Ketone body kinetics in humans: a mathematical model

A model has been developed to account for ketone body kinetics in man based on data following bolus injections of [14C]acetoacetate (A) and [14C]beta-OH butyrate (B) into normal humans in the postabsorptive state. The model consists of separate compartments for blood A and B that are linked by a tissue compartment in which rapid interconversion of the ketone bodies occurs. The probability of movement from blood into this compartment was assumed to be the same for both ketone bodies. Two slowly equilibrating tissue compartments are required to account for the slow components in the tracer data, and thus a five-compartment model is proposed. By modeling the transient tracer data with the tracee in a steady state, ketone body kinetics were defined in terms of the rapid interconversions of A and B, and the slow exchanges of carbon within the tissues. The rates of release of new A and B into blood, (UA and UB) were calculated. These rates were less than the apparent production rates, PRA and PRB, as the PR's included carbon atoms first released as the other ketone body. The exchange constants between the compartments were determined in addition to the fractional catabolic rates (FCR) and metabolic clearance rates (MCR) of A and B. The initial space of distribution was 10 L and the mean values +/- SD (n = 11), normalized to this volume, were UA = 6.4 +/- 5.0, UB = 8.8 +/- 8.0 (mumol L-1 min-1), FCRA = 0.226 +/- 0.142, FCRB = 0.188 +/- 0.124 (min-1), MCRA = 2.26 +/- 1.42, MCRB = 1.87 +/- 1.23 (L min-1) and PRA = 11.1 +/- 7.6, PRB = 12.7 +/- 10.0 (mumol L-1 min-1).     

Ketone body kinetics in normal,diabetic, and obese humans

We have developed a model for the kinetics of acetoacetate (A) and β-OH-butyrate (B) in normal subjects. The model contains separate compartments for blood A, B, and acetone, as well as three exchange compartments. By using the model, the synthesis, utilization, and clearance rates of A and B were determined separately. We have compared the model with others that have been proposed for ketone body metabolism and have used the model to analyse studies undertaken in newly diagnosed diabetic patients and obese subjects (before and after a 2 week period of starvation). We found that in diabetic and obese individuals the synthesis of ketone bodies was higher than normal and that the fractional losses of A and B were reduced. The results suggest that ketosis develops as a result of high synthesis rates coupled with decreased fractional loss of ketone bodies. In each group the metabolism of B was altered more than A.     

Zinc kinetics in insulin-dependent diabetes mellitus patients

Zinc has an important role in the control of carbohydrate metabolism, and diabetic patients are at risk for zinc deficiency. However, there are conflicting data concerning nutritional zinc status. In order to investigate this topic, 10 normal and 10 insulin-dependent diabetic patients were studied following venous zinc tolerance test. Our results found no evidence of zinc deficiency or of changes on the kinetic parameters of zinc in patients with insulin-dependent diabetes mellitus following a venous zinc tolerance test.     

Cellularity of rat adipose tissue: effects of growth, starvation, and obesity

The size, number, and rate of formation of mature adipocytes were studied in the epididymal pads and retroperitoneal adipose depots of the Sprague-Dawley rat. Early growth of these depots was accompanied by progressive enlargement of adipose cells as well as by increases in number. Beyond the 15th wk of life, the depot grew exclusively by the process of cellular enlargement, with no further change in cell number. Severe starvation during the 6th wk of life followed by normal feeding had no lasting effect on cell size or cell number; prolonged semistarvation beginning in the 15th wk greatly reduced cell size while cell number was unaffected. Likewise, extreme increases in depot size produced by hypothalamic lesions did not change cell number, but only cell size. The concept of a fixed number of mature adipocytes in the adult organism may be of central importance in caloric and metabolic equilibrium.     

Dynamics of starvation in humans

A differential equation model describing the dynamics of stored energy in the form of fat mass, lean body mass and ketone body mass during prolonged starvation is developed. The parameters of the model are estimated using available data for 7 days into starvation. A simulation of energy stores for a normal individual with body mass index between 19 and 24 and an obese individual with body mass index over 30 are calculated. The length of time the obese subject can survive during prolonged starvation is estimated using the model. Authors are listed in alphabetical order.     

