogin-1 overexpression. However, it is yet unclear whether the higher pharmacological dose of GCs induced muscle protein catabolism through MuRF1 and atrogin-1. In the present study, the role of atrogin-1 and MuRF1 in C2C12 cells protein metabolism during excessive dexamethasone (DEX) was studied. The involvement of Akt/forkhead box O1 (FoXO1) signaling pathway and the cross-talk between anabolic regulator mammalian target of rapamycin (mTOR) and catabolic regulator FoXO1 were investigated. High concentration of DEX increased MuRF1 protein level in a time-dependent fashion (P<0.05), while had no detectable effect on atrogin-1 protein (P>0.05). FoXO1/3a (Thr24/32) phosphorylation was enhanced (P<0.05), mTOR phosphorylation was suppressed (P<0.05), while Akt protein expression was not affected (P>0.05) by DEX. RU486 treatment inhibited the DEX-induced increase of FoXO1/3a phosphorylation (P<0.05) and MuRF1 protein; LY294002 (LY) did not restore the stimulative effect of DEX on the FoXO1/3a phosphorylation (P>0.05), but inhibited the activation of MuRF1 protein induced by DEX (P<0.05); rapamycin (RAPA) inhibited the stimulative effect of DEX on the FoXO1/3a phosphorylation and MuRF1 protein (P<0.05).

Glucocorticoids Enhance Muscle Proteolysis through a Myostatin-Dependent Pathway at the Early Stage

Myostatin, a member of the TGF-β superfamily of secreted proteins, is expressed primarily in skeletal muscle. It negatively regulates muscle mass and is associated with glucocorticoid-induced muscle atrophy. However, it remains unclear whether myostatin is involved in glucocorticoid-induced muscle protein turnover. The aim of the present study was to investigate the role of myostatin in protein metabolism during dexamethasone (DEX) treatment. Protein synthesis rates and the expression of the genes for myostatin, ubiquitin-proteasome atrogin-1, MuRF1, FoxO1/3a and mTOR/p70S6K were determined. The results show that DEX decreased (P<0.05) protein synthesis rates while increasing the abundance of myostatin. DEX increased (P<0.05) the level of phospho-FoxO1/3a (Thr 24/32) and the expression of MuRF1. In contrast, DEX treatment had no detectable effect on atrogin-1 protein levels (P>0.05). The phosphorylation levels of mTOR and p70S6K were decreased by DEX treatment (P<0.05). Follistatin treatment inhibited the DEX-induced increase in myostatin (P<0.05) and the activation of phosphor-FoxO1/3a (Thr 24/32) (P< 0.05) and MuRF1 (P<0.05). Follistatin treatment had no influence on the protein synthesis rate or on the phosphorylation levels of mTOR (Ser 2448) and p70S6K (Thr 389) (P> 0.05). In conclusion, the present study suggests that the myostatin signalling pathway is associated with glucocorticoid-induced muscle protein catabolism at the beginning of exposure. Myostatin is not a main pathway associated with the suppression of muscle protein synthesis by glucocorticoids.

Altered development and protein metabolism in skeletal muscles of broiler chickens (Gallus gallus domesticus) by corticosterone

Two trials were conducted to investigate the effect of corticosterone (CORT) on protein metabolism and the amino acid composition in muscle tissues of broiler chickens (Gallus gallus domesticus). In Trial 1, two groups of 30 broiler chickens were subjected to control or CORT treatment (30 mg/kg diet) from 28 to 39 days of age. In Trial 2, three groups of chickens of 28 days of age were randomly subjected to one of the following treatments for 7 days: CORT (30 mg/kg diet), pair-fed (maintaining the same feed intake as CORT treatment) and control treatments. The body mass gain and feed efficiency was significantly decreased by CORT treatment, while the food intake was decreased. The breast and thigh masses (% body mass) were significantly suppressed by CORT treatment, while the abdominal fat and liver masses (%) were obviously increased. The plasma levels of glucose, urate and total amino acid were significantly elevated by CORT treatment. The capacity for protein synthesis, estimated by RNA:protein ratio, were significantly suppressed by CORT in M. pectoralis major and M. biceps femoris. The 3-methylhistidine concentrations were significantly increased in both M. pectoralis major and M. biceps femoris of CORT chickens, compared to control but not the pair-fed chickens. The amino acid composition of M. pectoralis major and M. biceps femoris was not significantly affected by CORT treatment. In conclusion, the arrested growth in skeletal muscles induced by CORT administration has tissue specificity. The CORT treatment retards the growth of skeletal muscle by suppressed protein synthesis and augmented protein catabolism.

Mechanism for the increased skeletal muscle protein degradation in the obese Zucker rat

Obese (fa/fa) Zucker rats showed a decreased protein content in skeletal muscle compared with their lean counterparts. This was associated with both a decrease in the fractional rate of protein synthesis and an enhanced fractional rate of protein degradation in skeletal muscle, as studied by pre-loading body proteins with (14)C-bicarbonate. The increased protein degradation could be the result of the clearly enhanced expression for several transcripts of the ubiquitin genes in skeletal muscle. The results suggest that the increased protein degradation in the skeletal muscle of the obese animals may be due to increased activity of the ubiquitin-dependent proteolytic system.

