Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department

Background

The presence of alcohol or other substances of abuse in blood or urine from injured patients is often used as a proxy for substance influence at the time of injury. The aim of this study was to obtain an estimate of substance influence at the time of injury based on blood concentrations of alcohol and other substances of abuse, and to explore the relationship between the substance prevalence at the time of admittance to the hospital and the actual influence at the time of the injury.

Methods

The study included all adult patients admitted to the emergency department of a university hospital during 1 year (n = 996). Quantification in blood was done by an enzymatic method for alcohol, and by liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry for 28 other substances of abuse. Concentrations of alcohol and other substances in blood at the time of injury were calculated. The degree of influence was assessed on the basis of the calculated blood concentrations, with a threshold of influence set at a blood alcohol concentration (BAC) of 0.05 %, or a substance concentration leading to an influence similar to that of a BAC of 0.05 %.

Results

A total of 324 patients (32.5 %) were determined to be under the influence at the time of injury. In comparison, 394 patients (39.6 %) had one or more substances above the cut-off limit in blood at the time of admittance to the hospital. Alcohol was the most prevalent substance causing influence at 25.9 %. Among patients with violence-related injuries, almost 75 % were under the influence of alcohol and/or substances. Patients under the influence were younger, and men were more often under the influence than women. More patients were under the influence at nighttime and during weekends than at daytime and on weekdays.

Conclusions

About one third of the injured patients were determined to be under the influence at the time of injury, with alcohol being the most prevalent substance causing influence. Approximately 98 % of the patients with alcohol detected in blood at the time of admittance to the hospital were under the influence of alcohol at the time of injury.

Prevalence of ethyl glucuronide and ethyl sulphate among patients injured when driving or at work

AIMS

Presence of EtG or EtS among patients injured when driving or at work may indicate that very low BAC or residual effects of alcohol at the time of the accident may be associated with increased accident risk. The aim of this study was to assess: whether the alcohol metabolites EtG and EtS were present in a sample of patients injured when driving or injured at work, even if their blood alcohol concentration was negative; and, if EtG and EtS were present, what characterized these patients.

METHODS

Blood samples from patients admitted for treatment of injuries at a Norwegian emergency department were tested for alcohol, EtG and EtS. All samples were also analysed for medicinal and illicit psychoactive substances.

RESULTS

One hundred and ninety-two injured patients who were admitted <12 h after injury were included in the study. EtG or EtS were the most prevalent substances in the sample (17%), and a substantial proportion of the patients who tested negative for all other substances tested positive for EtG or EtS (8%). These patients were older than the rest of the sample and drank alcohol more often, according to their self-report.

CONCLUSION

EtG and EtS were prevalent among patients injured when driving or injured at work, including patients negative for all other substances. EtG and EtS should be included in future case-control studies of psychoactive substance use among injured patients to investigate the possible association between residual alcohol effects and injuries.

Associations between heavy episodic drinking and alcohol related injuries: a case control study

BACKGROUND

Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries.

METHODS

We applied a case - control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately.

RESULTS

An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox.

CONCLUSION

There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

Studying psychoactive substance use in injured patients: does exclusion of late arriving patients bias the results?

BACKGROUND

Most studies of the prevalence of psychoactive substances in injured emergency department patients have excluded those who arrive more than 6h after injury. This may cause a selection bias. The aim of this study was: (1) to describe the characteristics of patients who arrive more than 6h after injury, compared to patients who arrive sooner (2) to examine whether self-report can add to the assessment of alcohol use when the patient is assessed more than 6h after injury.

METHODS

Blood sample analysis and self-report data were used to assess the prevalence of psychoactive substances in injured patients admitted to an emergency department within 48 h of injury (n=1611). Discriminant function analysis was used to assess group differences.

RESULTS

The patients who arrived more than 6h after injury differed significantly from those who arrived earlier in several respects. They more often screened positive for hypnotics; they were older, they were more likely to have had a fall and they were more often injured at home and at night. Self reported use of alcohol showed good consistency with blood sample screening within 6h of injury and could therefore be used to assess alcohol use more than 6h after injury.

CONCLUSIONS

Patients who arrive more than 6h after injury differ significantly from those who arrive earlier. Future studies on the prevalence of psychoactive substances in emergency departments could expand the inclusion window.

Alcohol, psychoactive substances and non-fatal road traffic accidents--a case-control study

Background

The prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups.

Methods

Injured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses.

Results

In 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5%) and stimulants eg. cocaine or amphetamines (9.4%). This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9%) and benzodiazepines (0.8%). The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, p < 0.001), for more than three psychoactive substances (OR: 38.9, 95% CI: 8.2- 185.0, p < 0.001) and for alcohol alone (OR: 36.1, 95% CI: 13.2- 98.6, p < 0.001). Single use of non-alcohol substances was not associated with increased accident risk.

Conclusion

The prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.

Controlling for High-Density Lipoprotein Cholesterol Does Not Affect the Magnitude of the Relationship Between Alcohol and Coronary Heart Disease

Background—

This study tested the hypothesis that moderate alcohol intake exerts its cardioprotective effect mainly through an increase in the serum level of high-density lipoprotein cholesterol.

