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PubMed1987

Importance of glucagon in the control of futile cycling as studied in alloxan-diabetic dogs.

In order to determine the role of glucagon in futile or substrate cycling in diabetes, we measured tracer determined glucose kinetics during a combined infusion of 2-3H-glucose (total glucose production) and 6-3H-glucose (glucose production) in six alloxan-diabetic dogs. The animals received either a 420 min infusion of (1) somatostatin alone (0.3 microgram X kg-1 X min-1), (2) somatostatin with insulin replacement (100 microU X kg-1 X min-1) or (3) glucagon (6 ng X kg-1 X min-1) together with somatostatin and transient insulin replacement. When somatostatin was given alone, plasma glucagon (p less than 0.004) and insulin (p less than 0.0001) were suppressed. Glucose production and disappearance and plasma glucose concentrations fell (p less than 0.0001), but the metabolic clearance of glucose did not change significantly. In the basal state, futile cycling comprised 29 +/- 4%, 33 +/- 4% and 33 +/- 3% of total glucose production in the three groups of studies, which is high compared to normal dogs. The absolute rate of futile cycling fell slightly but significantly from 10.0 +/- 1.7 to 8.3 +/- 1.7 mumol X kg X -1 min-1 (p less than 0.0008). When insulin replacement was given during somatostatin infusion to correct for the small somatostatin-induced insulin suppression, there were similar changes in plasma glucagon, glucose concentrations and glucose kinetics as seen during the infusion of somatostatin alone. Futile cycling decreased to a slightly greater extent from 12.8 +/- 2.8 to 9.5 +/- 1.7 mumol X kg-1 X min.-1 (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1997

[Surgical metabolism].

Trauma, operative interventions, infection and other disturbances of homeostasis lead to a uniform reaction of the body, namely release and activation of hormones and cytokines. Profound alterations of substrate flow result, with mobilization of energy stores and degradation of structural and functional proteins of vital organs like the gut mucosa. Due to these reactions the energy demands of the organs are met and energy-consuming synthesis of substrates is indicated. Clinically, hypermetabolism, hyperglycemia, lipolysis and increased urea production with negative nitrogen balance can be observed. The metabolic reactivity is reached by an increased substrate cycling. To avoid negative consequences such as organ dysfunction, a rational situation-adapted substrate supply is warranted as well as reduction of catabolic stimuli and stimulation of anabolic factors. The metabolic care of the surgical patient is still a basic and important task.

Energy Metabolism↗
PubMed1991

Lactate metabolism in inactive skeletal muscle during lactacidosis.

Contributions of carbohydrate and fat metabolism to the removal of a lactate (Lac-) load were quantified in inactive soleus (SL), plantaris (PL), and white gastrocnemius (WG) rat hindlimb muscle. Male Sprague-Dawley rats were perfused for 60 min with normal perfusate (NP, n = 8) or a high-lactate perfusate (LP, n = 8), simulating ionic conditions found in arterial blood and plasma after intense exercise: Lac- = 11.0 mM, K+ = 7.88 mM, and pH = 7.15. Metabolite fluxes across the hindlimb were calculated from blood flow and arteriovenous differences. In NP, Lac- was continuously released (2.9 +/- 0.2 mumol.min-1 x 100 g-1). However, in LP, a rapid and significant uptake of Lac- increased muscle Lac- fivefold to 39.6 +/- 1.1, 33.1 +/- 2.2, and 28.8 +/- 1.7 mumol/g dry wt in SL, PL, and WG, respectively. Glucose and O2 uptakes were similar during LP and NP perfusion. Glycerol release increased eightfold to 3.3 +/- 0.7 mumol.min-1 x 100 g-1 in response to LP. Muscle ATP, creatine phosphate, glycogen, glycolytic intermediate, and triacylglycerol concentrations did not change. However, muscle lactate-to-pyruvate ratios were elevated in all muscles of the LP group postperfusion, indicating changes in the mass action ratio at the pyruvate dehydrogenase reaction. In LP, of 80 mumol of Lac- taken up, 11% was accounted for by increased muscle Lac-, 12-24% was oxidized, and 5% may have been involved in glycerol release. The remaining Lac- may have been involved in metabolic cycling along the glyconeogenic-glycolytic pathway and/or in triacylglycerol-free fatty acid substrate cycling.

