Reduced arginine availability and nitric oxide production

The precursor for nitric oxide (NO) synthesis is the amino acid arginine. Reduced arginine availability may limit NO production. Arginine availability for NO synthesis may be regulated by de novo arginine production from citrulline, arginine transport across the cell membrane, and arginine breakdown by arginase.     

Oral Citrulline Mitigates Inflammation and Jejunal Damage via the Inactivation of Neuronal Nitric Oxide Synthase and Nuclear Factor–κB in Intestinal Ischemia and Reperfusion

Background: Intestinal ischemia and reperfusion (I/R) is a life‐threatening emergency accompanied by inflammation and organ damage. We compared the mechanisms and the effects of arginine, citrulline, and glutamine on inflammation and intestinal damage. Materials and Methods: Male Wistar rats underwent 60 minutes of superior mesenteric artery occlusion and either 3 (I/R3) or 24 (I/R24) hours of reperfusion and were orally administered vehicle, arginine, citrulline, or glutamine 15 minutes before reperfusion and at 3, 9, and 21 hours of reperfusion. Results: I/R3 rats experienced jejunal damage and apoptosis, and I/R24 rats had liver dysfunction compared with normal rats (one‐way ANOVA, P < .05). Arginine and citrulline administrations improved jejunal morphology, and citrulline and glutamine administrations alleviated the loss of jejunal mass in I/R3 rats. I/R3‐increased circulating nitrate/nitrite (NOx), tumor necrosis factor–α, and interleukin‐6 were significantly decreased by citrulline, glutamine and citrulline, and arginine, glutamine, and citrulline, respectively. These amino acids decreased plasma NOx and interferon‐γ in I/R24, decreased jejunal neuronal nitric oxide synthase (NOS) protein in I/R3 rats, and alleviated jejunal apoptosis in I/R3 and I/R24 rats. In addition, the jejunal phosphorylated to total nuclear factor–κB (NF‐κB) ratio was decreased by arginine and citrulline in I/R24 rats. Conclusion: Oral administration of arginine, citrulline, and glutamine may alleviate systemic inflammation, jejunal apoptosis, and neuronal NOS in intestinal I/R. Citrulline may further attenuate jejunal damage by preserving jejunal mass, partially via the inactivation of NOS and the NF‐κB pathway. In conclusion, oral citrulline may have more benefits than arginine and glutamine in mitigating intestinal ischemia and reperfusion‐induced adverse effects.     

Interorgan amino acid exchange in humans: consequences for arginine and citrulline metabolism

BACKGROUND: The liver plays a central role in amino acid metabolism. However, because of limited accessibility of the portal vein, human data on this subject are scarce. OBJECTIVE: We studied hepatic amino acid metabolism in noncirrhotic fasting patients undergoing liver surgery. DESIGN: Twenty patients undergoing hepatectomy for colorectal metastases in a normal liver were studied. Before resection, blood was sampled from a radial artery, portal vein, hepatic vein, and renal vein. Organ blood flow was measured by duplex ultrasound scan. RESULTS: The intestine consumed glutamine and released citrulline. Citrulline was taken up by the kidney. This was accompanied by renal arginine release, which supports the view that glutamine is a precursor for arginine synthesis through an intestinal-renal pathway. The liver was found to extract citrulline from this pathway at a rate that was dependent on intestinal citrulline release (P < 0.0001) and hepatic citrulline influx (P = 0.03). Fractional hepatic extractions of citrulline (8.4%) and arginine (11.5%) were not significantly different. Eighty-eight percent of arginine reaching the liver passed it unchanged. Splanchnic citrulline release could account for one-third of renal citrulline uptake. CONCLUSIONS: This is the first study of hepatic and interorgan amino acid metabolism in humans with a normal liver. The data indicate that glutamine is a precursor of ornithine, which can be converted to citrulline by the intestine; citrulline is transformed in the kidneys to arginine. Hepatic citrulline uptake limits the amount of gut-derived citrulline reaching the kidney. These findings may have implications for interventions aimed at increasing systemic arginine concentrations.     

