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Bernhard W, Böckmann KA, Minarski M, Wiechers C, Busch A, Bach D, Poets CF, Franz AR. Evidence and Perspectives for Choline Supplementation during Parenteral Nutrition-A Narrative Review. Nutrients 2024; 16:1873. [PMID: 38931230 PMCID: PMC11206924 DOI: 10.3390/nu16121873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/03/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Choline is an essential nutrient, with high requirements during fetal and postnatal growth. Tissue concentrations of total choline are tightly regulated, requiring an increase in its pool size proportional to growth. Phosphatidylcholine and sphingomyelin, containing a choline headgroup, are constitutive membrane phospholipids, accounting for >85% of total choline, indicating that choline requirements are particularly high during growth. Daily phosphatidylcholine secretion via bile for lipid digestion and very low-density lipoproteins for plasma transport of arachidonic and docosahexaenoic acid to other organs exceed 50% of its hepatic pool. Moreover, phosphatidylcholine is required for converting pro-apoptotic ceramides to sphingomyelin, while choline is the source of betaine as a methyl donor for creatine synthesis, DNA methylation/repair and kidney function. Interrupted choline supply, as during current total parenteral nutrition (TPN), causes a rapid drop in plasma choline concentration and accumulating deficit. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) defined choline as critical to all infants requiring TPN, claiming its inclusion in parenteral feeding regimes. We performed a systematic literature search in Pubmed with the terms "choline" and "parenteral nutrition", resulting in 47 relevant publications. Their results, together with cross-references, are discussed. While studies on parenteral choline administration in neonates and older children are lacking, preclinical and observational studies, as well as small randomized controlled trials in adults, suggest choline deficiency as a major contributor to acute and chronic TPN-associated liver disease, and the safety and efficacy of parenteral choline administration for its prevention. Hence, we call for choline formulations suitable to be added to TPN solutions and clinical trials to study their efficacy, particularly in growing children including preterm infants.
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Affiliation(s)
- Wolfgang Bernhard
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Katrin A. Böckmann
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Michaela Minarski
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Cornelia Wiechers
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Annegret Busch
- Pharmaceutical Department, University Hospital, 72076 Tübingen, Germany; (A.B.); (D.B.)
| | - Daniela Bach
- Pharmaceutical Department, University Hospital, 72076 Tübingen, Germany; (A.B.); (D.B.)
| | - Christian F. Poets
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
| | - Axel R. Franz
- Department of Neonatology, University Children’s Hospital, 72076 Tübingen, Germany; (W.B.); (K.A.B.); (M.M.); (C.W.); (C.F.P.)
- Center for Pediatric Clinical Studies, University Children’s Hospital, 72076 Tübingen, Germany
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Minarski M, Maas C, Heinrich C, Böckmann KA, Bernhard W, Shunova A, Poets CF, Franz AR. Choline and Betaine Levels in Plasma Mirror Choline Intake in Very Preterm Infants. Nutrients 2023; 15:4758. [PMID: 38004152 PMCID: PMC10675502 DOI: 10.3390/nu15224758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Choline is essential for cell membrane formation and methyl transfer reactions, impacting parenchymal and neurological development. It is therefore enriched via placental transfer, and fetal plasma concentrations are high. In spite of the greater needs of very low birth weight infants (VLBWI), choline content of breast milk after preterm delivery is lower (median (p25-75): 158 mg/L (61-360 mg/L) compared to term delivery (258 mg/L (142-343 mg/L)). Even preterm formula or fortified breast milk currently provide insufficient choline to achieve physiological plasma concentrations. This secondary analysis of a randomized controlled trial comparing growth of VLBWI with different levels of enteral protein supply aimed to investigate whether increased enteral choline intake results in increased plasma choline, betaine and phosphatidylcholine concentrations. We measured total choline content of breast milk from 33 mothers of 34 VLBWI. Enteral choline intake from administered breast milk, formula and fortifier was related to the respective plasma choline, betaine and phosphatidylcholine concentrations. Plasma choline and betaine levels in VLBWI correlated directly with enteral choline intake, but administered choline was insufficient to achieve physiological (fetus-like) concentrations. Hence, optimizing maternal choline status, and the choline content of milk and fortifiers, is suggested to increase plasma concentrations of choline, ameliorate the choline deficit and improve growth and long-term development of VLBWI.
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Affiliation(s)
- Michaela Minarski
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Christoph Maas
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Christine Heinrich
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Katrin A. Böckmann
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Wolfgang Bernhard
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Anna Shunova
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Christian F. Poets
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
| | - Axel R. Franz
- Department of Neonatology, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany (W.B.)
