Evidence for a sodium-dependent proline and glycine-betaine uptake in the cyanobacterium <Emphasis Type="Italic">Nostoc muscorum</Emphasis>

The cyanobacterium Nostoc muscorum is able to utilized proline and glycine-betaine as a nitrogen source under unstressed growth conditions. This cyanobacterium when grow in modified Chu No. 10 medium (without Na⁺) unable to utilized proline and glycine-betaine as a nitrogen source. Spontaneously occurring mutant clones defective in Na⁺ transport (Na⁺-R) was isolated and analyzed for proline and glycine-betaine utilization. The mutant phenotype showed normal heterocyst frequency and nitrogenase activity even in the medium containing 1 mM proline or 1 mM glycine-betaine, indicates the role of Na⁺ for proline/glycine-betaine uptake. The Na⁺-R mutant showed 100% survival at pH 11 and was simultaneously able to uptake and utilize proline/glycine-betaine at higher alkaline pH. This indicates that proline and glycinebetaine uptake systems are more efficient at higher alkaline pH. Since, the hypersaline environments are rich in Na⁺ contents and have alkaline pH, therefore it is suggested that the origin and evolution of specific compatible solutes may not depend only on the osmoregulatory role they play, but also on the other ecological factors operating simultaneously in the organism’s niche.     

Evidence for a sodium-dependent proline and glycine-betaine uptake in the cyanobacterium Nostoc muscorum

The cyanobacterium Nostoc muscorum is able to utilized proline and glycine-betaine as a nitrogen source under unstressed growth conditions. This cyanobacterium when grow in modified Chu No. 10 medium (without Na+) unable to utilized proline and glycine-betaine as a nitrogen source. Spontaneously occurring mutant clones defective in Na+ transport (Na+-R) were isolated and analyzed for proline and glycine-betaine utilization. The mutant phenotype showed normal heterocyst frequency and nitrogenase activity even in the medium containing 1 mM proline or 1 mM glycine-betaine, indicates the role of Na+ for proline/glycine-betaine uptake. The Na+-R mutant showed 100% survival at pH 11 and was simultaneously able to uptake and utilize proline/glycine-betaine at higher alkaline pH. This indicates that proline and glycine-betaine uptake systems are more efficient at higher alkaline pH. Since, the hypersaline environments are rich in Na+ contents and have alkaline pH, therefore it is suggested that the origin and evolution of specific compatible solutes may not depend only on the osmoregulatory role they play, but also on the other ecological factors operating simultaneously in the organism's niche.     

Betaine as a Growth Factor for Pediococcus soyae

Besides P-factor, Pediococcus soyae requires betaine (glycine-betaine) as a specific growth promotant. The maximal growth is obtained with the supplementation of both betaine and P-factor to the synthetic medium, while betaine only gives the half-maximal growth. When the organism is cultured in 18% salted media, the addition of both betaine and P-factor is essential for the occurrence of growth. Thus, betaine is requisite for Ped. soyae as a growth promoting factor and also as a factor bestowing the osmotelerant ability.     

Glycine-betaine accumulation influences susceptibility of water-stressed barley to the aphid Schizaphis graminum

Water deficit increased susceptibility of barley to the aphid Schizaphis graminum. Proline and glycine-betaine accumulated in the stressed plants. These compounds were incorporated into artificial diets to test their effects on aphids. Survival of S. graminum was not affected by proline and glycine-betaine. In addition, glycine-betaine increased reproduction of the greenbug at concentrations similar to those found in stressed barley plants. When glycine-betaine was added to detached shoots of barley, population growth rate of S. graminum increased in that plant material kept in the betaine solutions. It is suggested that glycine-betaine accumulation may be responsible for the increased susceptibility of water-stressed barley to the greenbug.     