Oral arginine reduces systemic blood pressure in type 2 diabetes: its potential role in nitric oxide generation

OBJECTIVES: Arginine is converted in the endothelial cells to nitric oxide (NO) and citrulline. NO is a potent vasodilator in humans, but diabetics may have a reduced generation of NO which results in endothelial dysfunction. The aim of this study was to evaluate the effects of oral arginine on nitric oxide production, counter-regulatory hormones and blood pressure in mildly hypertensive type 2 diabetic patients. METHODS: A prospective, crossover clinical trial was performed over a three-day stay in the General Clinical Research Center. Six patients with type 2 diabetes mellitus and mild hypertension consented and were given orally three grams of arginine per hour for 10 hours on either day 2 or day 3. On both days 2 and 3, blood pressure was monitored between 5 AM and 4 PM and mean pressure determined. RESULTS: Oral arginine increased plasma citrulline from 31.3 +/- 6.0 to 41.5 +/- 6.0 micro mol/L (mean +/- SEM; p < 0.05) which may reflect an increased conversion of arginine into NO and citrulline. Arginine reduced systolic BP from 135 +/- 7 to 123 +/- 8 mmHg; p < 0.05. Diastolic BP fell from 86.9 +/- 1.7 to 80.7 +/- 2.4 mmHg; p < 0.05). The reduction in BP was noted to occur two hours after starting oral arginine, and BP returned to normal within one hour of stopping the arginine. The oral arginine had no effect on C-peptide, insulin or other hormone concentrations. CONCLUSIONS: These data suggest that oral arginine may increase endothelial nitric oxide synthase (NOS) to increase vascular NO and temporally reduce blood pressure in mildly hypertensive type 2 diabetic patients.     

Glutamine is an important precursor for de novo synthesis of arginine in humans

BACKGROUND: A metabolic relation exists between glutamine and arginine, 2 amino acids with properties that enhance the recovery of seriously ill patients. It is possible that glutamine exerts part of its beneficial effects by enhancing the availability of arginine. OBJECTIVES: We aimed to quantify under postabsorptive conditions the metabolic pathway of plasma glutamine into arginine via the intermediate citrulline and to establish the contribution of the kidneys to the synthesis of arginine. DESIGN: The study was conducted in patients during surgery. The metabolism of glutamine, citrulline, and arginine was studied by using intravenous administration of stable isotope tracers of the amino acids. Results were interpreted by using established equations. Parametric tests were used to test and correlate results. P < 0.05 was regarded as significant. RESULTS: Mean (+/-SE) whole-body plasma turnover rates of glutamine, citrulline, and arginine were 240 +/- 14, 6.2 +/- 0.6, and 42 +/- 2.9 micromol x kg(-1) x h(-1), respectively (P < 0.01). Plasma turnover of citrulline derived from glutamine was shown to be 5.1 +/- 0.7 micromol x kg(-1) x h(-1), and arginine derived from citrulline was shown to be 4.9 +/- 0.9 micromol x kg(-1) x h(-1) (P < 0.01). The contribution of plasma glutamine to plasma arginine derived from plasma citrulline was calculated to be 64%. The kidneys were observed to take up >50% of circulating plasma citrulline and to release equimolar amounts of arginine into plasma. CONCLUSIONS: This study shows that glutamine is an important precursor for the synthesis of arginine in humans. It also provides a firm basis for future studies exploring the effect of a treatment dose and the route of administration (enteral or parenteral) of glutamine.     

The 2007 ESPEN Sir David Cuthbertson Lecture: amino acids between and within organs. The glutamate-glutamine-citrulline-arginine pathway

In daily practice, the plasma concentration of amino acids is usually viewed as a parameter of production. However, both a high production and/or a reduced disposal capacity can result in an increased plasma concentration. In this presentation, I will discuss my research on interorgan relationships of the amino acids glutamate, glutamine, citrulline and arginine to explain the regulation of the plasma arginine level. The reduced glutamine disposal during liver failure is related to enhanced plasma glutamine level without any change in muscle and gut production or consumption rate. In contrast during sepsis, a small reduction in plasma glutamine is related to a substantially enhanced organ glutamate and glutamine production or consumption rate. These observations are a good example that plasma levels are directly related to production or consumption rates. Because glutamine breakdown in the gut produces citrulline, there is a good relation between the amount of metabolically active gut tissue and gut and whole body citrulline production. Arginine is produces from citrulline in the kidney and a reduced gut glutamine to citrulline conversion during sepsis explains the reduced de novo arginine production that is related to the reduced plasma arginine level. The interorgan route between muscle, gut, liver and kidney of the amino acids glutamate, glutamine, citrulline and arginine is a very good example of how complicated the regulation of plasma amino acid levels can be. However, in-depth research is necessary and will give us important clues to new nutritional strategies.     