Dietary supplementation with creatine monohydrate prevents corticosteroid-induced attenuation of growth in young rats

Corticosteroids are used as chemotherapeutic agents in many medical conditions, despite many common and potentially serious side effects. Supplementation with creatine monohydrate (CrM) can increase strength and lean body mass in humans and, therefore, may be a viable countermeasure to the side effects of corticosteroids. Therefore, the purpose of this study was to determine if CrM could prevent the attenuation of growth associated with corticosteroid administration. Forty male Sprague-Dawley rats were randomized to the following groups: control (CON, n = 10), 7 mg methylprednisolone x kg(-1) x week(-1) (PRED, n = 10), 2% CrM in diet (CD, n = 10), or CrM and methylprednisolone (CD-PRED, n = 10). Animals received either a weekly sham injection (saline; CON and CD) or an injection of methylprednisolone (PRED and CD-PRED) for 6 weeks. At the completion of the 6th week, body composition was determined and skeletal muscles were collected. Weight gain was attenuated in PRED as compared with all other groups (P < 0.05). Muscle total creatine and phosphocreatine were greater in the extensor digitorum longus in the CD and CD-PRED groups as compared with the CON and PRED groups (P < 0.05); however, total creatine and phosphocreatine in the soleus were not different. Mean fiber area was greater in type II fibers from the extensor digitorum longus in the CD and CD-PRED groups as compared with the CON and PRED groups (P < 0.05); no treatment effect was seen in the soleus. In conclusion, CrM supplementation prevented the attenuation of growth associated with corticosteroids and also increased type II muscle fiber area. These results could have important clinical implications for several patient populations commonly treated with corticosteroids, and further work is required to determine the specific mechanisms underlying the physiological effects that were observed.

Branched-chain amino acids: a role in skeletal muscle proteolysis in catabolic states?

A 48-h starvation period resulted in a great increase in muscle proteolysis-as measured following the release of tyrosine into the medium-in incubated isolated rat extensor digitorum longus (EDL) muscles. We have quantified the contribution of the different proteolytic systems to the increased protein degradation and observed a considerable activation in the ATP-dependent proteolytic (60%) and in the calcium-dependent (125%) systems, while no increases were observed in lysosomal proteolysis. The addition of 10 mM leucine to the incubation medium did not result in any changes in either total proteolytic rate or the activity rates of any of the different systems studied. In addition, the presence of the amino acid did not influence the levels of mRNA for the different genes studied-ubiquitin, C8 proteasome subunit, E2 conjugating enzyme, m-calpain, and cathepsin B. In a similar way, as observed during starvation, tumor growth resulted in increased protein degradation in incubated isolated EDL muscles from animals bearing the Yoshida AH-130 ascites hepatoma. The increased rate of protein degradation affected all the proteolytic systems studied: ATP- and calcium-dependent and lysosomal. Finally, leucine addition (10 mM), although not able to revert the increased proteolytic rate, resulted in a decrease in the gene expression for ubiquitin, C8 proteasome subunit and cathepsin B.

Neuromuscular complications in endocrine and metabolic disorders

Many of the endocrine and metabolic myopathies have no unique features, and for most clinicians, it is not possible to remember the clinical nuances of all the specific abnormalities and deficiencies responsible for these myopathies. This can make this group of diseases difficult to suspect. It is more important to recognize the general features of myopathic disease and to consider muscle biopsies as a preliminary diagnostic technique, with the potential for further investigation if a myopathy is confirmed.

TLC of some free amino acids from sanguine plasma

This research presents the results obtained from analysis by thin layer chromatography (TLC) of some free amino acids from sanguine plasma samples in the different degree progress in maladies: diabetes, renal syndrome and hepatic cirrhosis. The chromatograms were evaluated with a Shimadzu CS-9000 dual-wavelength flying-spot scanner. Better results were obtained in the case of hepatic cirrhosis.

Endocrine neuromyopathies

The myopathies associated with endocrine disorders range in clinical presentation from the relatively nonspecific pattern of proximal muscle weakness of glucocorticoid excess states to specific presentations of contractions produced in tetany. All endocrine neuromyopathies emphasize the role of skeletal muscle in protein, carbohydrate, and electrolyte metabolism. Hormonal abnormalities tend to compromise muscle force generation by indirect effects on muscle function. The recognition and effective treatment of all these disorders require the identification of the underlying hormonal imbalances and awareness of general medical problems produced by the endocrine disorders.

Activation of the ubiquitin pathway in rat skeletal muscle by catabolic doses of glucocorticoids

To evaluate whether catabolic levels of glucocorticoids activate the ubiquitin pathway in conjunction with their known proteolytic effect in skeletal muscle, rats were injected daily with corticosterone (CTC; 10 mg/100 g body wt) for 7 days. Two peaks of urinary excretion of 3-methylhistidine (3-MH), a specific marker of myofibrillar proteolysis, were observed at days 1 and 3 (165 and 295% of controls, respectively). Levels of ubiquitin pathway mRNAs in skeletal muscle were assessed around the 3-MH peaks. In the extensor digitorum longus, a first rise of two polyubiquitin (pUb) mRNAs was seen at day 1 (183 and 162% of control for the UbB and UbC transcripts, respectively, P < 0.01). An accumulation of both E2-14k mRNAs (140%, P < 0.02, and 157% of controls, P < 0.01) and proteasome C8 subunit mRNA (222% of control, P < 0.05) was seen at day 2. A second more important peak of induction of pUb mRNA was seen at day 3 (251 and 217% of controls for the UbB and UbC transcripts, respectively, P < 0.001). All transcripts returned to near control levels by day 4. In the soleus, induction of E2-14k mRNA started at day 3 and reached 216 and 208% of controls at day 4 (P < 0.001), whereas an increase of pUb mRNA was observed at days 3 (213 and 241%, P < 0.05) and 4 (211 and 221%, P < 0.001). A rise of proteasome C8 subunit mRNA accumulation was also seen in the soleus at days 3 (217%, P < 0.05) and 4 (157%, P < 0.05). Reduced ubiquitin conjugate levels, possibly due to their rapid degradation through increased proteasome activity, were observed in both muscle types at day 3. The parallel between the catabolic effects of CTC and activation of the ubiquitin pathway in muscles of CTC-treated rats strongly suggests the involvement of this system in glucocorticoid-induced muscular atrophy.

