Determination of protein synthesis in lymphocytes in vivo after surgery

Whole-body and splanchnic amino acid metabolism in sheep during an acute endotoxin challenge

Supplemented protein or specific amino acids (AA) are proposed to help animals combat infection and inflammation. The current study investigates whole-body and splanchnic tissue metabolism in response to a lipopolysaccharide (LPS) challenge with or without a supplement of six AA (cysteine, glutamine, methionine, proline, serine and threonine). Eight sheep were surgically prepared with vascular catheters across the gut and liver. On two occasions, four sheep were infused through the jugular vein for 20 h with either saline or LPS from Escherichia coli (2 ng/kg body weight per min) in a random order, plus saline infused into the mesenteric vein; the other four sheep were treated with saline or LPS plus saline or six AA infused via the jugular vein into the mesenteric vein. Whole-body AA irreversible loss rate (ILR) and tissue protein metabolism were monitored by infusion of [ring-2H2]phenylalanine. LPS increased (P<0·001) ILR (+17 %), total plasma protein synthesis (+14 %) and lymphocyte protein synthesis (+386 %) but decreased albumin synthesis (-53 %, P=0·001), with no effect of AA infusion. Absorption of dietary AA was not reduced by LPS, except for glutamine. LPS increased the hepatic removal of leucine, lysine, glutamine and proline. Absolute hepatic extraction of supplemented AA increased, but, except for glutamine, this was less than the amount infused. This increased net appearance across the splanchnic bed restored arterial concentrations of five AA to, or above, values for the saline-infused period. Infusion of key AA does not appear to alter the acute period of endotoxaemic response, but it may have benefits for the chronic or recovery phases.

Beneficial effect of amino acid supplementation, especially cysteine, on body nitrogen economy in septic rats

BACKGROUND AND AIMS

Muscle wasting and increased synthesis of proteins and compounds involved in host defense characterize severe injury. The aims of the studies reported were to determine which amino acids exhibited an increased tissue content linked to anabolic processes in infected rats by comparison with healthy pair-fed controls, and to explore whether diets supplemented with these amino acids attenuate the catabolic response to infection.

METHODS

Total amino acid content of the liver and the rest of the body were measured in control well-fed rats, in infected rats and their pair-fed controls 2 days after infection. In the nutritional protocols, infected rats were fed with a diet supplemented with alanine (basal diet), or threonine, serine, aspartate, asparagine and arginine (AA) or AA+cysteine (complete diet).

RESULTS

Infection significantly increased liver total amino acid content by 38% for most amino acids. In contrast, the percentage increase was cysteine 79.3, threonine 45.3, aspartate-asparagine 46.3 and serine 46.5. Whole body without liver content of most amino acids decreased after infection due to the catabolic response, while the content of cysteine increased by 6% (P<0.05) and those of threonine and arginine did not decrease. After infection, animals fed the complete diet lost less weight than animals fed the basal diet (P<0.05). Furthermore, AA plus cysteine supplementation reduced significantly urinary nitrogen excretion and muscle wasting.

CONCLUSIONS

The results provide evidence that diet supplementation with cysteine, threonine, serine, aspartate-asparagine and arginine supports the synthesis of vital proteins to spare body protein catabolism during infection.

An integrative approach to in-vivo protein synthesis measurement: from whole tissue to specific proteins

PURPOSE OF REVIEW

In-vivo estimation of protein turnover by stable isotopes in animals and humans has provided much relevant information on metabolic regulation and alterations for decades. While it was first appreciated at the whole body level in the 1970s and 1980s, new approaches have allowed inter-organ or tissue protein turnover rates to be measured, notably the incorporation rate of a labelled amino acid in muscle. These technical improvements have recently been completed by new isolation methods for the study of protein synthesis rates in various muscle and hepatic protein fractions in different blood cells or tissues such as bone and skin.

RECENT FINDINGS

This new insight into tissue protein synthesis opens the door for exploration of single proteins, which may be fully achievable in the near future through the combination of proteomics analysis and technical progress in mass spectrometry. This is, therefore, a new area in which not only quantitative but also qualitative changes in specific proteins will be considered for a fully integrative approach to assessing protein metabolism in physiology and disease.

SUMMARY

To understand the mechanisms by which protein metabolism is altered during physiopathological situations, it is of importance to measure the effect on specific proteins rather than on the body as a whole. Procedures are currently under development with the aim of isolating individuals proteins and to measure their synthesis rates by isotopic methods. Such technical progress is needed to gain a better understanding of the regulation of protein metabolism in situations in which loss of body protein mass occurs.

