The branched-chain amino acid requirement of parenterally fed neonatal piglets is less than the enteral requirement

An Overview of Parenteral Nutrition from Birth to Adolescence Based on a Composite Fish Oil Containing Lipid Emulsion and a Pediatric Amino Acid Solution

Intestinal failure (IF) is characterized by a critical reduction in functional gut mass below the minimum needed for optimal growth in children. It requires parenteral nutrition (PN) and home-PN (HPN), which is challenging in terms of meeting nutritional needs according to age, growth velocity, clinical situation, and rapid changes in fluid and electrolyte requirements. Due to these complex requirements, age-adapted multi-chamber bags (MCBs) are important additions to the nutrition armamentarium. The launch of composite fish oil (FO)-containing intravenous lipid emulsions (ILEs) heralded the development of MCBs containing these ILEs in combination with a crystalline amino acid solution adapted for pediatric use. The safety and efficacy of lipid and amino acid components in this context have been widely documented in numerous published studies. This narrative manuscript includes a review of the articles published in PudMed, Embase, and Google Scholar up to June 2023 for the age groups of term infants to children and adolescents. Preterm infants with their highly specific demands are not included. It aims to offer an overview of the clinical experience regarding the use of a composite FO-based ILE and a developed specific amino acid solution.

Postnatal hyperglycemia alters amino acid profile in retinas (model of Phase I ROP)

Nutritional deprivation occurring in most preterm infants postnatally can induce hyperglycemia, a significant and independent risk factor for suppressing physiological retinal vascularization (Phase I retinopathy of prematurity (ROP)), leading to compensatory but pathological neovascularization. Amino acid supplementation reduces retinal neovascularization in mice. Little is known about amino acid contribution to Phase I ROP. In mice modeling hyperglycemia-associated Phase I ROP, we found significant changes in retinal amino acids (including most decreased L-leucine, L-isoleucine, and L-valine). Parenteral L-isoleucine suppressed physiological retinal vascularization. In premature infants, severe ROP was associated with a higher mean intake of parenteral versus enteral amino acids in the first two weeks of life after adjustment for treatment group, gestational age at birth, birth weight, and sex. The number of days with parenteral amino acids support independently predicted severe ROP. Further understanding and modulating amino acids may help improve nutritional intervention and prevent Phase I ROP.

The biological functions and metabolic pathways of valine in swine

Valine is an essential amino acid and a type of branched-chain amino acid. Due to the involvement of branched-chain amino acids in various metabolic pathways, there has been a surge of interests in valine nutrition and its role in animal physiology. In pigs, the interactions between valine and other branched-chain amino acids or aromatic amino acids are complex. In this review, we delve into the interaction mechanism, metabolic pathways, and biological functions of valine. Appropriate valine supplementation not only enhances growth and reproductive performances, but also modulates gut microbiota and immune functions. Based on past observations and interpretations, we provide recommended feed levels of valine for weaned piglets, growing pigs, gilts, lactating sows, barrows and entire males. The summarized valine nutrient requirements for pigs at different stages offer valuable insights for future research and practical applications in animal husbandry.

Determining ideal balance among branched-chain amino acids in medical formula for Propionic Acidemia: A proof of concept study in healthy children

BACKGROUND

Propionic Acidemia (PROP) is an inherited metabolic disorder, with defect in the enzyme propionyl-CoA carboxylase (PCC) which catalyzes catabolism of two of the branched-chain amino acids (BCAA), valine, isoleucine. Nutritional management in PROP depends on dietary protein restriction and consumption of medical formula depleted of the offending amino acids. Recently, concerns have been raised about medical formula due to imbalanced content of BCAA (high leucine - another BCAA, and no valine/isoleucine), which negatively impacts plasma concentrations of BCAA, and growth in children with PROP.

OBJECTIVES AND METHODS

To determine an optimal BCAA ratio at which total body protein synthesis is optimized in healthy children using the indicator amino acid oxidation method (oxidation of L-¹³C-Phenylalanine to ¹³CO₂). This was accomplished by reducing leucine intake gradually from the current high dose in medical formula, in order to compare protein synthesis, under different BCAA ratios.

RESULTS

A total of 8 healthy children were studied, completing 42 study days. Significant differences in F¹³CO₂ with different BCAA ratios were found. BCAA ratio (leucine: isoleucine: valine) 1:0:0 was associated with the highest F¹³CO₂ (low protein synthesis) compared to other ratios. By reducing leucine intake, and isoleucine and valine at minimum PROP recommendations, BCAA ratio between1:0.26:0.28 to 1:0.35:0.4 was associated with optimal protein synthesis.

CONCLUSION

BCAA ratio of 1:0:0, present in medical formula limited total body protein synthesis. A balanced BCAA ratio was found between 1:0.26:0.28 and 1:0.35:0.4 (leucine:isoleucine:valine). Future research is needed to test this optimal BCAA ratio for optimizing protein synthesis in patients with PROP.

SYNOPSIS

The article describes a proof-of-concept study done on healthy school-aged children testing different ratios of branched chain amino acid (BCAA, leucine:isoleucine:valine), in order to determine an optimal ratio at which total body protein synthesis is improved and has implications for dietary management of children with Propionic Acidemia (PROP).

Methionine Nutrition and Metabolism: Insights from Animal Studies to Inform Human Nutrition

Methionine is a nutritionally indispensable amino acid, and is unique among indispensable amino acids due to its sulfur atom. Methionine is involved in cysteine synthesis via the transsulfuration pathway, which is rate limiting for the key antioxidant molecule, glutathione. Methionine is also the primary methyl donor in the body through S-adenosylmethionine via the transmethylation pathway, which is involved in the synthesis of several key metabolites including creatine and phosphatidylcholine. Methionine can also be remethylated from homocysteine, in the presence of betaine via choline and/or folate. Thus methionine demands from a dietary perspective are regulated not only by the presence of cysteine in the body, but also by the demands in vivo for the various metabolites formed from it, and also by the presence of these compounds in foods. Indeed, methionine, cysteine, and the various methyl donors/acceptors vary in human foods, and thus regulate methionine availability, especially under conditions of growth and development. Much of our understanding of methionine nutrition and metabolism arises from experiments in animal models. This is because most animal feed formulations are plant-based and plant sources are relatively low in methionine and cysteine amounts. Thus, this brief review will touch on some broad aspects of human methionine nutrition, including requirements in different life stages, disease, and bioavailability, with some examples from the insights/lessons learned from experiments initially conducted in animals.