Methods and Results—

In the Cohort of Norway (CONOR) study, 149 729 adult participants, recruited from 1994 to 2003, were followed by linkage to the Cause of Death Registry until 2006. At recruitment, questionnaire data on alcohol intake were collected, and the concentration of high-density lipoprotein cholesterol in serum was measured. Using Cox regression, we found that the adjusted hazard ratio for men for dying from coronary heart disease was 0.52 (95% confidence interval, 0.39–0.69) when consuming alcohol more than once a week compared with never or rarely. The ratio changed only slightly, to 0.55 (0.41–0.73), after the regression model included the serum level of high-density cholesterol. For women, the corresponding hazard ratios were 0.62 (0.32–1.23) and 0.68 (0.34–1.34), respectively.

Conclusions—

Alcohol intake is related to a reduced risk of death from coronary heart disease in the follow-up of a large, population-based Norwegian cohort study with extensive control for confounding factors. Our findings suggest that the serum level of high-density cholesterol is not an important intermediate variable in the possible causal pathway between moderate alcohol intake and coronary heart disease.

Prevalence of alcohol and other substances of abuse among injured patients in a Norwegian emergency department

BACKGROUND

Studies have found a high prevalence of both alcohol and other impairing psychoactive drugs in injured patient populations. The aim of this study was to assess the prevalence of potentially impairing psychoactive substances in all patients admitted to a hospital emergency department with injuries from accidents, assault or deliberate self harm.

METHODS

A total of 1272 patients over 18 years of age, admitted to the hospital within 12h of injury, were included. Presence of alcohol was determined by an enzymatic method and other drugs by liquid chromatography-mass spectrometry (LC-MS) or gas chromatography-mass spectrometry (GC-MS), both highly specific analytical methods for determining recent intake.

RESULTS

There were 510 (40%) women in the sample. Of the patients, 38% of the women and 48% of the men had a positive blood sample for psychoactive substances on admission. The most prevalent psychoactive substance was alcohol (27%) with an average concentration of 1.5 g/kg. A further 21% of patients tested showed use of medicinal drugs, and 9% showed use of illicit substances. Cannabis was the most prevalent illicit drug (6.2%). Diazepam (7.4%) and zopiclone (5.3%) were the most prevalent medicinal drugs. In road traffic accidents, 25% of the car drivers had positive findings, about half of them for alcohol.

CONCLUSION

Psychoactive substances were found in nearly half the patients admitted with injuries. The most common substance was alcohol. Alcohol was particularly related to violence, whereas medicinal drugs were most prevalent in accidents at home.

Increased locomotor activity induced by heroin in mice: pharmacokinetic demonstration of heroin acting as a prodrug for the mediator 6-monoacetylmorphine in vivo

We investigated the relative importance of heroin and its metabolites in eliciting a behavioral response in mice by studying the relationship between concentrations of heroin, 6-monoacetylmorphine (6MAM), and morphine in brain tissue and the effects on locomotor activity. Low doses (subcutaneous) of heroin (< or =5 micromol/kg) or 6MAM (< or =15 micromol/kg) made the mice run significantly more than mice given equimolar doses of morphine. There were no differences in the response between heroin and 6MAM, although we observed a shift to the left of the dose-response curve for the maximal response of heroin. The behavioral responses were abolished by pretreatment with 1 mg/kg naltrexone. Heroin was detected in brain tissue after injection, but the levels were low and its presence too short-lived to be responsible for the behavioral response observed. The concentration of 6MAM in brain tissue increased shortly after administration of both heroin and 6MAM and the concentration changes during the first hour roughly reflected the changes in locomotor activity. Both the maximal and the total concentration of 6MAM were higher after administration of heroin than after administration of 6MAM itself. The morphine concentration increased slowly after injection and could not explain the immediate behavioral response. In summary, the locomotor activity response after injection of heroin was mediated by 6MAM, which increased shortly after administration. Heroin acted as an effective prodrug. The concentration of morphine was too low to stimulate the immediate response observed but might have an effect on the later part of the heroin-induced behavioral response curve.

Disappearance of ethyl glucuronide during heavy putrefaction

INTRODUCTION

There are previous publications showing the use of ethyl glucuronide (EtG), a non-oxidative metabolite of ethanol, as a marker of ante-mortem ingestion of alcohol in forensic autopsy cases. The problem of possible degradation or formation of EtG during putrefaction is however not well studied and the aim of this study was to investigate the possibility of false negative and false positive EtG results by an in vitro study. Further, we used the information from the in vitro study on real cases, to get an impression of the practical problem of degradation or formation of EtG.

METHODS

An in vitro study was carried out to study the concentrations of EtG in blood samples under controlled conditions during putrefaction. In addition, to illustrate the practical problem of degradation or formation of EtG, we used routine samples analysed for EtG in blood. Blood samples from forensic autopsies with ethanol detected but EtG not detected in blood, and therefore suspected post-mortem ethanol formation, were identified. Fifteen such cases had urine samples available, and these were analysed for EtG. We hypothesised that since concentrations are often higher in urine, there would still be traces of EtG left in this medium if post-mortem degradation was the reason for the negative result in blood.

RESULTS

In this in vitro experiment, EtG was very unstable in blood samples at 30/40 degrees C without preservatives. On the other hand, EtG was stable with potassium fluoride at room temperature, and there was no formation of EtG either at 30 degrees C without preservatives, or at room temperature with potassium fluoride. Of the 15 routine cases where EtG in blood was negative, and the ethanol detected was assumed endogenous, six were positive for EtG in urine. In these cases, ethanol was probably ingested, and the negative EtG in blood may be a false negative result due to degradation during putrefaction.

