Haymond, Morey W.

Animal studies have shown that pancreatic enzyme secretion is independent of enzyme synthesis. To investigate this relationship in humans, we have coinfused 14C-labeled leucine tracer with cholecystokinin octapeptide in nine healthy adults for 4 h and measured the rate of appearance of secreted and newly labeled enzymes in the duodenum. Enzyme secretion was well maintained throughout, but newly labeled enzymes only appeared in juice between 75 and 101 min (median time, 86 min), indicating that initial secretion was dependent on the release of zymogen stores and that the median production time for new enzymes was 86 min. Between 85 and 225 min there was a curvilinear increase in the enrichment of secreted enzymes with newly synthesized enzymes, suggesting a median turnover rate of zymogen stores of 29%/h (range 12-47%/h). In conclusion, our results suggest that in healthy humans, postprandial pancreatic enzyme secretion is maintained by the export of a large stored pool and is not rate limited by enzyme synthesis, since it takes approximately 86 min for newly synthesized enzymes to take part in the digestive process.

High-dose glucocorticoid treatment results in protein wasting. To determine whether such therapy affects leucine oxidation in the postabsorptive state and the disposal of dietary amino acids, eight normal subjects were studied twice in random order, once after 5 days of prednisone (20 mg three times daily) and on a second occasion without prednisone as a control. In the postabsorptive state prednisone therapy increased (P less than 0.05) plasma concentrations of leucine, alpha-ketoisocaproate, glucose, insulin, and C-peptide, as well as leucine carbon flux and oxidation calculated by means of isotope dilution techniques and [1-13C]leucine. During infusion of a chemically defined meal, total leucine carbon flux and oxidation increased similarly on both study days, but leucine oxidation was greater (P less than 0.01) during prednisone treatment; net leucine balance became positive on the control day but remained negative or zero on the prednisone study day despite higher (P less than 0.05) plasma insulin concentrations. These studies demonstrate that high-dose glucocorticoid treatment impairs the balance of the essential amino acid leucine in both the postabsorptive and absorptive states in humans.

We previously proposed that, during the infusion of either labeled leucine or its alpha-ketoacid, alpha-ketoisocaproate (KIC), the plasma specific activity (SA) of the transaminated product of the infused tracer ("reciprocal pool SA") may better reflect the intracellular leucine SA than the plasma SA of either infused tracer ("primary pool SA"). To test this hypothesis, 14 dogs were simultaneously infused intravenously with [3H]leucine and [14C]KIC, and blood and tissue compartments were sampled. The ratios of [3H]-leucine to [14C]leucine [( 3H]/[14C]leucine) in mixed tissue proteins and in the intracellular space of striated muscle were the same as the ratio of the isotope infusion rates and similar, although slightly lower (P less than 0.01), than [3H]KIC/[14C]leucine SA (ratio of reciprocal pool SA) in plasma. Plasma [3H]KIC/[14C]leucine SA were essentially identical to the [3H]/[14C] of leucine in 1) mixed liver proteins, 2) intrahepatic free leucine, and 3) fibrin. The [3H]/[14C]leucine in mixed renal proteins and in the intracellular space of kidney and erythrocytes were similar to those of the venous plasma [3H]/[14C]leucine SA. The plasma [3H]KIC and [14C]leucine SA (the reciprocal pool SA) were similar to the SA of [3H]- and [14C]leucine in the intracellular space of all organs investigated with the exception of kidney. Therefore, in postabsorptive dogs, the plasma SA of the transaminated product of the infused labeled KIC or leucine is an excellent predictor of the intracellular leucine SA in all tissues investigated with the exception of kidney.