Arginine and Citrulline and the Immune Response in Sepsis

Arginine, a semi-essential amino acid is an important initiator of the immune response. Arginine serves as a precursor in several metabolic pathways in different organs. In the immune response, arginine metabolism and availability is determined by the nitric oxide synthases and the arginase enzymes, which convert arginine into nitric oxide (NO) and ornithine, respectively. Limitations in arginine availability during inflammatory conditions regulate macrophages and T-lymfocyte activation. Furthermore, over the past years more evidence has been gathered which showed that arginine and citrulline deficiencies may underlie the detrimental outcome of inflammatory conditions, such as sepsis and endotoxemia. Not only does the immune response contribute to the arginine deficiency, also the impaired arginine de novo synthesis in the kidney has a key role in the eventual observed arginine deficiency. The complex interplay between the immune response and the arginine-NO metabolism is further underscored by recent data of our group. In this review we give an overview of physiological arginine and citrulline metabolism and we address the experimental and clinical studies in which the arginine-citrulline NO pathway plays an essential role in the immune response, as initiator and therapeutic target.     

Systemic arginine depletion after a murine model of surgery or trauma

Background: Arginine metabolism and availability after surgery or trauma (ST) is an important modulator of immune responses. Arginine levels are significantly depleted in human trauma patients. Diets containing arginine administered to surgery patients have restored immune function. We hypothesized an arginase‐dependent depletion of arginine in a murine model of ST. In addition, we hypothesized a systemic arginase release in human trauma patients. Methods: Male mice were anesthetized and a laparotomy with bowel manipulation was used as a model of ST. Plasma was collected after ST for analysis of arginase activity and arginine, ornithine, and citrulline. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in plasma were measured after ST. Also, arginase activity was determined in human plasma from 4 healthy controls and 8 trauma patients. Results: Arginase activity increased maximally at 2–4 hours after ST, and arginine was significantly reduced after ST. Citrulline was significantly decreased at 8 and 12 hours after ST. Plasma AST and ALT did not significantly vary from control mice after ST. In addition, on day 1 after intensive care unit admission, human trauma patients exhibited a significant increase in arginase activity. Conclusions: The biological consequences of arginine depletion remain incompletely understood. These data are consistent with data showing that patients given arginine‐containing diets experience reduced morbidity. Understanding of arginine metabolism after ST may lead to therapies aimed at improving clinical outcome after ST.     

Acute reduction of circulating arginine in mice does not compromise whole body NO production

The amino acid arginine is the sole precursor for nitric oxide (NO) synthesis. We have now studied the role of acutely reducing circulating arginine on whole body NO production in mice. Measurements were performed in 4 groups of mice, treated with saline (SAL) or arginase (ASE), and SAL or bacterial endotoxin (LPS). After 5 h, a 57% reduction in circulating arginine was obtained by intravenous injections of arginase (SAL/SAL: 138+/-7; ASE/SAL: 59+/-10 microM, P<0.05). Reduced circulating arginine caused a reduction in plasma arginine flux (SAL/SAL: 82+/-6; ASE/SAL: 63+/-5 nmol/(10 g b.w. min), P<0.05), but did not change whole body NO production. LPS treatment caused an increase in NO production (SAL/SAL: 1.3+/-0.3 SAL/LPS 2.3+/-0.4 nmol/(10 g b.w. min), P<0.05), presumably by NOS-2 and was unaffected by reducing circulating arginine. Also, intestinal citrulline and renal arginine production were not increased in LPS-challenged mice with reduced circulating arginine levels. The present study indicates that an acute decrease in circulating arginine does not compromise whole body NO production and provides evidence against a role for renal arginine production to counteract an acute reduction of circulating arginine.     