Acidosis, Lactic↗
PubMed1984

In-vitro testosterone metabolism in the mouse preputial gland: intercellular co-operation and changes with cell maturation.

In-vitro [14C]testosterone metabolism was investigated in isolated cells of adult male mouse preputial sebaceous glands. Labelled steroids were extracted and chromatographed after a 2-h incubation, and were identified as 5 alpha-dihydrotestosterone, androstenedione, 5 alpha-androstane-3,17-dione, 5 alpha-androstane-3 alpha,17 beta-diol and 5 alpha-androstane-3 beta,17 beta-diol, androsterone and 3-epiandrosterone. In cells separated according to state of maturity (lipid content) by isopycnic centrifugation in a metrizamide gradient, maximal testosterone metabolism occurred in large, nearly mature cells. In this population, mean hydroxysteroid 5 alpha-reductase and 17 beta-hydroxysteroid dehydrogenase activities were 3.8 and 2.3 nmol/10(6) cells per 2h respectively, more than 100-fold greater than in the densest population, comprised of undifferentiated and early differentiating cells. It was also found that the profile of testosterone metabolites was dependent on the proportion of the label metabolized. The metabolite index (MI), i.e. the average number of enzymatic steps undergone per molecule of metabolite, increased with increasing substrate utilization. Metrizamide showed reversible, non-specific inhibition of testosterone metabolism and reduction of the MI. Thus, it was postulated that testosterone is metabolized sequentially by different cells, with metrizamide inhibiting cellular uptake and intercellular substrate transport. This suggested that most of the metabolites would be found in the medium, rather than in the cellular compartment. Further, in incubations run without cell disaggregation, efficient substrate cycling among cells should result in a high MI, independent of metrizamide concentration and substrate utilization. These predictions were all confirmed, providing strong evidence that testosterone metabolism is a co-operative effort among several cells in this tissue.

Animals↗
PubMed2002

A new bioassay including a small scale hepatocyte bioreactor for hepato-mediated toxicity testing in a target cell line.

New approaches for in vitro testing of hepato-mediated toxicity are undertaken to offer alternatives to in vivo animal testing. The described bioassay for hepato-mediated toxicity testing is based on a small scale hepatocyte-bioreactor with pig hepatocytes connected to a silicon sensor based microphysiometer system for monitoring of the extracellular acidification rate (EAR) of cells and the microphysiometer alone. EAR represents the metabolic activity of tested cells (hepatocytes and ZR 751 cells) under the influence of perfused media, compared to controls, which were set to 100%. Cyclophosphamide (CYCL), whose cytostatic effect is dependent on CYP 450 biotransformation was used as a model substrate. CYCL showed decrease of EAR in hepatocytes, but not in ZR 751 cells. Bioreactor supernatant including CYCL was pumped into the microphysiometer and EARs of the target ZR 751 cell line were recorded. After 7 h of bioreactor supernatant perfusion the ZR 751 cell line showed an EAR decrease of 18.68% +/- 10.18, as compared to controls (bioreactor supernatant from the identical set-up without CYCL). Thus the presented model of hepato-activated toxicity showed an EAR decrease in the ZR 751 cell line that reflected the toxic activation of CYCL by the bioreactor. This new bioassay serves as an example of future applications for hepatocyte bioreactors in automated toxicity testing devices, e.g. in preclinical drug studies or evaluation of hepato-mediated toxicity, not depending on cell destruction or further assays.

7-Alkoxycoumarin O-Dealkylase↗
PubMed1987

Substrate-induced alterations of high energy phosphate metabolism and contractile function in the perfused heart.