The ubiquitin-dependent proteolytic pathway in skeletal muscle: its role in pathological states

It is generally accepted that muscle wasting is caused by an increase in protein breakdown which seems to be associated with an ATP-dependent, non-lysosomal proteolytic system based on conjugation of proteins to the small polypeptide ubiquitin. Increases in ubiquitin conjugates and in ubiquitin mRNAs are found in the skeletal muscle of experimental animals with various pathological conditions such as infection, acidosis or cancer cachexia. In this review, Josep Argilés and Francisco López-Soriano discuss the role of the ubiquitin-dependent proteolytic pathway in muscle weight loss in pathological situations.

Effects of insulin and insulin-like growth factors on protein and energy metabolism in tumour-bearing rats

The effects of insulin-like growth factor-1 (IGF-I), and a more potent variant LR3-IGF-I, which binds poorly to IGF-binding proteins, were investigated in rats bearing a mammary adenocarcinoma. The effect of insulin, either alone or in combination with LR3-IGF-I, was also investigated. Peptides were infused via osmotic minipumps for 6-7 days after tumour size reached 5% of body weight. Infusion of IGFs alone at either 200 or 500 microgram/day significantly decreased food intakes as well as circulating levels of insulin and glucose, and consequently failed to promote muscle protein accretion in the host. Tumour growth was increased by the IGFs, especially by LR3-IGF-I, even though these peptides did not promote growth of the adenocarcinoma in cell culture. Infusion of LR3-IGF-I, and to a lesser extent IGF-I, led to decreased rates of muscle protein synthesis and increased muscle protein breakdown, but each of these measures was closely related to the final tumour burden (r2 = 0.454 and 0.810 respectively; P < 0.01) and possibly resulted from a decrease in substrate supply to the host tissues. Insulin infusion (100 micrograms/day) increased food consumption by more than 50% and significantly decreased tumour growth. Insulin and LR3-IGF-I had a synergistic effect on host weight, which increased by 19.1 +/- 1.9, -1.1 +/- 4.7 and 37.9 +/- 1.5 g for insulin, LR3-IGF-I and combined treatments respectively. Carcass protein was increased by more than 10% with insulin treatment, due to increased rates of synthesis and decreased rates of muscle protein breakdown, but LR3-IGF-I had no positive effect on carcass protein accretion, either alone or in combination with insulin. Similarly, the amount of carcass fat was increased almost 2-fold by insulin treatment, whereas it was decreased by 30% by LR3-IGF-I. These changes may have arisen either from direct hormone effects on metabolism or from the indirect effects of food intake, or both. Our results suggest that IGF administration may exacerbate an insulin insufficiency associated with the tumour-bearing state and further decrease metabolic substrate supply to the host. This can be overcome by co-infusion of insulin.

The opposing effects of insulin and hyperglycemia in modulating amino acid metabolism during a glucose tolerance test in lean and obese subjects

An intravenous glucose tolerance test (IVGTT) was administered in both lean (n = 9) and obese (n = 14) volunteers to ascertain the importance of the dynamic interactions between insulin and glucose on plasma concentrations of two amino acids known to be primarily used by skeletal muscle, namely leucine and isoleucine, and one amino acid, phenylalanine, which is primarily metabolized by the liver. After a 30-minute basal period, each subject received a bolus injection of glucose (0.3 g/kg IV) followed 20 minutes later by a bolus injection of tolbutamide (300 mg). Blood samples were drawn frequently for 180 minutes after the glucose infusion to determine plasma concentrations of glucose, insulin, leucine, isoleucine, and phenylalanine. Plasma glucose and insulin concentrations during the basal period were increased by 10% and 100%, respectively, in obese compared with lean individuals (P < .05), whereas phenylalanine, isoleucine, and leucine levels were similar between groups. During the IVGTT, plasma glucose level initially increased by twofold and slowly returned to basal level thereafter, whereas insulin level responded to glucose and tolbutamide infusions in a typical biphasic manner. Plasma leucine and isoleucine levels did not change from basal levels during the first 60 minutes of the IVGTT as hyperglycemic hyperinsulinemia prevailed in both groups. However, when plasma glucose had returned to near-basal levels, plasma leucine and isoleucine levels began to decrease, reaching a plateau of approximately 20% and 35% below basal, and plasma insulin level remained elevated in the lean and obese individuals, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Leucine metabolism in lactating and dry goats: effect of insulin and substrate availability

