Ribose administration during exercise: Effects on substrates and products of energy metabolism in healthy subjects and a patient with myoadenylate deaminase deficiency

Summary Nine healthy men and a patient with myoadenylate deaminase deficiency were exercised on a bicycle ergometer (30 minutes, 125 Watts) with and without oral ribose administration at a dose of 2 g every 5 minutes of exercise. Plasma or serum levels of glucose, free fatty acids, lactate, ammonia and hypoxanthine and the urinary hypoxanthine excretion were determined. After 30 minutes of exercise without ribose intake the healthy subjects showed significant increases in plasma lactate (p<0.05), ammonia (p<0.01) and hypoxanthine (p<0.05) concentrations and a decrease in serum glucose concentration (p<0.05). When ribose was administered, the plasma lactate concentration increased significantly higher (p< 0.05) and the increase in plasma hypoxanthine concentration was no longer significant. The patient showed the same pattern of changes in serum or plasma concentrations with exercise with the exception of hypoxanthine in plasma which increased higher when ribose was administered.Abbreviations FFA Free fatty acids     

Myoadenylate deaminase deficiency

Summary Myoadenylate deaminase (MAD) is the rate-limiting enzyme in the purine nucleotide cycle which is biochemically linked to glycolysis and the citric cycle and thereby providing energy during intense muscular activity. In muscle fibers, myoadenylate deaminase operates at considerably higher activity levels than in other organs. First detected using enzyme-histochemical methods, it now appears that deficiency of myoadenylate deaminase is one of the most frequent enzyme defects in muscle. The primary defect may occur as an isolated nosological entity or not infrequently it is also associated with a large spectrum of different neuromuscular conditions. It seems to be the primary unassociated MAD deficiency that has recently become amenable to successful treatment with D-ribose in high doses. Secondary MAD deficiency may occur in muscle fibers and muscles that have undergone structural damage as seen, for instance, in polymyositis, muscular dystrophy, and denervation.The wealth of biochemical, morphological, and clinical data that has accumulated since the discovery of MAD deficiency during the past decade provides nosological significance of MAD deficiency as a real entity.Abbreviations AD adenylate deaminase - AMP adenosine monophosphate - ATP adenosine triphosphate - GTP guanosine triphosphate - IMP inosine monophosphate - LAER lactate ammonium exercise ratio - MAD myoadenylate deaminase - MADD myoadenylate deaminase deficiency     

Muscle metabolism and red cell ATP/ADP concentration during bicycle ergometer in patients with AMPD-deficiency

Summary 6 patients with AMPD-deficiency and 6 control subjects performed exercise on a bicycle ergometer until heart rate was 200 minus age. During exercise the increase of ammonia plasma concentrations was reduced in AMPD-deficient patients compared with that of control subjects. Plasma concentrations of lactate, pyruvate, inosine, hypoxanthine and xanthine increased during exercise in both groups. The concentrations of lactate, inosine and hypoxanthine were lower in AMPD-deficient patients during exercise, the difference was not significant. In AMPD-deficient patients the ATP-concentrations of red blood cells increased during exercise in contrast to control subjects, whereas the ADP amount did not change significantly.Our data suggest that in AMPD-deficient-patients AMP is mainly reduced to adenosine during exercise resulting in decreased ammonia concentrations. The increased concentrations of ATP in red blood cells may be the consequence of increased phosphorylation.Abbreviations AMP, ADP, ATP adenosine-5-monophosphate, -diphosphate, -triphosphate - AMPD AMP deaminase (myoadenylate deaminase)     

Myoadenylate deaminase deficiency

Summary This report concerns two unrelated males; one had sarcoidosis, sarcoid myopathy and muscle weakness, and the other had exercise-induced weakness and myalgia. Both patients had a lack of ammonia rise in their serum after an ischemic work test, minimal histochemical activity of myoadenylate deaminase in repeated muscle biopsies, and less than 5% of normal biochemical activity of myoadenylate deaminase in their skeletal muscles. These three criteria establish primary myoadenylate deaminase deficiency as a separate primary metabolic muscle disease which merits differential diagnostic consideration when patients complain of muscle weakness and cramps.Abbreviations ACE angiotensin converting enzyme - CK creatine kinase - MAD myoadenylate deaminase - MADD myoadenylate deaminase deficiency     

