Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity

INTRODUCTION

The purpose of this study is to examine year-by-year effects of the 2014 Affordable Care Act Medicaid expansion on infant mortality by race and ethnicity over the first 6 years.

METHODS

Publicly available 2011-2019 Multiple Cause of Death data were extracted in October and analyzed by November 2021. A difference-in-differences event-study design compared infant mortality changes in states that expanded in 2014 to nonexpansion states.

RESULTS

In the main model, the 2014 Medicaid expansions were associated with a statistically significant decline in Black infants' mortality in 2018 and 2019 by 1.19 (95% CI= -2.27, -0.12) and 1.35 (95% CI= -2.45, -0.26) deaths per 1,000 live births, respectively. There was also a decline in mortality for Hispanic infants in 2015-2019, including by 0.8 (95% CI= -1.25, -0.36) and 1.28 (95% CI= -1.88, -0.68) deaths per 1,000 live births in 2015 and 2019, respectively. Overall, infant mortality declined by 0.37 (95% CI= -0.70, -0.05) deaths per 1,000 live births in 2019.

CONCLUSIONS

The study adds evidence on the association of the Affordable Care Act Medicaid expansions with a decline in mortality of Black and Hispanic infants. The findings shed light on the importance of examining year-by-year effects over multiple years.

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations

Background

Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict.

Methods

We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources.

Results

Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations' healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in 'underground' facilities to avoid risk of attacks.

Conclusion

The case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions.

Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial

BACKGROUND

Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations.

OBJECTIVE

The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon.

METHODS

This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients-1433 in the intervention group and 926 in the control group-was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp).

RESULTS

Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA_1c; P<.01), and in the proportion of HbA_1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA_1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA_1c poor control (P=.01), and age was statistically associated with annual HbA_1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA_1c showed that a mean decrease in HbA_1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA_1c score as compared with those in refugee camps (P<.01).

CONCLUSIONS

This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ).

Acute heat stress and dietary methionine effects on IGF-I, GHR, and UCP mRNA expression in liver and muscle of quails

This study evaluated the expression of insulin-like growth factor I (IGF-I), growth hormone receptor (GHR), and uncoupling protein (UCP) mRNA in muscle and liver of quails that were in thermal comfort or exposed to heat stress and that were fed diets with or without methionine supplementation. Meat quails were fed a diet that either met the nutritional demands for methionine (MS) or did not meet this demand (methionine-deficient diet, MD). The animals were either kept at a thermal comfort temperature (25°C) or exposed to heat stress (38°C for 24 h starting on the 6th day). RNA was extracted from liver and breast muscle, and cDNA was synthesized and amplified using quantitative reverse transcription-polymerase chain reaction. Animals that were fed the MS diet and remained at the thermal comfort temperature exhibited increased IGF-I mRNA expression in the liver (0.56 AU). The GHR mRNA expression in the liver and muscle was influenced by both the study variables. Animals receiving the MS diet showed higher GHR expression, while increased expression was observed in animals at the thermal comfort temperature. The UCP mRNA expression in the muscle was influenced by both methionine supplementation and heat stress. Higher expression was observed in animals that received the MD diet (2.29 vs 3.77 AU) and in animals kept in thermal comfort. Our results suggest that heat stress negatively affects the expression of growth-related genes and that methionine supplementation is necessary to appropriately maintain the levels of IGF-I, GHR, and UCP transcripts for animal metabolism.

Effects of methionine supplementation on the redox state of acute heat stress-exposed quails

The aims of the present study were to evaluate the possible effects of heat stress (HS) on H2O2 production and to evaluate whether methionine supplementation (MS) could mitigate the deleterious effects on cell metabolism and the redox state induced by oxidative stress. Meat quails (Coturnix coturnix coturnix) were fed a diet that either met the nutritional demands for methionine or did not meet this demand (methionine deficient [MD] diet) for 7 d. The animals were either kept at a thermal comfort temperature (25°C) or exposed to HS (38°C for 24 h, starting on the sixth day). Heat stress induced decreased food intake (P = 0.0140), decreased daily weight gain (P < 0.0001), and increased water intake (P = 0.0211). A higher rate of H2O2 production was observed in HS animals (0.0802 vs. 0.0692 nmol of reactive oxygen species [ROS] produced per minute per milligram of protein; P = 0.0042) and in animals fed with the MD diet (0.0808 vs. 0.0686 nmol of ROS produced per minute per milligram of protein; P = 0.0020). We observed effects of the interaction between diet and the environment on the activities of glutathione peroxidase (GP-x) and catalase (P = 0.0392 and P < 0.0001, respectively). Heat stress induced higher levels of GP-x activity in animals on the MS diet and higher catalase activity in animals on the MD diet. Glutathione (GSH) levels were higher in animals on the MS diet (P = 0.0273) and in animals that were kept in thermal comfort (P = 0.0018). The thiobarbituric acid reactive substances level was higher in HS animals fed with the MD diet (P = 0.0386). Significant effects of the interaction between supplementation and environment were observed on uric acid concentration levels, which were higher in HS animals fed the MS diet (P = 0.008), and on creatine kinase activity levels, which were lower in HS animals fed the MD diet (1,620.33 units/L; P = 0.0442). Our results suggest that under HS conditions, in which H2O2 production is increased, MS was able to mitigate ROS-induced damage, possibly by increasing the activities of antioxidant elements such as GSH, GPx activity, and uric acid concentration, which were present in higher levels in animals that were subjected to HS and fed the MS diet.