Dietary glutamine supplementation reduces plasma nitrate levels in rats

It was recently shown that L-glutamine inhibits vascular nitric oxide (NO) production in vitro. The present study investigated the effect of glutamine enriched enteral diets on in vivo NO production in the rat. Nitrate, the stable end-product of NO production, was measured in plasma and 24 h urine collections in glutamine supplemented rats (6.25%, 12.5% and 25% w/w) and compared to the effect of isocaloric, nitrogenous control diets. Glutamine supplementation increased plasma levels of glutamine (up to 91%), arginine (up to 17%) and citrulline (up to 54%). After 1 week of glutamine supplementation plasma nitrate levels were significantly reduced by 50% compared to control (P < 0. 0001); irrespective of the amount of supplementation. No further decrease was observed after 2 weeks of feeding. No differences in daily urinary losses were found between the groups. These results point to an in vivo inhibitory effect of glutamine supplemented enteral feeding on NO production.     

The feeding route (enteral or parenteral) affects the plasma response of the dipetide Ala-Gln and the amino acids glutamine, citrulline and arginine, with the administration of Ala-Gln in preoperative patients

Enhancement of depressed plasma concentrations of glutamine and arginine is associated with better clinical outcome. Supplementation of glutamine might be a way to provide the patient with glutamine, and also arginine, because glutamine provides the kidney with citrulline, from which the kidney produces arginine when plasma levels of arginine are low. The aim of the present study was to investigate the parenteral and enteral response of the administered dipeptide Ala-Gln, glutamine, citrulline and arginine. Therefore, seven patients received 20 g Ala-Gln, administered over 4 h, parenterally or enterally, on two separate occasions. Arterial blood samples were taken before and during the administration of Ala-Gln. ANOVA and a paired t test were used to test differences (P<0.05). Ala-Gln was undetectable with enteral administration, whereas Ala-Gln remained stable at a plasma concentration of 268 micromol/l throughout parenteral infusion and rapidly decreased towards zero after infusion was stopped. The highest level of glutamine was observed with parenteral infusion of the dipeptide, although enteral infusion also significantly increased plasma levels of glutamine. The highest plasma response of citrulline was observed with the enteral administration of the dipeptide, although parenteral administration also increased plasma levels of citrulline. Plasma arginine increased significantly with parenteral infusion, but not with enteral administration of Ala-Gln. In conclusion, administrations of Ala-Gln, parenteral or enteral, resulted in an increased plasma glutamine response, as compared with baseline. Interestingly, in spite of the high availability of citrulline with enteral administration of the dipeptide, only parenteral infusion of Ala-Gln increased plasma arginine concentration.     

Modulation of nitric oxide and cytokines production by L-arginine in human gut mucosa

BACKGROUND: Arginine is a conditionally essential amino-acid with immuno-modulatory properties, mainly through the nitric oxide (NO) pathway. AIM: To assess the effects of arginine on intestinal production of pro- and anti-inflammatory cytokines and NO in human gut. METHODS: An enteral solution of arginine or a control solution of amino-acids was administered to 8 healthy volunteers on a randomized cross-over design. Duodenal biopsies were taken. Pro- (IL-6, IL-8) and anti-inflammatory (IL-4, IL-10) cytokines mRNA expression was assessed by RT-PCR. Other biopsies were cultured with 0.1, 0.5 or 2 mM arginine or control amino-acids, under basal or IL-1beta-induced inflammatory conditions. Interleukin-4, IL-6, IL-8 and IL-10 production was measured in culture supernatant by ELISA and NO production by Griess reaction. RESULTS: Arginine enhanced the production of NO under inflammatory conditions in a dose-dependent manner (P=0.03). IL-1beta increased the production of IL-8 and IL-6 (P<0.01). Arginine had no effect on pro- and anti-inflammatory cytokines production both under basal and inflammatory conditions. CONCLUSIONS: Arginine enhanced the production of NO but did not affect that of cytokines in inflammatory human gut. Further clinical studies are required to assess whether arginine-enhanced NO production plays a beneficial or deleterious effect in intestinal inflammation.     

