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Biomedical subjects

H Vilstrup

Publications and source records attributed to H Vilstrup.

At least 127 records · Page 7Linked to original sources
PubMed1987

Plasma clearances of branched-chain amino acids in control subjects and in patients with cirrhosis.

In an attempt to clarify the pathogenesis of the decreased branched-chain amino acid (BCAA) plasma concentrations in cirrhosis, the plasma clearances were measured in 7 patients with cirrhosis and in 7 age- and sex-matched control subjects. BCAA were given as prime-continuous infusions. The plasma clearances of valine, isoleucine, and leucine, calculated as infusion rate divided by steady state concentration, were low normal in cirrhotics despite hyperinsulinaemia, but different BCAA had different clearances (P less than 0.01). The endogenous basal appearance rates of BCAA, estimated by the basal concentrations multiplied by the plasma clearances, were lower in cirrhotics (P less than 0.025). The apparent theoretical volumes of distribution of BCAA, assessed by the ratio between the clearance and the concentration decay constant after infusion stop, were on average 67% of the total body weight, and were neither different among the three BCAA, nor between the two groups. The urea nitrogen synthesis rate did not increase significantly, suggesting that most of the infused BCAA nitrogen was taken up in peripheral tissues. The decreased concentration of BCAA in cirrhotics (394 +/- 81 mumol/l (mean +/- SD) in the present series vs 510 +/- 68 in controls; P less than 0.025) is not attributable to changes in plasma clearance. The most likely explanation is decreased afflux of BCAA into plasma.

Adult↗
PubMed1987

Time dependent stimulating effect of glucagon on the capacity of urea-N synthesis in rats.

The effect of glucagon on the capacity of urea-N synthesis was examined in 24 rats as a function of time. First, the conditions for saturation of urea synthesis under glucagon influence were studied by the kinetics of urea-N synthesis rate in relation to arterial blood alpha-amino-N concentration between 5 and 17 mmol/l in 21 nephrectomized rats given zinc-glucagon (20 micrograms s.c. per day) for 14 days. Alanine was infused so that steady state concentrations of total alpha-amino-N was attained in each rat. The urea-N synthesis rate was calculated as accumulation in total body water corrected for intestinal hydrolysis. The relationship suggested a barrier limited substrate inhibition kinetics, as earlier found in control rats, and data were examined accordingly by non-linear regression analysis. The estimated kinetic constants were: Vmax = 71 mumol/(min X 100 g body wt), Km = 5.4 mmol/l, Ki = 2.4 mmol/l, and the barrier = 4.4 mmol/l. Vmax was increased three times compared with controls. The capacity of urea-N synthesis, i.e. the zenith of the relation, was attained in the concentration interval 7.5 to 12.0 mmol/l, as in controls. The capacity of urea-N synthesis was determined during i.v. infusion of zinc-glucagon (0.15 microgram per min) and after 2, 8, and 14 days of daily s.c. injections of 20 micrograms zinc-glucagon. Rats given zinc-protamine solution were controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Increased capacity of urea synthesis in streptozotocin diabetes in rats.

Diabetes was induced in Wistar rats by intravenous streptozotocin, 75 mg/kg. Four and 14 days after streptozotocin, fasting insulin decreased to about one-third, and fasting glucagon increased three-fold. The urea-N synthesis rate, stimulated by infusion of alanine, was measured at different amino acid concentrations 14 days after streptozotocin in 24 rats. The relationship was compatible with a barrier limited substrate inhibition kinetics. Data were examined accordingly by non-linear regression analysis. Among the estimated kinetic constants, only the 70% increase in Vmax was different from control values. In control rats the capacity of urea nitrogen synthesis, as measured within the amino acid concentration interval 7.3-11.6 mmol/l, was 10.2 +/- 1.1 mumol . (min 100 g BW)-1 (mean +/- SEM). The capacity was not different in 4 day diabetic rats, whereas it doubled in 14 day diabetic rats, 20.9 +/- 1.7 mumol (min 100 g BW)-1. The alanine elimination rate was 35% higher in the 14 day diabetic rats compared both to 4 day diabetic and control rats. The increase of urea synthesis is suggested to be due to enzyme induction by glucagon. The net nitrogen balance was negative at amino acid concentrations up to 25 mmol/l, indicating that the urea synthesis was increased at the expense of amino nitrogen.