CONCLUSION

Analysis of EtG in blood is a helpful tool to determine in vivo ingestion of ethanol in post-mortem cases. A negative result, however, especially in heavily putrefied cases, must be interpreted with caution. Analysis of an additional medium would be valuable in these cases.

A study of ethyl glucuronide in post-mortem blood as a marker of ante-mortem ingestion of alcohol

The possibility of post-mortem production of ethanol makes correct interpretation of ethanol detection in forensic autopsy samples difficult. Even though the levels of ethanol formed post-mortem are generally low, this may be highly relevant in cases where intake of alcohol was forbidden, for instance for pilots, professional drivers and countries with low legal alcohol limits for driving. Different criteria are used to determine whether a finding of ethanol is of exogenous origin, but there is no marker for alcohol ingestion that has been studied in detail. In this study, we wanted to evaluate the sensitivity and specificity of ethyl glucuronide (EtG), a direct minor metabolite of ethanol, measured in blood, as a marker of ante-mortem alcohol ingestion. Forensic autopsy cases were divided into groups with and without ante-mortem alcohol ingestion, according to strict inclusion criteria. In 93 cases with information on ante-mortem alcohol ingestion, EtG was detected in blood in all cases, even when levels of ethanol were low. In another 53 cases where there were no indications of ante-mortem alcohol intake, EtG could not be detected in blood in a single case, also in 11 cases in which ethanol was detected and considered to be most probably formed post-mortem. In conclusion, blood EtG determination seems to be a reliable marker of ante-mortem ingestion of alcohol, and it could be considered in forensic autopsy cases when post-mortem formation of ethanol is questioned.

Disposition of perfluorobutane in rats after intravenous injection of Sonazoid

The new ultrasound contrast agent Sonazoid was injected IV in rats at doses of 0.8 and 8 muL perfluorobutane (PFB)-containing microbubbles/kg body weight. Samples were obtained from blood, liver, spleen, fat, kidney, muscle, heart, lung and brain from both males and females and the PFB gas was analyzed using validated gas chromatography mass spectrometry methods. No differences were observed between genders or doses for any of the pharmacokinetic parameters. For all tissues, the highest concentrations were observed at the first time point (i.e., 5 min postinjection) (51% of injected dose in liver; total recovery of 69%). The highest concentrations of PFB in tissue were observed in spleen > liver > lung > kidney >> other tissues. At 24 h after dosing, the total amount of PFB remaining in the tissues was 1.9%. These data fit well with the finding that after a Sonazoid dose of 8 microL microbubbles/kg to male rats, more than 50% of the injected PFB was recovered in exhaled air by 20 min after dosing. During the first 24 h after administration, more than 96% of the PFB dose was recovered in exhaled air.

A respiration–metabolism chamber system and a GC–MS method developed for studying exhalation of perfluorobutane in rats after intravenous injection of the ultrasound contrast agent Sonazoid™

Sonazoid is a new contrast agent for ultrasound imaging comprising an aqueous suspension of lipid-stabilised perfluorobutane (PFB) gas microbubbles. A respiration-metabolism chamber system was developed to collect exhaled air following intravenous administration of Sonazoid to rats. Analysis of PFB in the exhaled rat air was performed using a modified version of an earlier published method for blood samples, i.e. an automatic headspace gas chromatographic mass spectrometric (GC-MS) method using electron impact ionisation. The calibration standards were PFB diluted in air (2.5-1800 pg/ml). Perfluoropentane (PFP) was used as an internal standard and the MS detector was set to single ion monitoring of the base fragment ions of PFB (m/z 69 and 119) and PFP (m/z 69). The calibration curve, made by plotting the peak area ratios of PFB (m/z 69) to PFP (m/z 69) against the theoretical concentration of PFB, was fitted to a linear equation with weighting 1/y2 and found to be reproducible. The lower limit of quantification (LLOQ) was 2.5 pg PFB/ml. The between-day variation of the method was below 2.6% relative standard deviation (R.S.D.) and the within-day variation of the method was below 6.4% R.S.D. The accuracy of the method was evaluated and showed a relative error less than 5.2%. PFB was found to be stable for 14 days when stored in Tedlar sample bags at room temperature. An even lower detection limit may be obtained by using the more time-consuming process of solid-phase micro extraction; thus, by concentrating PFB on carboxen-PDMS fibres an LLOQ of 0.5 pg PFB/ml was obtained. When five rats were given an i.v. bolus injection of Sonazoid at a dose of 8 microl microbubbles/kg a mean recovery of 96% (range, 81-110%) was found during 24 h; more than 50% was exhaled during the first 30 min after injection.