Influence of peripheral arterial occlusive disease on muscular metabolism

Summary The concentrations of lactate, ammonia and hypoxanthine were determined in blood from the femoral artery, femoral vein and cubital vein under resting conditions in 23 patients with stage II, 10 patients and 20 diabetics with stage IV peripheral arterial occlusive disease (PAOD) and in 19 healthy subjects. The metabolite concentrations were also measured immediately and 20 min after calf exercise in the patients with stage II PAOD and in the controls. At rest, there was a negative arteriovenous difference in femoral lactate level and a positive arteriovenous difference in the ammonia level in all groups. After exercise to the claudication limit, the femoral venous concentration and arteriovenous difference for lactate increased in the patient group significantly higher than in the controls, who were exercised three times as heavily. Furthermore, there was a significant rise in femoral venous ammonia concentration with inversion of the arteriovenous difference into the negative range and an increase in femoral venous hypoxanthine concentration only in the patients with PAOD and not in the controls. A significant correlation was found between the exercise-induced increases in lactate and ammonia. The results indicate activation of the purine nucleotide cycle in the muscles of limbs with impaired circulation, even for a short duration of load. This can be explained by activation of the AMP-deaminase in type I and type IIa muscle fibres by anoxaemia. The purine nucleotide cycle has an emergency metabolic function in ischaemia to maintain muscle contractility. Ammonia determination in femoral blood permits, in association with lactate and hypoxanthine determination, a precise quantitative assessment of the metabolic effects of PAOD.Abbreviations ADP adenosine diphosphate - AMP adenosine monophosphate - ATP adenosine triphosphate - AVD arteriovenous difference - IMP inosine monophosphate - PAOD peripheral arterial occlusive disease - PNC purine nucleotide cycle Dedicated to Prof. Dr. R. Hild on the occasion of his 60th birthday     

Metabolism of D-ribose administered continuously to healthy persons and to patients with myoadenylate deaminase deficiency

Summary D-ribose was administered orally or intravenously over at least 5 h to eight healthy volunteers and five patients with myoadenylate deaminase deficiency. Intravenous administration rates were 83, 167, and 222 mg/kg/h, which were well tolerated but oral administration of more than 200 mg/kg/h caused diarrhea. The average steady state serum ribose level ranged between 4.8 mg/100 ml (83 mg/kg/h, oral administration) and 81.7 mg/100 ml (222 mg/kg/h, intravenous administration). Serum glucose level decreased during ribose administration. The intestinal absorption rate of orally administered ribose was 87.8%–99.8% of the intake at doses up to 200 mg/kg/h without first pass effect. Urinary losses were 23% of the intravenously administered dose at 222 mg/kg/h. Ribose appeared to be excreted by glomerular filtration without active reabsorption; a renal threshold could not be demonstrated. The amount of ribose transported back from the tubular lumen depended on the serum ribose level. There was no difference in ribose turnover in healthy subjects and patients with MAD deficiency.Abbreviations MAD myoadenylate deaminase - i.v. intravenous(ly)     

Myoadenylate deaminase deficiency: Successful symptomatic therapy by high dose oral administration of ribose

Summary A 55 years old patient suffering from exercise-induced muscle pain and stiffness due to primary myoadenylate deaminase deficiency has been successfully treated with D-ribose since 1984: single doses of 4 grams administered at the beginning of exercise prevented the symptoms completely; on continuation of exercise this dose had to be repeated all 10–30 min. Total doses of 50–60 g per day were tolerated without side-effects.Abbreviations AMP, ADP, ATP adenosine-5-monophosphate, diphosphate, -triphosphate - GDP, GTP guanosine-5-diphosphate, -triphosphate - IMP inosine-5-monophosphate - MAD myoadenylate deaminase - PRPP Phosphoribosylpyrophosphate     