Cellular adaptation of Clostridioides difficile to high salinity encompasses a compatible solute-responsive change in cell morphology

Infections by the pathogenic gut bacterium Clostridioides difficile cause severe diarrhoeas up to a toxic megacolon and are currently among the major causes of lethal bacterial infections. Successful bacterial propagation in the gut is strongly associated with the adaptation to changing nutrition-caused environmental conditions; e.g. environmental salt stresses. Concentrations of 350 mM NaCl, the prevailing salinity in the colon, led to significantly reduced growth of C. difficile. Metabolomics of salt-stressed bacteria revealed a major reduction of the central energy generation pathways, including the Stickland-fermentation reactions. No obvious synthesis of compatible solutes was observed up to 24 h of growth. The ensuing limited tolerance to high salinity and absence of compatible solute synthesis might result from an evolutionary adaptation to the exclusive life of C. difficile in the mammalian gut. Addition of the compatible solutes carnitine, glycine-betaine, γ-butyrobetaine, crotonobetaine, homobetaine, proline-betaine and dimethylsulfoniopropionate restored growth (choline and proline failed) under conditions of high salinity. A bioinformatically identified OpuF-type ABC-transporter imported most of the used compatible solutes. A long-term adaptation after 48 h included a shift of the Stickland fermentation-based energy metabolism from the utilization to the accumulation of l -proline and resulted in restored growth. Surprisingly, salt stress resulted in the formation of coccoid C. difficile cells instead of the typical rod-shaped cells, a process reverted by the addition of several compatible solutes. Hence, compatible solute import via OpuF is the major immediate adaptation strategy of C. difficile to high salinity-incurred cellular stress.     

Effect of L-Carnitine Supplementation on Utilisation of Energy and Protein in Broiler Chicken Fed Different Dietary Fat Levels

Effects of a supplementation of 80mg L-carnitine perkg diet were studied in broiler chicken at two dietary levels of fat (4 and 8 %) and different feeding levels (ad libitum in a growth trial, 95 and 85 % of ad libitum in a balance trial). A low-carnitine basal diet adequate in amino acid concentration was used. In the growth trial, each diet was fed to 9 groups of 10 birds each for 16 days from day 5 of live onwards. Growth and feed intake were determined. At the end of the trial, birds were killed and homogenised for subsequent empty body analysis. Accretion of protein and energy was determined using a representative blank group killed at the beginning of the trial. In the balance trial, 8 individual birds were used per treatment. Birds were offered the feed at approximately 85 and 95% of ad libitum intake, which was determined with separate birds for both fat levels. Excreta were quantitatively collected three times daily for 8 consecutive days beginning on day 17 individually for each bird. Supplemented L-carnitine did not significantly affect any response criterion. However, growth and feed conversion tended to be improved by about 5% in the carnitine supplemented diets when fed ad libitum. An interaction between carnitine and fat level occurred with regard to feed conversion, indicating that carnitine had a positive effect at the high fat level, but not at the low fat level. L-carnitine did not positively affect the metabolisability of energy (ME/GE) and the efficiency of energy utilisation (RE/GE or RE/ME). Similarly, no significant carnitine effect was determined with regard to N accretion and the efficiency of utilisation of dietary protein in both trials. It is concluded that endogenous carnitine synthesis is not the limiting factor for energy utilisation in broiler chicken, even at high dietary fat concentration. Occasionally reported positive effects of supplemental carnitine were likewise caused by reasons other than improved energy or protein utilisation. Further studies on amino acid utilisation and catabolism should consider marginal amino acid supply.     

Osmotic regulation of intracellular solute pools in Lactobacillus plantarum.

Bacteria respond to changes in medium osmolarity by varying the concentrations of specific solutes in order to maintain constant turgor pressure. The cytoplasmic pools of K+, proline, glutamate, alanine, and glycine of Lactobacillus plantarum ATCC 14917 increased when the osmolarity of the growth media was raised from 0.20 to 1.51 osmol/kg by KCL. When glycine-betaine was present in a high-osmolarity chemically defined medium, it was accumulated to a high cytoplasmic concentration, while the concentrations of most other osmotically important solutes decreased. These observations, together with the effects of glycine-betaine on the specific growth rate under high-osmolarity conditions, suggest that glycine-betaine is preferentially accumulated in L. plantarum. Uptake of glycine-betaine, proline, glutamate, and alanine was studied in cells that were alternately exposed to hyper- and hypo-osmotic stresses. The rate of uptake of proline and glycine-betaine increased instantaneously upon increasing the osmolarity, whereas that of other amino acids did not. This activation occurred also under conditions in which protein synthesis was inhibited was most pronounced when cells were pregrown at high osmolarity. The duration of net transport was a function of the osmotic strength of the assay medium. Glutamate uptake was not activated by an osmotic upshock, and the uptake of alanine was low under all conditions tested. When cells were subjected to osmotic downshock, a rapid efflux of accumulated glycine-betaine, proline, and alanine occurred whereas the pools of other amin acids remained unaffected. The results indicate that osmolyte efflux is, at least to some extent, mediated via specific osmotically regulated efflux systems and not via nonspecific mechanisms as has been suggested previously.     

