Endocrine-metabolic relationships in patients with leprechaunism.

Leprechaunism is a rare, heritable syndrome, associated with multiple dysmorphic and pathologic features, suggestive of an endocrine dysfunction. Few endocrine and metabolic studies have been obtained because of the rarity of the syndrome, and the small size and early demise of these infants. The authors present here the clinical, anatomic, and endocrine-metabolic studies of three patients, with a view toward careful delineation of the syndrome and further characterization of the metabolic defect.

Glucose and insulin effects on the novo amino acid synthesis in young men: studies with stable isotope labeled alanine, glycine, leucine, and lysine.

We have explored interrelationships between te dynamic aspects of whole body glucose and alanine and glycine metabolism in adult humans. Using a primed, continuous intravenous infusion of [1-13C] leucine or lysine given simultaneously with [2H3] or [15N]alanine or [15N]glycine, respectively, whole body alanine and glycine fluxes and their rates of de novo synthesis were determined in three experiments with healthy young men. Subjects were studied in the post-absorptive state and during a 150 min period of an intravenous infusion with unlabeled glucose, at a rate of 4 mg.

Relationship of plasma leucine and alpha-ketoisocaproate during a L-[1-13C]leucine infusion in man: a method for measuring human intracellular leucine tracer enrichment.

The keto analog of leucine, alpha-ketoisocaproate (KIC), is formed intracellularly from leucine and is released, in part, into the systemic circulation. Therefore. KIC can be used to estimate intracellular leucine tracer enrichment in man during labeled-leucine tracer experiments without requiring tissue biopsy samples.

The conversion of phenylalanine to tyrosine in man. Direct measurement by continuous intravenous tracer infusions of L-[ring-2H5]phenylalanine and L-[1-13C] tyrosine in the postabsorptive state.

Steady state phenylalanine and tyrosine turnover and the rate of conversion of phenylalanine of tyrosine in vivo were determined in 6 healthy postabsorptive adult volunteers. Continuous infusions of tracer amounts of L-[ring-2H5]phenylalanine were determined intravenously for 13-14 hr. After 9-10 hr, a priming dose followed by a continuous infusion of L-[1-13C]tyrosine was added and maintained, along with the [2H5]phenylalanine infusion, for 4 hr.

The stimulus-secretion coupling of amino acid-induced insulin release. Metabolic response of pancreatic islets of L-glutamine and L-leucine.

L-Glutamine markedly enhances insulin release evoked by L-leucine in rat pancreatic islets. The metabolic situation found in the islets exposed to both L-glutamine and L-leucine was investigated. L-Leucine slightly decreased the rate of L-glutamine deamidation, inhibited the conversion of glutamate to 2-ketoglutarate by transamination, increased the oxidative deamination of L-glutamate, stimulated the recirculation of 2-ketoglutarate to glutamate and inhibited the further oxidative metabolism of 2-ketoglutarate.

Stable isotope tracer methods for in vivo investigations.

During the last two decades, in parallel with the growth of modern electronics, several new techniques have been developed for measuring stable isotopic enrichments in biochemistry and medicine. The development and potential of these techniques are discussed. Of these methods, mass spectrometry has been developed and refined the fullest to quantitate stable isotope tracers in very minute samples and for very large dilutions of tracer.

Lipid transport in the human newborn. Palmitate and glycerol turnover and the contribution of glycerol to neonatal hepatic glucose output.

Free fatty acid (FFA) transport was measured in 11 and glycerol turnover in 5 newborns with continuous tracer infusion of [1-(13)C]palmitate or [2-(13)C]glycerol, respectively. In addition, simultaneous determination of glucose production in the latter group with [6,6-(2)H(2)]glucose tracer and measurement of the appearance rate of [(13)C]glucose derived from [(13)C]glycerol allowed calculation of gluconeogenesis from glycerol.The average FFA inflow rate was 11.

Whole body leucine metabolism in adolescents with Crohn's disease and growth failure during nutritional supplementation.

The adaptive response of whole body leucine metabolism to nutritional supplementation was determined in 6 adolescents with Crohn's disease and growth failure. Five healthy adolescents served as controls for body composition studies. In the first study period, all subjects received a constant diet comparable to usual intakes.

Galactose intolerance in individuals with double heterozygosity for Duarte variant and galactosemia.