Early lactating goats show insulin resistance with respect to extramammary glucose utilization. However, much less is known about the two major factors, insulin and plasma amino acid concentration, that regulate protein metabolism in lactating goats. To examine this question, the in vivo effect of acute insulin was studied in goats during early lactation (12-31 days postpartum), midlactation (98-143 days postpartum), and the dry period (approximately 1 yr postpartum). Insulin was infused (at 0.36 or 1.79 nmol/min) under euglycemic and eukaliemic clamps. In addition, appropriate amino acid infusion was used to blunt insulin-induced hypoaminoacidemia or to create hyperaminoacidemia and maintain this condition under insulin treatment. Leucine kinetics were assessed using a primed continuous infusion of L-[1-14C]-leucine, which started 2.5 h before insulin. In all animals the insulin treatments failed to stimulate the nonoxidative leucine disposal (an estimate of whole body protein synthesis) under both euaminoacidemic and hyperaminoacidemic conditions. Thus, in goat as well as humans, infusion of insulin fails to stimulate protein synthesis even when combined with a substantially increased provision of amino acids. In contrast, insulin treatments caused a dose-dependent inhibition of the endogenous leucine appearance (an estimate of whole body protein degradation). Under euaminoacidemia the initial slope from the plot of the endogenous leucine appearance as a function of plasma insulin (an insulin sensitivity index) was steeper during early lactation than when compared with the dry period. A similar trend occurred during midlactation but not to any significant degree. These differences were abolished under hyperaminoacidemia. It was concluded that the ability of physiological insulin to inhibit protein degradation was improved during lactation, demonstrating a clear-cut dissociation between the effects of insulin on protein and glucose metabolism. This adaptation no doubt may provide a mechanism to save body protein.

Insulin-like growth factor-I and more potent variants restore growth of diabetic rats without inducing all characteristic insulin effects

The effects of graded doses of insulin-like growth factor-I (IGF-I) and two variants which bind poorly to IGF-binding proteins were investigated in 160 g streptozotocin-induced diabetic rats. The two variants were the truncated form, des(1-3)IGF-I, and another with arginine at residue 3 and an N-terminal extension, termed LR3-IGF-I. The peptides were infused via mini-osmotic pumps. Reference groups received either vehicle or insulin (30 i.u. per day). Treatment led to a marked dose-dependent increase in growth rate and nitrogen balance. The highest dose (695 micrograms/day) of IGF-I increased body weight by 48.1 +/- 1.7 g/7 days, compared with 11.0 +/- 2.8 g/7 days for the vehicle-treated group. The two variants were 2.5-3 times more potent than IGF-I in restoring growth. The insulin-treated group gained more weight (64.5 +/- 1.6 g/7 days), but the added gain was fat (92.5 +/- 4.8 g of fat/kg carcass wet wt., compared with 32.2 +/- 2.1 for all other groups) rather than protein. All peptides increased muscle protein-synthesis rates and RNA levels by up to 50%, with IGF-I the least potent. These high doses of IGFs did not decrease either the glucosuria or the daily excretion rate of N tau-methyl-histidine (N tau-MH). On the other hand, insulin treatment markedly decreased both glucosuria (from 82.7 +/- 5.4 to 4.5 +/- 3.3 mmol/day) and N tau-MH excretion (from 9.3 +/- 0.3 to 7.1 +/- 0.4 mumol/day per kg). This experiment shows that, although IGF-I and variants can restore growth in diabetic rats, other insulin-dependent metabolic processes in liver, muscle and adipose tissue are not restored.

Glucocorticoids activate the ATP-ubiquitin-dependent proteolytic system in skeletal muscle during fasting

Glucocorticoids are essential for the increase in protein breakdown in skeletal muscle normally seen during fasting. To determine which proteolytic pathway(s) are activated upon fasting, leg muscles from fed and fasted normal rats were incubated under conditions that block or activate different proteolytic systems. After food deprivation (1 day), the nonlysosomal ATP-dependent process increased by 250%, as shown in experiments involving depletion of muscle ATP. Also, the maximal capacity of the lysosomal process increased 60-100%, but no changes occurred in the Ca(2+)-dependent or the residual energy-independent proteolytic processes. In muscles from fasted normal and adrenalectomized (ADX) rats, the protein breakdown sensitive to inhibitors of the lysosomal or Ca(2+)-dependent pathways did not differ. However, the ATP-dependent process was 30% slower in muscles from fasted ADX rats. Administering dexamethasone to these animals or incubating their muscles with dexamethasone reversed this defect. During fasting, when the ATP-dependent process rises, muscles show a two- to threefold increase in levels of ubiquitin (Ub) mRNA. However, muscles of ADX animals failed to show this response. Injecting dexamethasone into the fasted ADX animals increased muscle Ub mRNA within 6 h. Thus glucocorticoids activate the ATP-Ub-dependent proteolytic pathway in fasting apparently by enhancing the expression of components of this system such as Ub.

Insulin-like growth factor-I (IGF-I) and especially IGF-I variants are anabolic in dexamethasone-treated rats