Previous studies have indicated that simultaneous infusions of two ketone body tracers ([13C]acetoacetate and [14C]beta-hydroxybutyrate) provide accurate estimates of exogenous ketone body inflow when an open two-pool model is employed. In the present studies, net hepatic ketone body production was determined from surgically placed arterial, portal venous, and hepatic venous catheters in conscious diabetic (n = 6) and 4-day fasted (n = 7) dogs. [13C]acetoacetate and [14C]beta-hydroxybutyrate were infused simultaneously, and ketone body production was calculated from either acetoacetate (AcAc) single-isotope data, beta-hydroxybutyrate (beta-OHB) single-isotope data, the sum of individual fluxes, or the two-pool model. In fasted animals, both the AcAc single-isotope calculation and the sum of individual fluxes overestimated net hepatic production by approximately 50% (P less than 0.05), whereas the beta-OHB single-isotope calculation and the two-pool model gave accurate estimates. In the diabetic animals, the beta-OHB single-isotope calculation underestimated net hepatic production by approximately 30% (P less than 0.05). The sum of individual fluxes overestimated net hepatic production by approximately 46% (P less than 0.05), whereas both the AcAc single-isotope calculation and the two-pool model gave accurate estimates. In conclusion, single-isotope methods give erroneous estimates of net hepatic production of ketone bodies. In contrast, a two-pool model provided an accurate estimate of net hepatic production and thus appears to be suitable for determination of ketone body kinetics in humans.

To determine whether fasting alters the ability of insulin to suppress endogenous glucose production or proteolysis, isotopic flux measurements of glucose, leucine, alpha-keto-isocaproate, and alanine were made in 13 normal volunteers after a 14-h (day 1) and an 84-h (day 4) fast. Using the “pancreatic clamp” technique, we achieved small increments in plasma insulin concentrations, as well as constant and identical plasma hormone and glucose concentrations, on both study days in seven subjects. The remaining six subjects were infused with saline and served as controls. Leucine rate of appearance (an index of proteolysis) was greater on day 4 than on day 1 (P less than 0.001), but decreased to equal values during the pancreatic clamp on each study day. During the pancreatic clamp, endogenous glucose production decreased to lesser (P less than 0.005) values on day 4 than on day 1. In conclusion, insulin suppresses proteolysis equally well before and after brief fasting, and endogenous glucose production is more completely suppressed by insulin after brief fasting than after an overnight fast.

Leucine and/or its alpha-keto acid, alpha-ketoisocaproate (KIC), have been reported to spare protein in humans. To determine whether specific amino acid infusions affect whole-body protein metabolism as estimated by changes in leucine flux and oxidation, five groups of normal subjects were infused with saline, leucine (0.47 and 0.94 mumol . kg-1 . min-1), isoleucine (0.47 mumol . kg-1 . min-1), or threonine (0.47 mumol . kg-1 . min-1). Independent estimates of leucine metabolism were obtained using simultaneous infusions of [3H]-leucine and alpha-[14C]ketoisocaproate. Nearly identical results were obtained using either tracer compared with the saline controls. Compared with the saline controls, leucine infusion 1) had no effect on estimated rates of appearance of endogenous leucine, 2) stimulated leucine oxidation, 3) decreased plasma concentrations of other amino acids, and 4) stimulated non-oxidized leucine disappearance in a dose-dependent fashion. In contrast, isoleucine and threonine infusions had no effect on leucine metabolism. Assuming the validity of the isotope model employed, these data suggest that the purported anabolic effect of leucine infusion on whole-body protein metabolism is mediated via stimulation of protein synthesis rather than decreased proteolysis.