Ketone body metabolism in the mother and fetus

Pregnancy is characterized by a rapid accumulation of lipid stores during the first half of gestation and a utilization of these stores during the latter half of gestation. Lipogenesis results from dietary intake, an exaggerated insulin response, and an intensified inhibition of glucagon release. Increasing levels of placental lactogen and a heightened response of adipose tissue to additional lipolytic hormones balance lipogenesis in the fed state. Maternal starvation in late gestation lowers insulin, and lipolysis supervenes. The continued glucose drain by the conceptus aids in converting the maternal liver to a ketogenic organ, and ketone bodies produced from incoming fatty acids are not only utilized by the mother but cross the placenta where they are utilized in several ways by the fetus: as a fuel in lieu of glucose; as an inhibitor of glucose and lactate oxidation with sparing of glucose for biosynthetic disposition; and for inhibition of branched-chain ketoacid oxidation, thereby maximizing formation of their parent amino acids. Ketone bodies are widely incorporated into several classes of lipids including structural lipids as well as lipids for energy stores in fetal tissues, and may inhibit protein catabolism. Finally, it has recently been shown that ketone bodies inhibit the de novo biosynthesis of pyrimidines in fetal rat brain slices. Thus during maternal starvation ketone bodies may maximize chances for survival both in utero and during neonatal life by restraining cell replication and sustaining protein and lipid stores in fetal tissues.     

Ketone body metabolism in the neonate: development and the effect of diet

In the course of mammalian development milk has evolved with unique characteristics as has the capacity of the neonatal rat to process this nutrient source. The primary carbon source in milk is fat, which provides two readily utilized metabolites, acetoacetate and D(-)-3-hydroxybutyrate (ketone bodies), as well as free fatty acids and glycerol. Carbohydrate provides less than 12% of the caloric content of rat milk and glucose has to be produced by the suckling rat to maintain glucose homeostasis. One would predict that glucose would be used sparingly and in pathways that cannot be satisfied by other readily available metabolites. Studies of the uptake of metabolites and the development of key enzymes for the utilization of glucose and ketone bodies by developing brain support the concept that ketone bodies are preferred substrates for the supply of carbon to respiration and lipogenesis. Astrocytes, oligodendrocytes, and neurons from developing brain all have an excellent capacity to use ketone bodies for respiration. By contrast, glucose is utilized preferentially in the hexose monophosphate shunt by all three cell populations. We are examining the requirement for ketone bodies by developing brain with the application of a system to rear rat pups artificially on a milk substitute that promotes a hypoketonemia.     

Obestatin, obesity and diabetes

The high prevalence of obesity and diabetes will lead to higher rates of morbidity and mortality. It is well known that ghrelin plays a potential role in obesity and diabetes. Obestatin, a novel 23 amino acid amidated peptide encoded by the same gene that encodes ghrelin, was initially reported to have opposite actions to ghrelin in the regulation of food intake, emptying of the stomach and body weight. Recent work suggests that obestatin also regulate beta-cell survival and insulin secretion. The ghrelin-obestatin system is, therefore, a promising target for the developing of new drugs for the treatment of obesity and diabetes. This review summarizes the interrelationship between obestatin, obesity and diabetes.     

HLA-dependent GM effects in insulin-dependent diabetes: evidence from pairs of affected siblings.

In a recent study of GM allotype frequencies in HLA-defined subsets of patients with insulin-dependent diabetes mellitus (IDDM) and similarly defined healthy sibling controls, we found evidence for an HLA-dependent GM effect on IDDM susceptibility. To circumvent problems inherent in such patient-control studies of complex diseases, we have now examined sharing of genes in the HLA and GM regions in 26 informative pairs of siblings who were both affected with IDDM. We found that: (1) in the total sample of affected sib-pairs, sharing of two HLA haplotypes was increased compared to Mendelian expectations, in agreement with many previous studies; (2) in the total sample, sharing of GM region genes (as measured by GM phenotype concordance) was not different from Mendelian expectations, given the distribution of parental mating types; and (3) affected sib-pairs who shared two HLA haplotypes showed significantly increased sharing of GM region genes compared to affected sib-pairs who shared one or zero HLA haplotypes (P = .018). These results provide new evidence for HLA-dependent effects of a locus at or near GM on susceptibility to IDDM.     