Glyphosate affects micro-organisms in rhizospheres of glyphosate-resistant soybeans

AIMS

Glyphosate-resistant (GR) soybean production increases each year because of the efficacy of glyphosate for weed management. A new or 'second' generation of GR soybean (GR2) is now commercially available for farmers that is being promoted as higher yielding relative to the previous, 'first generation' (GR1) cultivars. Recent reports show that glyphosate affects the biology and ecology of rhizosphere micro-organisms in GR soybean that affect yield. The objective of this research was to evaluate the microbiological interactions in the rhizospheres of GR2 and GR1 soybean and the performance of the cultivars with different rates of glyphosate applied at different growth stages.

METHODS AND RESULTS

A greenhouse study was conducted using GR1 and GR2 soybean cultivars grown in a silt loam soil. Glyphosate was applied at V2, V4 and V6 growth stages at three rates. Plants harvested at R1 growth stage had high root colonization by Fusarium spp.; reduced rhizosphere fluorescent pseudomonads, Mn-reducing bacteria, and indoleacetic acid-producing rhizobacteria; and reduced shoot and root biomass.

CONCLUSIONS

Glyphosate applied to GR soybean, regardless of cultivar, negatively impacts the complex interactions of microbial groups, biochemical activity and root growth that can have subsequent detrimental effects on plant growth and productivity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The information presented here will be crucial in developing strategies to overcome the potential detrimental effects of glyphosate in GR cropping systems.

Actions of quercetin on gluconeogenesis and glycolysis in rat liver

1. The action of quercetin on glucose catabolism and production was investigated in the perfused rat liver. 2. Quercetin inhibited lactate production from glucose: 80% inhibition was found at a quercetin concentration of 100 micro M, and at higher concentrations inhibition was complete. 3. Pyruvate production from glucose presented a complex pattern, but stimulation was evident at 100 and 300 micro M quercetin. Oxygen uptake tended to be increased. 4. Glucose synthesis from lactate and pyruvate was inhibited. Inhibition was already evident at 50 micro M quercetin and almost complete at 300 micro M. Concomitantly, the increment in oxygen uptake caused by lactate plus pyruvate was stimulated by 50 micro M quercetin, but clearly inhibited by higher concentrations (100-500 micro M). 5. Glucose phosphorylation in the high-speed supernatant fractions of liver homogenates was inhibited by quercetin, but only at concentrations above 150 micro M. 6. It is concluded that quercetin can inhibit both glucose degradation and production and increase the cytosolic NAD(+)/NADH ratio. 7. These effects are likely to arise from many causes. Reduction of oxidative phosphorylation, inhibition of Na(+)-K(+)-ATPase, inhibition of glucokinase and inhibition of glucose 6-phosphatase could all contribute to the overall action of quercetin.

Action of quercetin on glycogen catabolism in the rat liver

1. The influence of quercetin on glycogen catabolism and related parameters was investigated in the isolated perfused rat liver and subcellular systems. 2. Quercetin stimulated glycogenolysis (glucose release). This effect was already evident at a concentration of 50 microM maximal at 300 microM and declined at higher concentrations. Quercetin also stimulated oxygen consumption, with a similar concentration dependence. 3. Lactate production from endogenous glycogen (glycolysis) was diminished by quercetin without significant changes in pyruvate production. 4. Quercetin did not inhibit glucose transport into cells but decreased intracellular sequestration of [5-(3)H]glucose under conditions of net glucose release. 5. In isolated mitochondria, quercetin diminished the energy transduction efficiency. It also inhibited several enzymatic activities, e.g. the K(+)-ATPase/Na(+)-ATPase of plasma membrane vesicles and the glucose 6-phosphatase of isolated microsomes. 6. No significant changes of the cellular contents of AMP, ADP and ATP were found. The cellular content of glucose 6-phosphate, however, was increased (3.12-fold). 7. Some of the effects of quercetin (glycogenolysis stimulation) can be attributed to its action on mitochondrial energy metabolism, as, for example, uncoupling of oxidative phosphorylation. However, the multiplicity of the effects on several enzymatic systems certainly produces an intricate interplay that also generates complex and apparently contradictory effects.

Modeling the transformation of exogenously supplied cAMP in the perfused rat liver

A kinetic model describing the behavior of extracellularly supplied cAMP in the perfused rat liver was derived and compared with experimental data. The model was based on the following conditions and assumptions: a) labeled cAMP is being constantly infused (step input); b) permeation of the cell membrane is an essentially irreversible step (k(in) as transfer coefficient); c) the adenine moiety of cAMP incorporates into a nucleotide pool (km1 as transformation coefficient), which cannot permeate the cell membrane; d) the adenine moiety of cAMP can be transferred from the nucleotide pool to a nucleoside + free base pool (km2 as transformation coefficient), which is able to permeate the cell membrane (k(ef) as transfer coefficient). These events were described by a series of differential equations for which an analytical solution was obtained. Total cellular incorporation of label derived from [3H]cAMP was measured in the isolated perfused rat liver. The equations of the model were fitted to these experimental data by means of a least-squares procedure. In the fitting procedure the previously determined k(in) value (0.55 ml min(-1) ml cellular space(-1)) was used. The model is able to describe the experimental data (correlation coefficient = 0.993 +/- 0.008) with km1, km2 and k(ef) values of 17.11, 0.0948 and 1.385 min(-1), respectively. Simulations revealed the following sequence of decreasing intracellular pool sizes: nucleotide pool > nucleoside + free base pool > intracellular cAMP. The intracellular cAMP concentrations correspond to only 3.2% of the extracellular ones. This low proportion explains why it was generally difficult to detect cAMP in the cell space when this compound was added to an isolated cell system. The model and the parameters determined in the present work can be used to predict intracellular cAMP concentrations in the perfused liver for specific extracellular concentrations.