The bioenergetic basis by which the Krebs cycle substrate pyruvate increased cardiac contractile function over that observed with the Embden-Meyerhof substrate glucose was investigated in the isovolumic guinea pig heart. Alterations in the content of the high energy phosphate metabolites and the rate of high energy phosphate turnover were measured by 31P NMR. These were correlated to the changes in contractile function and rates of myocardial oxygen consumption. Maximum left ventricular developed pressure (LVDP) and high energy phosphates were observed with 16 mM glucose or 10 mM pyruvate. In hearts perfused with 16 mM glucose, the intracellular phosphocreatine (PCr) concentration was 15.2 +/- 0.6 mM with a PCr/Pi ratio of 10.3 +/- 0.9. The O2 consumption was 5.35 mumol/g wet weight/min, and these hearts exhibited a LVDP of 97 +/- 3.7 mm Hg at a constant paced rate of 200 beats/min. In contrast, when hearts were switched to 10 mM pyruvate, the PCr concentration was 18.3 +/- 0.4 mM, the PCr/Pi ratio was 30.4 +/- 2.2, the O2 consumption was 6.67 mumol/g wet weight/min, and the LDVP increased to 125 +/- 3.3 mm Hg. From NMR saturation transfer experiments, the steady-state flux of ATP synthesis from PCr was 4.9 mumol/s/g of cell water during glucose perfusion and 6.67 mumol/s/g of cell water during pyruvate perfusion. The flux of ATP synthesis from ADP was measured to be 0.99 mumol/s/g of cell water with glucose and calculated to be 1.33 mumol/s/g of cell water with pyruvate. These results suggest that pyruvate quite favorably alters myocardial metabolism in concert with the increased contractile performance. Thus, as a mechanism to augment myocardial performance, pyruvate appears to be unique.

Adenine Nucleotides↗
PubMed1988

Substrate effects in the post-ischemic myocardium.

A study was undertaken to examine the effects of glucose versus pyruvate as the sole substrate following severe myocardial ischemia. Glycolysis usually contributes only a small amount to total ATP production and may be rate limiting in providing tricarboxylic acid (TCA) cycle substrates. Consequently, pyruvate may be a more effective substrate by bypassing glycolysis to feed directly to the TCA cycle and oxidative phosphorylation. Isolated rat hearts were studied in a retrograde (Langendorff) perfusion apparatus while in an NMR spectrometer. Rate pressure product (RPP), myocardial oxygen consumption (MVO2), and the unidirectional Pi----ATP rate were measured in control and postischemic hearts with or without the inotrope dobutamine. The undirectional Pi----ATP rate was higher in the glucose than the pyruvate hearts and the difference increased further postischemia. This increase over that of the pyruvate hearts has been attributed to a glycolytic component of ATP metabolism. Oxygen consumption was higher in pyruvate hearts at equivalent levels of performance. It thus appears that the glycolysis rate is significant and may be elevated following severe myocardial ischemia. Perfusion with pyruvate requires increased rates of oxidative phosphorylation to make up for the loss of glycolytically produced ATP. Optimal postischemic substrate delivery may require several compounds, one of which should be glucose.

Adenosine Triphosphate↗
PubMed1997

Methylprednisolone inhibits uptake of Ca2+ and Na+ ions into concanavalin A-stimulated thymocytes.

The glucocorticoid drug methylprednisolone inhibits respiration in concanavalin A-stimulated rat thymocytes at concentrations that are relevant to its acute clinical efficacy against autoimmune diseases and spinal cord injury. Methylprednisolone affects several processes, including ion cycling, substrate oxidation reactions and RNA/DNA synthesis. The inhibition of respiration used to drive ATP-consuming cycles of Ca2+ and Na+ ions across the plasma membrane has been proposed to be either primary or secondary to restriction of cellular ATP supply. By comparing the effects of methylprednisolone with those of myxothiazol, an inhibitor of the mitochondrial electron transport chain, we show that the effects of methylprednisolone on Ca2+ and Na+ cycling are primary. We propose that methylprednisolone acts by affecting membrane properties to inhibit Ca2+ and Na+ uptake across the plasma membrane and to increase H+ uptake across the mitochondrial membrane, and that other effects are secondary.