Determination of perfluorobutane in rat blood by automatic headspace capillary gas chromatography and selected ion monitoring mass spectrometry

A new contrast agent (Sonazoid; NC100100) for ultrasound imaging has been developed. It is an aqueous suspension of lipid stabilised perfluorobutane (PFB) gas microbubbles. An automatic headspace capillary gas-chromatographic mass spectrometric method using electron impact ionisation was developed for analysis of Sonazoid PFB in rat blood. The calibration standards were gaseous PFB dissolved in ethanol in the range of 0.5-5000 ng PFB. Fluorotrichloromethane (CFC 11) was used as an internal standard of the method and the MS detector was set to single ion monitoring of the base fragment ions of PFB (m/z 69 and 119) and CFC 11 (m/z 101). The calibration graph, made by plotting the peak area ratios of PFB (m/z 69) to CFC 11(m/z 101) against the amount of PFB, was fitted to a second-order polynomial equation with weighting 1/y2 and found to be reproducible. The limit of quantification of the method was set to 0.4 ng PFB. The between-day variation of the method was below 9.2% relative standard deviation (RSD) and the within-day variation of the method was below 7.6% RSD. The accuracy of the method, as compared to Coulter counter, was estimated by determination of PFB in samples where Sonazoid was added to saline and found to range from 91.5% to 105.2%. PFB, added as Sonazoid, was found to be stable for at least 7 months in rat blood samples when stored at -20 degrees C.

In vivo stability and excretion of gadodiamide (GdDTPA-BMA), a hydrophilic gadolinium complex used as a contrast enhancing agent for magnetic resonance imaging

The stability and excretion of [14C]-gadodiamide (GdDTPA-BMA) was studied in male rats after i.v. injection of 0.3 mmol/kg [14C]-GdDTPA-BMA (Gd-diethylenetriaminepentaacetic-acid-bis-methylamide) formulated as gadodiamide injection (OMNISCAN, Nycomed Imaging AS, Oslo, Norway). Samples of blood and urine obtained within 60 min and 6 h postdosing, respectively, were analyzed for radiolabeled compounds. Analysis of GdDTPA-BMA in high and low molecular weight fractions of serum indicated no protein binding. HPLC analyses of urine samples obtained 0-2 h, 2-4 h and 4-6 h after injection revealed no detectable amounts of biotransformation products of GdDTPA-BMA. Serum samples obtained 30 min and 60 min after injection contained 9-13 microM of an unidentified compound which had a retention time different from all conceivable metabolites of gadodiamide. A similar concentration of this unknown compound was found in spiked predose serum samples. The total amount of the unknown compound in serum was less than 1% of the injected dose of [14C]-gadodiamide injection. It is concluded that gadodiamide, when administered i.v. as gadodiamide injection at a dosage of 0.3 mmol/kg, is stable in vivo and that the very major part of the dose (> 99%) is excreted in urine as an unchanged complex.

Interference of gadodiamide injection (OMNISCAN) on the colorimetric determination of serum calcium

The interference of the non-ionic magnetic resonance contrast medium gadodiamide injection (OMNISCAN, Nycomed Imaging, Oslo, Norway) in the colorimetric determination of serum calcium has been investigated in commercial reconstituted serum, and in serum from rabbits and humans dosed with the contrast medium. Inductively coupled plasma-atomic emission spectroscopy (ICP-AES) and ion-selective electrodes were used as reference methods for analysis of serum calcium. The results showed that the colorimetric reagent kit gave an apparent decrease in serum calcium after administration of a clinical dose of gadodiamide injection, and that the extent of interference is correlated to the concentration of the contrast medium. However, serum calcium was not changed when measured by means of an ion-selective electrode or ICP-AES. It is therefore recommended that colorimetric reagent kits should not be used for determination of serum calcium in samples taken within the first 24 h after administration of gadodiamide injection.

Detection and quantitation of gadolinium chelates in human serum and urine by high-performance liquid chromatography and post-column derivatization of gadolinium with Arsenazo III

A narrow-bore high-performance liquid chromatography method was developed for simultaneous separation of gadolinium diethylenetriaminepentaacetic acid (GdDTPA), the monomethylamide (GdDTPA-MMA) and the bis-methylamide (GdDTPA-BMA) in human serum and urine. The Gd complexes were detected at 658 nm after post-column derivatization with Arsenazo III. The serum samples were ultrafiltrated, whereas the urine samples were centrifuged and diluted before analysis. With an injection volume of 10 microliters on a 2.1 mm ID reversed-phase column, the limit of detection of GdDTPA-BMA was calculated as 0.3 microM and 1.1 microM in serum and urine, respectively. The method was validated with respect to GdDTPA-BMA with a limit of quantification set to 2 microM and 10 microM in serum and urine, respectively. The best fit of the calibration curve was obtained using non-linear regression according to the equation Y = A+BX+CX2 in the concentration ranges 2-800 microM and 10-2000 microM of GdDTPA-BMA in serum and urine, respectively. The precision of the method was found to range from 1 to 4% RSD. The recoveries of GdDTPA-BMA spiked in serum and urine were higher than 95% with an RSD equal to or less than 4%. The serum samples were stable for at least 5 months when stored at -70 degrees C, and the urine samples were stable for a least 6 months when stored at -20 degrees C.

Driving under the influence of toluene

Toluene is the most common volatile used for sniffing among adolescents. During 1983-1987, 114 drivers were arrested in Norway with blood toluene concentrations (BTCs) greater than 10 microM. Only four of these drivers were women. The age range was 15-34 years, and the mean age was 21. The mean BTC was 109 microM. There was no simple relation between blood toluene concentration and degree of impairment, however, most drivers with BTCs greater than 100 microM were considered as impaired or probably impaired by toluene. In a five year prospective study of rearrests among drivers arrested for driving after toluene sniffing, 12 out of 15 drivers were rearrested. They were responsible for 40 cases of suspected driving under influence of toluene, alcohol, or other drugs. The blood levels of toluene determined in this study must be regarded as minimum concentrations, since the toluene concentration fell rapidly in samples stored at 4 degrees C or 23 degrees C. Blood samples from drivers suspected of driving under influence of toluene must therefore be kept frozen.