Molecular characterization of the cai operon necessary for carnitine metabolism in Escherichia coii

The sequence encompassing the cai genes of Escherichia coli, which encode the carnitine pathway, has been determined. Apart from the already identified caiB gene coding for the carnitine dehydratase, five additional open reading frames were identified. They belong to the caiTABCDE operon, which was shown to be located at the first minute on the chromosome and transcribed during anaerobic growth in the presence of carnitine. The activity of carnitine dehydratase was dependent on the CRP regulatory protein and strongly enhanced in the absence of a functional H-NS protein, in relation to the consensus sequences detected in the promoter region of the cai operon. In vivo expression studies led to the synthesis of five polypeptides in addition to CaiB, with predicted molecular masses of 56 613 Da (CaiT), 42 564 Da (CaiA), 59311 Da (CaiC), 32 329 Da (CaiD) and 21 930 Da (CaiE). Amino acid sequence similarity or enzymatic analysis supported the function assigned to each protein. CaiT was suggested to be the transport system for carnitine or betaines, CaiA an oxidoreduction enzyme, and CaiC a crotonobetaine/carnitine CoA ligase. CaiD bears strong homology with enoyl hydratases/isomerases. Overproduction of CaiE was shown to stimulate the carnitine racemase activity of the CaiD protein and to markedly increase the basal level of carnitine dehydratase activity. It is inferred that CaiE is an enzyme involved in the synthesis or the activation of the still unknown cofactor required for carnitine dehydratase and carnitine racemase activities. Taken together, these data suggest that the carnitine pathway in E. coli resembles that found in a strain situated between Agrobacterium and Rhizobium.     

Carnitine: a novel compatible solute in Lactobacillus plantarum

The aim of this study was to unravel the identity of compatible solutes accumulated by Lactobacillus plantarum subjected to osmotic stress. Betaine was accumulated simulataneously with a novel compatible solute identified as carnitine, both present in the complex medium applied in this study. Beef extract provided the main source of carnitine in the medium. Both carnitine and betaine were accumulated to maximum concentrations of 248 and 231 mol.g dry weight^-1, respectively. A defined medium was devised devoid of carnitine. Addition of 0.5 mM carnitine to this medium increased the growth rate from 0.1 h^-1 to 0.2 h^-1 in media with 0.4 M sodium chloride. Also, carnitine made the organism more tolerant to sodium chloride. Growth occurred even when the sodium chloride concentration was raised from 0.5 M to 1.0 M. Quaternary compounds resembling the structure of carnitine and betaine enhanced the growth yield as well. -Butyrobetaine and succinylcholine restored the growth yield up to respectively 91 and 96% compared to non-stressed cells.Abbreviation MRS De Man, Rogosa and Sharpe (De Man et al. 1960)     

Accumulation of the compatible solutes, glycine-betaine and ectoine, in osmotic stress adaptation and heat shock cross-protection in the biocontrol agent Pantoea agglomerans CPA-2

AIMS: The effect of modifying the water activity (a(w)) of Pantoea agglomerans growth medium with the ionic solute NaCl on water stress resistance, heat-shock survival and intracellular accumulation of the compatible solutes glycine-betaine and ectoine were determined. METHODS AND RESULTS: The bacterium was cultured in an unmodified liquid medium or that modified with NaCl to 0.98 and 0.97 a(w), and viability of cells evaluated on a 0.96 a(w)-modified solid media to check water stress tolerance. Cells grown under ionic stress had better water stress tolerance than control cells. These cells also had cross-protection to heat stress (30 min, 45 degrees C). The modified cells accumulated substantial amounts of the compatible solutes glycine-betaine and ectoine in contrast to the control cells, which contained little or none of these two compounds. CONCLUSIONS: Improvement in osmotic and thermal tolerance of cells of the biocontrol agent P. agglomerans by modifying growth media with the ionic solute NaCl was achieved. The compatible solutes glycine-betaine and ectoine play a critical role in environmental stress tolerance improvement. SIGNIFICANCE AND IMPACT OF THE STUDY: This approach provides a method for improving the physiological quality of inocula and could have implications for formulation and shelf-life of biocontrol agents.     