Adenosine Triphosphate↗
PubMed1993

Contribution of glucose/glucose 6-phosphate cycle activity to insulin resistance in type 2 (non-insulin-dependent) diabetes mellitus.

It has been suggested that increased glucose/glucose 6-phosphate substrate cycling impairs net hepatic glucose uptake in Type 2 (non-insulin-dependent) diabetes mellitus and contributes to hyperglycaemia. To investigate glucose/glucose 6-phosphate cycle activity and insulin action in Type 2 diabetes we studied eight patients and eight healthy control subjects, using the euglycaemic glucose clamp and isotope dilution techniques with purified [2-3H]- and [6-3H] glucose tracers, in the post-absorptive state and eight patients and five healthy control subjects during consecutive insulin infusions at rates of 0.4 and 2.0 mU.kg-1 x min-1. [2-3H]glucose and [6-3H]glucose radioactivity in plasma samples were determined using selective enzymatic detritiation, allowing calculation of glucose turnover rates for each isotope, the difference being glucose/glucose 6-phosphate cycling. Endogenous glucose production ([6-3H]glucose) was greater in diabetic than control subjects in the post-absorptive state (15.6 +/- 1.5 vs 11.3 +/- 0.4 mumol.kg-1 x min-1, p < 0.05) and during the 0.4 mU insulin infusion (10.1 +/- 1.3 vs 5.2 +/- 0.3 mumol.kg-1 x min-1, p < 0.01) indicating hepatic insulin resistance. Glucose/glucose 6-phosphate cycling was significantly greater in diabetic than in control subjects in the post-absorptive state (2.6 +/- 0.4 vs 1.6 +/- 0.2 mumol.kg-1 x min-1, p < 0.05) but not during the 0.4 mU insulin infusion (2.0 +/- 0.4 vs 2.0 +/- 0.3 mumol.kg-1 x min-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes Mellitus, Type 2↗
PubMed2006

Kinetics and product analysis of the reaction catalysed by recombinant homoaconitase from Thermus thermophilus.

HACN (homoaconitase) is a member of a family of [4Fe-4S] cluster-dependent enzymes that catalyse hydration/dehydration reactions. The best characterized example of this family is the ubiquitous ACN (aconitase), which catalyses the dehydration of citrate to cis-aconitate, and the subsequent hydration of cis-aconitate to isocitrate. HACN is an enzyme from the alpha-aminoadipate pathway of lysine biosynthesis, and has been identified in higher fungi and several archaea and one thermophilic species of bacteria, Thermus thermophilus. HACN catalyses the hydration of cis-homoaconitate to (2R,3S)-homoisocitrate, but the HACN-catalysed dehydration of (R)-homocitrate to cis-homoaconitate has not been observed in vitro. We have synthesized the substrates and putative substrates for this enzyme, and in the present study report the first steady-state kinetic data for recombinant HACN from T. thermophilus using a (2R,3S)-homoisocitrate dehydrogenase-coupled assay. We have also examined the products of the reaction using HPLC. We do not observe HACN-catalysed 'homocitrate dehydratase' activity; however, we have observed that ACN can catalyse the dehydration of (R)-homocitrate to cis-homoaconitate, but HACN is required for subsequent conversion of cis-homoaconitate into homoisocitrate. This suggests that the in vivo process for conversion of homocitrate into homoisocitrate requires two enzymes, in simile with the propionate utilization pathway from Escherichia coli. Surprisingly, HACN does not show any activity when cis-aconitate is substituted for the substrate, even though other enzymes from the alpha-aminoadipate pathway can accept analogous tricarboxylic acid-cycle substrates. The enzyme shows no apparent feedback inhibition by L-lysine.