Zymosan-induced changes in glucose release and fatty acid oxidation in the perfused rat liver

The aim of the present study was to investigate the actions of zymosan on glucose release and fatty acid oxidation in perfused rat livers and to determine if Kupffer cells and Ca2+ ions are implicated in these actions. Zymosan caused stimulation of glycogenolysis in livers from fed rats. In livers from fasted rats zymosan caused gradual inhibition of glucose production and oxygen consumption from lactate plus pyruvate. Ketogenesis, oxygen consumption, and [14C-]-CO2 production were inhibited by zymosan when the [1-14C]-palmitate was supplied exogenously. However, ketogenesis and oxygen consumption from endogenous sources were not inhibited. An interference with substrate-uptake by the liver may be the cause of the changes in gluconeogenesis and oxidation of fatty acids from exogenous sources. The pretreatment of the rats with gadolinium chloride and the removal of Ca2+ ions did not suppress the effects of zymosan on glucose release, a finding that argues against the participation of Kupffer cells or Ca2+ ions in the liver responses. The hepatic metabolic changes caused by zymosan could play a role in the systemic metabolic alterations reported to occur after in vivo zymosan administration.

Transport of cyclic AMP and synthetic analogs in the perfused rat liver

The purpose of the present work was to investigate the transport of cyclic AMP (cAMP) and analogs in the rat liver. The experimental system was the isolated once-through perfused liver. Transport was measured by employing the multiple-indicator dilution technique. The single-pass recovery of tracer [(32)P]cAMP was equal to 94.4 +/- 1. 4%; no significant extracellular transformation of cAMP occurred during a single passage. The unidirectional influx rates of dibutyryl-cAMP were a saturable function of its concentration, with K(m) = 72.75 +/- 9.24 microM and V(max) = 0.464 +/- 0.026 micromol min(-1) (mL cellular space)(-1). The unidirectional influx rates of cAMP were much lower than those of dibutyryl-cAMP and were a linear function of the concentration (up to 100 microM). The transfer coefficient for influx (k(in)) was equal to 0.860 +/- 0.058 mL min(-1) (mL extracellular space)(-1). cAMP inhibited the influx of dibutyryl-cAMP; the IC(50) was 0.83 mM. The following series of increasing unidirectional influx rates was found: cAMP < monobutyryl-cAMP approximately 2-aza-epsilon-cAMP < rp-cAMPS approximately sp-cAMPS < 8-Br-cAMP approximately dibutyryl-cGMP approximately 8-Cl-cAMP < O-dibutyryl-cAMP. There was no precise correlation between the rates of influx of the various cyclic nucleotides and their lipophilicity. It was concluded that the penetration of cAMP and its analogs into the liver cells was a facilitated process. Lipophilicity was not the only factor determining the rate of transport. The transformation of dibutyryl-cAMP was limited by both transport and activity of the intracellular enzymic systems. The intracellular transformation of exogenous cAMP, however, was limited by the transport process.

The role of Ca2+ and hemodynamics in the action of diltiazem on hepatic energy metabolism

Diltiazem causes vasoconstriction in the liver when present at high concentrations, an action that is strictly Ca2+-dependent. Diltiazem is also active on energy metabolism. This toxic action could be partly a consequence of hemodynamic effects. In the absence of Ca2+, the hemodynamic effects are no longer present and, consequently, Ca2+-free experiments are useful for distinguishing between hemodynamics-dependent and hemodynamics-independent effects. The experimental system used was the hemoglobin-free perfused rat liver from fed and fasted rats. Diltiazem was infused at various concentrations in the presence and absence of Ca2+. Several metabolic parameters were measured: lactate and pyruvate production (glycolysis), glycogenolysis, oxygen uptake, gluconeogenesis, and the cellular levels of lactate, pyruvate, glucose, AMP, ADP, and ATP. The effects of diltiazem can be divided into three groups: (1) Effects that are strictly dependent on the Ca2+-mediated hemodynamic action. This group comprises inhibition of oxygen uptake at all concentrations (50-500 micromol/L) inhibition of lactate, pyruvate, and glucose release at high concentrations; the decrease in cellular ATP; the increase in cellular AMP; and the cellular accumulation of glucose and lactate. (2) Effects that are independent of the hemodynamic action. The most relevant effect of this type is inhibition of gluconeogenesis. (3) Effects that are influenced by Ca2+ but are independent of the hemodynamic effects. This is the typical case of lactate and glucose release from endogenous glycogen, whose stimulation by low diltiazem concentrations is more pronounced in the presence of Ca2+ than in its absence.

Effects of norepinephrine on the metabolism of fatty acids with different chain lengths in the perfused rat liver

The effects of norepinephrine on ketogenesis in isolated hepatocytes have been reported as ranging from stimulation to inhibition. The present work was planned with the aim of clarifying these discrepancies. The experimental system was the once-through perfused liver from fasted and fed rats. Fatty acids with chain lengths varying from 8-18 were infused. The effects of norepinephrine depended on the metabolic state of the rat and on the nature of the fatty acid. Norepinephrine clearly inhibited ketogenesis from long-chain fatty acids (stearate > palmitate > oleate), but had little effect on ketogenesis from medium-chain fatty acids (octanoate and laureate). With palmitate the decrease in oxygen uptake was restricted to the substrate stimulated portion; with stearate, the decrease exceeded the substrate stimulated portion; with oleate, oxygen uptake was transiently inhibited. Withdrawal of Ca2+ attenuated the inhibitory effects. 14CO2 production from [1-14C]oleate was inhibited. Net uptake of the fatty acids was not affected by norepinephrine. In livers from fed rats, oxygen uptake and ketogenesis from stearate were only transiently inhibited. The conclusions are: (a) in the fasted state norepinephrine reduces ketogenesis and respiration by means of a Ca2+-dependent mechanism; (b) the degree of inhibition varies with the chain length and the degree of saturation of the fatty acids; (c) norepinephrine favours esterification of the activated long-chain fatty acids in detriment to oxidation; (d) in the fed state the stimulatory action of norepinephrine on glycogen catabolism induces conditions which are able to reverse inhibition of ketogenesis and oxygen uptake.