Animals↗
PubMed1986

Glucoregulation in acute liver failure.

Five patients with fatal acute liver failure, given 5 g h-1 of glucose for the previous 12 h, were investigated by the hyper- and euglycaemic glucose 'clamp' technique, and the results compared with reported control values. Initial average blood glucose concentration was normal (6.0 mmol l-1, range 5.0-8.8). Plasma insulin and C-peptide concentrations were increased about tenfold (1450 pmol l-1, range 330-4021, and 3000 pmol l-1, range 670-7650, respectively). The whole body glucose metabolic rate was decreased to about half control values (21 mumol min-1 kg-1, range 6-28) and the insulin sensitivity of the glucose metabolism was decreased to about 15% (9.4 m3 min-1 kg-1, range 3.6-14.4). The calculated metabolic clearance of insulin was normal (520 ml min-1 (m2)-1, range 305-1027) and the calculated systemic delivery rate of insulin was about sixfold increased (1135 pmol min-1 (m2)-1, range 474-2010). The initial glucagon concentrations were fifty-fold increased (550 pmol 1, range 72-1309) and not suppressible by glucose and insulin. The patients thus exhibited pronounced insulin insensitivity and hyperinsulinaemia, attributable primarily to pancreatic hypersecretion. The reason for the relation between, and the pathogenetic importance of, these findings is not known.

Acute Disease↗
PubMed1986

Insulin and glucose decreases the capacity of urea-N synthesis in the rat.

The relationship between insulin concentration (32-980 mU/l) and the capacity of urea-N synthesis (CUNS) was investigated with alanine as nitrogen source in 26 nephrectomized rats. The blood glucose concentration was kept constant by the 'glucose clamp' technique, and the endocrine pancreatic response was controlled by somatostatin. The CUNS was determined as the accumulation of urea corrected for intestinal hydrolysis at a constant amino acid concentration within the interval 7.3-11.6 mmol/l. At insulin concentration above 200 mU/l CUNS was decreased from 10 to 6 mumol (min X 100 g body wt)-1. At lower insulin concentrations the decrease was proportional. Hyperglycaemia 14.8 mmol/l decreased CUNS to 6.3 mumol (min X 100 g body wt)-1. The basal rate of urea-N synthesis was reduced from 3.8 to 1.9 mumol (min X 100 g body wt)-1 by insulin concentrations above 200 mU/l. The estimated alanine elimination (5.8 mumol(min X 100 g body wt)-1) was unchanged by insulin and reduced to 3.3 mumol(min X 100 g body wt)-1) by hyperglycaemia. Somatostatin infusion had no effect on CUNS or alanine elimination. It is suggested that the capacity of urea-N synthesis is subject to short term regulation independently by insulin and glucose.

Alanine↗
PubMed1985

Kinetics of urea synthesis and alanine uptake by perfused rat livers.

Eight livers of 200 g rats were isolated and perfused in a single pass system with a semi-synthetic medium to which alanine was added to concentrations from 0.5 to 15 mmol/l. In each liver, 4-5 sets of urea synthesis rate and alanine uptake rate at different alanine concentrations were measured. The urea synthesis rate in relation to the alanine concentration was compatible with substrate inhibition kinetics. The kinetic constants were (mean +/- SD): Vmax = 10.34 +/- 3.41 mumol urea-N/(min X 100 g b.w.), Km = 1.56 +/- 0.67 mmol/l, and Ki = 5.35 +/- 2.44 mmol/l. The alanine uptake rate followed Michaelis-Menten kinetics with the constants (mean +/- SD) Vmax = 7.51 +/- 1.68 mumol/(min X 100 g b.w.) and Km = 2.14 +/- 1.04 mmol/l. The constants were assessed by non-linear iterative regression analysis. Urea synthesis exceeded alanine uptake at alanine concentrations below 2 mmol/l, and was smaller at higher concentrations. In two experiments, alanine metabolites were measured. The glucose production rate in relation to the alanine concentration suggested substrate inhibition. At high alanine concentrations, ammonia, lactate and pyruvate were released by the livers. The results indicate that whole liver urea synthesis and gluconeogenesis is inhibited by high blood alanine concentrations, in contrast to alanine uptake.