Fibrinolytic and hypoglycemic effects of the Pro-Gly-Pro-Leu peptide during development of insulin-dependent diabetes in rats

Repeated (over 7 days) intranasal introduction of the Pro-Gly-Pro-Leu peptide into animals at a dose of 1 mg/kg before injection of the diabetogenic metabolite alloxan provided effective protection of an organism against development of insulin-dependent diabetes mellitus and prevented development of hyper-coagulating alterations in the system of hemostasis. An increasing in the anticoagulating and fibrinolytic activities in rat blood plasma was detected. The peptide under study also showed antidiabetogenic action: repeated intranasal introduction of the Pro-Gly-Pro-Leu peptide into animals for 7 days inhibited development of diabetes symptoms in rats pretreated with alloxan.     

The effects of starvation and experimental diabetes on phosphoenol-pyruvate carboxykinase in the guinea pig.

1. Approx. 85% of liver phosphoenolpyruvate carboxykinase is associated with the mitochondrial fraction in the fed guinea pig. Enzyme activity is unchanged in diabetes, but doubles during starvation. In contrast with earlier reports, both cytoplasmic and mitochondrial activities were found to be increased. 2. In kidney cortex, total enzyme activity is increased in both starved and diabetic animals. These changes are associated with increases in the cytoplasmic activity alone. 3. In diabetic animals the mean blood-glucose concentration was 23.1 mM. Other blood metabolites were lower than those in the rat, and the animals did not show significant ketosis. 4. Changes in the rates of gluconeogenesis from lactate and propionate paralleled those in phosphoenolpyruvate carboxykinase activity.     

Immune islet killing mechanisms associated with insulin-dependent diabetes: in vitro expression of cellular and antibody-mediated islet cell cytotoxicity in humans

In previous work we have shown that some bacteria can bind to human lymphocytes and can be used to identify lymphocyte subpopulations in conventionally stained blood smears. These bacteria are of different species or genera, which makes it difficult to study the binding mechanism. Also, the main marker for B cells, Brucella melitensis, is of very small size and highly pathogenic. Here we show that B cells as well as some of the T cell subpopulations can be identified by different mutants obtained from a strain of an Escherichia coli. Two procedures were used to generate mutants. First, E. coli-YS57 (pro-his-trp-) was mutagenized with N-methyl-N'-nitro-N-nitrosoguanidine and the binding to mouse spleen cells was used as a selective pressure. Second, phage-resistant mutants of E. coli-YS57 were obtained and tested for the ability to bind to lymphocytes. Out of 10 strains selected by the former procedure, 5 bound to a significant number of human lymphocytes. All four phage-resistant mutants bound to human lymphocytes. Out of the total of nine mutants that bound to lymphocytes, six bound consistently, i.e., they bound to similar percentages of peripheral blood lymphocytes from different normal donors. One phage-resistant mutant, E. coli USC-106, bound only to B cells. The subpopulations of lymphocytes identified by the mutants were essentially the same as those identified by different species or genera of bacteria. We concluded that E. coli mutants can be obtained that identify human lymphocyte subpopulations and that one of these mutants recognizes B cells; these mutants may be used to study the nature of the receptors for bacteria on lymphocytes, which appear to have a lectin-like nature.     

Ketone bodies in fish skin mucus as an indicator of starvation: a preliminary report

The detection of starvation is a major problem in fish husbandry. Too often the discovery of starving animals is not made until pathogenic organisms are about to overcome the weakened animals. A simple test, using a commercial plastic strip with a reagent area that changes colour in the presence of starvation-induced ketones, was applied to this problem in the mullet, Mugil cephalus. The strip identified ketones in the fish skin mucus, and demonstrated its value in detecting starvation in fishes.     