Protein synthesis rates of human PBMC and PMN can be determined simultaneously in vivo by using small blood samples

Immune cell functions can be evaluated in vivo by measuring their specific protein fractional synthesis rates (FSR). Using stable isotope dilution techniques, we describe a new method allowing simultaneous in vivo assessment of FSR in two leukocyte populations in healthy human subjects, using small blood samples. Peripheral blood mononuclear cell (PBMC) and polymorphonuclear neutrophil (PMN) FSR were measured during primed continuous intravenous infusion of l-[1-13C]leucine. Immune cells from 6 ml of whole blood were isolated by density gradient centrifugation. In a first study, we calculated the FSR using plasma [13C]leucine or α-[13C]ketoisocaproate (KIC) enrichments as precursor pools. In a second study, we compared protein FSR in leukocytes, using enrichments of either intracellular or plasma free [13C]leucine as immediate precursor pools. The present approach showed a steady-state enrichment of plasma and circulating immune cell free [13C]leucine precursor pools. The linearity of labeled amino acid incorporation rate within mixed PBMC and PMN proteins also was verified. Postabsorptive protein FSR was 4.09 ± 0.39%/day in PBMC and 1.44 ± 0.08%/day in PMN when plasma [13C]KIC was the precursor pool. The difference between PBMC and PMN FSR was statistically significant, whatever the precursor pool used, suggesting large differences in their synthetic activities and functions. Use of the plasma [13C]KIC pool led to an underestimation of leukocyte FSR compared with the intracellular pool (PBMC: 6.04 ± 0.94%/day; PMN: 2.98 ± 0.30%/day). Hence, the intracellular free amino acid pool must be used as precursor to obtain reliable results. In conclusion, it is possible to assess immune cell metabolism in vivo in humans by using small blood samples to directly indicate their metabolic activity in various clinical situations and in response to regulating factors.

Acute phase protein levels and thymus, spleen and plasma protein synthesis rates differ in adult and old rats

Aging induces a dysregulation of immune and inflammation functions that may affect protein synthesis rates in lymphoid tissue and plasma proteins. We quantified in vivo synthesis rates of thymus, spleen and plasma proteins, including albumin and acute phase proteins, in adult (8 mo old) and old (22 mo old) rats using the flooding dose method [L-(1-(13)C) phenylalanine]. Immunosenescence was reflected by thymus atrophy and spleen hypertrophy in old rats but not in adult rats. A low albumin plasma level associated with high concentrations of fibrinogen, alpha(2)-macroglobulin, alpha(1)-acid glycoprotein and proteins other than albumin revealed a low grade inflammation in old rats. Protein fractional synthesis rates (FSR) and protein synthesis efficiencies of thymus were 29 and 26% lower in old than in adult rats, respectively; these variables did not differ in spleen. Protein absolute synthesis rates (ASR) of the thymus and spleen were 76% lower and 67% greater in old than adult rats, respectively. The FSR and ASR of albumin and other plasma proteins were greater in old than in adult rats. Protein synthesis measurement is a valuable nonimmunological tool to assess, in vivo, immune and inflammatory variables. Alterations in secondary lymphoid organs and plasma protein synthesis may contribute to the significant repartitioning of amino acids in old compared with adult rats and may be involved in sarcopenia.

Response of in vivo protein synthesis in T lymphocytes and leucocytes to an endotoxin challenge in healthy volunteers

In vivo determination of protein synthesis in immune cells reflects metabolic activity and immunological activation. An intravenous injection of endotoxin to healthy volunteers was used as a human sepsis model, and in vivo protein synthesis of T lymphocytes and leucocytes was measured. The results were related to plasma concentrations of selected cytokines, peripheral cell counts and subpopulations of immune cells. The subjects (n = 8 + 8) were randomized to an endotoxin (4 ng/kg) or a saline group. In vivo protein synthesis was determined twice: before and 1-2.5 h after the endotoxin/saline injection. Protein synthesis decreased in isolated T lymphocytes, but increased in leucocytes. Plasma levels of TNF-alpha, IL-8, IL-6, IL-1 ra and IL-10 were elevated, whereas IL-2 and IFN-gamma, produced predominantly by T lymphocytes, did not change in response to endotoxin. Neutrophils increased, whereas lymphocytes and monocytes decreased 2.5 h after the endotoxin injection. Flow cytometry revealed a drop in total CD3+ T lymphocytes and CD56+ natural killer cells, accompanied by an increase in CD15+ granulocytes. In summary, in vivo protein synthesis decreased in T lymphocytes, while the total leucocyte population showed a concomitant increase immediately after the endotoxin challenge. The changes in protein synthesis were accompanied by alterations in immune cell subpopulations and in plasma cytokine levels.