Alanine↗
PubMed1985

Discrimination between organic and hepatic encephalopathy by means of continuous reaction times.

Measurement of continuous reaction times (CRT) was applied to 105 hospitalized controls, 65 patients with brain damage and 47 patients with hepatic encephalopathy. One hundred and fifty reaction times were measured in every patient. The best discrimination between controls and patients with organic brain damage was obtained with the 10 percentile of the reaction time distribution (86% correct classification). The 90 percentile discriminated best between controls and patients with hepatic encephalopathy (86% correct classification). Furthermore, the ratio between the 50 percentile and the difference between the 10 and 90 percentile made it possible to discriminate between the two groups of patients (91% correct classification), which indicates that the CRT test is suitable as a screening device for discrimination between organic brain damage and hepatic encephalopathy.

Adult↗
PubMed1985

Functional status of the liver during chronic renal failure: an experimental study in the rabbit.

Quantitative and qualitative measures of liver function were investigated in rabbits with chronic renal failure (CRF) induced 3 months earlier by surgical reduction of renal mass, and compared with a sham-operated control group. In the CRF group the galactose elimination capacity (GEC) was significantly decreased by 25%, but when related to liver weight the difference was not statistically significant. The clearance of antipyrine was unaffected. The serum activities of alanine aminotransferase, lactate dehydrogenase and alkaline phosphatase were similar in the two groups. The prothrombin index was increased by 20%, and the serum albumin concentration decreased by 9%. By light microscopy no significant morphological changes were found in the livers of the CRF rabbits. The results do not indicate significant changes of the hepatic functional status during moderate chronic renal insufficiency.

Animals↗
PubMed1985

A method for determination of the capacity of urea synthesis in the rat.

The relationship between total blood alpha-amino nitrogen concentration and urea synthesis rate was investigated with alanine as nitrogen source in 24 rats. Alanine was given as prime-continuous doses for 70 min so that constant amino acid concentration was attained between 5.5 and 34 mmol/l. Urea synthesis rate was assessed as accumulation in body water, corrected for intestinal hydrolysis. There was a positive correlation between nitrogen balance and alpha-amino nitrogen concentration. Urea synthesis rate in relation to amino acid concentration suggested barrier-limited substrate inhibition kinetics and data were examined accordingly by non-linear regression analysis. The estimated kinetic constants (mean +/- standard deviation) were: Vmax: 19.2 +/- 3.3 mumol (min X 100 g BW)-1, Km: 1.74 +/- 0.5 mmol/l, Ki: 6.84 +/- 1.9 mmol/l, and the barrier: 5.4 +/- 0.13 mmol/l. Because of the substrate inhibition, saturation cannot be attained, but the maximum synthesis rate, i.e. the capacity of urea nitrogen synthesis (CUNS), can be measured within 95% of the theoretical maximum in the concentration interval 7.3-11.6 mmol/l. CUNS was 9.16 +/- 0.81 mumol (min X 100 g BW)-1 (mean +/- standard deviation). Substrate-independent regulation of urea synthesis, e.g. by changes in liver mass or hormonal concentration, can be studied by this measure.

Alanine↗
PubMed1985

Increased intestinal hydrolysis of urea in patients with alcoholic cirrhosis.