The administration of insulin-like growth factor-I (IGF-I) via subcutaneously implanted osmotic pumps partially reversed a catabolic state produced by the co-administration of 20 micrograms of dexamethasone/day to 150 g male rats. Marked dose-dependent effects on body weight and nitrogen retention were produced, with the highest IGF-I dose, 695 micrograms/day, giving a 6 g increase in body weight over 7 days, compared with a 19 g loss in the dexamethasone-only group and an 18 g gain in pair-fed controls. Two IGF-I analogues that bind poorly to IGF-binding proteins, the truncated form, des(1-3)IGF-I, and a variant with an N-terminal extension as well as arginine at residue 3, LR3IGF-I, were approx. 2.5-fold more potent than IGF-I. The response with LR3IGF-I was particularly striking because this peptide binds 3-fold less well than IGF-I to the type 1 IGF receptor. The increased potencies of the IGF-I variants may relate to the substantially increased plasma levels of IGF-binding proteins, particularly IGFBP-3, produced by the combined treatment of dexamethasone with IGF-I or the variants. These binding proteins would be expected to decrease the transfer of IGF-I, but not that of the variants, from blood to tissue sites of action. Measurements of muscle protein synthesis at the end of the treatment period and muscle protein breakdown by 3-methylhistidine (3MH) excretion throughout the experiment indicated coordinate anabolic effects of the IGF peptides on both processes. Thus 3MH excretion was decreased at the highest IGF-I dose from 83.5 +/- 4.2 (S.E.M.) mumol/kg per 7 days to 65.1 +/- 2.2, compared with 54.9 +/- 1.2 in the pair-fed controls. Part of this response in 3MH excretion may have reflected a decrease in gut protein breakdown, because IGF-I and especially the IGF analogues increased the gut weight by up to 45%. Notwithstanding the effects on protein synthesis and breakdown, the fractional carcass weights remained low in the IGF-treated groups, although the increase in total carcass weight reflected nitrogen rather than fat gain. The dexamethasone-induced changes in liver, spleen and heart weight were restored towards normal by the IGF treatment. The experiment demonstrates the potential of IGF-I treatment of catabolic states and especially the value of modified forms of growth factors that bind weakly to IGF-binding proteins.

Increased weight gain, nitrogen retention and muscle protein synthesis following treatment of diabetic rats with insulin-like growth factor (IGF)-I and des(1-3)IGF-I

We have examined the effects of infusing recombinant human growth hormone (hGH), insulin-like growth factor-I (IGF-I), the truncated IGF-I analogue, des(1-3)IGF-I, and insulin over a 7-day period in streptozotocin-induced diabetic rats. IGF-I at a dose of 1.05 or 1.08 mg/kg per day in two experiments increased body weight and nitrogen retention above those of vehicle-infused controls to about 30% of the improvement achieved with 25 or 30 units of insulin/kg per day, but only in the second experiment were the differences statistically significant (P less than 0.05). A 2.5-fold higher IGF-I dose, or des(1-3)IGF-I at 1.08 mg/kg per day, gave effects that were approx. 70% of those obtained with insulin. hGH at 1.38 mg/kg per day was not effective. The IGF peptides, unlike insulin, did not ameliorate the diabetic glucosuria. The improvements in nitrogen balance could be accounted for in part by increases in muscle protein synthesis. Muscle protein breakdown, as assessed by 3-methylhistidine excretion, was inhibited by insulin, but not by the IGF peptides. Carcass fat increased substantially following insulin administration. This did not occur with the IGF peptides, suggesting that IGF predominantly stimulates the growth of lean tissue. IGF-I concentrations and IGF-I-binding proteins in plasma were increased by IGF-I, especially at the higher dose, whereas hGH produced only a transient increase in IGF-I. Des(1-3)IGF-I induced binding proteins, but had only a slight effect on measured IGF-I concentrations. We conclude that IGF peptides stimulate muscle protein synthesis and improve nitrogen balance in diabetes without obviously influencing the abnormal carbohydrate metabolism. Moreover, des(1-3)IGF-I is at least as potent as the full-length IGF-I.

IGF-I and the truncated analogue des-(1-3)IGF-I enhance growth in rats after gut resection

Effects of insulin-like growth factor I (IGF-I) administration and that of the truncated analogue des-(1-3)IGF-I have been examined in 170-g rats over a 7-day period after surgery to remove 80% of the jejunum plus ileum. The doses administered via osmotic infusion pumps were 0.96 and 2.4 mg.kg-1.day-1 IGF-I and 0.96 mg.kg-1.day-1 des-(1-3)IGF-I. All groups lost weight on the day after surgery, but over the next 3 days the des-(1-3)IGF-I and high-dose IGF-I groups stabilized better and subsequently gained significantly (P less than 0.05) more weight than the vehicle or low-dose IGF-I groups over the last 3 days. The weight gains (mean +/- SE) for the groups over this last 3-day period were 14.0 +/- 1.7, 14.4 +/- 2.9, 21.9 +/- 1.7, and 20.8 +/- 1.0 g for the vehicle, low-dose IGF-I, high-dose IGF-I, and des-(1-3)IGF-I groups, respectively. The nitrogen balances over the last 3 days for the high-dose IGF-I and des-(1-3)IGF-I groups, at 242 +/- 14 and 217 +/- 13 mg/d, respectively, were significantly (P less than 0.05) more positive than the control group at 153 +/- 21 mg/d. These differences could at least partially be explained by changes in muscle protein breakdown, as assessed by 3-methyl-L-histidine excretion. The kidneys were heavier in all treatment groups and the thymus after administration of des-(1-3)IGF-I.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute effects of corticosterone on tissue protein synthesis and insulin-sensitivity in rats in vivo