Amino Acids in Intestinal Physiology and Health

Dietary protein digestion is an efficient process resulting in the absorption of amino acids by epithelial cells, mainly in the jejunum. Some amino acids are extensively metabolized in enterocytes supporting their high energy demand and/or production of bioactive metabolites such as glutathione or nitric oxide. In contrast, other amino acids are mainly used as building blocks for the intense protein synthesis associated with the rapid epithelium renewal and mucin production. Several amino acids have been shown to support the intestinal barrier function and the intestinal endocrine function. In addition, amino acids are metabolized by the gut microbiota that use them for their own protein synthesis and in catabolic pathways releasing in the intestinal lumen numerous metabolites such as ammonia, hydrogen sulfide, branched-chain amino acids, polyamines, phenolic and indolic compounds. Some of them (e.g. hydrogen sulfide) disrupts epithelial energy metabolism and may participate in mucosal inflammation when present in excess, while others (e.g. indole derivatives) prevent gut barrier dysfunction or regulate enteroendocrine functions. Lastly, some recent data suggest that dietary amino acids might regulate the composition of the gut microbiota, but the relevance for the intestinal health remains to be determined. In summary, amino acid utilization by epithelial cells or by intestinal bacteria appears to play a pivotal regulator role for intestinal homeostasis. Thus, adequate dietary supply of amino acids represents a key determinant of gut health and functions.

Dietary Branched-Chain Amino Acids Regulate Food Intake Partly through Intestinal and Hypothalamic Amino Acid Receptors in Piglets

Strategies to increase feed intake are of great importance for producing more meat in swine production. Intestinal and hypothalamic amino acid receptors are found to largely participate in feed intake regulation. The purpose of the current research is to study the function of branched-chain amino acid (BCAA) supplementation in the regulation of feed intake through sensors that can detect amino acids in piglets. Twenty-four piglets were assigned one of four treatments and fed one of the experimental diets for either a short period (Expt. 1) or a long period (Expt. 2): a normal protein diet (NP, 20.04% CP), a reduced-protein diet (RP, 17.05% CP), or a reduced-protein test diet supplemented with one of two doses of BCAAs (BCAA1, supplemented with 0.13% l-isoleucine, 0.09% l-leucine, and 0.23% l-valine; BCAA2, supplemented with the 150% standardized ileal digestibility BCAA requirement, as recommended by the National Research Council (2012)). In Expt. 1, no differences were observed in the feed intake among piglets fed different diets ( P > 0.05). In Expt. 2, compared with the RP group, the feed intake of piglets was significantly increased after sufficient BCAAs were supplemented in the BCAA1 group, which was associated with decreased cholecystokinin secretion ( P < 0.05), down-regulated expression of type-1 taste receptors 1/3 (T1R1/T1R3) in the intestine, as well as increased expression of pro-opiomelanocortin, activated general control nonderepressible 2 (GCN2), and eukaryotic initiation factor 2α (eIF2α) in the hypothalamus ( P < 0.05). However, the feed intake was decreased for unknown reasons when the piglets were fed a BCAA over-supplemented diet. Our study confirmed that a BCAA-deficient diet inhibited feed intake through two potential ways: regulating the amino acid T1R1/T1R3 receptor in the intestine or activating GCN2/eIF2α pathways in the hypothalamus.

Postprandial Amino Acid Kinetics of Milk Protein Mixtures are Affected by Composition, But Not Denaturation, in Neonatal Piglets

BACKGROUND

Multiple studies have indicated that formula-fed infants show a different growth trajectory compared with breastfed infants. The observed growth rates are suggested to be linked to higher postprandial levels of branched chain amino acids (BCAAs) and insulin related to differences in protein quality.

OBJECTIVE

We evaluated the effects of milk protein denaturation and milk protein composition on postprandial plasma and hormone concentrations.

METHODS

Neonatal piglets were bolus-fed randomly, in an incomplete crossover design, 2 of 3 milk protein solutions: native whey protein isolate (NWPI), denatured whey protein isolate (DWPI), or protein base ingredient, comprising whey and casein (PBI). Postprandial plasma amino acids (AAs), insulin, glucagon-like peptide 1, glucose, and paracetamol concentrations were assayed. Plasma responses were fitted with a model of first-order absorption with linear elimination.

RESULTS

DWPI (91% denatured protein) compared with NWPI (91% native protein) showed lower essential amino acids (EAAs) (∼10%) and BCAA (13-19%) concentrations in the first 30-60 min. However, total amino acid (TAA) concentration per time-point and area under the curve (AUC), as well as EAA and BCAA AUC were not different. PBI induced a ∼30% lower postprandial insulin spike than NWPI, yet plasma TAA concentration at several time-points and AUC was higher in PBI than in NWPI. The TAA rate constant for absorption (k a) was twofold higher in PBI than in NWPI. Plasma BCAA levels from 60 to 180 min and AUC were higher in PBI than in NWPI. Plasma EAA concentrations and AUCs in PBI and NWPI were not different.

CONCLUSIONS

Denaturation of WPI had a minimal effect on postprandial plasma AA concentration. The differences between PBI and NWPI were partly explained by the difference in AA composition, but more likely differences in protein digestion and absorption kinetics. We conclude that modifying protein composition, but not denaturation, of milk protein solutions impacts the postprandial amino acid availability in neonatal piglets.

Tryptophan requirement of the enterally fed term infant in the first month of life

OBJECTIVES

Tryptophan not only is an amino acid essential to protein synthesis but also serves as a precursor in 2 important metabolic pathways: the serotonin and the kynurenine pathways. Tryptophan is related to sleeping patterns. The objective of the present study was to determine the tryptophan requirement of term infants using the indicator amino acid oxidation (IAAO) method with L-[1-C]phenylalanine as the indicator.

METHODS

Enterally fed infants were randomly assigned to tryptophan intakes ranging from 0.5 to 73 mg · kg · day as part of an elemental diet. After 1-day adaptation to the test diet, [C]bicarbonate and L-[1-C]phenylalanine tracers were given enterally. Breath samples were collected at baseline and during isotopic plateaus. The mean tryptophan requirement was determined by using the biphasic linear regression crossover analysis on the fraction of CO2 recovery from L-[1-C]phenylalanine oxidation (FCO2). Data are presented as mean ± standard deviation.

RESULTS

A total of 30 term neonates (gestational age 39 ± 1 weeks) were studied at 9 ± 4 days. FCO2 decreased until a tryptophan intake of 15 mg · kg · day; additional increases in tryptophan intake did not affect FCO2. Mean requirement was determined to be 15 mg · kg · day.

CONCLUSIONS

The mean tryptophan requirement for elemental formula-fed term infants is 15 mg · kg · day. This requirement is lower than the present recommended intake of 29 mg · kg · day, which is based on the average intake of a breastfed infant.

Branched-chain amino acid requirements for enterally fed term neonates in the first month of life

BACKGROUND

Knowledge of essential amino acid requirements in infants is important because excessive intake of protein can lead to increased long-term morbidity such as obesity. A deficient intake may lead to suboptimal growth and impaired neurodevelopment. The current recommended branched-chain amino acid requirements in infants aged 0-1 mo are based on the amino acid content of human milk.

OBJECTIVE

We quantified the requirements for isoleucine, leucine, and valine for term neonates by using the indicator amino acid oxidation method with [1-(13)C]phenylalanine as the indicator.