Regional heterogeneities in the production of uric acid from adenosine in the bivascularly perfused rat liver

The heterogeneity of the liver parenchyma in relation to uric acid production from adenosine was investigated using the bivascularly perfused rat liver in the anterograde and retrograde modes. Adenosine was infused in livers from fed rats during 20 min at four different concentrations (20, 50, 100 and 200 microM) according to four experimental protocols as follows: (A) anterograde perfusion, with adenosine infusion into the portal vein; (B) anterograde perfusion, with adenosine in the hepatic artery, (C) retrograde perfusion, with adenosine in the hepatic vein; (D) retrograde perfusion, with adenosine in the hepatic artery. With protocols A, B, and D uric acid production from adenosine was always characterized by initial bursts followed by progressive decreases toward smaller steady-states. With protocol C the initial burst was present only when 200 microM adenosine was infused. The initial bursts in uric acid production were accompanied by simultaneous increases in the ratio of uric acid production/adenosine uptake rate. These initial bursts are thus representing increments in the production of uric acid that are not corresponded by similar increments in the metabolic uptake rates of adenosine. Global analysis of uric acid production revealed that the final steady-state rates were approximately equal for all infusion rates with protocols A, B and C, but smaller with protocol D. This difference, however, can be explained in terms of the differences in accessible cellular spaces, which are much smaller when protocol D is employed. When the analysis was performed in terms of the extra amounts of uric acid produced during the infusion of adenosine, where the initial bursts are also taken into account, different dose-response curves were found for each experimental protocol. These differences cannot be explained in terms of the accessible cell spaces and they are likely to reflect regional heterogeneities. From the various dose-response curves and from the known characteristics of the microcirculation of the rat liver it can be concluded that the initial bursts in uric acid production are generated in periportal hepatocytes. The reason for this heterogeneity could be related to the metabolic effects of adenosine, especially to oxygen uptake inhibition, which is likely to produce changes in the ATP/AMP ratios.

The hemodynamic effects of diltiazem in the isolated perfused rat liver are Ca(2+)-dependent

AIMS/BACKGROUND

Diltiazem reduces systemic blood pressure by decreasing the vascular smooth muscle tone. In the liver however, diltiazem seems to cause vasoconstriction, as evidenced by increases in portal pressure. The questions raised by this observation are concerned with a) the site of action of diltiazem (large vessels or sinusoids), b) the formation of permeability barriers and c) the role of Ca2+. The experiments in the present study should provide an answer to these questions.

METHODS

The experimental system was the hemoglobin-free perfused rat liver. The multiple-indicator dilution technique was employed with simultaneous injection of [14C]sucrose and [3H]water. Mean transit times and distribution spaces were calculated from the normalized outflow profiles.

RESULTS

Calcium alone did not affect the hemodynamics of the liver. Diltiazem, however, changed several hemodynamic parameters when Ca2+ was present, but it was inactive in the absence of this cation. The hemodynamic effects of 500 microM diltiazem were: a) diminution of the transit time through the large vessels (t(o)) and, consequently, of the accessible vascular space (66.9%); b) diminution of the mean transit time of [14C]sucrose (tsuc) and, consequently, of the accessible sinusoidal space (28.1%); c) diminution of the mean transit time of tritiated water (twater) and, consequently, of the accessible cellular space (68.9%); d) diminution of the cellular to extracellular space ratio (theta) from 1.42 +/- 0.05 to 0.46 +/- 0.11.

CONCLUSIONS

The linear superposition of the tritiated water and labeled sucrose curves, predicted by Goresky's model, could be optimized even when the curves were obtained with diltiazem + Ca2+, indicating that the distribution of both tracers was still flow-limited. The hemodynamic effects of diltiazem seem to be restricted to a vasoconstriction of the great vessels, an action which was strictly dependent on Ca2+. At the concentration of 500 microM, the effects of diltiazem were pronounced to the point of excluding completely about 2/3 of the liver parenchyma from the microcirculation, as indicated by the observed reduction in the accessible cell space. The sinusoids that were still supplied with perfusion fluid suffered considerable distension (2.19 fold) because the whole perfusate flow was deviated into the remaining 1/3 microcirculatory units. Diltiazem did not seem to induce the formation of intrahepatic shunts or diffusion barriers in the liver.

The role of hemodynamics in the action of diltiazem on hepatic fatty acid metabolism

The hemodynamic effects of diltiazem in the liver are strictly Ca2+ -dependent Consequently, Ca2+ -free perfusion can be used for investigating the metabolic effects of diltiazem without interference by hemodynamics. Livers were perfused with Krebs/Henseleit-bicarbonate buffer (pH 7.4). For performing Ca2+ -free perfusion the cation was omitted from the perfusion fluid and the cellular pools were exhausted by repeated phenylephrine infusions. Three conditions were investigated with and without Ca2+ : (1) substrate-free perfusion fluid; (2) 0.3 mM [1-(14)C]octanoate infusion; (3) 0.3 mM [1-(14)C]palmitate infusion. The following results were obtained: 1. Oxygen uptake stimulation caused by octanoate and palmitate was abolished by 500 microM diltiazem in the presence of Ca2+; in the absence of Ca2+ there was no inhibition (octanoate) or it was much smaller (palmitate); 2. The 14CO2 production was inhibited in the presence of Ca2+; in the absence of Ca2+ there was no inhibition (palmitate) or even stimulation (octanoate). 3. Ketogenesis from endogenous sources, from palmitate and from octanoate was inhibited by diltiazem in the presence as well as in the absence of Ca2+. The beta-hidroxybutyrate/acetoacetate ratio was diminished in the presence and in the absence of Ca2+ . It was concluded that inhibition of fatty acid oxidation by diltiazem depends partly on the Ca2+ -dependent hemodynamic effects and partly on a Ca2+ -independent action on some enzymatic system.