Assessment of muscular metabolism in peripheral arterial occlusive disease using31P nuclear magnetic resonance spectroscopy

Summary The behaviour of muscular metabolism was investigated in 10 patients with peripheral arterial occlusive disease stage II at rest and after maximum erometric calf exercise. The intracellular concentrations of phosphocreatine, inorganic phosphate and adenosine triphosphate as well as muscle pH were measured by means of³¹P magnetic resonance spectroscopy and compared with those from a control group. In addition, arteriovenous differences in concentrations of lactate, pyruvate, ammonia, hypoxanthine and alanine in the femoral blood were determined. The fall in intracellular phosphocreatine concentration during exercise was significantly greater in the calf muscles of patients with arterial occlusion than in controls and correlated linearly with the increase in femoral arteriovenous differences in lactate, ammonia and alanine. A significant fall in intracellular pH occurred during muscular activity only in the patient group, but not in the identically exercised control group. The fall in pH correlated closely with the rise in arteriovenous lactate difference in the femoral blood. The intramuscular ATP concentration remained constant throughout the exercise procedure. The behaviour of both the directly and indirectly measured metabolites permits the deduction of activation of the creatine kinase reaction, glycolysis, myokinase reaction and the purine nucleotide cycle during exercise-induced hypoxia in the presence of arterial occlusive disease. The anaerobic production of energy is sufficient to maintain the ATP concentration even during claudication pain. Magnetic resonance spectroscopy proved to be a useful tool for non-invasive assessment of the metabolic changes in peripheral arterial occlusive disease.Abbreviations ADP adenosine diphosphate - AMP adenosine monophosphate - ATP adenosine triphosphate - AVD arteriovenous difference - (P)AOD (peripheral) arterial occlusive disease - IMP inosine monophosphate - NAD⁺ nicotinamide adenine dinucleotide - PCr phosphocreatine - P₁ inorganic phosphate - ³¹P-MRS ³¹phosphorus magnetic resonance spectroscopy - NMR nuclear magnetic resonance - PNC purine nucleotide cycle     

The effect of high-intensity training on purine metabolism in man

The effect of intermittent high-intensity training on the activity of enzymes involved in purine metabolism and on the concentration of plasma purines following acute short-term intense exercise was investigated. Eleven subjects performed sprint training three times per week for 6 weeks. Muscle biopsies for determination of enzyme activities were obtained prior to and 24 h after the training period. After training, the activity of adenosine 5′-phosphate (AMP) deaminase was lower (P < 0.001) whereas the activities of hypoxanthine phosphoribosyl transferase (HPRT) and phosphofructokinase were significantly higher compared with pre-training levels. The higher activity of HPRT with training suggests an improved potential for rephosphorylation of intracellular hypoxanthine to inosine monophosphate (IMP) in the trained muscle. Before and after the training period the subjects performed four independent 2-min tests at intensities from a mean of 106 to 135 % of Vo_max. Venous blood was drawn prior to and after each test. The accumulation of plasma hypoxanthine following the four tests was lower following training compared with prior to training (P < 0.05). The accumulation of uric acid was significantly lower (46% of pre-training value) after the test performed at 135% of Fo_2mM (P < 0.05). Based on the observed alterations in muscle enzyme activities and plasma purine accumulation, it is suggested that high intensity intermittent training leads to a lower release of purines from muscle to plasma following intense exercise and, thus, a reduced loss of muscle nucleotides.     