Aconitate Hydratase↗
PubMed1994

Nutrient support of the healing wound.

Wound healing is a series of complex physicochemical interactions that require various micronutrients at every step. In the critically ill or severely injured patient, wound healing is impaired by the protein-catabolic, hypermetabolic response to stress. The hypothalamus responds to cytokine stimulation by increasing the thermoregulatory set-point and by augmenting elaboration of stress hormones (catecholamines, cortisol, and glucagon). In turn, the stress hormones induce thermogenic futile substrate cycling, lipolysis, and proteolysis. Increased glucose production results at the expense of skeletal muscle degradation, producing amino acid substrate for hepatic gluconeogenesis. Nutritional support of the hypermetabolic state is an essential part of ensuring efficient wound healing in these patients. Protein catabolism cannot be reversed by increased amino acid availability alone, due partly to a defect in amino acid transport. This defect can be reversed by anabolic agents, such as growth hormone and insulin-like growth factor-1. Growth hormone treatment dramatically improves wound healing in severely burned children. Supplementation with protein and vitamins, specifically arginine and vitamins A, B, and C, provides optimum nutrient support of the healing wound.

Adult↗
PubMed1997

Leishmania spp.: nitric oxide-mediated metabolic inhibition of promastigote and axenically grown amastigote forms.

The antimicrobial effect of activated macrophages on parasites involves nitric oxide (NO). NO induces intracellular parasite killing in murine leishmaniasis. Nevertheless, the mechanisms of action of NO as a final effector molecule on intracellular forms of Leishmania are unknown. The recent development of axenically grown amastigote forms of different Leishmania species allowed direct investigation of NO activity on active and dividing populations of the mammalian stage of various Leishmania species, which normally are only found intracellularly. Authentic NO gas, which reproduced the antimicrobial effect elaborated by activated macrophages, was flushed on promastigote and axenically cultured amastigote forms of L. mexicana, L. amazonensis, and L. chagasi suspended in degassed phosphate-buffered saline (PBS). After NO treatment, the viability of parasites gradually decreased as a function of time postflushing when compared to controls. Interestingly NO killing was more effective on promastigote forms than on amastigote forms. After 12-hr postflushing incubation in PBS, cultures of NO-treated parasites, contrary to controls (N2-treated), failed to proliferate whatever the species and the developmental stage considered. Addition of both FeSO4 and L-cysteine to PBS immediately after NO treatment reversed the capacity of authentic NO gas to inhibit the multiplication of both parasite stages of Leishmania. Supplementation of PBS with alpha-ketoglutarate and cis-aconitate (citric acid cycle substrates) also reversed the leishmanicidal activity of NO, whereas addition of citrate was less effective. The course of the developmental life cycle in vitro was also inhibited by NO gas treatment. Enzymatic analysis showed that aconitase activity was dramatically reduced by NO gas, whereas glucose phosphate isomerase, aspartate transferase, and phosphoglucomutase activities were unchanged. In accordance, promastigote and amastigote forms of Leishmania were shown to be killed by antimycin A, an inhibitor of mitrochondrial respiration. All these data demonstrated that NO action led to lethal metabolic inhibition in both developmental parasite stages by, at least in part, triggering iron loss from enzyme(s) with iron-sulfur prosthetic groups, in particular aconitase.

Aconitate Hydratase↗
PubMed1984

Imbibitional chilling injury in pollen: involvement of the respiratory chain.