The route of administration (enteral or parenteral) affects the conversion of isotopically labeled L-[2-15N]glutamine into citrulline and arginine in humans

BACKGROUND: Glutamine exhibits numerous beneficial effects in experimental and clinical studies. It has been suggested that these effects may be partly mediated by the conversion of glutamine into citrulline and arginine. The intestinal metabolism of glutamine appears to be crucial in this pathway. The present study was designed to establish the effect of the feeding route, enteral or parenteral, on the conversion of exogenously administered glutamine into citrulline and arginine at an organ level in humans, with a focus on gut metabolism. METHODS: Sixteen patients undergoing upper gastrointestinal surgery received an IV or enteral (EN) infusion of L-[2-(15)N]glutamine. Blood was sampled from a radial artery and from the portal and right renal vein. Amino acid concentrations and enrichments were measured, and net fluxes of [(15)N]-labeled substrates across the portal drained viscera (PDV) and kidneys were calculated from arteriovenous differences and plasma flow. RESULTS: Arterial [(15)N]glutamine enrichments were significantly lower during enteral tracer infusion (tracer-to-tracee ratio [labeled vs unlabeled substrate, TTR%] IV: 6.66 +/- 0.35 vs EN: 3.04 +/- 0.45; p < .01), reflecting first-pass intestinal metabolism of glutamine during absorption. Compared with IV administration, enteral administration of the glutamine tracer resulted in a significantly higher intestinal fractional extraction of [(15)N]glutamine (IV: 0.15 +/- 0.03 vs EN: 0.44 +/- 0.08 micromol/kg/h; p < .01). Furthermore, enteral administration of the glutamine tracer resulted in higher arterial enrichments of [(15)N]citrulline (TTR% IV: 5.52 +/- 0.44 vs EN: 8.81 +/- 1.1; p = .02), and both routes of administration generated a significant enrichment of [(15)N]arginine (TTR% IV: 1.43 +/- 0.12 vs EN: 1.68 +/- 0.18). This was accompanied by intestinal release of [(15)N]citrulline across the PDV, which was higher with enteral glutamine (IV: 0.38 +/- 0.07 vs EN: 0.72 +/- 0.11 micromol/kg/h; p = .02), and subsequent [(15)N]arginine release in both groups. CONCLUSIONS: In humans, the gut preferably takes up enterally administered glutamine compared with intravenously provided glutamine. The route of administration, enteral or IV, affects the quantitative conversion of glutamine into citrulline and subsequent renal arginine synthesis in humans.     

Citrulline and the gut

PURPOSE OF REVIEW: Citrulline, a nonprotein amino acid, is an important source of endogenous arginine. The gut is the main source of citrulline in humans. Hence, citrulline is a potential biomarker of short bowel function. Conversely, citrulline uptake by the gut is important for an oral supply of this amino acid as an alternative to arginine. This review discusses these two aspects of citrulline, as well as the recent developments in the understanding of its metabolism. RECENT FINDINGS: Citrullinemia is such an efficient marker when the active mass of the bowel is affected that it can be used as a prognostic marker for parenteral nutrition weaning (if citrullinemia is >20 micromol/l) and as a factor for deciding between parenteral and enteral nutrition (as long as the pathology is considered). Citrullinemia should be used with care as a marker either of the intestinal absorption or following small bowel transplantation. SUMMARY: Citrulline is easily taken up by the gut, with a broad set of transporters that can remove it from the lumen in the enterocytes. This is confirmed by pharmacokinetic studies and the efficacy is so great that oral complementation with citrulline seems more efficient than complementation with arginine to provide arginine.     

Arginine metabolism in infected cell cultures as a marker character for the differentiation of orthopoxviruses.