The influence of Ca2+ on the effects of glucagon on hepatic glycolysis

1. The influence of Ca2+ on the effects of glucagon on glycolysis was investigated in the isolated perfused rat liver. Livers from fed rats were perfused in an open system with Krebs/Henseleit-bicarbonate buffer (pH 7.4). Glucose release, lactate plus pyruvate production (glycolysis) and oxygen uptake were measured. The following results were obtained: 2. In livers perfused with Ca(2+)-free Krebs/Henseleit-bicarbonate buffer and after depletion of the intracellular pools, the initial and transient stimulation of glycolysis, which is normally observed shortly after the onset of glucagon infusion, was more pronounced when compared to livers perfused with normal perfusion fluid (2.5 mM Ca2+) and without previous depletion of the intracellular pools (controls); the subsequent inhibition of glycolysis was delayed in Ca(2+)-free perfused livers and was less pronounced in comparison with the controls at the end of the glucagon infusion period (20 min). 3. Perfusion with a Ca(2+)-free medium supplemented with EDTA, without previous depletion of the intracellular pools, also produced a substantial reduction in the effects of glucagon on glycolysis. 4. Ca(2+)-free perfusion did not affect the stimulative action of glucagon on glucose release (glycogenolysis) and oxygen uptake. 5. Glycolysis inhibition by cAMP also was abolished in Ca(2+)-free perfused livers, and the initial stimulation was enhanced. 6. Mn2+, a metal ion known as a competitor of Ca2+, considerably reduced the action of glucagon on glycolysis; Mn2+ did not affect the basal rates of glycolysis. 7. Sr2+, a metal ion that is often recognized as Ca2+ by several biological structures and processes, increased the inhibitory action of glucagon on glycolysis. 8. Several organic compounds, which directly or indirectly take part in Ca2+ fluxes, were also able to diminish (e.g., verapamil) or even to abolish (carbenoxolone) the inhibitory action of glucagon on glycolysis. 9. It was concluded that, under the conditions of the living cell, Ca2+ is important for glycolysis inhibition by glucagon. In principle at least, the results can be explained in terms of the known Ca2+ dependencies of several protein kinases and protein phosphatases.

Hepatic heterogeneity in the response to AMP studies in the bivascularly perfused rat liver

The zonation of the purinergic action of AMP in the hepatic parenchyma was investigated in the bivascularly perfused rat liver by means of anterograde and retrograde perfusion. Livers from fed rats were used and AMP (100 microM) was infused according to four different experimental protocols: (A) anterograde perfusion and AMP infusion via the portal vein; (B) anterograde perfusion and AMP infusion via the hepatic artery; (C) retrograde perfusion and AMP via the hepatic vein; (D) retrograde perfusion and AMP via the hepatic artery. The response of the liver cells was heterogeneous. Oxygen uptake inhibition by AMP predominates in cells situated shortly after the intrasinusoidal confluence of the portal vein and hepatic artery. Oxygen consumption in all other cells seems to be increased by AMP. Glycogenolysis stimulation by AMP (glucose release) was more pronounced in the periportal cells situated in the region of the intrasinusoidal confluence of the portal vein and the hepatic artery. It can be concluded that the heterogenic response of the liver to AMP is similar to the heterogenic response to ATP.

Hepatic heterogeneity in the response to ATP studied in the bivascularly perfused rat liver

The zonation of the purinergic action of ATP in the hepatic parenchyma was investigated in the bivascularly perfused rat liver by means of anterograde and retrograde perfusion. Livers from fed rats were used, and ATP was infused according to four different experimental protocols: (A) anterograde perfusion and ATP infusion via the portal vein; (B) anterograde perfusion and ATP via the hepatic artery; (C) retrograde perfusion and ATP via the hepatic vein; (D) retrograde perfusion and ATP via the hepatic artery. The following metabolic parameters were measured: glucose release, lactate production and oxygen consumption. The hemodynamic effects were evaluated by measuring the sinusoidal mean transit times by means of the indicator-dilution technique. ATP was infused during 20 min at four different rates (between 0.06-0.77 micromol min[-1] g liver[-1]; 20-200 microM) in each of the four experimental protocols. The results that were obtained allow several conclusions with respect to the localization of the effects of ATP along the hepatic acini: (1) In retrograde perfusion the sinusoidal mean transit times were approximately twice those observed in anterograde perfusion. ATP increased the sinusoidal mean transit times only in retrograde perfusion (protocols C and D). The effect was more pronounced with protocol D. These results allow the conclusion that the responsive vasoconstrictive elements are localized in a pre-sinusoidal region; (2) All hepatic cells, periportal as well as perivenous, were able to metabolize ATP, so that concentration gradients were generated with all experimental protocols. Extraction of ATP was more pronounced in retrograde perfusion, an observation that can be attributed, partly at least, to the longer sinusoidal transit times. In anterograde perfusion, the extraction of ATP was time-dependent, a phenomenon that cannot be satisfactorily explained with the available data; (3) ATP produced a transient initial inhibition of oxygen uptake when protocols A and B were employed. These protocols are the only ones in which the cells situated shortly after the intrasinusoidal confluence of the portal vein and the hepatic artery were effectively supplied with ATP. The decrease in oxygen consumption was more pronounced at low ATP infusions when protocol B was employed. These observations allow the conclusion that the former phenomenon is localized mainly in cells situated shortly after the intrasinusoidal confluence of the portal vein and hepatic artery. Oxygen consumption in all other cells, especially the proximal periportal ones, is increased by ATP; (4) In agreement with previous data found in the literature, glycogenolysis stimulation by ATP was more pronounced in the periportal region. The cells that respond more intensively are not the proximal periportal ones, but those situated in the region of the intrasinusoidal confluence of the portal vein and the hepatic artery.