DESIGN

Fully enterally fed term infants received randomly graded amounts of isoleucine (5-216 mg · kg(-1) · d(-1)), leucine (5-370 mg · kg(-1) · d(-1)), or valine (5-236 mg · kg(-1) · d(-1)) as part of an elemental formula. Data are expressed as means ± SDs.

RESULTS

Eighty-three Asian, term neonates (mean ± SD birth weight: 3.3 ± 0.4 kg; gestational age: 39.4 ± 1.3 wk) were studied at a postnatal age of 13 ± 5 d. Mean requirements for isoleucine, leucine, and valine (measured in boys only) were 105 mg · kg(-1) · d(-1) (r(2) = 0.61, P < 0.001), 140 mg · kg(-1) · d(-1) (r(2) = 0.26, P < 0.01), and 110 mg · kg(-1) · d(-1) (r(2) = 0.35, P = 0.001), respectively.

CONCLUSIONS

Current human milk-based recommendations for isoleucine and valine in term infants aged 0-1 mo are correct. However, the current recommendation for leucine (166 mg · kg(-1) · d(-1)) is higher than the mean requirement of 140 mg · kg(-1) · d(-1) that we determined in this study. This trial was registered at www.trialregister.nl as NTR1610.

Splanchnic first pass disappearance of threonine and lysine do not differ in healthy men in the fed state

We previously showed that the splanchnic bed of neonates takes up a significantly higher amount (43%) of threonine in contrast to lysine (12%). We questioned whether this same pattern applied in adult humans and found no information in the literature. Therefore, our objective in the current study was to determine the difference in splanchnic first pass disappearance of threonine and lysine in adult humans during the fed state. During two 5-d study periods, 6 healthy men received l-[1-(13)C]threonine or l-[1-(13)C]lysine enterally or parenterally randomized to either study d 3 or 5, respectively. The diets were in the form of an amino acid mixture providing a protein intake of 1 g · kg(-1) · d(-1) and an energy intake of 1.5 times the resting energy expenditure. Blood and breath samples were collected at baseline and plateau for amino acid and 11CO(2) enrichment. Splanchnic disappearances in adult males were similar for threonine and lysine. The splanchnic disappearance of threonine as a percentage of intake was 17.9% (8.4 mg · kg(-1) · d(-1)) in the healthy men compared with 18.5% (11.2 mg · kg(-1) · d(-1)) for lysine. We conclude that the threonine requirement of the gut of healthy men consuming a liquid formula diet based on free amino acids is similar to the lysine requirement, which is in contrast to our previous findings for neonates.

Re-print of "Intestinal luminal nitrogen metabolism: role of the gut microbiota and consequences for the host"

Alimentary and endogenous proteins are mixed in the small intestinal lumen with the microbiota. Although experimental evidences suggest that the intestinal microbiota is able to incorporate and degrade some of the available amino acids, it appears that the microbiota is also able to synthesize amino acids raising the view that amino acid exchange between the microbiota and host can proceed in both directions. Although the net result of such exchanges remains to be determined, it is likely that a significant part of the amino acids recovered from the alimentary proteins are used by the microbiota. In the large intestine, where the density of bacteria is much higher than in the small intestine and the transit time much longer, the residual undigested luminal proteins and peptides can be degraded in amino acids by the microbiota. These amino acids cannot be absorbed to a significant extent by the colonic epithelium, but are precursors for the synthesis of numerous metabolic end products in reactions made by the microbiota. Among these products, some like short-chain fatty acids and organic acids are energy substrates for the colonic mucosa and several peripheral tissues while others like sulfide and ammonia can affect the energy metabolism of colonic epithelial cells. More work is needed to clarify the overall effects of the intestinal microbiota on nitrogenous compound metabolism and consequences on gut and more generally host health.

Differential regulation of protein synthesis and mTOR signaling in skeletal muscle and visceral tissues of neonatal pigs after a meal

Protein synthesis (PS) increases after a meal in neonates, but the time course of the changes in PS in different tissues after a meal is unknown. We aimed to evaluate the changes in tissue PS, mammalian target of rapamycin complex 1 (mTORC1) activation, and proportion of ribosomal protein (rp) mRNAs in polysomes over 4 h after a bolus meal in neonatal pigs (n = 6/group; 5- to 7-d-old). The results show a more sustained increase in PS in glycolytic compared with mixed fiber type muscles and no changes in oxidative muscles. PS increased in liver, jejunum, and pancreas but not in kidney and heart. Feeding did not affect AMP-activated protein kinase or RAS-related GTP binding B activation. Phosphorylation of tuberous sclerosis complex 2, proline-rich Akt substrate of 40 kD, mTOR, eukaryotic initiation factor 4E binding protein, and rp S6 kinase 1 increased in all tissues after feeding. The proportion of mRNAs encoding rp S4 and S8 in liver polysomes increased within 30 min postfeeding. These results suggest that feeding stimulates mTORC1 signaling in muscle and viscera, but mTORC1 activation alone is not sufficient to stimulate PS in all tissues.

Dietary oligosaccharides increase colonic weight and the amount but not concentration of bacterially synthesized folate in the colon of piglets

Recently, we demonstrated that the large pool of folate present in the colon of humans can be absorbed. Here, we investigated whether the net amount of folate synthesized by bacteria in the colon of piglets can be modified by feeding prebiotics to alter their microbial milieu. Male piglets (age 5 d, n = 12) were randomized to a milk-based formula containing either 5 g/L inulin + 5 g/L galactooligosaccharides (IN-GOS) or 5 g/L maltodextrin (control). Body weight did not differ between groups during the 28-d feeding intervention. However, the mean weight of colonic tissue (38%) and their contents (238%) was higher in the IN-GOS than in the control group (P = 0.004, P = 0.0001, respectively). Total bacterial load in the colon of piglets fed IN-GOS was 531% greater and the total amount of folate found in the colon contents was 53% greater than that of controls (P = 0.002, P = 0.02, respectively). Indices of blood folate status (plasma and RBC folate and plasma homocysteine) and folate concentrations in liver and kidneys were unaffected. Both groups exhibited low RBC folate (56 ± 23 nmol/L) and elevated homocysteine (24 ± 7 μmol/L) concentrations, evidence of deficiency if present in humans. In conclusion, dietary supplementation with 5 g of inulin + 5 g of galactooligosaccharides increased the weight, bacterial load, and total folate content in the piglet colon; however, these changes were insufficient to modify indices of whole body folate status. Future studies investigating the impact of feeding prebiotics on localized folate status at the level of the colonocyte are warranted.