Arginine has been shown to be essential for the replication of several orthopoxviruses in mouse sarcoma 180 cells and in chick embryo fibroblast cultures. Both host systems are characterized by their inabilities to utilize citrulline for the biosynthesis of arginine due to deficiencies in the requisite cellular enzymes and cell multiplication is absolutely dependent on the availability of exogenous arginine. Virus replication in such cells maintained with citrulline results from the induction of virus-specific enzymes. Significant virus yields in the absence of exogenous arginine or citrulline can arise from the replenishment of intracellular amino acid pools by increased utilization of arginyl residues in cellular proteins. The extent of the phenotypic expression of these characters in infected cells permitted significant discrimination between the viruses examined. Distinctions could be drawn between rabbitpox, ectromelia, cowpox, buffalopox and vaccinia strains. However, cowpox could not be distinguished from other viruses isolated from diseased animals in European zoos.     

Arginine metabolism in infected cell cultures as a marker character for the differentiation of orthopoxviruses

Arginine has been shown to be essential for the replication of several orthopoxviruses in mouse sarcoma 180 cells and in chick embryo fibroblast cultures. Both host systems are characterized by their inabilities to utilize citrulline for the biosynthesis of arginine due to deficiencies in the requisite cellular enzymes and cell multiplication is absolutely dependent on the availability of exogenous arginine. Virus replication in such cells maintained with citrulline results from the induction of virus-specific enzymes. Significant virus yields in the absence of exogenous arginine or citrulline can arise from the replenishment of intracellular amino acid pools by increased utilization of arginyl residues in cellular proteins. The extent of the phenotypic expression of these characters in infected cells permitted significant discrimination between the viruses examined. Distinctions could be drawn between rabbitpox, ectromelia, cowpox, buffalopox and vaccinia strains. However, cowpox could not be distinguished from other viruses isolated from diseased animals in European zoos.     

Metabolic effects of glutamine and glutamate ingestion in healthy subjects and in persons with chronic obstructive pulmonary disease

BACKGROUND: Because low plasma glutamate and glutamine concentrations are often seen in chronic obstructive pulmonary disease (COPD), glutamine or glutamate supplementation may be a good option for preventing further metabolic disturbances in COPD patients. However, the metabolic effects of glutamate supplementation have never been compared with those of glutamine supplementation. OBJECTIVE: We compared the metabolic effects of repeated ingestion of glutamine and glutamate in COPD patients and in age-matched healthy control subjects. DESIGN: On 3 d separated by intervals of > or = 2 d, a protocol of primed constant and continuous infusion of [2H5]phenylalanine and [2H2]tyrosine was performed for 3 h in 8 stable male COPD patients and 8 healthy control subjects. After a 90-min tracer infusion, all subjects ingested a glutamine or glutamate drink or the same amount of water every 20 min for 80 min. Blood samples were taken at the end of the postabsorptive and ingestion periods to test for effects on plasma amino acid and substrate concentrations and whole-body protein turnover. RESULTS: Glutamate but not glutamine ingestion resulted in higher plasma ornithine concentrations than did water ingestion (P < 0.01). The change in plasma arginine, citrulline, and urea concentrations was significantly (P < 0.01) higher after glutamine ingestion than after water or glutamate ingestion. Whole-body protein turnover decreased overall, independent of the drink consumed. CONCLUSIONS: Repeated ingestion of glutamine and glutamate resulted in different effects on the plasma amino acid concentration. In both groups, ingestion of glutamine but not of glutamate increased the plasma concentrations of citrulline and arginine, substrates produced in the intestine and the liver.     

Citrulline can preserve proliferation and prevent the loss of CD3 zeta chain under conditions of low arginine

BACKGROUND: Arginine depletion by the enzyme Arginase I, decreases expression of the TCR zeta chain preventing T-cell activation and causing T-cell dysfunction. We hypothesized that citrulline could substitute for arginine under conditions of increased arginase expression. Thus, the goal was to establish a possible mechanism of how citrulline could overcome arginine depletion caused by arginase. METHODS: Jurkat cells were cultured, with or without arginase, in media containing different amino-acid constituents: complete RPMI containing arginine (C-RPMI) (arginine), Arginine-Free-RPMI (Arg-Free RPMI) and Citrulline-containing RPMI (Cit RPMI). Incorporation of citrulline was measured via uptake of 3H-citrulline, whereas proliferation was measured via 3H-thymidine incorporation. zeta Chain was analyzed by 2-color flow cytometry. Argininosuccinate synthase (AS) and argininosuccinate lyase expression was detected using Northern blots, RT-PCR, and Western blots. RESULTS: Jurkat cells exhibited a significant decrease in proliferation and 5 chain expression when cultured in the presence of arginase or in the absence of arginine. With citrulline, zeta chain expression and proliferation were maintained in the absence of arginine or in the presence of the enzyme arginase. Jurkat cells, cultured in the absence of arginine, were associated with a 5-fold increase in citrulline uptake. The absence of arginine was also associated with increased expression of AS. CONCLUSIONS: T cells exhibit the molecular capability of increasing citrulline membrane transport and up-regulating AS expression, thus exhibiting the necessary mechanisms for converting citrulline into arginine and escaping the ill effects of arginine depletion. Therefore, citrulline has the potential to be a substitute for supplemental arginine in diseases associated with arginase-mediated T cell dysfunction.     

