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Plasma amino acids imbalance in patients with liver disease

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Abstract

The venous plasma amino acid patterns have been determined in 12 normal individuals and in 71 shunted and nonshunted cirrhotics in various grades of hepatic encephalopathy. The free amino acids have been determined by an amino autoanalyzer; the total and free tryptophan have been measured by a spoctrophotofluorimetric method. In 14 instances arterial plasma amino acid patterns have been measured simultaneously. High levels of aromatic and sulfurated amino acids and low levels of branched-chain amino acids have been constantly found in all cirrhotics. Methionine, phenylalanine, valine, leucine, tyrosine, and free tryptophan showed a statistical difference between controls and all other groups. These altered patterns did not correlate either with the grade or the evolution of the coma or with the presence of the surgical anastomosis. No statistical differences were lated with the grade and evolution of the hepatic encephalopathy was free tryptophan. The molar ratios between the amino acids sharing the same transport system across the blood-brain-barrier have been considered. A very good correlation with the grade of the mental disorder was found with the ratios free tryptophan/phenylalanine-tyrosine-methionine-valine-leucine-isoleucine and free tryptophan/branched-chain amino acids.

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References

  1. Fischer JE, Baldessarini RJ: False neurotransmitters and hepatic failure. Lancet 2:75–79, 1971

    Google Scholar 

  2. Munro NM, Fernstrom JD, Wurtman RJ: Insulin, plasma amino acid imbalance and hepatic coma. Lancet 1:772–724 (1975).

    Google Scholar 

  3. Soeters PB, Fischer JE: Insulin, glucagon, amino acid imbalance, and hepatic encephalophathy. Lancet 2:880–882, 1976

    Google Scholar 

  4. Fischer JE: Hepatic coma in cirrhosis, portal hypertension, and following portacaval shunt. Arch Surg 108:325–335. 1974

    Google Scholar 

  5. Lam KC, Tall AR, Goldstein GB, Mistillis SP: Role of a false neurotransmitter, octopamine, in the pathogenesis of hepatic and renal encephalopathy. Scand J Gastroenterol 8:465–472, 1973

    Google Scholar 

  6. Knell AJ, Davidson RR, Williams R, Kantamaneni BD, Curzon G: Dopamine and serotonine metabolism in hepatic encephalopathy. Br Med J 1:549–551, 1974

    Google Scholar 

  7. Manghani KK, Lunzer MR, Billing BH, Sherlock S: Urinary and serum octopamine in patients with portal-systemic encephalopathy. Lancet 2:943–946, 1975

    Google Scholar 

  8. Rossi-Fanelli F, Attili A, Cascino A, Capocaccia L, Crifo C: Contenuto di octopamina nel sangue umano. Bol Soc It Biol Sper 50:691–694, 1974

    Google Scholar 

  9. Rossi-Fanelli F, Cangiano C, Attili A, Angelico M, Cascino A, Capocaccia L, Strom R, Crifò C: Octopamine plasma levels and hepatic encephalopathy: A re-appraisal of the problem. Clin Chim Acta 67:255–261, 1976

    Google Scholar 

  10. Wu C, Bollman JL, Butt HR: Changes in free amino acids in the plasma during hepatic coma. J Clin Invest 34:845–849, 1955

    Google Scholar 

  11. Iber FI, Rosen H, Levenson SH, Chalmers TC: The plasma amino acids in patients with liver failure. J Lab Clin Med 50:417–425, 1957

    Google Scholar 

  12. Iob V, Coon WW, Sloan M: Altered clearance of free amino acids in patients with cirrhosis of the liver. J Surg Res 6:233–239, 1966

    Google Scholar 

  13. Ning M, Lowenstein LM, Davidson CS: Serum amino acid concentrations in alcoholic hepatitis. J Lab Clin Med 70:554–562, 1967

    Google Scholar 

  14. Sherwin R, Joshi P, Hendler R, Felig P, Conn HO: Hyperglucagonaemia in Laenmec's cirrhosis: role of portal-systemic shunting. N Engl J Med 290:239–242, 1974

    Google Scholar 

  15. Fishcher JE, Yoshimura N, Aguirre A, James JH, Cummings MG, Abel RM, Deindoefer F: Plasma amino acids in patients with hepatic encephalopathy. Am J Surg 127:40–47, 1974

    Google Scholar 

  16. Fischer JE, Rosen H, Ebeld AM, James JH, Keane J, Soeters PB, Yoshimura N: Different plasma amino acids patterns in hepatic encephalopathy in fulminant hepatitis and Laennec's cirrhosis. Therapeutic implications. Clin Res 26:432, 1976

    Google Scholar 

  17. Fischer JE, Ebeid AM, Rosen H, James JH, Keane J, Soeters PB: Improvement in hepatic encephalopathy by normalization of plasma amino acids. Gastroenterology 70: A123/981, 1976

    Google Scholar 

  18. Fischer JE, Baldessarini RJ: Pathogenesis and therapy of hepatic coma. Progress in Liver Diseases, Vol. V, H Popper and F Schaffner (eds). Grunte and Stratton, New York, 1976