Leucine supplementation of a low-protein meal increases skeletal muscle and visceral tissue protein synthesis in neonatal pigs by stimulating mTOR-dependent translation initiation

Protein synthesis and eukaryotic initiation factor (eIF) activation are increased in skeletal muscle of neonatal pigs parenterally infused with amino acids. Leucine appears to be the most effective single amino acid to trigger these effects. To examine the response to enteral leucine supplementation, overnight food-deprived 5-d-old pigs were gavage fed at 0 and 60 min a: 1) low-protein diet (LP); 2) LP supplemented with leucine (LP+L) to equal leucine in the high-protein diet (HP); or 3) HP diet. Diets were isocaloric and equal in lactose. Fractional protein synthesis rates and translation initiation control mechanisms were examined in skeletal muscles and visceral tissues 90 min after feeding. Protein synthesis rates in longissimus dorsi, gastrocnemius, and masseter muscles, heart, jejunum, kidney, and pancreas, but not liver, were greater in the LP+L group compared with the LP group and did not differ from the HP group. Feeding LP+L and HP diets compared with the LP diet increased phosphorylation of mammalian target of rapamycin (mTOR), 4E-binding protein 1, ribosomal protein S6 kinase-1, and eIF4G and formation of the active eIF4E·eIF4G complex in longissimus dorsi muscle. In all tissues except liver, activation of mTOR effectors increased in pigs fed LP+L and HP vs. LP diets. Our results suggest that leucine supplementation of a low-protein meal stimulates protein synthesis in muscle and most visceral tissues to a rate similar to that achieved by feeding a high-protein meal and this stimulation involves activation of mTOR downstream effectors.

An overview of the therapeutic effects of leucine supplementation on skeletal muscle under atrophic conditions

The characterization of the mechanisms underlying skeletal muscle atrophy under different conditions has been a constant focus of research. Among anti-atrophic therapies, amino acid supplementation, particularly with leucine, has received a lot of attention. Supplementation has been shown to have remarkable effects on muscle remodeling through protein turnover modulation. This may then impact physiological parameters related to muscle function, and even quality of life. In light of this, leucine supplementation could be a useful therapy for mitigating the atrophic effects of catabolic conditions. The purpose of this review is to present the major results of human studies evaluating the effects of leucine supplementation on structure and function of skeletal muscle in atrophic conditions such as muscle disuse, sarcopenia, and cancer.

Parenteral amino acid intakes in critically ill children: a matter of convenience

BACKGROUND

Parenteral and enteral amino acid requirements for nutrition balance and function have not been defined in critically ill children or adults. In addition to playing a role in protein synthesis, amino acids trigger signaling cascades that regulate various aspects of fuel and energy metabolism and serve as precursors for important substrates. Amino acids can also be toxic. In this study, parenteral intakes of essential and nonessential amino acids (EAAs and NEAAs) supplied to critically ill children were assessed as an initial step for further studies aimed at establishing parenteral amino acid requirements.

METHODS

A retrospective review was conducted to assess intakes of parenteral amino acid for 116 critically ill children, and these intakes were compared with EAA intakes recommended by the Institute of Medicine. Because there are no recommended intakes for NEAA, NEAA intakes were compared with mixed muscle protein content in the older children and breast milk amino acid content in the infants.

RESULTS

Parenteral EAAs were provided in amounts that exceeded recommended intakes for healthy children, except for phenylalanine and methionine, which although excessive, were given in less generous amounts. NEAAs were supplied in lower or higher amounts than the content of mixed muscle proteins or breast milk. Parenteral amino acid formulas are limited in taurine, glutamine, and asparagine despite the fact that inflammatory/immune proteins are rich in these amino acids.

CONCLUSIONS

Amino acid composition of parenteral formulas is variable and lacks scientific support. Parenteral amino acid intakes should be based on measured requirements to maintain nutrition and functional balance and on knowledge of toxicity.

Almost all enteral aspartate is taken up in first-pass metabolism in enterally fed preterm infants

BACKGROUND & AIMS

The intestine is a major site of amino acid metabolism, especially in neonates. Neonatal animals derive energy needed for metabolic processes from dietary glucose and amino acids. Rats were found to oxidize non-essential amino acids such as aspartate, glutamate and glutamine in the intestine at a high rate. We have previously found that glutamate and glucose are important sources of energy for the splanchnic tissues in fully fed preterm infants. However, no data are available on splanchnic aspartate metabolism in human preterm infants. In the present study we studied whole-body and splanchnic aspartate metabolism and determined the metabolic fate of aspartate.

METHODS

In eight, enterally fed, preterm infants (gestational age 31 weeks (wk)+/-3 SD, range: 26-34wk) splanchnic and whole-body aspartate kinetics were assessed by dual tracer ([U-(13)C]aspartate and [D(3)]aspartate) techniques.

RESULTS

Splanchnic first-pass aspartate uptake was almost complete (77+/-15%). Almost all (80+/-9%) of the (13)C administered as [U-(13)C]aspartate used in first-pass was recovered as CO(2) in expired breath.

CONCLUSION

The splanchnic tissues extract almost all of the dietary aspartate in preterm infants. The majority of the labeled carbon is recovered in expired breath, making it most likely that the sequestered carbon skeleton of aspartate is utilized for energy generation.

Regulation of hepatic metabolism by enteral delivery of nutrients

The liver plays a unique role in nutrient homeostasis. Its anatomical location makes it ideally suited to control the systemic supply of absorbed nutrients, and it is the primary organ that can both consume and produce substantial amounts of glucose. Moreover, it is the site of a substantial fraction (about 25 %) of the body's protein synthesis, and the liver and other organs of the splanchnic bed play an important role in sparing dietary N by storing ingested amino acids. This hepatic anabolism is under the control of hormonal and nutritional changes that occur during food intake. In particular, the route of nutrient delivery, i.e. oral (or intraportal) v. peripheral venous, appears to impact upon the disposition of the macronutrients and also to affect both hepatic and whole-body nutrient metabolism. Intraportal glucose delivery significantly enhances net hepatic glucose uptake, compared with glucose infusion via a peripheral vein. On the other hand, concomitant intraportal infusion of both glucose and gluconeogenic amino acids significantly decreases net hepatic glucose uptake, compared with infusion of the same mass of glucose by itself. Delivery of amino acids via the portal vein may enhance their hepatic uptake, however. Elevation of circulating lipids under postprandial conditions appears to impair both hepatic and whole-body glucose disposal. Thus, the liver's role in nutrient disposal and metabolism is highly responsive to the route of nutrient delivery, and this is an important consideration in planning nutrition support and optimising anabolism in vulnerable patients.