To assess the contributions of leucine and alpha-ketoisocaproate (KIC) derived from the portal vein vs. hepatic artery for hepatic protein synthesis, 14-postabsorptive dogs were infused simultaneously with [1-14C]- and [4,5-3H]leucine or [1-14C]- and [4,5-3H]KIC. On one occasion one tracer was infused via a leg vein and the other via mesenteric infusion catheters, and dogs were restudied with both tracers infused systemically. The ratios of systemically to portally infused tracers in portal and arterial plasma leucine were used as indexes of the radioactivity in the potential precursor pools and in fibrinogen-bound leucine as a paradigm of hepatic protein synthesis. In the dogs given leucine tracers, the relative proportions of systemically to portally infused radioactivity in portal free leucine (0.50 +/- 0.06) were lower (P less than 0.001) than in arterial free leucine (1.22 +/- 0.03) and not different from that bound in fibrinogen (0.43 +/- 0.02). In the dogs infused intraportally with KIC, these values were 0.81 +/- 0.04, 0.97 +/- 0.05, and 0.74 +/- 0.05, respectively. In the control studies these ratios were not significantly different from the expected value of 1.0. The results suggest that, in postabsorptive dogs, fibrinogen is exclusively synthesized from portally delivered leucine with little or no contribution from the hepatic artery, whereas portally delivered KIC contributes little directly to fibrinogen synthesis. These data are consistent with zonation of hepatic amino acid metabolism and/or protein synthesis.

These studies were performed to determine whether protein turnover during exercise and after weight loss is influenced by obesity and body fat distribution. Leucine carbon flux was measured before, during, and after 2.5 h of bicycle exercise in 10 upper body obese, 9 lower body obese, and 6 nonobese, age-matched, premenopausal women. The obese women then followed an energy-restricted diet for 16 wk, resulting in approximately 8 kg weight loss. Baseline leucine carbon flux was greater (P < 0.01) in obese women than in nonobese women but decreased in a similar fashion in response to exercise in all groups. There were no differences between upper body and lower body obese women during exercise. After weight loss, baseline leucine carbon flux decreased (P < 0.05) similarly in both groups of obese women and was further suppressed by exercise. Thus obesity phenotype has no specific effect on either baseline protein turnover or the antiproteolytic response to moderate intensity exercise or weight loss. We conclude that the previously observed defect in insulin suppression of leucine flux in upper body obese women appears related to insulin resistance and does not represent an inherent abnormality of protein metabolism.

Human growth hormone (hGH) and prednisone cause insulin resistance and glucose intolerance. However, it is unknown whether hGH and prednisone antagonize insulin action on protein, fat, and carbohydrate metabolism by a common or independent mechanism. Therefore, protein, fat, and carbohydrate metabolism was assessed simultaneously in four groups of eight subjects each after 7 days of placebo, recombinant DNA hGH (rhGH; 0.1 mg · kg−1 · day−1), prednisone (0.8 mg · kg−1 · day−1), or rhGH and prednisone administration after an 18-h fast and during gut infusion of glucose and amino acids (fed state). Fasting plasma glucose concentrations were similar during placebo and rhGH but elevated (P &lt; 0.001) during combined treatment, whereas plasma insulin concentrations were higher (237 ± 57 pmol/ml, P &lt; 0.001) during combined than during placebo, rhGH, or prednisone treatment (34, 52, and 91 pM, respectively). In the fed state, plasma glucose concentrations were elevated only during combined treatment (11.3 ± 2.1 mM, P &lt; 0.001). Plasma insulin concentrations were elevated during therapy with prednisone alone and rhGH alone (667 ± 72 and 564 ± 65 pmol/ml, respectively, P &lt; 0.001) compared with placebo (226 ± 44 pmol/ml) but lower than with the combined rhGH and prednisone treatment (1249 ± 54 pmol/ml, P &lt; 0.01). Protein oxidation ([14C]leucine) increased (P &lt; 0.001) with prednisone therapy, decreased (P &lt; 0.001) with rhGH treatment, and was normal during the combined treatment. By indirect calorimetry, glucose oxidation was similar in all groups; fasting fat oxidation was decreased by prednisone (P &lt; 0.001) and increased by rhGH, although only significantly in the fed state (P &lt; 0.01). In summary, insulin antagonism of rhGH and prednisone are probably caused by independent mechanisms in which rhGH and prednisone may reciprocally regulate the oxidation of protein and fat while decreasing the efficiency of glucose disposal.