Transport of glycine-betaine by Listeria monocytogenes

Uptake of [¹⁴C]glycine-betaine by Listeria monocytogenes was stimulated by NaCl with optimal stimulation at 0.4–0.5 M. The glycine-betaine transport system had a K _m of 22 M and a V _max of 11.7 nmol^-1 min^-1 mg^-1 protein when grown in the absence of NaCl. When grown in the presence of 0.8 M NaCl the V _max increased to 27.0 nmol^-1 min^-1 mg^-1 protein in 0.8 M NaCl. At NaCl concentrations above 0.5 M the uptake rate of glycine-betaine was reduced. Measurement of intracellular K⁺ concentrations and fluorescent dye quenching indicated that higher NaCl concentrations also led to a decrease in the electrochemical potential difference across the cytoplasmic membrane. Uptake of glycine was also observed, but this was not stimulated by NaCl.     

Gbu Glycine Betaine Porter and Carnitine Uptake in Osmotically Stressed Listeria monocytogenes Cells

The food-borne pathogen Listeria monocytogenes grows actively under high-salt conditions by accumulating compatible solutes such as glycine betaine and carnitine from the medium. We report here that the dominant transport system for glycine betaine uptake, the Gbu porter, may act as a secondary uptake system for carnitine, with a K_m of 4 mM for carnitine uptake and measurable uptake at carnitine concentrations as low as 10 μM. This porter has a K_m for glycine betaine uptake of about 6 μM. The dedicated carnitine porter, OpuC, has a K_m for carnitine uptake of 1 to 3 μM and a V_max of approximately 15 nmol/min/mg of protein. Mutants lacking either opuC or gbu were used to study the effects of four carnitine analogs on growth and uptake of osmolytes. In strain DP-L1044, which had OpuC and the two glycine betaine porters Gbu and BetL, triethylglycine was most effective in inhibiting growth in the presence of glycine betaine, but trigonelline was best at inhibiting growth in the presence of carnitine. Carnitine uptake through OpuC was inhibited by γ-butyrobetaine. Dimethylglycine inhibited both glycine betaine and carnitine uptake through the Gbu porter. Carnitine uptake through the Gbu porter was inhibited by triethylglycine. Glycine betaine uptake through the BetL porter was strongly inhibited by trigonelline and triethylglycine. These results suggest that it is possible to reduce the growth of L. monocytogenes under osmotically stressful conditions by inhibiting glycine betaine and carnitine uptake but that to do so, multiple uptake systems must be affected.     

Identification of the main glutamine and glutamate transporters in Staphylococcus aureus and their impact on c-di-AMP production

A Staphylococcus aureus strain deleted for the c-di-AMP cyclase gene dacA is unable to survive in rich medium unless it acquires compensatory mutations. Previously identified mutations were in opuD, encoding the main glycine-betaine transporter, and alsT, encoding a predicted amino acid transporter. Here, we show that inactivation of OpuD restores the cell size of a dacA mutant to near wild-type (WT) size, while inactivation of AlsT does not. AlsT was identified as an efficient glutamine transporter, indicating that preventing glutamine uptake in rich medium rescues the growth of the S. aureus dacA mutant. In addition, GltS was identified as a glutamate transporter. By performing growth curves with WT, alsT and gltS mutant strains in defined medium supplemented with ammonium, glutamine or glutamate, we revealed that ammonium and glutamine, but not glutamate promote the growth of S. aureus. This suggests that besides ammonium also glutamine can serve as a nitrogen source under these conditions. Ammonium and uptake of glutamine via AlsT and hence likely a higher intracellular glutamine concentration inhibited c-di-AMP production, while glutamate uptake had no effect. These findings provide, besides the previously reported link between potassium and osmolyte uptake, a connection between nitrogen metabolism and c-di-AMP signalling in S. aureus.     