Amino acids - Guidelines on Parenteral Nutrition, Chapter 4

Protein catabolism should be reduced and protein synthesis promoted with parenteral nutrion (PN). Amino acid (AA) solutions should always be infused with PN. Standard AA solutions are generally used, whereas specially adapted AA solutions may be required in certain conditions such as severe disorders of AA utilisation or in inborn errors of AA metabolism. An AA intake of 0.8 g/kg/day is generally recommended for adult patients with a normal metabolism, which may be increased to 1.2-1.5 g/kg/day, or to 2.0 or 2.5 g/kg/day in exceptional cases. Sufficient non-nitrogen energy sources should be added in order to assure adequate utilisation of AA. A nitrogen calorie ratio of 1:130 to 1:170 (g N/kcal) or 1:21 to 1:27 (g AA/kcal) is recommended under normal metabolic conditions. In critically ill patients glutamine should be administered parenterally if indicated in the form of peptides, for example 0.3-0.4 g glutamine dipeptide/kg body weight/day (=0.2-0.26 g glutamine/kg body weight/day). No recommendation can be made for glutamine supplementation in PN for patients with acute pancreatitis or after bone marrow transplantation (BMT), and in newborns. The application of arginine is currently not warranted as a supplement in PN in adults. N-acetyl AA are only of limited use as alternative AA sources. There is currently no indication for use of AA solutions with an increased content of glycine, branched-chain AAs (BCAA) and ornithine-alpha-ketoglutarate (OKG) in all patients receiving PN. AA solutions with an increased proportion of BCAA are recommended in the treatment of hepatic encephalopathy (III-IV).

Metabolic fate and function of dietary glutamate in the gut

Glutamate is a main constituent of dietary protein and is also consumed in many prepared foods as an additive in the form of monosodium glutamate. Evidence from human and animal studies indicates that glutamate is a major oxidative fuel for the gut and that dietary glutamate is extensively metabolized in first pass by the intestine. Glutamate also is an important precursor for bioactive molecules, including glutathione, and functions as a key neurotransmitter. The dominant role of glutamate as an oxidative fuel may have therapeutic potential for improving function of the infant gut, which exhibits a high rate of epithelial cell turnover. Our recent studies in infant pigs show that when glutamate is fed at higher (4-fold) than normal dietary quantities, most glutamate molecules are either oxidized or metabolized by the mucosa into other nonessential amino acids. Glutamate is not considered to be a dietary essential, but recent studies suggest that the level of glutamate in the diet can affect the oxidation of some essential amino acids, namely leucine. Given that substantial oxidation of leucine occurs in the gut, ongoing studies are investigating whether dietary glutamate affects the oxidation of leucine in the intestinal epithelial cells. Our studies also suggest that at high dietary intakes, free glutamate may be absorbed by the stomach as well as the small intestine, thus implicating the gastric mucosa in the metabolism of dietary glutamate. Glutamate is a key excitatory amino acid, and metabolism and neural sensing of dietary glutamate in the developing gastric mucosa, which is poorly developed in premature infants, may play a functional role in gastric emptying. These and other recent reports raise the question as to the metabolic role of glutamate in gastric function. The physiologic significance of glutamate as an oxidative fuel and its potential role in gastric function during infancy are discussed.

Folate is absorbed across the colon of adults: evidence from cecal infusion of (13)C-labeled [6S]-5-formyltetrahydrofolic acid

BACKGROUND

Folate deficiency increases the risk of several human diseases. Likewise, high intakes of folate, particularly synthetic folic acid intake, may be associated with adverse health outcomes in humans. A more comprehensive understanding of the "input side" of folate nutrition may help to set dietary recommendations that strike the right balance between health benefits and risks. It is well known that the microflora in the colon produce large quantities of folate that approach or exceed recommended dietary intakes; however, there is no direct evidence of the bioavailability of this pool in humans.

OBJECTIVE

The objective was to determine whether, and to what extent, the natural folate vitamer 5-formyltetrahydrofolic acid is absorbed across the intact colon of humans.

DESIGN

During screening colonoscopy, 684 nmol (320 microg) [(13)C]glutamyl-5-formyltetrahydrofolic acid was infused directly into the cecum of 6 healthy adults. Three or more weeks later, each subject received an intravenous injection of the same compound (172 nmol). Blood samples were collected before and after each treatment. The ratio of labeled to unlabeled folates was determined in plasma by tandem mass spectrometry.

RESULTS

The apparent rate of folate absorption across the colon of a bolus dose of [(13)C]5-formyltetrahydrofolic acid infused into the cecum was 0.6 +/- 0.2 nmol/h, as determined by the appearance of [(13)C(5)]5-methyltetrahydrofolic acid in plasma. In comparison, the rate of appearance of [(13)C(5)]5-methyltetrahydrofolic acid after an intravenous injection of [(13)C(5)]5-formyltetrahydrofolate was 7 +/- 1.2 nmol/h.

CONCLUSION

Physiologic doses of natural folate are absorbed across the intact colon in humans.

Portal infusion of amino acids is more efficient than peripheral infusion in stimulating liver protein synthesis at the same hepatic amino acid load in dogs

BACKGROUND

Hepatic glucose uptake is enhanced by the portal delivery of glucose, which creates a negative arterioportal substrate gradient. Hepatic amino acid (AA) utilization may be regulated by the same phenomenon, but this has not been proven.

OBJECTIVE

We aimed to assess hepatic AA balance and protein synthesis with or without a negative arterioportal AA gradient.

DESIGN

Somatostatin was infused intravenously, and insulin and glucagon were replaced intraportally at 4- and 3-fold basal rates, respectively, in 3 groups (n = 9 each) of conscious dogs with catheters for hepatic balance measurement. Arterial glucose concentrations were clamped at 9 mmol/L. An AA mixture was infused intravenously to maintain basal concentrations (EuAA), intraportally to mimic the postmeal AA increase (PoAA), or intravenously (PeAA) to match the hepatic AA load in PoAA. Protein synthesis was assessed with a primed, continuous [(14)C]leucine infusion.

RESULTS

Net hepatic glucose uptake in the PoAA condition was < or =50% of that in the EuAA and PeAA conditions (P < 0.05). In the PoAA and PeAA conditions, hepatic intracellular leucine concentrations were 2- to 2.5-fold those in the EuAA condition (P < 0.05); net hepatic leucine uptake and [(14)C]leucine utilization were approximately 2-fold greater (P < 0.05) and albumin synthesis was 30% greater (P < 0.05) in the PoAA condition than in the EuAA and PeAA conditions. Phosphorylation of ribosomal protein S6 [downstream of the mammalian target of Rapamycin complex 1 (mTORC1)] was significantly higher in the PoAA, but not PeAA, condition than in the EuAA condition.

CONCLUSIONS

Portal, but not peripheral, AA delivery significantly enhanced hepatic protein synthesis under conditions in which AAs, glucose, insulin, and glucagon did not differ at the liver, an effect apparently mediated by mTORC1 signaling.

Total sulfur amino acid requirement and metabolism in parenterally fed postsurgical human neonates

BACKGROUND

Except for tyrosine, the amino acid requirements of human neonates receiving parenteral nutrition (PN) have not been experimentally derived.

OBJECTIVES

The objectives were to determine the total sulfur amino acid (TSAA) requirement (methionine in the absence of cysteine) of postsurgical, PN-fed human neonates by using the indicator amino acid oxidation (IAAO) technique with L-[1-(13)C]phenylalanine as the indicator.