Fatal intoxications in the Nordic countries. A forensic toxicological study with special reference to young drug addicts

Fatal intoxications in the 15-34 age group in the five Nordic countries during the years 1984 and 1985 (Sweden only in 1984) were investigated. The known drug addicts were studied separately. The highest incidence of intoxications, calculated per 10(5) population, was found in Finland (11.3), followed by Denmark (10.3), Sweden (8.5), Iceland (7.2) and Norway (6.6). The percentage of intoxications caused by drugs was 92 in Denmark, 71 in Norway, 66 in Sweden, 50 in Finland and 17 in Iceland. Ethanol intoxications were seen 5-7 and 2-3 times as frequently in Finland and in Iceland, respectively, than in the other three countries. Carbon monoxide intoxications accounted for two-thirds of all fatal intoxications in Iceland. Drug addicts accounted for 62% of all fatal intoxications in the Danish material. The corresponding figures were 33% in the Norwegian, 16% in the Swedish and 5% in the Finnish material. No deaths in drug addicts were found in Iceland. Most drug addicts in Denmark, Norway and Sweden died of hard drugs and most in Norway and Sweden, from heroin or morphine, whereas in Denmark other strong analgesics, such as methadone, dextropropoxyphene and ketobemidone, accounted for 40% of all hard-drug-related fatal intoxications. To a certain extent the results reflect differences in the legal autopsy routines in the various Nordic countries. However, the ascertainment of drug addicts is assumed to be near-complete in each country.

An experimental study on ethanol elimination at subphysiological temperatures

Hepatocytes isolated from fed and fasted rats have been used to study the rate of ethanol elimination at different incubation temperatures. In the presence of exogenous pyruvate, hepatocytes from fed and 42 hr fasted rats, eliminated ethanol at 37 degrees by a rate of 11.6 +/- 3.4 and 6.4 +/- 0.8 nmol/min./mg of cell protein (+/- S.D.; n = 5), respectively, which are comparable to the rates obtained in vivo. The ethanol oxidation rate in cells from rats of both nutritional states correlated linearily to the incubation temperature (t = 24-37 degrees) with a temperature coefficient (Q10) of 1.8-2.3. (Q10, (= temperature coefficient) is the factor by which the enzyme activity is increased on raising the temperature 10 degrees). These findings indicate that the oxidation is not controlled by processes which involve membrane transitions in the temperature range 24-37 degrees. Our results indicate that a hypothermic individual with a body temperature of 27 degrees would have a 40-50 per cent inhibition of the ethanol elimination rate. Thus, the observed dependency of the ethanol oxidation on the body temperature has to be regarded in back-calculations of blood ethanol concentrations in forensic toxicology.

Diethyl ether inhibits ethanol metabolism in vivo by interaction with alcohol dehydrogenase

The ethanol disappearance rate was determined in fed rats given 20-40 mM ethanol and anesthetized with pentobarbital (control group) and diethyl ether. The control ethanol disappearance rate was 0.27 +/- 0.02 mM/min (+/- SD, n = 4). Rats anesthetized with diethyl ether (blood levels of 9-13 mM) revealed an ethanol disappearance rate of 0.13 +/- 0.05 mM/min (+/- SD, n = 7), i.e., 52% inhibition of the control rate. Kinetic studies on crystalline and lyophilized alcohol dehydrogenase from equine liver demonstrated that 20 mM diethyl ether inhibited the initial rate of ethanol oxidation by 55%. By using ethanol as the variable substrate the inhibition of alcohol dehydrogenase was described by a mixed noncompetitive/uncompetitive mechanism.

Acute interaction of halothane and enflurane with the metabolism of ethanol in isolated hepatocytes and liver cytosol preparations from the rat

The effects of halothane and enflurane on ethanol (40 mM) oxidation were studied in isolated rat hepatocytes. Anaesthetic (halothane, enflurane and diethyl ether) effect on the activity of alcohol dehydrogenase (ADH) was studied in incubations of cytosol preparations from rat liver. Mean rates of ethanol metabolism ranged from 0.44 to 0.49 mumol ethanol metabolized/mg cell protein/hour in control hepatocytes from fasted and fed animals. These rates were enhanced by 2- and 3-fold in hepatocytes from fed and fasted animals, respectively, when pyruvate (5 mM) was added. Halothane and enflurane both caused dose dependent inhibition of ethanol metabolism (15-40%) in all hepatocytes without exogenous addition of pyruvate. The inhibitory effect was present also after pyruvate stimulation in hepatocytes from fasted animals, but disappeared in hepatocytes from fed animals when pyruvate was added. The rate of ethanol oxidation by cells from fed rats was enhanced by approximately 40% when the concentration of ethanol was increased from 20 mM to 80 mM. The anaesthetic inhibition of ethanol metabolism was about 20% more pronounced at the higher ethanol concentration compared to the lower concentration when no pyruvate was added. In the presence of pyruvate the effect of anaesthetics was again reversed regardless of ethanol concentration. Halothane (2 mM) and enflurane (2 mM) both caused about 25% inhibition of the ADH-activity in cytosol preparations while ether (30 mM) caused more than 50% inhibition. No inhibition of hepatocyte uptake of ethanol was caused by any of the three anaesthetics.(ABSTRACT TRUNCATED AT 250 WORDS)