Myogenic hyperuricemia. A common pathophysiologic feature of glycogenosis types III, V, and VII

To identify the mechanism of hyperuricemia in glycogen storage diseases (glycogenoses) that affect muscle, we studied the effects of exercise and prolonged rest on purine metabolism in two patients with glycogenosis type III (debrancher deficiency), one patient with type V (muscle phosphorylase deficiency), and one patient with type VII (muscle phosphofructokinase deficiency). All had hyperuricemia except for one patient with glycogenosis type III. Plasma concentrations of ammonia, inosine, and hypoxanthine increased markedly in all the patients after mild leg exercise on a bicycle ergometer. The plasma urate concentrations also increased, but with a delayed response. Urinary excretion of inosine, hypoxanthine, and urate increased greatly after exercise, consistently with the increases in plasma levels. Hypoxanthine and urate concentrations were extremely high in the plasma and urine of the patient with glycogenosis type VII. With bed rest, the plasma hypoxanthine level returned to normal within a few hours, and the plasma urate concentration decreased from 18.6 to 10.6 mg per deciliter (1106 to 630 mumol per liter) within 48 hours. Similarly, the urinary excretion of these purine metabolites was reduced by bed rest. These findings indicate that muscular exertion in patients with glycogenosis types III, V, and VII causes excessive increases in blood ammonia, inosine, and hypoxanthine due to accelerated degradation of muscle purine nucleotides. These purine metabolites subsequently serve as substrates for the synthesis of uric acid, leading to hyperuricemia.     

Influence of ambient temperature on plasma ammonia and lactate accumulation during prolonged submaximal and self-paced running

This study examined the effects of heat stress on the accumulation of plasma ammonia, lactate, and urate during prolonged running. Nine highly trained endurance runners completed two running trials in a counterbalanced fashion in cool (15°C) and in hot (35°C) humid (60% relative humidity) conditions. Subjects ran on a motorised treadmill at 70% of peak treadmill running speed for 30 min (submaximal) followed by a self-paced 8-km performance run. Blood was drawn at pre-exercise, end-submaximal and end-performance run and analysed for plasma ammonia, lactate, and urate. Four subjects failed to complete the performance run in the heat and the performance times for the rest of the subjects was increased from 27.3 (0.6) min in cool conditions to 31.3 (1.2) min in hot conditions (P<0.05). The end-performance rectal temperature was 38.6 (0.1) and 39.2 (0.1)°C (P<0.05) in cool and hot conditions, respectively. Differences in plasma lactate at the end of submaximal running were not significant. However, at the end of performance runs lactate was 6.0 (0.9) mmol·l^–1 in cool and 3.1 (0.5) mmol·l^–1 in hot conditions, values that were significantly different (P<0.05). Plasma ammonia increased from pre-exercise to ≅59 μmol·l^–1 at the end-submaximal runs for both coditions and further at the end of performance runs to 108.5 (11) μmol·l^–1 (P<0.05) in hot but not in cool conditions. Plasma urate increased from pre-exercise to 311.2 (25.9) μmol·l^–1 at end-submaximal runs and to ≅320.4 μmol·l^–1 at end-performance runs in hot and cool environments. The findings that plasma urate accumulation was similar at the completion of running in both conditions, while ammonia was significantly augmented in hot conditions compared with cool, suggest that ammonia accumulation during heat stress exercise might be derived from sources other than purine catabolism. Electronic Publication     

Urinary lactate excretion to monitor the efficacy of treatment of type I glycogen storage disease

The purpose of this study was to investigate the usefulness of urinary lactate measurements to assess the adequacy of dietary treatment in patients with type I glycogen storage disease (GSD-I). We determined the correlation of urine and blood lactate concentrations in 21 GSD-I patients during 24-h admissions to the General Clinical Research Center (GCRC) during which hourly blood samples and aliquots of every void were obtained. In all but 1 patient, we found a good correlation between blood lactate concentrations and urinary lactate excretion. One patient did not excrete lactate in significant amounts despite elevated blood lactate concentrations. In 17 patients, the highest blood lactate concentrations occurred during the night. Markedly elevated nighttime average blood lactate concentrations above 3.5 mmol/l resulted in a urinary lactate concentration above the normal limit of 0.067 mmol/mmol creatinine in the first morning urine specimen. Mildly elevated nighttime blood lactate concentrations (between 2.2 and 3.5 mmol/l) led to urinary lactate concentrations that were either normal or moderately elevated. All patients with normal blood lactate concentrations during the night also had normal first morning urinary lactate concentrations. The degree of urinary lactate excretion in relation to blood lactate concentrations varied by individual. Urinary filter paper specimens, collected at home during the night and in the morning and mailed to the laboratory, were used to monitor the dietary compliance of 5 GSD-I patients at home over a period of 6 to 9 weeks prior to their GCRC admissions. These data suggested variable degrees of dietary control. In conclusion, the urinary lactate concentration is a useful parameter to monitor therapy of GSD-I patients at home. To be interpretable, the baseline urinary lactate concentration in relation to the blood lactate concentration has to be determined.     