The effect of corticosterone treatment on the sensitivity of muscle protein synthesis to insulin infusion was assessed in post-absorptive young rats. To select the optimal time period for corticosterone treatment, protein synthesis was measured by injection of L-[2,6-3H]phenylalanine (1.5 mmol/kg body weight) 1, 4, 12 or 24 h after injection of corticosterone (5 mg/kg body wt.). Muscle protein synthesis was significantly decreased at 4 h and the effect was maximal by 12 h; liver protein synthesis was elevated at 12 h and 24 h. The dose-response of muscle protein synthesis to a 30 min infusion with 0-150 munits of insulin/h was then compared in rats pretreated with corticosterone (10 mg/100 g body wt.) or vehicle alone. When no insulin was infused, corticosterone inhibited protein synthesis in gastrocnemius muscle. High doses of insulin stimulated protein synthesis, but the inhibition by corticosterone was similar to that in the absence of insulin. At intermediate doses of insulin there was an increased requirement for insulin to elicit an equivalent response in muscle protein synthesis. Plantaris muscle responded in a manner similar to that of gastrocnemius, but neither soleus muscle nor liver responded significantly to insulin. These data suggest that corticosterone has two modes of action; one which is independent from and opposite to that of insulin, and a second which causes insulin-resistance through a decrease in sensitivity rather than a change in responsiveness.

Dexamethasone-induced catabolism and insulin resistance in L6 myoblasts are reversed by the removal of serum

1. One hundred nanomolar dexamethasone reduced protein synthesis by 16% and also decreased the accretion of protein and RNA in L6 myoblasts when foetal calf serum was present; these effects were reversed when serum was omitted from the medium. 2. Insulin (100 microU/ml) increased protein synthesis, protein accretion and RNA accretion both in the presence and the absence of serum. 3. Dexamethasone inhibited the effects of 100 microU insulin/ml in the presence of serum and induced insulin resistance; in the presence of 25 or 100 nM dexamethasone insulin was ineffective at concentrations below 250 microU and 1 mU/ml respectively.

Myofibrillar protein catabolism in rat steroid myopathy measured by 3-methylhistidine excretion in the urine

The fractional rate of breakdown of myofibrillar protein in rat skeletal muscle was measured during subcutaneous cortisone acetate treatment (10 mg/100 g body weight per day). The daily urinary excretion of 3-methylhistidine divided by the 3-methylhistidine pool of the skeletal muscle was used to determine the fractional breakdown rate of myofibrillar protein. The mean fractional breakdown rate remained within the normal range throughout the first 5 days, but decreased significantly from the 16th day of treatment. When the daily 3-methylhistidine excretion was divided by the creatinine excretion, the rate showed the same trend of change. These results strongly suggest that the loss of myofibrillar protein induced by cortisone administration is not caused by increased breakdown but by decreased synthesis.

Regulation of muscle protein turnover: possible implications for modifying the responses to trauma and nutrient intake

The physiological control of muscle protein balance has been reviewed. In addition to trauma, fasting and reduced activity have been shown to cause muscle protein loss through changes in synthesis and breakdown. Many of the effects of these states are mediated by alterations in the concentrations of insulin, glucagon, steroids and catecholamines. Branched-chain amino acids also appear to have specific effects in improving protein synthesis. Recently, prostaglandins have been identified as having a central role as mediators in the control of protein metabolism by many hormones and pathological states. Identification of factors which control muscle protein synthesis leads to the possibility that the metabolic response to illness and injury and its attendant muscle protein loss could be open to pharmacological manipulation. Inhibition of prostaglandin synthesis by non-steroidal anti-inflammatory drugs can improve muscle protein turnover, but their clinical usefulness may be limited by side-effects. Hormonal manipulation may offer the possibility of abolishing the metabolic response. For example, inhibition of adrenal secretion in surgical patients by spinal anaesthesia appears to modify many of the metabolic effects of injury. A variety of other treatments have been used to minimize the metabolic derangements of injury. Some of these have considerable potential, but as yet clinical benefits from their use have not been positively identified. It is likely that a pharmacological approach to the nutritional disorders of stress and injury will prove to be of major interest in the future.

Rates of muscle protein breakdown in chickens selected for increased growth rate, food consumption or efficiency of food utilisation as assessed by N tau-methylhistidine excretion

1. N tau-methylhistidine excretion, growth rate, food consumption and body composition was determined in 12 4 to 5 week old chickens sampled from each of 4 lines selected for increased body-weight gain (line W), for increased food consumption (line F), for improved efficiency of food utilisation (line E) or at random (line C), after 12 generations of selection. 2. The use of N tau-methylhistidine as an index of myofibrillar protein breakdown was validated in male and female chickens of lines E and F by following the fate of injected N tau-(14CH3)methylhistidine. Most of the radioactivity (79.3 +/- 1.1%) was excreted in 4 d, with the remainder retained in the carcase. In excreta, 94 +/- 2% of the radioactivity was associated with free N tau-methylhistidine and for the carcase, this value was 88 +/- 3%. 3. In the main experiment, final body weights averaged 497, 651, 588 and 537 g and food: gain ratio averaged 2.47, 2.21, 3.14 and 2.06 for lines C, W, F and E respectively, Carcase protein content (g/100 g body weight) was not different between the lines. 4. N tau-methylhistidine excretion was 5.86, 5.48, 6.43 and 4.99 mumoles/mole carcase-N/d for lines C, W, F and E, respectively. The rate for line F was significantly higher than for lines W and C and that for line E was significantly less than for the control line. 5. The N tau-methylhistidine excretion rate was positively correlated with food: gain ratio. 6. Selection for rapid growth, high food consumption or improved food utilisation results in changes in N tau-methylhistidine excretion which suggest proportionate changes in muscle protein turnover.