Increase in mitochondrial content of long-chain acyl-CoA in brown adipose tissue during cold-acclimation

The mitochondrial content of long-chain acyl-CoA esters in the brown adipose tissue of guinea pigs increased 3.5-fold from a level of 92 +/- 17 pmol per mg protein (+/- S.E.; n = 7) in the control animals adapted at 22 degrees C to a new steady-state level of 328 +/- 20 pmol per mg protein (+/- S.E.; n = 46) after 10 days of cold-acclimation (5 degrees C). These low values of long-chain acyl-CoA species and the slow adaptive response for their increase do not support the proposal (Cannon, B., Sindin, U. and Romert, L. (1977) FEBS Lett. 4, 43-46) that the fatty acid CoA-esters have a physiological function in the regulation of the H+ (or OH-) permeability of the mitochondrial inner membrane. Experimental evidence is presented supporting the proposal that the long-chain acyl-CoA species are largely confined to the cytosolic side of the inner membrane. The activity of the adenine nucleotide translocase, as estimated at 25 degrees C in the reverse direction, was found to increase 5-fold upon depletion of the mitochondria of fatty acids (free and esterified) by preincubation with bovine serum albumin. The presence of potent inhibitors, i.e., long-chain acyl-CoA species, of adenine nucleotide translocation in brown adipose tissue of thermogenically active animals further supports the conclusion that ATP hydrolyzing mechanisms contribute insignificantly to long-term thermogenesis. The low values of long-chain acyl-CoA hydrolase (EC 3.1.2.1) activity, as measured in intact mitochondria and on a mitochondrial matrix fraction (i.e., 1.6 nmol X min-1 per mg protein), do not support the proposal that the hydrolase activity plays a significant role in the loose-coupling of brown adipose tissue mitochondria, either by a futile cycle mechanism or promoted by free fatty acid-induced uncoupling.

Acyl-CoA synthetase activity of rat heart mitochondria. Substrate specificity with special reference to very-long-chain and isomeric fatty acids

The acyl-CoA synthetase (acid: CoA ligase (AMP-forming), EC 6.2.1.3) activity of rat heart has been measured in fatty acid-depleted fractions of mitochondria, microperoxisomes and microsomes. The assay was based on (i) the measurement of the reaction product AMP by high-performance liquid chromatography or (ii) a coupled reaction in which the intramitochondrial (matrix) CoASH is the final acyl acceptor and the redox state of the flavoproteins in the acyl-CoA dehydrogenase pathway is used to determine the intramitochondrial level of acyl-CoA. This spectrophotometric method was also used to estimate the 'outer' carnitine long-chain acyltransferase (palmitoyl-CoA:L-carnitine O-palmitoyltransferase, EC 2.3.1.21) activity. Comparison of the distribution of long-chain acyl-CoA synthetase activity and marker enzymes in the various subcellular fractions revealed that the synthetase activity is exclusively localized in the mitochondrial fraction. Experimental evidence is presented in support of the conclusion that the chain-length specificity of saturated and monounsaturated fatty acids (16:1-22:1) for the acyl-CoA synthetase is mainly determined by the availability of the fatty acid at the active site, which is largely determined by the affinity of binding of fatty acids to the bulk phase of the mitochondrial phospholipids. Among the 22:1 isomers, 22:1(11) (cis) (cetoleic acid) revealed a slightly higher activity (1.4-fold) than 22:1(13) (cis) (erucic acid). The polyunsaturated fatty acids tested were rather poor substrates. Using isolated intact mitochondria and 16:0 or 22:1(13) (cis) as the substrates, it was found that the initial rate of the 'outer' long-chain acyltransferase activity was approximately four times higher than that of the long-chain acyl-CoA synthetase. The data support the hypothesis that the long-chain acyl-CoA synthetase reaction is rate-limiting in the sequence of coupled reactions leading to beta-oxidation in the mitochondrial matrix.

Hydrodynamic parameters and isolation of mitochondria, microperoxisomes and microsomes of rat heart

1. Analytical differential centrifugation of rat heart homogenates revealed a single population of mitochondria and microperoxisomes. Using cytochrome c oxidase, malate dehydrogenase and amine oxidase as mitochondrial marker enzymes, the s-value of mitochondria was estimated to s = 10326 +/- 406 S (average for the three marker enzymes). The s-value of microperoxisomes was found to be s = 1381 +/- 40 S using catalase as the marker enzyme. The s-value for the two organelles did not change significantly when the isoosmotic sucrose medium was substituted by an isoosmotic mannitol medium. 2. Analytical differential centrifugation revealed a polydispercity of the microsomal fraction using glucose-6-phosphatase and NADPH-cytochrome c reductase as the marker enzymes. The s-values were found to be sH1 = 1569 +/- 412 S (NADPH-cytochrome c reductase), sH2 = 1195 +/- 400 S (glucose-6-phosphatase) and sL = 153 +/- 28 S (NADPH-cytochrome c reductase and glucose-6-phosphatase). The recovery of marker enzymes in the isolated subcellular fractions was in the range of 84-94%. 3. When the mitochondrial and microperoxisomal fractions were subjected to isopycnic gradient centrifugation, using a self-generating gradient of polyvinylpyrrolidone-coated colloidal silica particles (Percoll) in 0.25 M sucrose medium, buoyant densities of 1.10 g/cm3 (main fraction of mitochondria) and 1.06 g/cm3 (main fraction of microperoxisomes) were obtained. The density gradient centrifugation separated microperoxisomes from contaminating lysosomes of high specific activity in acid phosphatase. A value 1.04 g/cm3 was found for the density of the microsomal fraction. 4. Based on the estimated s-values, an optimal procedure is described for the isolation of mitochondrial and microperoxisomal fractions from rat heart muscle.