- Center for Pediatric Clinical Studies, University Children’s Hospital, Tübingen University Hospital, 72076 Tübingen, Germany
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Guerra G, Segrado F, Pasanisi P, Bruno E, Lopez S, Raspagliesi F, Bianchi M, Venturelli E. Circulating choline and phosphocholine measurement by a hydrophilic interaction liquid chromatography-tandem mass spectrometry. Heliyon 2023; 9:e21921. [PMID: 38027764 PMCID: PMC10665723 DOI: 10.1016/j.heliyon.2023.e21921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Given the growing interest in studying the role of choline and phosphocholine in the development and progression of tumor pathology, in this study we describe the development and validation of a fast and robust method for the simultaneous analysis of choline and phosphocholine in human plasma. Methods Choline and phosphocholine quantification in human plasma was obtained using a hydrophilic interaction liquid chromatography-tandem mass spectrometry technique. Assay performance parameters were evaluated using EMA guidelines. Results Calibration curve ranged from 0.60 to 38.40 μmol/L (R2 = 0.999) and 0.08-5.43 μmol/L (R2 = 0.998) for choline and phosphocholine, respectively. The Limit Of Detection of the method was 0.06 μmol/L for choline and 0.04 μmol/L for phosphocholine. The coefficient of variation range for intra-assay precision is 2.2-4.1 % (choline) and 3.2-15 % (phosphocholine), and the inter-assay precision range is < 1-6.5 % (choline) and 6.2-20 % (phosphocholine). The accuracy of the method was below the ±20 % benchmarks at all the metabolites concentration levels. In-house plasma pool of apparently healthy adults was tested, and a mean concentration of 15.97 μmol/L for Choline and 0.34 μmol/L for Phosphocholine was quantified. Conclusions The developed method shows good reliability in quantifying Choline and Phosphocholine in human plasma for clinical purposes.
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Affiliation(s)
- Giulia Guerra
- Nutrition Research and Metabolomics Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Segrado
- Nutrition Research and Metabolomics Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Patrizia Pasanisi
- Nutrition Research and Metabolomics Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eleonora Bruno
- Nutrition Research and Metabolomics Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Lopez
- Unit of Oncological Gynecology, Department of Oncologycal Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Unit of Oncological Gynecology, Department of Oncologycal Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Bianchi
- Nutrition Research and Metabolomics Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Venturelli
- Nutrition Research and Metabolomics Unit, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Böckmann KA, Bernhard W, Minarski M, Shunova A, Wiechers C, Poets CF, Franz AR. Choline supplementation for preterm infants: metabolism of four Deuterium-labeled choline compounds. Eur J Nutr 2023; 62:1195-1205. [PMID: 36460779 PMCID: PMC10030424 DOI: 10.1007/s00394-022-03059-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Supply of choline is not guaranteed in current preterm infant nutrition. Choline serves in parenchyma formation by membrane phosphatidylcholine (PC), plasma transport of poly-unsaturated fatty acids (PUFA) via PC, and methylation processes via betaine. PUFA-PC concentrations are high in brain, liver and lung, and deficiency may result in developmental disorders. We compared different deuterated (D9-) choline components for kinetics of D9-choline, D9-betaine and D9-PC. METHODS Prospective study (1/2021-12/2021) in 32 enterally fed preterm infants (28 0/7-32 0/7 weeks gestation). Patients were randomized to receive enterally a single dose of 2.7 mg/kg D9-choline-equivalent as D9-choline chloride, D9-phosphoryl-choline, D9-glycerophosphorylcholine (D9-GPC) or D9-1-palmitoyl-2-oleoyl-PC(D9-POPC), followed by blood sampling at 1 + 24 h or 12 + 60 h after administration. Plasma concentrations were analyzed by tandem mass spectrometry. Results are expressed as median (25th/75th percentile). RESULTS At 1 h, plasma D9-choline was 1.8 (0.9/2.2) µmol/L, 1.3 (0.9/1.5) µmol/L and 1.2 (0.7/1.4) µmol/L for D9-choline chloride, D9-GPC and D9-phosphoryl-choline, respectively. D9-POPC did not result in plasma D9-choline. Plasma D9-betaine was maximal at 12 h, with lowest concentrations after D9-POPC. Maximum plasma D9-PC values at 12 h were the highest after D9-POPC (14.4 (9.1/18.9) µmol/L), compared to the other components (D9-choline chloride: 8.1 [5.6/9.9] µmol/L; D9-GPC: 8.4 (6.2/10.3) µmol/L; D9-phosphoryl-choline: 9.8 (8.6/14.5) µmol/L). Predominance of D9-PC comprising linoleic, rather than oleic acid, indicated fatty-acyl remodeling of administered D9-POPC prior to systemic delivery. CONCLUSION D9-Choline chloride, D9-GPC and D9-phosphoryl-choline equally increased plasma D9-choline and D9-betaine. D9-POPC shifted metabolism from D9-betaine to D9-PC. Combined supplementation of GPC and (PO) PC may be best suited to optimize choline supply in preterm infants. Due to fatty acid remodeling of (PO) PC during its assimilation, PUFA co-supplementation with (PO) PC may increase PUFA-delivery to critical organs. This study was registered (22.01.2020) at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502. STUDY REGISTRATION This study was registered at the Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020502.