Increased serum adenosine deaminase activity in schizophrenic receiving antipsychotic treatment

Adenosine is an important modulator of the nervous system that has been implicated in the pathophysiology of schizophrenia. We studied peripheral adenosine metabolism by determining the activity of serum adenosine deaminase, which converts adenosine into inosine, and 5'-nucleotidase, which converts AMP into adenosine, in 26 DSM-IV male schizophrenic patients under antipsychotic monotherapy and 26 healthy volunteers balanced for age and race. Schizophrenic patients treated either with typical antipsychotics or clozapine showed increased serum adenosine deaminase activity compared to controls (controls=18.96+/-4.61 U/l; typical=25.09+/-10.98 U/l; clozapine=30.32+/-10.83 U/l; p<0.05, ANOVA) and 5'-nucleotidase activity was also increased in patients on clozapine. After adjusting for confounding factors, adenosine deaminase, but not 5'-nucleotidase, alterations remained significant particularly in the clozapine group. This result suggests that either altered adenosine metabolism is present in schizophrenic patients or is influenced by treatment with antipsychotics, particularly clozapine.     

Microassay for blood adenosine deaminase: study of the role of the enzyme in the ammoniagenesis of the blood sample

A microassay for adenosine deaminase is elaborated. It is based on the colorimetric measurement of small amounts of ammonia raised during adenosine deamination and separated by continuous flow dialysis. The analytical qualities of the microassay are reported. The enzymic activity concentration in whole arterial blood of 30 control subjects is 2.54 +/- 1,68 micro katal/l (mean +/- 2ET). It is slightly lower in venous blood. The values are higher in man than in women. 92 p. cent of the enzymic activity of whole blood are due to the erythrocytes. The distribution of the arterial enzymic activity concentrations is not significantly different in a group of 85 cirrhotic patients when compared to the control group. No tight correlation can be found between blood adenosine deaminase concentrations and either blood ammonia nor shed blood ammoniagenesis. Inhibitors of adenosine deaminase have little effects on the in vitro ammoniagenesis.     

Plasma hypoxanthine and ammonia in humans during prolonged exercise

In this study we examined the time course of changes in the plasma concentration of oxypurines [hypoxanthine (Hx), xanthine and urate] during prolonged cycling to fatigue. Ten subjects with an estimated maximum oxygen uptake (V˙O_2max) of 54 (range 47–67) ml?·?kg^?1?·?min^?1 cycled at [mean?(SEM)] 74?(2)% of V˙O_2max until fatigue [79?(8) min]. Plasma levels of oxypurines increased during exercise, but the magnitude and the time course varied considerably between subjects. The plasma concentration of Hx ([Hx]) was 1.3?(0.3)?μmol/l at rest and increased eight fold at fatigue. After 60?min of exercise plasma [Hx] was >10?μmol/l in four subjects, whereas in the remaining five subjects it was <5?μmol/l. The muscle contents of total adenine nucleotides (TAN?=?ATP+ADP+AMP) and inosine monophosphate (IMP) were measured before and after exercise in five subjects. Subjects with a high plasma [Hx] at fatigue also demonstrated a pronounced decrease in muscle TAN and increase in IMP. Plasma [Hx] after 60?min of exercise correlated significantly with plasma concentration of ammonia ([NH₃], r?=?0.90) and blood lactate (r?=?0.66). Endurance, measured as time to fatigue, was inversely correlated to plasma [Hx] at 60?min (r?=??0.68, P?3] or blood lactate. It is concluded that during moderate-intensity exercise, plasma [Hx] increases, but to a variable extent between subjects. The present data suggest that plasma [Hx] is a marker of adenine nucleotide degradation and energetic stress during exercise. The potential use of plasma [Hx] to assess training status and to identify overtraining deserves further attention.     