The most frequent cause for an abnormal result during screening of newborn infants for galactosemia is double heterozygosity for Duarte variant and galactosemia, in which galactose-1-phosphate uridyl transferase activity is reduced to approximately 17% of normal. Thirty-nine oral galactose tolerance tests were performed in 27 infants and children with this condition. In comparison to age-matched controls, all children with this genetic variant reached much higher levels of blood galactose and galactose-1-phosphate following oral galactose challenge.

Stable isotope dilution method for measurement of palmitate content and labeled palmitate tracer enrichment in microliter plasma samples.

In studies where [1-13C]palmitic acid is employed as isotopic tracer in vivo, we have described a selected ion monitoring gas-liquid chromatography-mass spectrometry micro-method which allows plasma tracer enrichment as well as plasma palmitate content to be determined in the same 100-microliter sample through the use of [5,5,6,6-2H4]palmitic acid as assay internal standard. For standard solutions in the range equivalent to plasma palmitic acid concentrations of 10--2500 microM, assay precision was +/- 5%. For plasma samples in the physiologic range (approximately 30--200 microM palmitate) assay precision averaged better than +/- 2%.

Quantitative aspects of glucose production and metabolism in healthy elderly subjects.

The metabolic basis for the reduced glucose tolerance that occurs during aging in humans has been explored with the aid of a primed constant intravenous infusion method of labeled glucose (6-3H; 6,6,2H- and U-13C-glucose). Healthy young adult men and women (24 +/- 3 yr) and elderly men and women (75 +/- 4 yr) participated in a series of studies designed to quantify rates of plasma glucose appearance, oxidation, and recycling while subjects were in the postabsorptive (basal) state and to determine rates of hepatic glucose production and glucose disappearance in response to intravenous glucose at approximately 1 and 2 mg x kg-1min-1 and also 4 mg x kg-1min-1 without or with a simultaneous infusion of insulin to maintain normoglycemia. Basal rates of glucose production were 2.

Hepatic ultrastructure in leprechaunism. Hepatic ultrastructural evidence suggesting a syndrome with defective hepatic glucose release.

Leprechaunism is a congenital syndrome with characteristic habitus and facies, with fasting hypoglycemia and hyperinsulinism. In response to a glucose challenge there is prolonged severe hyperglycemia with an increased hyperinsulinemia. Our studies on such a patient showed a normal response of the serum glucose to glucagon stimulation in the fed state but no response in the postabsorptive state.

The use of deuterated phenylalanine for the in vivo assay of phenylalanine hydroxylase activity in children.

Fifteen children, five with phenylketonuria (PKU), five with hyperphenylalaninaemia, and five phenotypically normal but at risk of being carriers for PKU, were given [ring 2H5]phenylalanine orally in amounts ranging from 75 mg/kg to 10 mg/kg. Plasma was assayed for [2H5]phenylalanine and [2H4]tyrosine at hourly intervals, the amino acids being measured as the N-acetyl, n-propyl esters by gas chromatography-mass spectroscopy. The results obtained were calculated as the log of the ratio [2H5]phenylalanine: [2H4]tyrosine in the plasma.

Regulation of leucine metabolism in man: a stable isotope study.

Leucine catabolism is regulated by either of the first two degradative steps: (reversible) transamination to the keto acid or subsequent decarboxylation. A method is described to measure rates of leucine transamination, reamination, and keto acid oxidation. The method is applied directly to humans by infusing the nonradioactive tracer, L-[15N,1-13C]leucine.

Direct measurement of gluconeogenesis from [2,3]13C2]alanine in the human neonate.

The functional integrity of the gluconeogenic pathway was measured in nine term infants, four appropriate-for-gestational age (AGA), and five normoglycemic small-for-gestational age (SGA), by determination of 13C2 enrichment in blood glucose during the constant infusion of tracer [2,3]13C2]alanine between 4 and 8 h of postnatal age. Alanine flux, calculated from the steady-state blood [2,3-13C2]alanine enrichment was 16.6 +/- 1.

Epinephrine plasma thresholds for lipolytic effects in man: measurements of fatty acid transport with [l-13C]palmitic acid.

To determine the plasma epinephrine thresholds for its lipolytic effect, 60-min epinephrine infusions at nominal rates of 0.1, 0.5, 1.

Whole-body leucine and lysine metabolism: response to dietary protein intake in young men.

Whole-body leucine and lysine metabolism was explored in young adult men by a primed constant intravenous infusion of a mixture of L-[1-13C]leucine and L-[alpha-15N]lysine over a 4-h period. Subjects were studied after an overnight fast (postabsorptive state) or while consuming hourly meals (fed state) after adaptation to diets providing either a surfeit level of protein (1.5 g.