Fourteen patients with biopsy-proven alcoholic liver cirrhosis in a clinically stable phase but with compromised liver function entered the study, together with 10 control persons. All had normal creatinine clearance, and none received antibiotics or hormones. They ingested a diet containing 1 g of protein/kg body weight daily during the study. The fractional intestinal loss of newly synthesized urea, determined by a 14C-urea tracer method, was increased from 0.17 +/- 0.08 in controls to 0.26 +/- 0.08 in cirrhotics (mean +/- SD, P less than 0.02). Urea nitrogen synthesis rate, determined as urinary excretion rate, corrected for accumulation in the total body water and for fractional intestinal loss, was the same in controls and cirrhotics (26.1 +/- 3.8 and 22.1 +/- 6.8 mmol/h, respectively). The patients with cirrhosis had a significantly greater nitrogen balance than the control group (12.5 +/- 7.0 mmol/h versus 7.0 +/- 5.9 mmol/h; P less than 0.05). Furthermore, there was a positive correlation between intestinal loss and blood urea nitrogen concentration (r = 0.68, P less than 0.01) in patients with cirrhosis but not in controls. The increased endogenous ammonia load of cirrhotics corresponds to an extra protein intake of 30-35 g/day. In patients with cirrhosis prophylactic treatment with, for example, lactulose is rational before reduction in dietary protein.

Adult↗
PubMed1984

Liver function during chronic renal failure in rabbits.

In rabbits with chronic renal insufficiency the prothrombin index was increased by 25% and the alanine aminotransferase activity decreased by 20%; the results of other routine tests of hepatic function were not affected. The galactose elimination capacity was decreased by 12%, whereas the body clearance of antipyrine was unchanged. No change in hepatocytic structure was found.

Alanine Transaminase↗
PubMed1984

Effects of glucose on alanine-derived urea synthesis.

The effect of glucose on alanine-stimulated urea synthesis was studied in six healthy volunteers during 6 h of constant alanine infusion, 2.8 mmol h-1 kg-1 b. wht., and during 12 h of constant glucose infusion, 4.0 mmol h-1 kg-1 b. wht., with superimposed alanine infusion. The urea nitrogen synthesis rate (UNSR) was determined at intervals of 2 h as urinary excretion rate corrected for accumulation and intestinal hydrolysis. UNSR depended on the blood alanine and glucagon concentration, but was not correlated with glucose, lactate, or insulin concentrations. The slope of the linear relation between UNSR and alanine concentration (the 'Functional Hepatic Nitrogen Clearance') was on the average 24.4 1 h-1 and decreased to 12.8 1 h-1 by glucose (mean difference +/- SE of the difference 10.6 +/- 7.3, P less than 0.01). The relation between glucagon and alanine concentration was linear, and the slope was decreased to 40 per cent by glucose (P less than 0.05). The slope of the linear relation between UNSR and glucagon was not changed by glucose. Thus the catabolism of alanine nitrogen is decreased by glucose because of a reduction of the urea synthesis. Data suggest that this may be due to a depression of the glucagon response to alanine.

Adult↗
PubMed1984

Number connection test and continuous reaction times in assessment of organic and metabolic encephalopathy: a comparative study.

Number Connection Test (NCT) and Continuous Reaction Times (CRT) have been used for assessment of encephalopathy in groups of 105 controls, 65 brain damaged patients and 22 patients with hepatic encephalopathy. With the use of NCT, 65% of the patients with cerebral damage could be correctly classified with regard to presence versus absence of brain disease, whereas the use of CRT gave 85% correct classification. With regard to hepatic encephalopathy the CRT was better for classification than NCT; respectively 86% and 64% were correctly classified. The NCT could not separate the patient with brain damage from the patients with hepatic encephalopathy, whereas CRT could classify respectively 95% and 86% correctly. When the tests were performed on five successive days, the NCT scores showed a learning effect, whereas the CRT gave stable measures. This means that the CRT was superior to the NCT for classification purposes.

Adult↗
PubMed1984

The effect of continuous vasopressin infusion on splanchnic blood flow, liver function, and portal and central venous pressures in patients with cirrhosis.