    Google Scholar 

  19. Capocaccia L, Cangiano C, Attili AF, Angelico M, Cascino A, Rossi-Fanelli F: Octopamine and ammonia plasma levels in hepatic encephalopathy. Clin Chim Acta 75:99–105, 1977

    Google Scholar 

  20. Aguirre A, Yoshimura N, Westmann T, Fischer E: Plasma amino acids in dogs with two experimental forms of liver damage. J Surg Res 16:339–354, 1974

    Google Scholar 

  21. Duggan DE, Udenfriend S: Spectrofluorimetric determination of tryptophan in plasma and of tyrosine and tryptophan in protein hydrolysates. J Biol Chem 223:313–320, 1956

    Google Scholar 

  22. Davidson N: Neurotransmitter Amino acids. Academic Press, New York, 1976

    Google Scholar 

  23. Pardridge WM, Connor JD, Crawford IL: Permeability changes in the blood brain barrier: Causes and consequences. CRC Crit Rev Toxicol 3:159–199, 1975

    Google Scholar 

  24. Record CO, Buxton B, Chase RA, et al: Plasma and brain amino acids in fulminant hepatic failure and their relationship to hepatic encephalopathy. Eur J Clin Invest 6:387–394, 1976

    Google Scholar 

  25. James JM, Hodgman M, Funovics JM, Fischer JE: Alterations in brain octopamine and brain tyrosine following portacaval anastomosis in rats. J Neurochem 27:223–227, 1976

    Google Scholar 

  26. Hutson DG, Ono J, Dombro RS, Levi JU, Zeppa R: Changes in tryptophan concentrations in plasma and cerebrospinal fluid during hepatic coma. Gastroenterology 71:A19/912, 1976

    Google Scholar 

  27. Sourkes TI, Young SN, Garelis E: Gradients of concentrations of tryptophan and 5-hydroxyindolacetic acid (5-HIAA) in cerebrospinal fluid (CSF). Acta Vitaminol Enzymol 29:97–99, 1975

    Google Scholar 

  28. Cangiano C, Calcaterra V, Cascino A, Capocaccia L: Bound and free tryptophan plasma levels in hepatic encephalopathy. Rend Gastroenterol 8:186–189, 1976

    Google Scholar 

  29. Capocaccia L, Rossi Fanelli F, Calcaterra V, Cascino A, Cangiano C: Tryptophan plasma levels in hepatic encephalopathy. Clin Res 24:5, A628, 1976

    Google Scholar 

  30. McMenamy RM, Oncley JL: The specific binding ofl-tryptophan to serum albumin. J Biol Chem 233:1436–1440, 1958

    Google Scholar 

  31. Tagliamonte A, Biggio G, Vargiu L, Gessa GL: Free tryptophan in serum controls brain tryptophan levels and serotonin synthesis. Life Sci 12:277–287, 1973

    Google Scholar 

  32. Mortiaux A, Dawson AM: Plasma free fatty acids in liver diseases. Gut 2:304–309, 1961

    Google Scholar 

  33. James JH, Hodgman JM, Funovics JM, Yoshimura N, Fischer JE: Brain tryptophan, plasma free tryptophan and distribution of plasma neutral amino acids. Metabolism 25:471–476, 1976

    Google Scholar 

  34. Daniel PM, Love ER, Moorhouse SR, Pratt OE: Amino acids, insulin, and hepatic coma. Lancet 2:179–180, 1975

    Google Scholar 

  35. Cummings MG, James JH, Soeters PB, Keane JM, Foster J, Fischer JE: Regional brain study of indoleamine metabolism in the rat in acute hepatic failure. J Neurochem 27:741–746, 1976

    Google Scholar 

  36. Munro HN, Fernstrom JD, Wurtman RJ: Plasma neutral amino acids and tryptophan in cirrhosis. Lancet 2:419, 1975

    Google Scholar 

  37. Cummings MG, Soeters PB, James JH, Keane JM, Fischer JE: Regional brain indoleamine metabolism following chronic portacaval anastomosis in the rat. J Neurochem 27:501–509, 1976

    Google Scholar 

  38. Bender DA: Serum amino acids and brain trytophan uptake. Lancet 2:278–279, 1975

    Google Scholar 

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Authors and Affiliations

  1. III Clinica Medica, University of Rome, Viale Pola 29, 00198, Roma, Italy

    Antonia Cascino, Carlo Cangiano, Vincenzo Calcaterra, Filippo Rossi-Fanelli & Livio Capocaccia

Authors
  1. Antonia Cascino
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  2. Carlo Cangiano
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  3. Vincenzo Calcaterra
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  4. Filippo Rossi-Fanelli
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  5. Livio Capocaccia
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Additional information

This work was supported by Grant 30.3.1971, no. 118, 500.6/Contract 72, from Ministero della Sanita. Dir. Gen. Sery. Med. Soc., Div. VI.

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Cascino, A., Cangiano, C., Calcaterra, V. et al. Plasma amino acids imbalance in patients with liver disease. Digest Dis Sci 23, 591–598 (1978). https://doi.org/10.1007/BF01072593

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