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Affiliation(s)
- Katrin A Böckmann
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany.
| | - Wolfgang Bernhard
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Michaela Minarski
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Anna Shunova
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Cornelia Wiechers
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
| | - Axel R Franz
- Department of Neonatology, Faculty of Medicine, Eberhard Karls University, Calwer Straße 7, 72076, Tuebingen, Germany
- Center for Pediatric Clinical Studies, Eberhard Karls University, Tübingen, Germany
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Different choline supplement metabolism in adults using deuterium labelling. Eur J Nutr 2023; 62:1795-1807. [PMID: 36840817 DOI: 10.1007/s00394-023-03121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/14/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Choline deficiency leads to pathologies particularly of the liver, brain and lung. Adequate supply is important for preterm infants and patients with cystic fibrosis. We analysed the assimilation of four different enterally administered deuterium-labelled (D9-) choline supplements in adults. METHODS Prospective randomised cross-over study (11/2020-1/2022) in six healthy men, receiving four single doses of 2.7 mg/kg D9-choline equivalent each in the form of D9-choline chloride, D9-phosphorylcholine, D9-alpha-glycerophosphocholine (D9-GPC) or D9-1-palmitoyl-2-oleoyl-glycero-3-phosphoryl-choline (D9-POPC), in randomised order 6 weeks apart. Plasma was obtained at baseline (t = - 0.1 h) and at 0.5 h to 7d after intake. Concentrations of D9-choline and its D9-labelled metabolites were analysed by tandem mass spectrometry. Results are shown as median and interquartile range. RESULTS Maximum D9-choline and D9-betaine concentrations were reached latest after D9-POPC administration versus other components. D9-POPC and D9-phosphorylcholine resulted in lower D9-trimethylamine (D9-TMAO) formation. The AUCs (0-7d) of plasma D9-PC concentration showed highest values after administration of D9-POPC. D9-POPC appeared in plasma after fatty acid remodelling, predominantly as D9-1-palmitoyl-2-linoleyl-PC (D9-PLPC), confirming cleavage to 1-palmitoyl-lyso-D9-PC and re-acylation with linoleic acid as the most prominent alimentary unsaturated fatty acid. CONCLUSION There was a delayed increase in plasma D9-choline and D9-betaine after D9-POPC administration, with no differences in AUC over time. D9-POPC resulted in a higher AUC of D9-PC and virtually absent D9-TMAO levels. D9-POPC is remodelled according to enterocytic fatty acid availability. D9-POPC seems best suited as choline supplement to increase plasma PC concentrations, with PC as a carrier of choline and targeted fatty acid supply as required by organs. This study was registered at Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020498, 22.01.2020. STUDY REGISTRATION This study was registered at Deutsches Register Klinischer Studien (DRKS) (German Register for Clinical Studies), DRKS00020498.
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Adeyemo T, Jaiyesimi A, Bumgardner JG, Lohr C, Banerjee A, McKenna MC, Waddell J. Choline Improves Neonatal Hypoxia-Ischemia Induced Changes in Male but Not Female Rats. Int J Mol Sci 2022; 23:13983. [PMID: 36430459 PMCID: PMC9694200 DOI: 10.3390/ijms232213983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Choline is an essential nutrient with many roles in brain development and function. Supplementation of choline in early development can have long-lasting benefits. Our experiments aimed to determine the efficacy of choline supplementation in a postnatal day (PND) 10 rat model of neonatal hypoxia ischemia (HI) at term using both male and female rat pups. Choline (100 mg/kg) or saline administration was initiated the day after birth and given daily for 10 or 14 consecutive days. We determined choline's effects on neurite outgrowth of sex-specific cultured cerebellar granule cells after HI with and without choline. The magnitude of tissue loss in the cerebrum was determined at 72 h after HI and in adult rats. The efficacy of choline supplementation in improving motor ability and learning, tested using eyeblink conditioning, were assessed in young adult male and female rats. Overall, we find that choline improves neurite outgrowth, short-term histological measures and learning ability in males. Surprisingly, choline did not benefit females, and appears to exacerbate HI-induced changes.
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Affiliation(s)
- Tayo Adeyemo
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Ayodele Jaiyesimi
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Jill G. Bumgardner
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Charity Lohr
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Aditi Banerjee
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Mary C. McKenna
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Jaylyn Waddell
- Department of Pediatrics, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
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