Vitamin and Amino Acid Requirements of Pediococcus soyae and Pediococcus acidilactici Kitahara’s Strain

Nutritional requirements of three strains of Ped. soyae, one strain of Ped. acidilactici (Kitahara’s strain) were determined from a complete synthetic medium. Upon inspection by the single omission method, Ped. soyae required glycine-betaine, uracil, riboflavine, pyridoxine or pyridoxal, pantothenic acid, nicotinic acid, leucovorin, biotin, glutamic acid, arginine, histidine, isoleucine, leucine, phenyl alanine, valine, tryptophane, methionine, cystine and serine with exception of the P-factor. In addition to the above mentioned nutrients, a representative strain of the organism required xanthine, folic acid, thiamine, aspartic acid and threonine for the minimum synthetic medium. Ped. acidilactici Kitahara’s strain required riboflavine, pyridoxine, pantothenic acid, nicotinic acid, biotin and all components of the basal medium consisting of amino acids except methionine, but it did not require leucovorin, glycine-betaine and organic bases. Nutritional requirements of Ped. pentosaceus, Kitahara’s strain was proved to be quite identical with Ped. cerevisiae Pederson (= Ped. pentosaceus Mees).     

Gbu glycine betaine porter and carnitine uptake in osmotically stressed Listeria monocytogenes cells

The food-borne pathogen Listeria monocytogenes grows actively under high-salt conditions by accumulating compatible solutes such as glycine betaine and carnitine from the medium. We report here that the dominant transport system for glycine betaine uptake, the Gbu porter, may act as a secondary uptake system for carnitine, with a K(m) of 4 mM for carnitine uptake and measurable uptake at carnitine concentrations as low as 10 microM. This porter has a K(m) for glycine betaine uptake of about 6 micro M. The dedicated carnitine porter, OpuC, has a K(m) for carnitine uptake of 1 to 3 microM and a V(max) of approximately 15 nmol/min/mg of protein. Mutants lacking either opuC or gbu were used to study the effects of four carnitine analogs on growth and uptake of osmolytes. In strain DP-L1044, which had OpuC and the two glycine betaine porters Gbu and BetL, triethylglycine was most effective in inhibiting growth in the presence of glycine betaine, but trigonelline was best at inhibiting growth in the presence of carnitine. Carnitine uptake through OpuC was inhibited by gamma-butyrobetaine. Dimethylglycine inhibited both glycine betaine and carnitine uptake through the Gbu porter. Carnitine uptake through the Gbu porter was inhibited by triethylglycine. Glycine betaine uptake through the BetL porter was strongly inhibited by trigonelline and triethylglycine. These results suggest that it is possible to reduce the growth of L. monocytogenes under osmotically stressful conditions by inhibiting glycine betaine and carnitine uptake but that to do so, multiple uptake systems must be affected.     

Carnitine suppression of position-effect variegation in Drosophila melanogaster

Carnitine is a well-known naturally occurring compound, very similar to butyrate, with an essential role in intermediary metabolism mainly at the mitochondrial level. Since butyrate inhibits the enzyme histone deacetylase and is capable of suppressing position-effect variegation in Drosophila melanogaster, we tested a further possible function of carnitine in the nucleus, using an assay for the suppression of position-effect variegation. We tested three physiological forms of carnitine (l-carnitine, l-propionylcarnitine, l-acetylcarnitine) for the ability to suppress two different chromosomal rearrangements, inducing variegation of the white ⁺ and brown ⁺ genes. The results show that the carnitine derivatives are capable of suppressing the position-effect variegation, albeit with different efficiencies. The carnitine derivatives interact lethally with Su-var(2)1 ⁰¹, a mutation that induces hyperacetylation of histones, whilst hyperacetylated histories accumulated in both the nuclei of HeLa cells and Drosophila polytene chromosomes treated with the same compounds. These results strongly suggest that the carnitine derivatives suppress position-effect variegation by a mechanism similar to that of butyrate. It is suggested that carnitines may have a functional role in the nucleus, probably at the chromatin level.     