Bacterial infection affects protein synthesis in primary lymphoid tissues and circulating lymphocytes of rats

Bacterial infection alters whole-body protein homeostasis. Although immune cells are of prime importance for host defense, the effect of sepsis on their protein synthesis rates is poorly documented. We analyzed protein synthesis rates in rat primary lymphoid tissues and circulating lymphocytes after infection. Male Sprague-Dawley rats were studied 1, 2, 6 or 10 d after an intravenous injection of live Escherichia coli. Control healthy rats consumed food ad libitum (d 0) or were pair-fed to infected rats. Protein synthesis was quantified using a flooding dose of L-(4,4,4-(2)H(3))valine. Sepsis induced a delayed increase in total blood leukocytes and a rapid and persistent inversion of the counts. Basal fractional rates of protein synthesis (ks) were 117, 73 and 29%/d in bone marrow, thymus and circulating lymphocytes, respectively. Pair-feeding strongly depressed the absolute protein synthesis rates (ASR) of bone marrow (d 2 and 10) and thymus (d 2-10). The infection per se increased bone marrow, thymus and circulating lymphocyte ks but at various postinfection times. It decreased bone marrow (d 1) and thymus (d 1 and 2) ASR but increased lymphocyte (d 2 and 10) and bone marrow (d 10) ASR. Our results reflect the deleterious effect of anorexia on primary lymphoid tissues. The host defense against bacterial infection exhibited time- and tissue-dependent modifications of protein synthesis, indicating that blood lymphocyte protein data are not representative of the immune system as a whole. Optimization of nutritional supports would be facilitated by including protein synthesis measurements of the immune system.

Metabolic bases of amino acid requirements in acute diseases

Acute diseases are characterized by a catabolic state, resulting in a negative nitrogen balance and muscle wasting. Increasing protein intake often proves to have little effect in limiting muscle protein loss. This suggests a qualitative inadequacy of the usual nutritional supports to meet the amino acid requirements of the critically ill patient. Therefore, it can be assumed that the additional intake of limiting amino acids would allow the sparing of muscle proteins. The aim of this review is to examine whether metabolic and kinetics studies using labelled amino acids can help identify the pathways activated in injury and their specific amino acid requirements. The kinetics of cysteine, arginine and glutamine, which are mainly cited as conditionally indispensable in stress situations, are presented. Moreover, amino acids can act as mediators or signal molecules and modulate numerous functions. The optimal conditions allowing the best expression of these activities are discussed.

Lymphocyte responses following open and minimally invasive thoracic surgery

BACKGROUND

Immunosuppression associated with surgery may predispose to increased tumour growth or recurrence. Lymphocytes are central components of the immune network, signalling specific and non-specific responses in tumour immunosurveillance. This study was therefore designed to compare the effects of minimally invasive and conventional approaches to major thoracic surgery on lymphocyte populations and oxidative activity.

PATIENTS AND METHODS

The effects of conventional and minimally invasive video-assisted thoracic surgery (VATS) on the numbers and types of circulating lymphocytes and on lymphocyte oxidation were compared in a prospective randomized study of 41 patients undergoing lobectomy for peripheral bronchogenic carcinoma. Blood taken pre-operatively and on days 2 and 7 post-operatively was analysed for T (CD4, CD8), B (CD19) and natural killer (NK) (CD56, CD16) cell counts and for lymphocyte oxidative activity. Leucocyte numbers were compared with pre-surgical values and oxidative rate with healthy donor controls.

RESULTS

Lymphocyte counts fell after surgery; VATS was associated with less effect on circulating T (CD4) cells at 2 days and on NK lymphocytes at 7 days post-surgery. Lymphocyte oxidation was less suppressed in the VATS group 2 days after surgery. In general, post-surgical changes in key cells of cellular immunity were smaller in the VATS group, and recovery to normal levels was more rapid.

CONCLUSION

The degree of invasiveness of thoracic surgery may influence the extent of immunosuppression in patients undergoing pulmonary lobectomy for pulmonary neoplasm.