DESIGN

Fifteen postsurgical neonates were randomly assigned to receive 1 of 18 methionine intakes ranging from 10 to 120 mg x kg(-1) x d(-1), delivered in a customized, cysteine-free amino acid solution. Breath and urine samples were collected for the measurement of (13)CO(2) and amino acid enrichment. Blood samples were collected at baseline and after the test methionine infusion for the measurement of plasma methionine, homocysteine, cystathionine, and cysteine concentrations.

RESULTS

Breakpoint analysis determined the mean TSAA requirements to be 47.4 (95% CI: 38.7, 56.1) and 49.0 (95% CI: 39.9, 58.0) mg x kg(-1) x d(-1) with the use of oxidation and F(13)CO(2), respectively.

CONCLUSIONS

This is the first study to report the TSAA requirement of postsurgical, PN-fed human neonates. The estimated methionine requirement expressed as a proportion of the methionine content of current commercial pediatric PN solutions was 90% (range: 48-90%) of that found in the lowest methionine-containing PN solution.

Indicator amino acid oxidation: concept and application

The indicator amino acid oxidation (IAAO) method is based on the concept that when 1 indispensable amino acid (IDAA) is deficient for protein synthesis, then all other IDAA, including the indicator amino acid, will be oxidized. With increasing intakes of the limiting amino acid, IAAO will decrease, reflecting increasing incorporation into protein. Once the requirement for the limiting amino acid is met, there will be no further change in the indicator oxidation. Originally, the IAAO method was designed to determine amino acid requirements in growing pigs. The minimally invasive IAAO method developed in humans has been systematically applied to determine IDAA requirements in adults. Due to its noninvasive nature, the IAAO method has also been used to determine requirements for amino acids in neonates and children, and in disease. The IAAO model has recently been applied to determine the metabolic availability (MA) of amino acids from dietary proteins and to determine total protein requirements. The IAAO method is robust, rapid, and reliable; it has been used to determine amino acid requirements in different species, across the life cycle, and in diseased populations. The recent application of IAAO to determine MA of amino acids and protein requirements is also very novel.

Morphological changes in the liver, thymus, spleen, and small intestine of animals after leucine treatment

Leucine treatment (100 mg/kg daily for 5 days) leads to activation of the hepatocyte nuclear system and granular endoplasmic reticulum and to a drastic increase in the number of mitochondria, characterized by polymorphism. In the spleen, Malpighian bodies and periarterial lymphoid sheaths are enlarged, lymphocytes infiltrate the periarterial zone, and the mantle zone is enlarged. In the thymus, the width of the cortical matter shrinks, while that of the medulla increases. The content of lymphocytes in the medulla decreases, while that of Hassal's bodies increases. Unambiguous effects of leucine on the small intestinal morphology (mainly on the villous epithelium) were shown. Goblet cells in the villous epithelium were sharply stenosed because of decreased secretory granules in them.

Parenterally fed neonatal piglets have a low rate of endogenous arginine synthesis from circulating proline

Parenterally fed neonatal piglets cannot synthesize sufficient arginine to maintain arginine status, presumably due to the intestinal atrophy that occurs with parenteral feeding. Parenteral feeding-induced atrophy can be reduced by the infusion of glucagon-like peptide 2 (GLP-2). GLP-2 infusion was hypothesized to increase the rate of endogenous arginine synthesis from proline, the major arginine precursor, in parenterally fed piglets receiving an arginine-deficient diet. Male piglets, fitted with jugular vein catheters for diet and isotope infusion, and femoral vein catheters for blood sampling (d 0), were allocated to a continuous infusion of either GLP-2 (n = 5; 10 nmol x kg(-1) x d(-1)) or saline (n = 5) for 7 d. Piglets received 2 d of a complete diet, followed by 5 d of an arginine-deficient [0.60 g x kg(-1) x d(-1)] diet. Piglets received primed, constant infusions of [guanido-(14)C]arginine to measure arginine flux (d 6) and [U-(14)C]proline (d 7) to measure proline conversion to arginine. Plasma arginine concentrations and arginine fluxes indicated a similar whole-body arginine status. Piglets receiving GLP-2 showed improvements in intestinal variables, including mucosal mass (P < 0.01) and villus height (P < 0.001), and a greater rate of arginine synthesis (micromol x kg(-1) x h(-1)) from proline (11.6 vs. 6.3) (P = 0.03). Mucosal mass (R(2) = 0.71; P = 0.002) and villus height were correlated (R(2) = 0.66; P = 0.004) with arginine synthesis. This study was the first to quantitate arginine synthesis in parenterally fed neonates and showed that although GLP-2 infusion increased arginine synthesis in a manner directly related to mucosal mass, this increased arginine synthesis was insufficient to improve whole-body arginine status in piglets receiving a low arginine diet.

Splanchnic metabolism of ingested amino acids in neonates

PURPOSE OF REVIEW

Neonates typically show rapid growth. Nutrient absorption in the neonatal period is higher than during any other time in life so as to meet the requirements for this rapid growth. Generally, nutrients are administered enterally, and in the past the gut was considered to absorb and digest these nutrients without major metabolism. Recent animal and human work has, however, revealed that the intestine and other splanchnic tissues contribute significantly to whole-body metabolism, and have their own specific functions. This review focuses on these observations.

RECENT FINDINGS

The splanchnic tissues take up greatly different proportions of each of the amino acids, ranging from 80-100% for threonine and several nonessential amino acids to 15-30% for lysine. The metabolic fates of the utilized substrates differ as well. Some are predominantly used for constitutive protein synthesis, others for energy generation or for formation of (glyco-)proteins that are secreted into the lumen. Glucose appears to be the major contributor to energy generation, but amino acids are important as well.

SUMMARY

Both animal and human studies have shown that the intestine uses substantial amounts of dietary amino acids. This has several implications for the nutritional needs of infants to maintain growth, especially during times of inadequate enteral nutrition.

Nutritional and functional importance of intestinal sulfur amino acid metabolism

The metabolism of sulfur amino acids, methionine and cysteine, has been linked to several key aspects of human health and cellular function. In addition, the metabolism of dietary amino acids by the gastrointestinal tract is nutritionally important for normal function. In the case of sulfur amino acids (SAAs), in vivo, stable isotope studies in adults suggest that the splanchnic tissues utilize as much as 30-44% of the dietary methionine and cysteine. Similarly, the dietary methionine requirement is 30% lower in total parenteral nutrition (TPN)-fed piglets, a condition in which dietary nutrients largely bypass intestinal metabolism. These data suggest that intestinal metabolism of methionine is substantial, yet the intestinal metabolic fate of dietary methionine is largely unknown. Dietary cysteine likely plays a key role in intestinal epithelial antioxidant function as a precursor for glutathione. Moreover, cysteine and glutathione may also regulate epithelial cell proliferation via modulation of redox status. Recent evidence indicates that transformed colonic epithelial cells are capable of methionine transmethylation and transsulfuration. This review discusses the evidence of intestinal SAA metabolism and how this affects nutrient requirements and epithelial function.