Microperoxisomes and mitochondria of brown adipose tissue. Hydrodynamic parameters, isolation and capacity of long-chain fatty acid oxidation

1. Analytical differential centrifugation of brown adipose tissue homogenates from cold-acclimated guinea pigs revealed a polydispersity of both mitochondria and peroxisomes, with at least two populations of each organelle. The estimated values were sH = 16685+/-4220 S and sL = 4792+/-951 S (mitochondria), and sH = 3364+/-1706 S and sL = 889+/-177 S (peroxisomes). Based on these s values, an optimal procedure is described for the isolation of subcellular fractions enriched in mitochondria and peroxisomes, respectively. 2. When the mitochondrial and peroxisomal fractions were subjected to isopycnic gradient centrifugation on a self-generating gradient of poly(vinylpyrrolidone)-coated colloidal silica particles (Percoll) in 0.25 M sucrose medium, buoyant densities of about 1.11 g/cm3 (main fraction of mitochondria) and 1.07 g/cm3 (main fraction of peroxisomes) were obtained. A value of 1.06 g/cm3 was found for the microsomal fraction. 3. The main peroxisomal fraction, isolated by gradient centrifugation, did not reveal any significant oxidation of palmitoyl-CoA as measured by conventional polarographic technique, whereas a small rate of oxidation (about 2.7+/-0.2 nmol/min per mg peroxisomal protein) was observed when measured as NAD+ reduction. This rate contributes no more than 1% of the mitochondrial oxidation of this fatty acid and it is, therefore, concluded that peroxisomal oxidation of the predominant long-chain fatty acids found in this tissue does not make a quantitatively significant contribution to fatty acid oxidation.

Transport of ascorbate into guinea pig liver mitochondria

The amount of ascorbate associated with guinea pig liver mitochondria was estimated by high-performance liquid chromatography. Incubation of mitochondria with ascorbate revealed a time-dependent and temperature-dependent accumulation of the vitamin. A steady-state level of ascorbate was obtained in the mitochondria after about 20 min of incubation at 37 degrees C, whereas no accumulation was observed at 0 degrees C. The matrix concentration of ascorbate was highly correlated to the concentration of ascorbate in the incubation medium. The initial rate of accumulation (about 7 pmol/mg protein per min at 10 degrees C) was three orders of magnitude less than for compounds that are transported across the mitochondrial inner membrane by specific carriers. Experiments with the enzyme ascorbate oxidase demonstrated that the mitochondrial membrane is also permeable to dehydroascorbate, and that the accumulated dehydroascorbate is stable in the mitochondria. There was no effect of the energy state of the mitochondrial membrane of the initial transport rate of ascorbate. Electrostatic binding of ascorbate to the membrane was excluded from experiments performed in isosmotic potassium chloride medium. Diffusion of ascorbate across the mitochondrial inner membrane accounts for the experimental findings.

Acyl-CoA synthetase activity of rat liver microsomes. Substrate specificity with special reference to very-long-chain and isomeric fatty acids

1. A fatty acid-depleted rat liver microsomal fraction has been used for the measurement of acyl-CoA synthetase (acid : CoA ligase (AMP-forming), EC 6.2.1.3) activity. The assay was based on measurement of the reaction product AMP by high-performance liquid chromatography (HPLC). The synthetase activity (V') revealed an optimum at 12 : 0 with saturated fatty acids as substrate, and at 14 : 1 with mono-unsaturated fatty acids. The apparent Michaelis constant, on the other hand, showed no systematic dependence on the fatty acid chain-length. 2. The mono-unsaturated fatty acids from 14 : 1 to 22 : 1 gave higher activities than the corresponding saturated fatty acids, and the relative differences were greatest with the very-long-chain fatty acids eicosaenoic (20 : 1 (11) (cis)) and docosaenoic acid (22 : 1 (11) (cis)). The synthetase activity with saturated and mono-unsaturated fatty acids was found to correlate to their capacity factor (k') on reversed phase chromatography (HPLC). This finding may indicate that the observed chain-length dependence of the activity largely reflects the partition of the fatty acids between a hydrophobic and a hydrophilic phase. In general, the position of the double bond and the cis/trans configuration had little effect on the V' values except for 22 : 1 (11)(cis) which revealed a 2-fold higher activity tha 22 : 1 (13) (cis). 3. The polyunsaturated fatty acid 22 : 6 (all cis) ;was notably found to be a much better substrate than other C22 fatty acids. 4. The present study does not support the idea of more than a single ATP-dependent acyl-CoA synthetase in the rat liver microsomal fraction.

