Background Skeletal muscle loss (sarcopenia) is a major clinical complication in alcoholic cirrhosis with no effective therapy. Skeletal muscle autophagic proteolysis and myostatin expression (inhibitor of protein synthesis) are increased in cirrhosis and believed to contribute to anabolic resistance. A prospective study was performed to determine the mechanisms of sarcopenia in alcoholic cirrhosis and potential reversal by leucine. Methods In 6 well-compensated, stable alcoholic cirrhotic patients and 8 controls, serial vastus lateralis muscle biopsies were obtained before and 7h after a single oral BCAA mixture enriched with leucine (BCAA/LEU). Primed-constant infusion of L-[ring-2H5]-phenylalanine was used to quantify whole body protein breakdown (WbPB) and muscle protein fractional synthesis rate (FSR) using liquid chromatography/mass spectrometry. Muscle expression of myostatin, mTOR targets, autophagy markers, protein ubiquitination and intracellular amino acid deficiency sensor, general control of nutrition 2 (GCN2) were quantified by immunoblots and leucine transporter (SLC7A5) and glutamine exchanger (SLC38A2) by real time PCR. Results Following oral administration, plasma BCAA concentrations showed a similar increase in cirrhosis and controls. Skeletal muscle FSR was 9.63±0.36%/h in controls and 9.05±0.68%/h in cirrhotics (p=0.54). Elevated WbPB in cirrhosis was reduced with BCAA/LEU (p=0.01). Fasting skeletal muscle molecular markers showed increased myostatin expression, impaired mTOR signaling and increased autophagy in cirrhosis compared to controls (p<0.01). BCAA/LEU did not alter myostatin expression but mTOR signaling, autophagy measures and GCN2 activation were consistently reversed in cirrhotic muscle (p<0.01). SLC7A5 expression was higher in basal state in cirrhosis than controls (p<0.05) but increased with BCAA/LEU only in controls (p<0.001). Conclusions We demonstrate that impaired mTOR1 signaling and increased autophagy in skeletal muscle of alcoholic cirrhosis patients is acutely reversed by BCAA/LEU.

Arginine is derived from dietary protein intake, body protein breakdown, or endogenous de novo arginine production. The latter may be linked to the availability of citrulline, which is the immediate precursor of arginine and limiting factor for de novo arginine production. Arginine metabolism is highly compartmentalized due to the expression of the enzymes involved in arginine metabolism in various organs. A small fraction of arginine enters the NO synthase (NOS) pathway. Tetrahydrobiopterin (BH4) is an essential and rate-limiting cofactor for the production of NO. Depletion of BH4 in oxidative-stressed endothelial cells can result in so-called NOS3 "uncoupling," resulting in production of superoxide instead of NO. Moreover, distribution of arginine between intracellular transporters and arginine-converting enzymes, as well as between the arginine-converting and arginine-synthesizing enzymes, determines the metabolic fate of arginine. Alternatively, NO can be derived from conversion of nitrite. Reduced arginine availability stemming from reduced de novo production and elevated arginase activity have been reported in various conditions of acute and chronic stress, which are often characterized by increased NOS2 and reduced NOS3 activity. Cardiovascular and pulmonary disorders such as atherosclerosis, diabetes, hypercholesterolemia, ischemic heart disease, and hypertension are characterized by NOS3 uncoupling. Therapeutic applications to influence (de novo) arginine and NO metabolism aim at increasing substrate availability or at influencing the metabolic fate of specific pathways related to NO bioavailability and prevention of NOS3 uncoupling. These include supplementation of arginine or citrulline, provision of NO donors including inhaled NO and nitrite (sources), NOS3 modulating agents, or the targeting of endogenous NOS inhibitors like asymmetric dimethylarginine.

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Specific differences exist between young and older adults in amino acid metabolism.

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-Acylcarnitines are derived from mitochondrial acyl-CoA metabolism and have been associated with diet-induced insulin resistance. However, plasma acylcarnitine profiles have been shown to poorly reflect whole body acylcarnitine metabolism. We aimed to clarify the individual role of different organ compartments in whole body acylcarnitine metabolism in a fasted and postprandial state in a porcine transorgan arteriovenous model. Twelve cross-bred pigs underwent surgery where intravascular catheters were positioned before and after the liver, gut, hindquarter muscle compartment, and kidney. Before and after a mixed meal, we measured acylcarnitine profiles at several time points and calculated net transorgan acylcarnitine fluxes. Fasting plasma acylcarnitine concentrations correlated with net hepatic transorgan fluxes of free and C2-and C16-carnitine. Transorgan acylcarnitine fluxes were small, except for a pronounced net hepatic C2-carnitine production. The peak of the postprandial acylcarnitine fluxes was between 60 and 90 min. Acylcarnitine production or release was seen in the gut and liver and consisted mostly of C2-carnitine. Acylcarnitines were extracted by the kidney. No significant net muscle acylcarnitine flux was observed. We conclude that liver has a key role in acylcarnitine metabolism, with high net fluxes of C2-carnitine both in the fasted and fed state, whereas the contribution of skeletal muscle is minor. These results further clarify the role of different organ compartments in the metabolism of different acylcarnitine species.acylcarnitines; pigs; fatty acid oxidation; mixed-meal test ACYLCARNITINES ARE INTERMEDIATES of mitochondrial acyl-CoA metabolism, which have gained much attention as markers of inherited metabolic diseases (34) and more recently for their possible involvement in diet-induced insulin resistance and glucose intolerance (2,12,14,16, 18,24). Acylcarnitines are carboxylic acids of different chain lengths derived from different substrates (e.g., fatty acids, amino acids or acetyl-CoA) that are transesterified from CoA to L-carnitine, enabling them to enter or exit the mitochondrion (33). Exchange of acylcarnitines also occurs over the cell membrane. This leads to a specific acylcarnitine profile in plasma composed of acylcarnitines originating from and consumed by the different organs and compartments where the respective acyl-CoAs are metabolized (33). Historically, acylcarnitine profiles have been measured to detect mitochondrial fatty acid oxidation (FAO) disorders (34). More recently, studies have discussed alterations in the acylcarnitine profile, measured mostly in plasma, in relation to deranged FAO and glucose intolerance or insulin resistance (2,12,14). Because increased acylcarnitine levels correlated with markers of glucose intolerance in obesity, acylcarnitines were proposed to potentially induce insulin resistance (10,11,26).However, we have shown previously that the plasma acylcarnitine profile should be interpreted with caution, as it does not reflect the acylcarniti...

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The liver selectively extracts most BAs and BAs with highest affinity for the most important metabolic BA receptor, TGR5, are typically low in both porcine and human peripheral circulation. Our findings raise questions about the magnitude of a peripheral TGR5 signal and its ultimate clinical application.