Effects of dietary l‐carnitine supplements on growth and body composition in beluga sturgeon (Huso huso) juveniles

The effects of dietary l ‐carnitine on growth performance, whole body composition and feed utilization were studied in beluga, Huso huso. Fish were randomly allocated in 15 tanks (30 fish per tank) and triplicate groups were fed to satiety during 84 days one of five isonitrogenous (41% CP) and isoenergetic (20 MJ kg^?1) diets, each differing in l ‐carnitine content [0 (control), 300, 600, 900 and 1200 mg kg^?1 diet]. At the end of the trial, fish grew from 19‐ to 23‐fold in weight, from 8.4 g to a maximum of 191 g. Fish fed 300–600 mg l ‐carnitine had the highest specific growth rate (SGR, 3.69 and 3.72% day^?1) and protein efficiency ratio (PER, 0.95 and 0.99), and the lowest feed conversion ratio (FCR, 1.4 and 1.3) than the other groups (P < 0.0001). SGR, PER and FCR were the poorest for fish fed 1200 mg l ‐carnitine, while fish fed the unsupplemented and 900 mg l ‐carnitine supplemented diet showed intermediate performance. Body lipid concentration decreased significantly from 5.8 to 5.1% (P < 0.0001) with dietary l ‐carnitine supplementation increasing from 0 to 300 mg. Energy content was significantly lower in fish fed the 900 and 1200 mg l ‐carnitine diet (5.8 MJ kg^?1), when compared with the other treatment groups (6.4–6.6 MJ kg^?1). The results indicated that feeding sturgeon on diets supplemented with 300 mg l ‐carnitine kg^?1 diet improved growth performance, and stimulated protein‐sparing effects from lipids.     

Microbiological assay of carnitine

A method for carnitine assay has been devised by the growth response of the yeast Torulopsis bovina. As little as 0.0005 μg/ml of l (?) carnitine could be assayed by this method. Free carnitine was assayed in several biological materials together with the carnitine present as soluble esters. Lipid-bound carnitine was precipitated by trichloroacetic acid and assayed independently. Average recovery of added carnitine in the free-carnitine assays was 95%. In lipid-bound carnitine assays, recovery of added carnitine ranged from 76.2 to 95%. Treatment of materials for the microbiological assays included separation in ion-exchange resins and alkaline or acid hydrolyses. Materials containing negligible amounts of carnitine esters could be assayed directly without further treatment.     

Carnitine resembles choline in the induction of cholinesterase,acid phosphatase,and phospholipase C and in its action as an osmoprotectant in Pseudomonas aeruginosa

The present study demonstrates that under conditions of iso or hyperosmolarity, P. aeruginosa utilized carnitine as the carbon, nitrogen or carbon and nitrogen sources. As occurred in the case of choline, the bacteria synthesized cholinesterase (ChE), acid phosphatase (Ac.Pase) and phospholipase C (PLC) under any of these conditions and in the presence of high or low P_i concentrations.Carnitine acted as an osmoprotectant when the cells were grown in the presence of preferred carbon and nitrogen sources and high NaCl concentrations. Under these conditions the three enzyme activities were not produced.The osmotically stressed bacteria grown under any of the above conditions accumulated betaine. Its presence indicated that carnitine may be metabolized by P. aeruginosa to produce betaine which could account for the induction of the three enzyme activities or its action as an osmoprotectant.The phosphatidylcholine encountered in the host cell membranes allows the bacteria to obtain free choline by the coordinated action of PLC and Ac.Pase. Since the consequence of this action may be cell disruption, the increase of free carnitine in the natural environment of the bacteria is also possible. These two compounds, choline and carnitine, acting in conjunction or separately, may increase the production of PLC and Ac.Pase activities by P. aeruginosa and thus enhance the degradative effect upon the host cells.     

Chronic Sodium Benzoate Therapy in Children with Inborn Errors of Urea Synthesis: Effect on Carnitine Metabolism and Ammonia Nitrogen Removal

Sodium benzoate (SB) therapy is known to increase ammonia (NH₃) nitrogen elimination via conjugation with glycine and excretion as urinary hippurate. In 16 children with inborn errors of urea synthesis we studied two issues: (1) the effect of chronic SB administration upon carnitine metabolism and (2) the efficacy of chronic SB therapy as measured by the molar ratio of hippurate excretion to SB intake. Measurements were performed during elective hospitalizations when the patients were in stable metabolic condition. We found that chronic SB therapy is not associated with a constant level of hippurate elimination and that interindividual and intraindividual variability may result in irregular removal of NH₃nitrogen. This variability may be due to various factors including the formation of small quantities of benzoylcarnitine, which was detected in the plasma of three of four patients receiving SB and carnitine therapy and in one of two patients on SB therapy without carnitine supplementation. The ratios of acyl to free carnitine were elevated in both plasma and urine in patients not receiving carnitine supplementation, but were normal in patients receiving supplementation.