Acyl-CoA synthetase activity of brown adipose tissue mitochondria. Substrate specificity and its relation to the endogenous pool of long-chain fatty acids

1. A new assay of acyl-CoA synthetase (acid:CoA ligase (AMP-forming), EC 6.2.1.3) activity was developed for application to measurements on isolated intact mitochondria. The assay was based on the formation of the product AMP as determined by high-performance liquid chromatography (HPLC), making corrections for the partial conversion of AMP to ADP by the adenylate kinase reaction. 2. The substrate specificity of the long-chain acyl-CoA synthetase was measured in brown adipose tissue mitochondria, isolated from cold-acclimated guinea-pigs. Using mitochondria largely deficient of endogenous fatty acids, the synthetase activity (V') revealed an optimum at 12 :0 and 13 : 0 with saturated fatty acids as the substrate. In contrast to other tissues, the highest V' values were observed with unsaturated fatty acids 18 : 1 (9) (cis) and 18 : 2 (9, 12) (all cis). The apparent Michaelis constant varied within a narrow range and revealed no systematic dependence on the chain-length as was the case for V'. Since the mitochondria have a high capacity of fatty acid binding, with unknown affinity, the estimated K'm values are, however, of questionable significance. 3. The pattern of chain-length specificity in the synthetase reaction of the mitochondria compares well with the pattern of endogenous long-chain fatty acids in which mainly four species contribute, i.e. 18 : 1 (42 mol%) and 18 : 2 (18 mol%), 16 : 0 (26 mol%) and 18 : 0 (14 mol%).

Long-chain acyl-CoA synthetase and "outer" carnitine long-chain acyltransferase activities of intact brown adipose tissue mitochondria

1. The activities of long-chain acyl-CoA synthetase (acid: CoA ligase (AMP-forming), EC 6.2.1.3) and the "outer" carnitine long-chain acyltransferase (palmitoyl-CoA: L-carnitine O-palmitoyltransferase, EC 2.3.1.21) have been estimated in intact brown adipose tissue mitochondria. The assay of both enzymes is based on a coupled reaction in which the intramitochondrial (matrix) CoASH is the final acyl acceptor and the oxidation-reduction state of the flavoproteins in the acyl-CoA dehydrogens pathway is used to determine the intramitochondrial level of acyl-CoA. 2. Using endogenous fatty acids as the substrate, the progress curve of acyl-CoA synthetase activity was in most mitochondrial preparations linear within the first 30 s. When initial rates were measured, the Km value for CoASH (2.4 micron) was lower than previously determined for the acyl-CoA synthetase in brown adipose tissue mitochondria as well as in mitochondria of other tissues. The pH activity curve indicates that the unprotonated form of the fatty acids represents the substrate of acyl-CoA synthetase, i.e. similar to the effect of pH on the binding of fatty acids to bovine serum albumin. 3. Experimental evidence is presented that at temperatures higher than the transition temperature of the acyl-CoA synthetase (i.e. Tt = 19 degrees C), this enzymic reaction is rate-limiting in the sequence of coupled reactions leading to beta-oxidation in the mitochondrial matrix. 4. The initial rate of the long-chain acyl-COA synthetase reaction was estimated to v = 119 +/- 16 nmol . min-1 . mg-1 protein (mean +/- S.D., n = 5) at an optimal concentration of palmitate which exceeds that of rat heart mitochondria by a factor of 10.

On the rate-limiting step in the transfer of long-chain acyl groups across the inner membrane of brown adipose tissue mitochondria

Brown adipose tissue mitochondria predominantly oxidize fatty acids in order to generate heat for non-shivering thermogenesis, and have an unusually high capacity for net transfer of long-chain fatty acyl groups from the outer to the inner (matrix) compartment. The activities of the "outer" and "inner" carnitine long-chain acyltransferases have been estimated in isolated mitochondria of cold-acclimated guinea pits by the continuous spectrophotometric recording of the redox level of flavoproteins in the acyl-CoA dehydrogenase pathway. This redox level is determined by the intramitochondrial content of acyl-CoA under the selected experimental conditions. The apparent initial rate of the "inner" acyltransferase (palmitoyl-L-carnitine added) is three order of magnitudes higher than the "outer" acyltransferase (palmitoyl-CoA added), and this difference is not influenced by the substrate concentration, pH and reaction temperature. Thus, the "outer" acyltransferase reaction is rate limiting in the transfer of long-chain acyl groups across the inner membrane of these mitochondria and catalyzes a non-equilibrium reaction in the intact organelle. Estimates of the absolute rate of the "outer" long-chain acyltransferase indicate that it exceeds that of rat liver mitochondria by a factor of 20.

Newly synthesized hepatic cholesterol as precursor for cholesterol and bile acids in rat bile

Adult, male rats were given simultaneously 3H-mevalonate and 14C-cholesterol on autologous lipoproteins intravenously in barbital anaesthesia. The specific radioactivities of sterols in bile, liver and serum were determined. Newly synthesized hepatic cholesterol was a better substrate for cholic and chenodeoxycholic acid than was cholesterol reaching the liver via plasma lipoproteins. The cholesterol secreted into bile was derived from a pool of liver cholesterol which was in close contact with newly synthesized cholesterol. Specific radioactivity of chenodeoxycholate in bile was higher than that of cholate in bile, both when newly made radioactive cholesterol and when radioactive cholesterol on plasma lipoproteins was the precursor for the labelled bile acids.