Glyoxalase in diabetes, obesity and related disorders

Diabetes was the first disease state where evidence emerged for increased formation of methylglyoxal. Metabolism of methylglyoxal by the glyoxalase system has been linked to the development of vascular complications of diabetes - nephropathy, retinopathy, neuropathy and cardiovascular disease. Increased formation of methylglyoxal in hyperglycaemia associated with diabetes and down regulation of glyoxalase 1 by inflammatory signalling in vascular cells leads to a marked increased modification of proteins by methylglyoxal to form advanced glycation endproducts at the sites of vascular complications. Hotspot protein targets of methylglyoxal that suffer functional impairment - the dicarbonyl proteome - likely play a key role in the mechanisms underlying the development of vascular complications in diabetes: particularly modification of integrin binding sites in extracellular matrix proteins leading to endothelial cell shedding and anoikis, modification of mitochondrial proteins and increased formation of reaction oxygen species, and modification of apolipoprotein B100 of low density lipoprotein leading to its increased atherogenicity. Some current therapeutic agents counter partially dysfunctional metabolism of methylglyoxal by the glyoxalase system in diabetes - including the recent development of high dose thiamine therapy for early stage diabetic nephropathy. Further pharmacologic strategies are required to overcome the down regulation of glyoxalase1 in diabetes. The glyoxalase system is likely to be a continuing and future focus for research on clinical biomarkers and therapeutic development for respectively assessment of metabolic control and prevention of vascular complications in diabetes and obesity.     

Effects of triglycerides, obesity, and starvation on ghrelin transport across the blood-brain barrier

Human ghrelin is transported across the blood-brain barrier (BBB) of normal mice. Here, we studied the effects of triglycerides, obesity, and starvation in retired breeder mice maintained on a high fat diet, mice age-matched to the retired breeders but maintained on normal chow, and 8-week-old mice maintained on breeder chow. The rate of ghrelin transport across the BBB was studied by both the intravenous administration method of multiple-time regression analysis and by the brain perfusion method. We found that (1) obese, aged mice lost the ability to transport intravenously administered ghrelin across the BBB, resulting in an inverse relation between body weight and ghrelin BBB permeability; (2) serum triglycerides promoted transport of intravenously administered ghrelin across the BBB, whereas epinephrine had no effect; (3) fasting tended to promote ghrelin transport across the BBB as most readily shown in brain perfusion studies; (4) evidence suggested that a serum factor promoted ghrelin transport in 8-week-old mice. Overall, these results show that serum factors and physiological states influence the rate at which ghrelin is transported across the blood-brain barrier.     

Lack of acute zinc effects in glucose metabolism in healthy and insulin-dependent diabetes mellitus patients

Acute or chronic zinc administration may cause hyperglycemia in experimental animals. These findings are attributed to permissive actions of glucocorticoids and glucagon upon hepatic gluconeogenesis and glycogenolysis. The effect of Zn⁺⁺ on plasma glucose, C-peptide, glucagon, and cortisol was investigated in healthy and insulin-dependent diabetes mellitus (IDDM) patients. Ten normal individuals (5 of each sex, aged 24.10 ± 1.96) and 10 IDDM (5 of each sex, aged 25.20 ± 8.10) were tested at 7:00 AM after 12-h fast. Twenty-five mg of Zn⁺⁺ were administered intravenously during 1 min, and blood samples were collected from the contralateral arm at 0, 3, 30, 60, 90 and 120 min after Zn⁺⁺ injection. The plasma levels of glucose, C-peptide, and glucagon remained constant throughout the experimental period in both groups studied. Plasma cortisol levels decreased significantly, which is consistent with our previous findings. These results suggest that, in contrast to experimental animals, acute Zn⁺⁺ administration, despite decreasing cortisol levels, does not change carbohydrate metabolism in human beings.