Indices of mineral metabolism in relation to blood pressure in a sample of a healthy population

Indices of mineral metabolism in blood and urine were analysed in relation to blood pressure in 97 healthy subjects aged 16-82 years. In a multivariate analysis, after allowing for the effects of sex, body mass index (BMI) and age, there was an inverse relationship between plasma level of ionized calcium and mean blood pressure (MBP) (beta = -50.0 mmHg/mmol/l P-ionized calcium, p = 0.0005). In univariate analyses MBP also showed statistically significant inverse relationships with plasma ionized calcium, serum phosphate and renal threshold concentration of phosphate; positive relationships to MBP were found for fasting urinary excretion of calcium and cyclic adenosine monophosphate. However, when examined multivariately, only the relation between MBP and plasma ionized calcium persisted. This study supports previous findings of an inverse relationship between blood pressure and serum ionized calcium and extends the observations to the physiological range. It is further evident from this study that BMI and age should be taken into account in analyses of the relationship between blood pressure and mineral metabolism.     

Increased ammonia production during forearm ischemic work test in McArdle's disease

Summary A patient with typical features of late onset McArdle's disease is described. During forearm ischemic work test the patient exhibited an exaggerated increase in ammonia release, largely exceeding normal values. It is suggested, that this is due to an activation of the myokinase/myoadenylate deaminase pathway. Besides lack of lactate release increased ammonia release during ischemia may be a typical feature of McArdle's disease.Supported by Deutsche Forschungsgemeinschaft SFB-89 Kardiologie and Volkswagenstiftung     

The effect of AMPD1 genotype on blood flow response to sprint exercise

Inherited deficiency of skeletal muscle myoadenylate deaminase (mAMPD) is a genetic disorder characterized primarily by a 34C>T transition in exon 2 of the AMPD1 gene. mAMPD deficient individuals exhibit alterations in ATP catabolic flow, resulting in greater adenosine accumulation during high intensity exercise that may possibly enhance exercise-induced hyperaemia. This study tested the hypothesis that individuals with diminished mAMPD activity due to mutations in the AMPD1 gene develop a greater and faster blood flow response to high intensity exercise than individuals with two AMPD1 normal alleles (NN). Four 34C>T homozygotes, two compound heterozygotes (34C>T in one allele and a recently identified 404delT mutation in the other AMPD1 allele), collectively termed MM, one 34C>T heterozygote (NM) and eight NN males were studied. They performed a 30 s Wingate cycling test with monitoring of power output and other parameters of exercise performance. Common femoral artery blood flow was measured before and after (up to 25 min) exercise, using ultrasonography. Mean power during Wingate cycling was approximately 10% lower in MM/NM than in NN; p<0.01. Blood flow response to exercise also differed between MM/NM and NN individuals (ANOVA; p<0.001). There was also a difference in peak post-exercise blood flow (p<0.05), and the subsequent fall in blood flow during the recovery phase (T1/2) occurred more than twice as fast in MM/NM compared to NN subjects (7.8+/-1.1 min vs. 16.1+/-1.4 min, p<0.001). These results suggest a better circulatory adaptation to exercise in individuals with diminished mAMPD activity, probably due to an AMPD1 genotype-dependent increase in adenosine formation.     

Prenatal detection of a probable heterozygote for ADA deficiency and severe combined immunodeficiency disease using a microradioassay

A pregnancy at risk for adenosine deaminase deficiency and severe combined immunodeficiency disease has been investigated by assay of adenosine deaminase activity in cultured amniotic fluid cells using a microradioassay. A low-normal level of activity consistent with heterozygote status in the foetus was found and confirmed after birth by assay of red cell and fibroblast adenosine deaminase activities. It is suggested that the radio-assay method offers significant advantages in sensitivity and specificity over the standard spectrophotometric procedure.