In vivo protein synthesis of circulating human T lymphocytes does not respond to a cortisol challenge within 24 h

BACKGROUND

Although immunocompetence is often measured by assessing responsiveness of lymphocytes to mitogenic stimulation in vitro, this approach may not reflect the in vivo situation. The aim of this investigation was to determine in vivo the protein synthesis rate (FSR) in isolated T lymphocytes and to study the effect of a short-term cortisol infusion on FSR.

METHODS

Healthy volunteers (n=24) were randomised into 4 groups. A continuous cortisol infusion (6 microg kg(-1) min(-1)) during 6 h was given to groups 1 and 2, whereas groups 3 and 4 served as control groups and received saline infusion. Protein synthesis was studied before and after 6 h of the cortisol/saline infusion (groups 1 and 3) or 24 h after the start of the infusion (groups 2 and 4). FSR was determined in vivo by the flooding method. The isotopic enrichment of phenylalanine in plasma and lymphocyte protein was determined with gas chromatography-mass spectrometry.

RESULTS

The FSR in T lymphocytes was 13.6+/-0.9%/24 h as a mean value (+/-SD) of the first determination in 4 groups. There was no significant difference in FSR from the baseline value immediately after the cortisol infusion (group 1: 13.3+/-1.4%/24 h vs 13.5+/-2.8%/24 h) or 24 h after the start of the infusion (group 2: 13.6+/-0.7%/24 h vs 12.3+/-2.4%/24 h).

CONCLUSION

The metabolic activity of circulating T lymphocytes, as reflected by a quantitative measurement of in vivo protein synthesis of human T lymphocytes, was not affected by the increased level of cortisol.

Measurement of protein synthesis in human tissues by the flooding method

The flooding procedure for measuring protein synthesis in individual tissues with amino acids labelled with stable isotopes is explained, and its advantages for studies in humans are described. The application of this method for investigating the effects of nutrition in healthy volunteers and sick patients is illustrated with examples of studies on skeletal muscle, liver (including albumin) and lymphocytes.

Tissue protein synthesis rates in critically ill patients

OBJECTIVES

The aims of this study were to simultaneously determine the in vivo rates of protein synthesis in skeletal muscle, peripheral blood lymphocytes, and serum albumin in critically ill patients; to establish whether a relationship between the responses of these tissues could be observed; and to demonstrate if a protein synthesis pattern characteristic of critical illness exists.

DESIGN

Descriptive study.

SETTING

Intensive care unit of a 1000-bed university hospital.

PATIENTS

Fifteen patients treated in the intensive care unit.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Rates of tissue protein synthesis were determined in vivo once during the course of critical illness, using the flooding method with L-(2H5)phenylalanine. Protein synthesis in muscle was 1.49 +/- 0.16%/day; in circulating lymphocytes (i.e., mononuclear cells), protein synthesis was 11.10 +/- 1.82%/day. Albumin synthesis was 12.81 +/- 1.23%/day when expressed as the fractional rate, and was 184 +/- 19 mg/kg/day when expressed as the absolute rate.

CONCLUSIONS

The individual tissues responded differently to trauma, and showed a wide range of values. The responses were not significantly correlated with each other and no pattern of tissue protein synthesis characteristic of critical illness was observed. However, both muscle protein and albumin synthesis rates correlated with metabolic status and clinical indices of the severity of illness.

Protein metabolism in critical illness

In summary, protein metabolism of critically ill patients is a field open to new investigations that will help us to understand better the mechanism behind 'autocannibalism', which is still today associated with mortality. Although the underlying disease is the major determinant of mortality, nutritional depletion will add morbidity, an addition that grows over time in the ICU. With conventional treatment the velocity of the catabolic process can at best be slowed down and the patient be bought time for other types of treatment to work. New forms of specific nutrition and adjuvant therapies may give us tools to prevent muscle depletion, without endangering the supply of essential substrates to the tissues in the splanchnic area. Muscle is at present a limiting organ for the ICU patient in two respects. A depleted muscle can no longer provide enough substrates for the splanchnic organs to maintain intestinal integrity and to maintain a high immunocompetence. In addition, a depleted muscle will be restored back to normal only very slowly; in elderly patients restoration may not even occur at all. The effects of an attenuation of muscle depletion on rehabilitation time have yet to be evaluated. An understanding of protein metabolism may be the key to better patient care in the ICU in the future.