Effect of glucocorticoids on contractile apparatus of rat skeletal muscle

Skeletal muscles which have a high oxidative potential are less sensitive to the catabolic action of dexamethasone. In fast-twitch white muscles, where the oxidative capacity is low, the alkaline proteinase activity as well as the rise in the number of lysosomes was more pronounced. It seems that the glucocorticoid-caused myopathy is a result of elevated degradation of contractile proteins. This process of degradation of contractile proteins begins in the myosine filaments and then spreads to the thin filaments and the z-line.

Hormonal control of muscle growth

In muscle of whole animals, pituitary growth hormone, the thyroid hormones, and insulin are major growth-promoting hormones, and the glucocorticoids have significant catabolic actions. At the cellular level the primary anabolic hormones for cultured myoblasts are the somatomedins (insulin-like growth factors) and fibroblast growth factor. In these cells physiological concentrations of growth hormone, thyroid hormones, and insulin have no growth-promoting effect; some of the reported actions of insulin probably result from cross-reaction with the somatomedin receptor. Results with purified proteins do not support the view that mitogens block myoblast differentiation; transforming growth factor-beta and interferon are nonmitogenic proteins that inhibit differentiation, insulin-like growth factors are mitogens that stimulate differentiation, and fibroblast growth factor is the only purified mitogen that inhibits differentiation. At least six serum-free media have now been devised for the growth of various kinds of muscle cells under closely defined conditions.

Glucocorticoid-mediated activation of muscle branched-chain alpha-keto acid dehydrogenase in vivo

Muscle branched-chain alpha-keto acid dehydrogenase, the rate-limiting enzyme for branched-chain amino acid oxidation in skeletal muscle, was measured after treatment of rats with glucocorticoids. Cortisone treatment (10 mg X 100 g body wt-1 X day-1 for 2-5 days) resulted in an approximate doubling of the percentage of active enzyme. To further characterize this effect, the enzyme complex was measured 4 h after the intraperitoneal injection of 6 alpha-methylprednisolone, a water-soluble glucocorticoid with rapid onset effects. The percentage of active enzyme increased linearly as the dose of methylprednisolone was increased from 0.125 to 12.5 mg/100 g body wt, while total enzyme activity was unchanged. Administration of insulin with glucose had no significant effect on the activity of the enzyme. However, treatment of rats with insulin and glucose after methylprednisolone administration partially blocked branched-chain alpha-keto acid dehydrogenase activation. The activity of the enzyme complex was correlated with the concentration of leucine in plasma and muscle. Activation of skeletal muscle branched-chain alpha-keto acid dehydrogenase by increased glucocorticoids may play a role in the acceleration of branched-chain amino acid oxidation observed during severe stress.

Synergism of triiodothyronine and corticosterone on muscle protein breakdown

The concerted effect of triiodothyronine (T3) and corticosterone on muscle protein synthesis and breakdown was studied. Thyroidectomized young male rats were treated with T3 (1.5 microgram/100 g body weight per day), corticosterone (10 mg/100 g body weight per day) and both T3 and corticosterone for 4 days. On the 3rd day of the experiment urine was collected to measure N tau-methylhistidine excretion as an index of muscle protein breakdown. On the last day of the experiment, the rates of protein synthesis in skeletal muscles were measured by the large-dose [3H]phenylalanine method. N tau-Methylhistidine excretion was slightly increased by T3 treatment and it was increased about 3-times by corticosterone treatment. When both T3 and corticosterone were administered, it was increased about 6-fold. The rate of muscle protein breakdown calculated from the difference between the rate of protein synthesis and the growth rate was consistent with these findings. The rate of muscle protein synthesis was increased by T3, and it was decreased by corticosterone. The rate was the same as that of the thyroidectomized control group when the animals were given T3 and corticosterone, showing that T3 restrained the inhibiting effect of corticosterone on muscle protein synthesis. The results indicate that a physiological level of T3 enhances the catabolic action of pharmacological doses of glucocorticoids on muscle protein breakdown.

Acute cortisol excess results in unimpaired insulin action on lipolysis and branched chain amino acids, but not on glucose kinetics and C-peptide concentrations in man

To assess whether acute cortisol excess impairs insulin action on lipolysis, plasma amino acids, endogenous insulin secretion, and glucose kinetics, nine normal subjects were studied after acute cortisol excess (80 mg hydrocortisone by mouth) and after placebo. Insulin sensitivity was assessed 6 hours after hydrocortisone using the glucose clamp technique (insulin infusion of 20 mU/m2 X minute for 120 minutes, plasma insulin levels of approximately equal to 50 mU/L). Hyperinsulinemia suppressed plasma free fatty acids (FFA) similarly by 75 and 76%, respectively. Most plasma amino acid concentrations were increased after hydrocortisone; however, the insulin-induced decrease of branched chain amino acids, serine, threonine, and tyrosine was unimpaired after hydrocortisone. Plasma C-peptide concentrations were less suppressed during hyperinsulinemia after hydrocortisone than after placebo (by 0.15 +/- 0.03 v 0.25 +/- 0.02 nmol/L, P less than 0.01), suggesting diminished insulin-induced suppression of insulin secretion. The glucose infusion rates required to maintain euglycemia were 35% lower (P less than 0.01) after hydrocortisone due to decreased insulin effects on metabolic clearance rate of glucose and diminished suppression of hepatic glucose production (0.4 +/- 0.1 v -0.1 +/- 0.1 mg/kg X minute, p less than 0.05, 3-3H-glucose infusion method). The data demonstrate that acute elevation of plasma cortisol to levels near those observed in severe stress results in insulin resistance of peripheral and hepatic glucose metabolism but in unimpaired insulin effects on plasma FFA and branched chain amino acids, suggesting that cortisol's lipolytic and proteolytic effects are antagonized by elevated plasma insulin levels.