Production, uptake, and metabolic effects of cyclic AMP in the bivascularly perfused rat liver

Production, uptake, and metabolic effects of cyclic AMP (cAMP) were measured in the bivascularly perfused rat liver in anterograde and retrograde perfusion. Glucagon, cAMP, N6,2'-O-dibutyryl cAMP and N6-monobutyryl cAMP were infused into the portal vein (anterograde perfusion), the hepatic vein (retrograde perfusion), or the hepatic artery (anterograde and retrograde perfusion) in order to reach different cell populations. The following results were obtained: (1) cAMP release caused by glucagon was directly proportional to the cell spaces that were accessible via the hepatic artery in anterograde and retrograde perfusion; since the metabolic effects of glucagon were not proportional to the accessible cell spaces, this observation also implies a disproportion between cAMP release and metabolic effects of the hormone; (2) when cAMP and N6,2'-O-dibutyryl cAMP were given to all liver cells (e.g. when infused into the portal vein), their metabolic effects were qualitatively and quantitatively the same and qualitatively equal to the effects of glucagon; (3) the changes caused by cAMP were a function of the cell spaces that can be reached via the hepatic artery in anterograde and retrograde perfusion; this behaviour contrasts markedly with that of glucagon, whose metabolic effects were practically independent of the accessible cell spaces; and (4) the effects of N6,2'-O-dibutyryl cAMP and N6-monobutyryl cAMP were independent of the cell spaces that were accessible via the hepatic artery in anterograde and retrograde perfusion; in this respect their behaviour was equal to that of glucagon. It is apparent that exogenously added cAMP mimicked the metabolic effects of glucagon in the liver only when it was supplied to all liver cells. Since glucagon, N6,2'-O-dibutyryl cAMP, and N6-monobutyryl cAMP were able to produce a full response even when given to only 30% of the liver parenchyma, it was concluded that cAMP production under the stimulus of glucagon or in consequence of the metabolic transformation of N6,2'-O-dibutyryl cAMP and N6-monobutyryl cAMP occurs in a compartment to which exogenous cAMP has no access. cAMP generated within this compartment is possibly able to diffuse from cell to cell.

Ca2+ dependence of gluconeogenesis stimulation by glucagon at different cytosolic NAD(+)-NADH redox potentials

The influence of Ca2+ on hepatic gluconeogenesis was measured in the isolated perfused rat liver at different cytosolic NAD(+)-NADH potentials. Lactate and pyruvate were the gluconeogenic substrates and the cytosolic NAD(+)-NADH potentials were changed by varying the lactate to pyruvate ratios from 0.01 to 100. The following results were obtained: a) gluconeogenesis from lactate plus pyruvate was not affected by Ca(2+)-free perfusion (no Ca2+ in the perfusion fluid combined with previous depletion of the intracellular pools); gluconeogenesis was also poorly dependent on the lactate to pyruvate ratios in the range of 0.1 to 100; only for a ratio equal to 0.01 was a significantly smaller gluconeogenic activity observed in comparison to the other ratios. b) In the presence of Ca2+, the increase in oxygen uptake caused by the infusion of lactate plus pyruvate at a ratio equal to 10 was the most pronounced one; in Ca(2+)-free perfusion the increase in oxygen uptake caused by lactate plus pyruvate infusion tended to be higher for all lactate to pyruvate ratios; the most pronounced difference was observed for lactate/pyruvate ratio equal to 1. c) In the presence of Ca2+ the effects of glucagon on gluconeogenesis showed a positive correlation with the lactate to pyruvate ratios; for a ratio equal to 0.01 no stimulation occurred, but in the 0.1 to 100 range stimulation increased progressively, producing a clear parabolic dependence between the effects of glucagon and the lactate to pyruvate ratio. d) In the absence of Ca2+ the relationship between the changes caused by glucagon in gluconeogenesis and the lactate to pyruvate ratio was substantially changed; the dependence curve was no longer parabolic but sigmoidal in shape with a plateau beginning at a lactate/pyruvate ratio equal to 1; there was inhibition at the lactate to pyruvate ratios of 0.01 and 0.1 and a constant stimulation starting with a ratio equal to 1; for the lactate to pyruvate ratios of 10 and 100, stimulation caused by glucagon was much smaller than that found when Ca2+ was present. e) The effects of glucagon on oxygen uptake in the presence of Ca2+ showed a parabolic relationship with the lactate to pyruvate ratios which was closely similar to that found in the case of gluconeogenesis; the only difference was that inhibition rather than stimulation of oxygen uptake was observed for a lactate to pyruvate ratio equal to 0.01; progressive stimulation was observed in the 0.1 to 100 range. f) In the absence of Ca2+ the effects of glucagon on oxygen uptake were different; the dependence curve was sigmoidal at the onset, with a well-defined maximum at a lactate to pyruvate ratio equal to 1; this maximum was followed by a steady decline at higher ratios; at the ratios of 0.01 and 0.1 inhibition took place; oxygen uptake stimulation caused by glucagon was generally lower in the absence of Ca2+ except when the lactate to pyruvate ratio was equal to 1. The results of the present study demonstrate that stimulation of gluconeogenesis by glucagon depends on Ca2+. However, Ca2+ is only effective in helping gluconeogenesis stimulation by glucagon at highly negative redox potentials of the cytosolic NAD(+)-NADH system. The triple interdependence of glucagon-Ca(2+)-NAD(+)-NADH redox potential reveals highly complex interrelations that can only be partially understood at the present stage of knowledge.