Continuous vasopressin infusion has been shown to control bleeding from oesophageal varices in patients with cirrhosis of the liver. The mortality, however, has not been changed. To investigate whether reduction of portal blood flow over a period of hours deteriorates the liver function, we measured the splanchnic blood flow and galactose and oxygen consumption in five cirrhotic patients during liver vein catheterization. Vasopressin was given as a continuous infusion of 0.2 units per min for three h. The splanchnic blood flow was reduced to 70% of control values and remained so throughout the infusion. After three h no impairment of the liver function was found. The wedged hepatic pressure (portal pressure) rose slightly, probably due to the increase of the central venous pressure reflecting impaired cardiac function. The reported beneficial effect of vasopressin on varix bleeding probably depends on the reduced portal flow per se.

Adult↗
PubMed1984

Galactose elimination kinetics in perfused rat liver after two thirds hepatectomy.

Galactose elimination kinetics was studied in isolated perfused livers (single pass) from rats subjected to two thirds partial hepatectomy 6 h earlier or immediately before investigation. No difference was found between the two groups in the maximum galactose elimination rate or in the half saturation galactose concentration. This is in contrast with in vivo observation of restored galactose elimination capacity 6 h after two thirds hepatectomy. The discrepancy indicates that extrahepatic factors may be of importance for the metabolic regulation in the liver during regeneration.

Animals↗
PubMed1984

Kinetics of glucose metabolism in relation to insulin concentrations in patients with alcoholic cirrhosis and in healthy persons.

To characterize the insulin resistance in alcoholic cirrhosis we determined in vivo insulin-glucose disposal dose-response relationships in 6 patients with alcoholic cirrhosis of varying severity and in 6 control subjects, using the glucose-insulin clamp technique. Each subject was infused sequentially with insulin at rates of 0.5, 1.0, 2.0, and 10 mU/min X kg, each rate for 2 h. Euglycemia was maintained by a continuous servo-adjusted glucose infusion. The amount of glucose infused during the last 40 min of each 2-h period, corrected for accumulation in the glucose space, reflects overall net glucose metabolism. The dose-response curves demonstrated saturation kinetics. Lineweaver-Burk plots were consistently convex, rejecting a simple Michaelis-Menten relationship, but were linear when accommodated to allosterism with two active sites. The calculated affinity constant (i.e., the concentration of insulin leading to half-maximum glucose metabolism) of patients with cirrhosis was higher than that of normal controls (104 +/- 30 vs. 32 +/- 3 mU/L, mean +/- SD). In addition the maximum rate of glucose metabolism was significantly lower than that of normals (53 +/- 9 vs. 72 +/- 16 mumol/min X kg). We conclude that, in patients with alcoholic cirrhosis, insulin resistance is caused both by a marked decrease in sensitivity to insulin and a decreased maximum effect of insulin, indicating a combined receptor-postreceptor defect as the underlying cause.

Adult↗
PubMed1983

Kinetics of galactose uptake by perfused rat livers: applicability of a family of models.

Mathematical models for general substrate uptake mechanisms in the liver have been used to describe the kinetics of galactose removal. In this study sets of galactose uptake rates to galactose concentration relations obtained by perfusion of ten livers of 200 g rats were examined. The rate of galactose uptake (v) was related to the galactose concentration in the sinusoids (calculated as the logarithmic mean of in- and outlet concentration, ĉ). In all experiments a saturation pattern emerged, but the resulting 1/v versus 1/ĉ plots were all markedly convex, discarding simple Michaelis-Menten kinetics. Data were therefore examined in the light of a family of kinetic models, including the following modifications: substrate inhibition, porto-systemic shunting, and allosterism. The kinetic constants were assessed by iterative procedures, aiming at linearization of the double reciprocal plots. The two latter models were found to fit the experimental data by entering a shunting of 61% of the hepatic blood flow, or two active sites, respectively. Since this degree of shunting is improbable the results speak in favour of allosterism. The work gives an example of whole-liver kinetic considerations when simple Michaelis-Menten is insufficient.

Allosteric Regulation↗