Metabolic acidosis stimulates protein degradation in rat muscle by a glucocorticoid-dependent mechanism

Metabolic acidosis is associated with enhanced renal ammonia-genesis which is regulated, in part, by glucocorticoids. The interaction between glucocorticoids and chronic metabolic acidosis on nitrogen utilization and muscle protein metabolism is unknown. In rats pair-fed by gavage, we found that chronic acidosis stunted growth and caused a 43% increase in urinary nitrogen and an 87% increase in urinary corticosterone. Net protein degradation in incubated epitrochlearis muscles from chronically acidotic rats was stimulated at all concentrations of insulin from 0 to 10(4) microU/ml. This effect of acidosis persisted despite supplementation of the media with amino acids with or without insulin, indomethacin, and inhibitors of lysosomal thiol cathepsins. Acidosis did not change protein synthesis; hence, the increase in net protein degradation was caused by stimulation of proteolysis. Acidosis did not increase glutamine production in muscle. The protein catabolic effect of acidosis required glucocorticoids; protein degradation was stimulated in muscle of acidotic, adrenalectomized rats only if they were treated with dexamethasone. Moreover, when nonacidotic animals were given 3 micrograms/100 g of body weight dexamethasone twice a day, muscle protein degradation was increased if the muscles were simply incubated in acidified media. We conclude that chronic metabolic acidosis depresses nitrogen utilization and increases glucocorticoid production. The combination of increased glucocorticoids and acidosis stimulates muscle proteolysis but does not affect protein synthesis. These changes in muscle protein metabolism may play a role in the defense against acidosis by providing amino acid nitrogen to support the glutamine production necessary for renal ammoniagenesis.

Insulin-mediated reduction of whole body protein breakdown. Dose-response effects on leucine metabolism in postabsorptive men

In vivo effects of insulin on plasma leucine and alanine kinetics were determined in healthy postabsorptive young men (n = 5) employing 360-min primed, constant infusions of L-[1-13C]leucine and L-[15N]alanine during separate single rate euglycemic insulin infusions. Serum insulin concentrations of 16.4 +/- 0.8, 29.1 +/- 2.7, 75.3 +/- 5.0, and 2,407 +/- 56 microU/ml were achieved. Changes in plasma 3-methyl-histidine (3-MeHis) were obtained as an independent qualitative indicator of insulin-mediated reduction in proteolysis. Hepatic glucose output was evaluated at the lowest insulin level using D-[6,6-2H2]glucose. The data demonstrate a dose-response effect of insulin to reduce leucine flux, from basal values of 77 +/- 1 to 70 +/- 2, 64 +/- 3, 57 +/- 3, and 52 +/- 4 mumol(kg X h)-1 at the 16, 29, 75, and 2,407 microU/ml insulin levels, respectively (P less than 0.01). A parallel, progressive reduction in 3-MeHis from 5.8 +/- 0.3 to 4.3 +/- 0.3 microM was revealed. Leucine oxidation estimated from the 13C-enrichment of expired CO2 and plasma leucine (12 +/- 1 mumol[kg X h]-1) and from the 13C-enrichment of CO2 and plasma alpha-ketoisocaproate (19 +/- 2 mumol[kg X h]-1) increased at the 16 microU/ml insulin level to 16 +/- 1 and 24 +/- 2 mumol(kg X h)-1, respectively (P less than 0.05 for each), but did not increase at higher insulin levels. Alanine flux (206 +/- 13 mumol(kg X h)-1) did not increase during the clamp, but alanine de novo synthesis increased in all studies from basal rates of 150 +/- 13 to 168 +/- 23, 185 +/- 21, 213 +/- 29, and 187 +/- 15 mumol(kg X h)-1 at 16, 29, 75, and 2,407 microU/ml insulin levels, respectively (P less than 0.05). These data indicate the presence of insulin-dependent suppression of leucine entry into the plasma compartment in man secondary to a reduction in proteolysis and the stimulation of alanine synthesis during euglycemic hyperinsulinemia.

The effect of exercise on protein turnover in isolated soleus and extensor digitorum longus muscles

The rate of protein degradation was found to be increased in isolated soleus and extensor digitorum muscles of 60-80 g rats after exercise consisting of running for 120 min. These findings support the hypothesis that exercise causes an increase in skeletal muscle protein degradation, and that both red and white muscles are affected similarly.

Increased protein degradation after eccentric exercise

The purposes of these experiments were to compare the activities of glucose 6-phosphate dehydrogenase (G6PDH) and the lysosomal enzyme N-acetyl-beta-glucosaminidase (NAG) in rat muscles and to assess protein degradation after eccentric exercise (running down a 18 degrees grade). The following results were obtained: (1) Muscles in which the G6PDH activity was increased also showed an increase in NAG activity that was smaller and occurred later and/or was more prolonged than the increase in G6PDH activity. (2) The urinary 3-methylhistidine/creatinine ratio was statistically elevated for 3 days after eccentric exercise and this increase was much larger and more prolonged than previously observed in rats run on the level. Taken together our results suggest that increased protein degradation after exercise is due to increased proteolysis of muscle tissue damaged during the exercise bout and that lysosomal enzymes may be involved in this degradation.