Effects of the nonsteroidal anti-inflammatory drug piroxicam on energy metabolism in the perfused rat liver

1. The actions of piroxicam, a nonsteroidal and noncarboxylic anti-inflammatory drug, on the metabolism of the isolated perfused rat liver were investigated. The main purpose was to verify if piroxicam is also active on glycogenolysis and energy metabolism, as demonstrated for several carboxylic nonsteroidal anti-inflammatories. 2. Piroxicam increased oxygen consumption in livers from both fed and fasted rats. 3. Piroxicam increased glucose release and glycolysis from endogenous glycogen (glycogenolysis). 4. Gluconeogenesis from lactate plus pyruvate was inhibited. 5. The action of piroxicam on oxygen consumption was blocked by antimycin A, but not by atractyloside. 6. The action of piroxicam in the perfused rat liver metabolism seems to be a consequence of its action on mitochondria. 7. It can be concluded that inhibition of energy metabolism and stimulation of glycogenolysis are not specific properties of carboxylic nonsteroidal anti-inflammatory drugs.

Bivascular liver perfusion in the anterograde and retrograde modes: zonation of the response to inhibitors of oxidative phosphorylation

The action of cyanide (500 microM), 2,4-dinitrophenol (50 microM) and atractyloside (100 microM) on glycogen catabolism and oxygen uptake was investigated in the bivascularly perfused liver of fed rats. Cyanide, 2,4-dinitrophenol and attractyloside were infused at identical rates into the hepatic artery in either the anterograde or retrograde perfusion. The accessible aqueous cell spaces were determined by means of the multiple-indicator dilution technique. Glucose release, oxygen uptake and glycolysis were measured as metabolic parameters. Oxygen uptake changes per unit cell space caused by atractyloside (inhibition) and 2,4-dinitrophenol (stimulation) were equal in the retrograde perfusion (periportal cells) and the anterograde perfusion (space enriched in perivenous cells); the decreases caused by cyanide were higher in the retrograde perfusion. Glucose release from periportal cells was not increased upon inhibition of oxidative phosphorylation, a phenomenon which was independent of the mechanism of action of the inhibitor. There were nearly identical changes in glycolysis in the periportal and perivenous cells. It was concluded that: (1) oxygen concentration in the perfused rat liver, if maintained above 100 microM, had little influence on the zonation of the respiratory activity; (2) in spite of the lower activities of the key enzymes of glycolysis in the periportal hepatocytes, as assayed under standard conditions, these cells were as effective as the perivenous ones in generating ATP in the cytosol when oxidative phosphorylation was impaired; (3) the key enzymes of glycogenolysis and glycolysis in periportal and perivenous cells responded differently to changes in the energy charge.

The action of glucagon infused via the hepatic artery in anterograde and retrograde perfusion of the rat liver is not a function of the accessible cellular spaces

The metabolic action of glucagon in the different spaces that can be reached via the hepatic artery in the bivascularly perfused rat liver of fed rats was investigated. When perfusion was performed in the anterograde mode, glucagon (10 mM) was infused either into the portal vein (type 1 experiment) or into the hepatic artery (type 2); in the retrograde mode, the hormone was infused either into the hepatic vein (type 3) or into the hepatic artery (type 4). The aqueous cell spaces were measured by means of the multiple-indicator dilution technique. Glucose release, oxygen uptake and glycolysis (lactate plus pyruvate production) were measured as metabolic parameters. The following results were obtained. (1) The aqueous cell space accessible via the hepatic artery in the type 2 experiment was 0.63 ml/g; in the type 4 experiment this space was 0.18 ml/g (only periportal cells); glucagon up to 10 nM did not affect these cellular spaces nor did it affect the vascular spaces. (2) The effects of glucagon on glucose release, oxygen uptake and glycolysis were practically the same in all types of experiment (1 to 4), i.e., the action of glucagon was not a function of the accessible cell spaces. (3) When the respiratory chain of the liver cells accessible via the hepatic artery in the type 4 experiment was inhibited by cyanide, glucagon still increased oxygen uptake; oxygen uptake stimulation by glucagon was completely blocked only when cyanide was given to all liver cells. (4) Calcium depletion did not affect the action of glucagon on glucose release and oxygen uptake in the type 4 experiment. It was concluded that, in addition to the receptor-elicited response, the action of glucagon can also be propagated by cell-to-cell communication.

Zonation of the action of glucagon on gluconeogenesis studied in the bivascularly perfused rat liver

We have measured the action of glucagon, infused into the hepatic artery, on gluconeogenesis from lactate in the rat liver, bivascularly perfused in both the anterograde and retrograde modes. Concerning glucose production and oxygen uptake per unit cell space, the response of the periportal cells reached via the hepatic artery in retrograde perfusion to glucagon is superior to the response of the cells reached via the same vessel in anterograde perfusion. This phenomenon, however, most probably reflects zonation of gluconeogenesis rather than zonation of the hormonal action. The latter conclusion is based on the observation that the fractional change caused by the hormone is the same for all liver cells.