Response to lysine in a wheat gluten diet in adult minipigs after short-and long-term dietary adaptation as assessed with an indicator amino acid oxidation and balance technique1,2

An experiment was conducted to examine the response to wheat gluten (WG)-based diets at two lysine levels in adult minipigs (23 kg BW) using the indicator AA oxidation (IAAO) approach and N balance. Twenty minipigs (n = five per group), fitted with reentrant ileoileal cannulas allowing collection of ileal effluents, were fed restrictively two WG-based diets (WG and WG + Lys; 2.7 and 6.6 g of lysine/kg, respectively) for adaptation periods of 10 and 100 d. On d 7 and 9, for pigs fed the diets for 10 d, and on d 97 and 99, for pigs fed the diets for 100 d, primed i.v. fasted/fed tracer protocols with [(13)C]bicarbonate, and [(13)C]leucine were performed. With the WG diet, [(13)C]bicarbonate recoveries (%) were lower irrespective of the adaptation period, and higher during the fed period (fasted: WG + Lys = 82.5, and WG = 69.1; fed: WG + Lys = 90.6, and WG = 85.9; P < 0.05). Leucine oxidation rate was higher with the lower lysine intake (WG = 194.6 vs. 109.5 mg/[kg BW x d]; P < 0.05). Wheat gluten feeding resulted in a negative leucine balance independent of the adaptation period (WG = -29.1, and WG + Lys = 48.2 mg/[kg BW x d]; P < 0.05). In contrast with the IAAO method, N balance did not differ between the two lysine intakes, possibly because of an underestimation of N losses. The finding of a lower (13)C bicarbonate recovery with the lower dietary lysine intake suggests that caution should be taken in using a single recovery factor for all AA oxidation studies.

Amino acid needs for early growth and development

Few data exist on amino acid needs in infants and children, mainly because until recently, amino acid requirements were determined using nitrogen balance. The advent of the indicator amino acid oxidation (IAAO) method permits studies to be conducted with minimal adaptation to the test amino acid. In light of the very limited data available for human infants, toddlers, and children, it was proposed that a factorial approach should be used to estimate their essential amino acid requirements. Using amino acid oxidation techniques, dietary essential amino acid requirements in adults have been nearly completed. Data on changes in total body potassium are now available for infants and children. From these data it is possible to calculate protein deposition during growth, and hence, it is now possible to estimate the amino acid requirements in children using a factorial model. However, there has been no independent verification of the model. Recently we determined total branched chain-amino acid requirements for young adults and children, and we can provide data to support the validity of the factorial model. IAAO has been used on children with liver disease as young as 3 y. The minimally invasive IAAO model opens the door for determination of dietary essential amino acid requirements in infants and children during health and disease. For study of preterm neonates, we used a piglet model to show that the amino acid needs for parenteral feeding are markedly reduced for several essential amino acids; this suggests that current commercial total parenteral nutrition amino acid solutions are less than ideal.

Animal models of amino acid metabolism: a focus on the intestine

One important advantage of animal models is that they permit invasive approaches and can be especially valuable when evaluating tissue and specific features of metabolism in situ. The focus of this presentation is current models, which are providing insights into the pivotal importance of the gastrointestinal tract in amino acid metabolism. Intestinal amino acid metabolism is conceptually and technically difficult to approach and multiple processes must be accounted for: protein synthesis and degradation; transit of amino acids in both directions across the basolateral surface of enterocytes, in addition to uptake on the apical side; arterio-portal differences as well as net portal appearance during uptake of defined amino acid mixtures appearing on the luminal side; first pass amino acid metabolism. These key features are largely impossible to study without access to invasive approaches in vivo and cannot be reproduced in vitro. Douglas Burrin, Ron Ball, and Vickie Baracos and their co-workers have used the domestic piglet to study intestinal protein metabolism in situ in three distinctly different and complementary approaches. Collectively, their approaches allow a means to describe the key elements of intestinal amino acid capture (and release) and the means to probe their physiological and pathological variation. It seems evident that the portal-drained viscera represent sites of quantitatively important amino acid catabolism, and that this capacity combined with hepatic metabolism would largely limit the possibility of toxic sequelae of amino acids taken orally.

Enteral tryptophan requirement determined by oxidation of gastrically or intravenously infused phenylalanine is not different from the parenteral requirement in neonatal piglets

We have recently shown that the requirements of several amino acids differ substantially when neonates are fed parenterally as opposed to enterally. Our first objective was to determine whether the tryptophan requirement was different in parenterally fed (IV(fed)/IV(dose)) versus enterally fed (IG(fed)/IV(dose)) piglets. Because of the extensive extraction of amino acids by the gut, our other objective was to determine whether the route of isotope administration [i.e. intragastric (IG(fed)/IG(dose)) versus i.v. (IG(fed)/IV(dose)) dose] affects the estimate of tryptophan requirement in enterally fed piglets. We used the indicator amino acid oxidation technique in piglets (10 +/- 0.5 d old, 2.79 +/- 0.28 kg) receiving a complete elemental diet for 6 d either intragastrically or intravenously. Piglets were randomly assigned to receive test diets containing one of seven levels of tryptophan. All animals received a primed, constant infusion of l-[1-(14)C]phenylalanine either parenterally (IV(fed)/IV(dose) and IG(fed)/IV(dose)) or enterally (IG(fed)/IG(dose)). The mean tryptophan requirements for IV(fed)/IV(dose) (0.145 +/- 0.023 g/kg/d), IG(fed)/IV(dose) (0.127 +/- 0.022 g/kg/d), and IG(fed)/IG(dose) (0.113 +/- 0.024 g/kg/d) were similar as were the safe intakes (upper 95% confidence interval) (0.185, 0.164, 0.154 g/kg/d, respectively). These data indicate that tryptophan is not extensively used by the gut, in contrast to all the other amino acids we have studied. Furthermore, in spite of a splanchnic extraction of 27% of the phenylalanine dose, the route of isotope infusion does not affect the tryptophan requirement as determined by indicator amino acid oxidation.

Proteins and amino acids in enteral nutrition

PURPOSE OF REVIEW

This review reports recent findings on the effect of enterally fed protein and amino acids on metabolism, function, and clinical outcome, particularly during the neonatal period.

RECENT FINDINGS

Splanchnic tissues metabolize significant proportions of some enteral amino acids and this likely contributes to the higher requirement for these amino acids when they are provided enterally versus parenterally. Splanchnic tissues are particularly key in the provision of nutrition to preterm infants, who possess an exceedingly high protein anabolic drive, but limited tolerance to aggressive enteral feeding. The protein anabolic response to specific proteins is influenced by the rate of digestion and the pattern of feeding, as well as the amino acid composition of the proteins. The post-prandial rise in amino acids and insulin stimulates neonatal tissue protein synthesis by modulation of the nutrient and insulin signaling pathways that lead to translation initiation. A flurry of investigations into the metabolic response and clinical impact of individual amino acids suggests that leucine, glutamine, and arginine, in particular, have specific roles in regulating protein synthesis and immune function.