The uptake of glutamine and release of arginine, citrulline and proline by the small intestine of developing pigs

Arteriovenous (A-V) differences in the plasma concentrations of amino acids across the jejunum were studied in preweaning (14- to 21-d-old) and post-weaning (29- to 58-d-old) pigs in the postabsorptive state. Glutamine was the only amino acid that was extracted by the small intestine in both pre- and post-weaning pigs. The production of citrulline by the jejunum was low in preweaning pigs, but was threefold greater in the post-weaning pigs than in the preweaning pigs. The output of proline by the intestine was observed in the post-weaning pigs but not in the preweaning pigs. Arginine and alanine were the predominant amino acids released by the jejunum of the pre- and post-weaning pigs, respectively. Whereas glutamate was the major amino acid formed from glutamine in pig enterocytes in vitro, the jejunum of the post-weaning pigs released comparable amounts of citrulline, proline and glutamate in vivo. There were no significant A-V differences in the concentrations of urea, ornithine, taurine, tyrosine, serine, glycine and nutritionally essential amino acids in either the preweaning or the post-weaning pigs. Thus, we demonstrated for the first time the uptake in vivo of glutamine and the release of arginine, alanine, citrulline, glutamate and proline by the small intestine of developing pigs. Our findings on the release in vivo of citrulline (the precursor of arginine) and proline by the small intestine of the pre- and post-weaning pigs provide a basis for explaining why arginine and proline are nutritionally essential amino acids for young suckling piglets but not for adult pigs.     

In vivo arginine production and intravascular nitric oxide synthesis in hypotensive sepsis

BACKGROUND: Arginine is important in the response to infections and is a precursor for the synthesis of the vasodilator nitric oxide (NO). Low plasma arginine is correlated with a worse prognosis in patients with sepsis, and increased NO has been implicated in the hypotension of sepsis. Data on in vivo arginine and NO kinetics are lacking in hypotensive septic adults. OBJECTIVE: We aimed to measure in vivo arginine production and the intravascular NO synthesis rate in hypotensive septic patients. DESIGN: Arginine flux and the fractional and absolute synthesis rates of plasma NO were measured in fasted healthy (n = 10) and hypotensive septic (n = 6) adults by using a 6-h constant infusion of [15N2-guanidino]arginine. Urinary excretion of the NO metabolites nitrite and nitrate (NOx) and plasma concentrations of NOx, arginine, and creatinine were also measured. RESULTS: All patients had hyperdynamic septic shock and impaired renal function. Compared with the control subjects, the patients had slower arginine flux (99 +/- 8 compared with 50 +/- 7 micromol x kg(-1) x h(-1); P < 0.01), lower plasma arginine concentrations (75 +/- 8 compared with 40 +/- 11 micromol/L; P < 0.01), higher plasma NOx concentrations (30 +/- 4 compared with 65 +/- 1.8 micromol/L), and a slower fractional synthesis rate of NOx. There was no significant difference in the absolute synthesis rate of NOx between groups. In patients with sepsis, the plasma NOx concentration correlated with the glomerular filtration rate and plasma creatinine but not with mean arterial pressure. CONCLUSIONS: Patients with septic shock have a shortage in the availability of arginine associated with a slower production. Impaired renal excretion of NOx is a contributor to the high plasma NOx in these patients.