Chilling injury is sustained by dry pollen of Typha latifolia L. upon hydration in germination medium at 0 degrees C. This injury is evidenced as poor germination, low vigor, and depressed respiration. Isolated mitochondria showed multiple sites of impaired electron transport. Besides losses of cytochrome (Cyt) c and NAD(+), the activities of membrane-bound enzyme complexes such as Cyt oxidase, NADH-duroquinone oxidoreductase, succinate-duroquinone oxidoreductase, and malate-duroquinone oxidoreductase were severely affected.Similarly, as in isolated mitochondria, in situ tests of mitochondrial activity showed that Cyt c was partially lost from its site of action. Re-addition of the lost Cyt c to the grains restored the N,N,N',N'-tetramethyl p-phenylenediamine dihydrochloride plus ascorbate-mediated electron transport from Cyt c to O(2), but did not significantly accelerate the overall O(2) uptake. Electron flow to duroquinone in the injured grains was low, indicating that lesions at the substrate side of ubiquinone determine the rate of O(2) consumption. Leakage of NAD(+), and also of adenylate phosphates and Krebs cycle substrates out of the injured grains, was considerable.Increasing the initial moisture content of the grains strongly enhanced their resistance to cold hydration. Below 17% moisture content (fresh weight basis), the decrease in vigor closely matched the loss of NAD(+) and adenosine phosphates. Vitality was irreversibly lost by cold hydration below 10 to 12% initial moisture content.Injury to dry pollen was prevented by imbibition at 27 degrees C. Decrease of vigor and increased leakage, however, started below 20 degrees C, and complete loss of vitality occurred below 10 degrees C.These results are interpreted as evidence that loss of membrane integrity is the primary cause of imbibitional chilling injury.

Journal Article↗
PubMed1981

Factors governing substrate-induced generation and extrusion of protons in the yeast Saccharomyces cerevisiae.

Experiments with respiration deficient (rho-), ADP/ATP transport deficient (op1) and double (op1 rho-) mutants, with glycolytic and tricarboxylic acid cycle substrates showed that the substrate-induced acidification of yeast suspensions is closely associated with glycolysis. The glucose/proton stoichiometry is 2.5 : 1 to 4 : 1 depending on glucose concentration. The kinetics of the process are complex, the acidification curve having a very fast initial component and two slower exponential components. The first component suggests an initial proton efflux from endogenous sources, triggered by exogenous substrates. The acidification process exhibits two Km values at about 1 and 15 mM D-glucose, indicating two distinct saturable pathways of proton extrusion. The total extent of acidification and thus the final pHout reaches a saturation value with increasing glucose concentration and suspension density. Both the total extent and the rate of acidification are subject to control by extracellular pH which reflects the tendency of the cells to build a fixed [H+]out/[H+]in ratio. When the control is lifted, both quantities are considerably increased. A crucial role in the substrate-induced acidification is thus played by active membrane processes and their control mechanisms.

Acid-Base Equilibrium↗
PubMed2004

Probing the structure and dynamics of end-grafted flexible polymer chain layers by combined atomic force-electrochemical microscopy. Cyclic voltammetry within nanometer-thick macromolecular poly(ethylene glycol) layers.

The combined atomic force-electrochemical microscopy (AFM-SECM) technique was used in aqueous solution to determine both the static and dynamical properties of nanometer-thick monolayers of poly(ethylene glycol) (PEG) chains end-grafted to a gold substrate surface. Approach of a microelectrode tip from a redox end-labeled PEG layer triggered a tip-to-substrate cycling motion of the chains' free ends as a result of the redox heads' oxidation at the tip and re-reduction at the substrate surface. As few as approximately 200 chains at a time could be addressed in such a way. Quantitative analysis of the data, in the light of a simple model of elastic bounded diffusion SECM positive feedback, gave access to the end-tethered polymer layer thickness and the end-to-end diffusion coefficient of the chains. The thickness of the grafted PEG layer was shown to increase with the chain surface coverage, while the end-to-end diffusion coefficient was found to be constant and close to the one predicted by Rouse dynamics. At close tip-substrate separation, slowing of the chains' motion, as a consequence of their vertical confinement within the tip-substrate gap, was observed and quantitatively modeled.

Journal Article↗
PubMed1990

Triglyceride/fatty acid cycling is increased after exercise.