Zonation of gluconeogenesis from lactate and pyruvate in the rat liver studied by means of anterograde and retrograde bivascular perfusion

Gluconeogenesis from lactate and pyruvate and associated parameters were investigated in the bivascularly and hemoglobin-free perfused rat liver. The substrates were infused either via the portal vein (anterograde perfusion mode), via the hepatic vein (retrograde mode) or via the hepatic artery (anterograde and retrograde modes). The rates of lactate and pyruvate infusion were 10.3 and 3.5 mumol min-1 g-1, respectively. The metabolic rates measured when the substrates were infused into the hepatic artery were referred to the cellular spaces accessible in each perfusion mode. The following results were obtained when the substrates were infused into the hepatic artery: (1) gluconeogenesis from lactate was equal to 2.08 +/- 0.2 mumol min-1 ml-1 in the retrograde mode and 1.33 +/- 0.08 mumol min-1 ml-1 in the anterograde mode (P = 0.019); (2) gluconeogenesis from pyruvate was equal to 0.66 +/- 0.11 mumol min-1 ml-1 in the retrograde mode and 0.7 +/- 0.11 mumol min-1 ml-1 in the anterograde mode (P = 0.78); (3) oxygen uptake increase with lactate was 1.75 +/- 0.14 mumol min-1 ml-1 in the retrograde mode and 1.05 +/- 0.07 mumol min-1 ml-1 in the anterograde mode (P = 0.002); (4) oxygen uptake increase with pyruvate was equal to 0.59 mumol min-1 ml-1 in the retrograde mode and 0.57 +/- 0.05 mumol min-1 ml-1 in the anterograde mode (P = 0.73); (5) pyruvate production from lactate was 0.28 +/- 0.06 mumol min-1 ml-1 in the retrograde mode and 0.39 +/- 0.05 mumol min-1 ml-1 in the anterograde mode (P = 0.28); (6) lactate production from pyruvate was equal to 0.52 +/- 0.05 mumol min-1 ml-1 in the retrograde mode and 0.99 +/- 0.08 mumol min-1 ml-1 in the anterograde mode (P < 0.001). Since only periportal cells are supplied with substrates when they are infused via the hepatic artery in retrograde perfusion, these results allow the conclusion that gluconeogenesis from lactate predominates in periportal hepatocytes. When pyruvate is the sole substrate, however, gluconeogenesis in periportal and perivenous cells presents no difference.

Transport and metabolism of palmitate in the rat liver. Net flux and unidirectional fluxes across the cell membrane

The unidirectional fluxes of palmitate across the liver cell membrane and metabolic uptake rates were measured employing the multiple-indicator dilution technique. The following results were obtained: (1) Influx and net uptake rates do not vary proportionally to each other when albumin and palmitate concentrations are varied. (2) Efflux is significant for albumin concentrations in the range between 1.5 and 500 microM. (3) At 150 microM albumin net uptake rates are proportional to the total (bound plus free) extracellular palmitate concentration in the range from 10 to 600 microM; the dependence of influx rates on the palmitate concentration is rather concave up. (4) When albumin and palmitate are both varied at an equimolar ratio, pseudo-saturation appears in the net uptake rates; the influx rates also show pseudo-saturation, but with a declining tendency at the higher concentrations. (5) The intracellular palmitate concentration is strongly influenced by albumin. At very low concentrations of the protein (1.5 microM) the intracellular concentration is practically equal to the extracellular one; at physiological albumin concentrations, however, the intracellular palmitate concentration is less than 2% of the extracellular one. (6) Saturation of net uptake with respect to the intracellular palmitate concentration was not observed with concentrations up to 46 microM.

Hepatic metabolism of meal-fed rats: studies in vivo and in the isolated perfused liver

Hepatic metabolic fluxes (glycolysis, glucose release, glycogenolysis, oxygen consumption, ketogenesis and gluconeogenesis), hepatic glycogen and food ingestion in meal-fed rats were measured and compared to appropriate controls. The following results were obtained: 1) in livers from meal-fed rats a higher fraction of glucosyl units derived from glycogen is used in glycolysis instead of being released in the form of glucose; 2) the rate of glycogen catabolism in livers from meal-fed rats is less than expected when one compares their glycogen levels with those of the appropriate controls; 3) the livers from meal-fed rats become much less ketotic than the livers from rats which were not trained to eat a single meal daily. It was concluded that the liver of meal-fed rats is well adapted to the main characteristics of those animals, e.g., increased lipogenesis from glycolysis products and a reduced need for carbon units from the liver (glucose and ketone bodies) as a consequence of enhanced food intake.

The sensitivity of glycogenolysis to glucagon, epinephrine and cyanide in livers from rats in different metabolic conditions

The action of glucagon, epinephrine and cyanide on hepatic glycogen catabolism in meal-fed rats and the corresponding controls was investigated using the isolated perfused liver. The amounts of glycogen catabolites (glucose, L-lactate and pyruvate) released were correlated with the glycogen content of the livers at the different times after feeding. Irrespective of the metabolic condition, the sensitivity of glycogenolysis to glucagon was roughly proportional to the glycogen content of the livers. However, glycogenolysis in livers from meal-fed rats was less sensitive to epinephrine and cyanide. The difference between meal-fed and controls (ad libitum-fed) was particularly pronounced at 22 hours after feeding. It was concluded that resistance to hepatic glycogen depletion in meal-fed rats during the fasting period may be, partly at least, the consequence of a reduced sensitivity of glycogenolysis to epinephrine and to situations of reduced rates of oxidative phosphorylation.

The relation between inhibition of glycolysis and stimulation of oxygen uptake due to glucagon in livers from rats in different metabolic conditions

The relation between the effects of glucagon on oxygen consumption and glycolysis in livers from rats under different metabolic conditions was examined. Respiration of substrate-free perfused livers with different glycolytic fluxes, induced by changes in the pattern of food intake, responds differently to the infusion of 1 nM glucagon. The increases in oxygen uptake caused by 1 nM glucagon correlate reasonably well with the absolute decreases in glycolysis. The degree of inhibition of glycolysis is approximately constant (58 per cent) for all metabolic conditions. When no recovery of glycolysis occurs upon cessation of glucagon infusion, the same happens with oxygen consumption, which remains stimulated. It is concluded that in livers with no appreciable biosynthetic activities, the action of glucagon on respiration and glycolysis may be interpreted in terms of an interaction of interpreted in terms of an interaction of cytosolic and mitochondrial ATP generating processes.