SUMMARY

Recent findings suggest that enteral nutrition support that provides an optimum combination of proteins and amino acids can have a beneficial impact on the clinical outcome of patients.

Parenteral and enteral routes of feeding in neonatal piglets require different ratios of branched-chain amino acids

The requirements for total branched-chain amino acids (BCAA), isoleucine, leucine and valine, in neonatal piglets receiving parenteral and enteral nutrition was determined recently. The optimum ratio among BCAA during different routes of feeding is not yet known. In this study, the ratio of BCAA during parenteral and enteral feeding was tested using the indicator amino acid oxidation (IAAO) technique. Male Yorkshire piglets (n=24) received amino acid-based diets containing adequate nutrients for 5 d. Phenylalanine oxidation and kinetics were determined from a 4-h primed, constant infusion of L-[1-14C]-phenylalanine on d 6 and 8. On d 6, all piglets received a BCAA diet which met 75% of the total BCAA requirement, based on our previous research, with a ratio of 1:1.8:1.2 of isoleucine/leucine/valine. On d 8, the piglets were randomly assigned to receive one of the 3 test diets supplemented with isoleucine (+isoleucine), leucine (+leucine) or valine (+valine) to meet 100% of requirement, with the remaining two BCAA at 75% of requirement. The difference in phenylalanine oxidation (% of dose) between d 6 and 8 was used as an indicator of BCAA adequacy. In enterally fed piglets, the change in the percentage of the dose oxidized was minimal for all 3 test diets (mean=1.15%). In parenterally fed piglets, the difference in phenylalanine oxidation (% of dose) between d 6 and 8 was +isoleucine (12.6%), +leucine (2%) and +valine (6.6%). The ratio of 1:1.8:1.2 of isoleucine/leucine/valine is appropriate for enteral feeding, but during parenteral feeding, isoleucine was first limiting and valine was second limiting.

Branched-chain amino acid catabolism: unique segregation of pathway enzymes in organ systems and peripheral nerves

We have examined the localization of the first two enzymes in the branched-chain amino acid (BCAA) catabolic pathway: the branched-chain aminotransferase (BCAT) isozymes (mitochondrial BCATm and cytosolic BCATc) and the branched-chain alpha-keto acid dehydrogenase (BCKD) enzyme complex. Antibodies specific for BCATm or BCATc were used to immunolocalize the respective isozymes in cryosections of rat tissues. BCATm was expressed in secretory epithelia throughout the digestive tract, with the most intense expression in the stomach. BCATm was also strongly expressed in secretory cells of the exocrine pancreas, uterus, and testis, as well as in the transporting epithelium of convoluted tubules in kidney. In muscle, BCATm was located in myofibrils. Liver, as predicted, was not immunoreactive for BCATm. Unexpectedly, BCATc was localized in elements of the autonomic innervation of the digestive tract, as well as in axons in the sciatic nerve. The distributions of BCATc and BCATm did not overlap. BCATm-expressing cells also expressed the second enzyme of the BCAA catabolic pathway, BCKD. In selected monkey and human tissues examined by immunoblot and/or immunohistochemistry, BCATm and BCATc were distributed in patterns very similar to those found in the rat. The results show that BCATm is in a position to regulate BCAA availability as protein precursors and anabolic signals in secretory portions of the digestive and other organ systems. The unique expression of BCATc in neurons of the peripheral nervous system, without coexpression of BCKD, raises new questions about the physiological function of this BCAT isozyme.

Dietary Cysteine Reduces the Methionine Requirement by an Equal Proportion in Both Parenterally and Enterally Fed Piglets

The sulfur amino acids (SAA), methionine and cysteine, are normally supplied in a 50:50 ratio in the oral diet of pigs. In contrast, cysteine is not included in any appreciable amounts in parenteral solutions due to its instability in solution. Cysteine can replace part of the methionine requirement, but is not required when methionine is supplied at a level that meets the entire SAA requirement. However, the role of the gut on cysteine sparing has not been investigated. In the present study, the enteral and parenteral methionine requirement was determined, with excess dietary cysteine, by using the indicator amino acid oxidation (IAAO) technique. Piglets [n = 28, 2 d, 1.65 +/- 0.014 kg (SE)] were fed elemental diets containing adequate energy, phenylalanine and excess tyrosine, with varied methionine concentrations and excess cysteine [0.55 g/(kg. d)]. Diets were infused continuously via intravenous (parenteral) or gastric (enteral) catheters. Phenylalanine oxidation was determined during a primed, constant infusion of L-[1-(14)C]-phenylalanine, by measuring expired (14)CO(2) and plasma specific radioactivity (SRA) of phenylalanine. For both the parenteral and enteral groups, phenylalanine oxidation (% of dose) decreased linearly (P < 0.01) as methionine intake increased and then became low and unchanging. Using breakpoint analysis, the methionine requirement was estimated to be 0.25 and 0.18 g/(kg. d) for enteral and parenteral feeding, respectively. These data show that the parenteral methionine requirement is approximately 70% of the enteral requirement when measured in the presence of excess dietary cysteine (P < 0.05). A comparison with our previous studies in which methionine was the only source of sulfur amino acids shows that the addition of dietary cysteine reduces the methionine requirement by approximately 40% in both enterally and parenterally fed neonatal piglets. Therefore, dietary cysteine is equally effective in sparing dietary methionine whether fed enterally or parenterally.

The methionine requirement is lower in neonatal piglets fed parenterally than in those fed enterally

The requirements for the sulfur amino acids (SAA), methionine (Met) and cysteine (Cys), have seldom been determined in neonates and to our knowledge have not previously been determined directly in parenterally fed neonates. The sulfur amino acids are catabolized largely in the liver and kidney, and their metabolism by the gut has been studied less frequently. In the present research, the enteral and parenteral Met requirement was determined, without dietary Cys, using the indicator amino acid oxidation (IAAO) technique. Piglets [n = 32, 2 d old, 1.66 +/- 0.13 kg (SD)] received elemental diets containing adequate energy, phenylalanine (Phe) and excess tyrosine, with varied Met concentrations and no Cys. Diets were infused continuously via intravenous or intragastric catheters. Phenylalanine oxidation was determined during a primed, constant infusion of L-[1-(14)C]-Phe, by measuring expired (14)CO(2) and plasma specific radioactivity of Phe. For both parenteral and enteral groups, Phe oxidation (% of dose) decreased linearly (P < 0.01) as Met intake increased, then became low and unchanging. Using breakpoint analysis, the Met requirement was estimated to be 0.42 and 0.29 g/(kg. d) for enteral and parenteral feeding, respectively. Breakpoint analysis using absolute phenylalanine oxidation [ micro mol/(kg. h)] resulted in an estimation of the Met requirement of 0.44 and 0.26 g/(kg. d) for enteral and parenteral feeding, respectively. These data show that the parenteral Met requirement is approximately 69% of the enteral requirement and suggest that extraction of SAA by first-pass splanchnic metabolism may be responsible for this difference.