After exercise, there is a prolonged increase in O2 consumption termed the excess postexercise O2 consumption (EPOC). In this study, we have assessed the relative contribution of the triglyceride/fatty acid (TG/FA) substrate cycle to EPOC. Six healthy, young men exercised for 2 hours at 51% of maximal O2 uptake. The total energy expenditure and the rate of FA oxidation were estimated from measurements of O2 uptake, respiratory exchange ratio, and urinary nitrogen excretion while the subjects rested in bed for 3.5 hours postexercise. During the last part of the recovery period, the rate of FA mobilization was determined by infusion of glycerol. The rate of TG/FA cycling was calculated from the difference between the rate of FA mobilization and oxidation. An identical control study without exercise was also performed. The total EPOC during the recovery period was 7.82 +/- 1.51 L O2 (a 15% +/- 3% increase above the control O2 consumption). The rate of FA oxidation increased from 252 +/- 36 mumol/min (control) to 360 +/- 27 mumol/min (3 hours postexercise). The rate of FA mobilization increased from 666 +/- 108 mumol/min (control) to 1833 +/- 456 mumol/min (3 hours postexercise). TG/FA cycling was found to increase from 414 +/- 90 mumol FA/min (control) to 1473 +/- 435 mumol FA/min (3 hours postexercise). The energy cost of these rates of TG/FA cycling was found to be 0.09 +/- 0.02 kJ/min (control) and 0.31 +/- 0.09 kJ/min (3 hours postexercise). It is concluded that the energy cost of the increased TG/FA cycling rate may account for as much as half of the delayed component of EPOC.

Adult↗
PubMed1997

Insulin action and hepatic glucose cycling in Cushing's syndrome.

OBJECTIVE: Although it is well established that hypercortisolism causes insulin resistance, the mechanisms responsible for impaired insulin action in Cushing's syndrome are unclear. This study investigated the contribution of the glucose/glucose-6-phosphate substrate cycle (G/G6P). PATIENTS: Eight patients with Cushing's syndrome and seven control subjects were studied. All had normal fasting plasma glucose. DESIGN: Insulin action was assessed using the euglycaemic glucose clamp at insulin infusion rates of 0.4 and 2.0 mU/kg/min combined with a simultaneous infusion of [2(3)H]- and [6(3)-H]-glucose. Glucose/ glucose-6-phosphate cycle activity was calculated as the difference in glucose turnover rates determined separately for [2(3)H]- and [6(3)H]-glucose by selective enzymatic detritiation. MEASUREMENTS AND RESULTS: Exogenous glucose infusion rates required to maintain euglycaemia were significantly lower in Cushing's patients compared to controls, during the 0.4 mU/kg/min (7.8 +/- 1.2 vs 15.7 +/- 0.5 mumol/kg/min, P < 0.001) and the 2.0 mU/ kg/min insulin infusions (26.2 +/- 2.8 vs 51.5 +/- 3.5 mumol/ kg/min, P < 0.001). Endogenous glucose production was similar in both groups in the postabsorptive state (10.2 +/- 0.3 vs 10.8 +/- 0.4 mumol/kg/min, P = 0.50) and suppressed to a similar degree during hyperinsulinaemia. G/G6P cycle activity was markedly increased in the Cushing's group in the postabsorptive state (5.4 +/- 1.1 vs 2.0 +/- 0.5 mumol/kg/min, P = 0.028) and during the 0.4 mU/kg/min (3.2 +/- 0.6 vs 1.2 +/- 0.4 mumol/kg/min, P = 0.014) and 2.0 mU/kg/min insulin infusions (3.3 +/- 0.8 vs 1.1 +/- 0.5 mumol/kg/min, P = 0.049). CONCLUSIONS: Patients with Cushing's syndrome show marked peripheral insulin resistance and enhanced hepatic G/G6P cycle activity. In the fasting state increased glucose/glucose-6-phosphate cycle activity may be a protective mechanism limiting hyperglycaemia. During hyperinsulinaemia G/G6P cycle activity was increased but insulin resistance was predominantly due to reduced peripheral glucose uptake.

3-Hydroxybutyric Acid↗