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An Investigation of the Protein Metabolism in Healthy

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An Investigation of the Protein Metabolism in Healthy AN INVESTIGATION OF THE PROTEIN METABOLISM IN HEALTHY SUBJECTS AND WEIGHT-LOSING CANCER PATIENTS by DONALD CAMPBELL McMILLAN F.I.M.L.S. A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY to THE UNIVERSITY OF GLASGOW from RESEARCH CONDUCTED IN THE UNIVERSITY DEPARTMENT OF SURGERY, GLASGOW ROYAL INFIRMARY MARCH 1992 © DONALD C. McMILLAN 1 ProQuest Number: 11007691 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 11007691 Published by ProQuest LLC(2018). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 Glasgow UNIVERSITY LIBRARY 9 iia , 1 CONTENTS PAGE Contents 2 List of Tables 8 List of Figures 13 Acknowledgements 15 Declaration 17 Dedication 20 Summary 21 1. INTRODUCTION AND AIMS 1.1 Protein metabolism in man 24 1.2 Turnover measurements using isotope tracers 27 1.3 Measurement of stable isotopes 29 1.4 Protein turnover measurements 29 1.5 Cancer cachexia 1.5.1 Weight loss in cancer (cancer cachexia) 30 1.5.2 Body composition in cancer cachexia 32 1.5.3 Energy metabolism in cancer cachexia 33 1.5.4 Whole body protein metabolism in cancer cachexia 34 1.5.5 Tissue protein metabolism in cancer cachexia 36 1.6 Aims of the thesis 39 1.7 Plan of thesis 39 2 PAGE 2. TECHNIQUES FOR MEASURING WHOLE BODY PROTEIN TURNOVER AND TISSUE PROTEIN SYNTHESIS RATES IN MAN 2.1 Introduction 40 2.2 Precursor methods 43 2.3 End-product methods 45 2.4 Tissue protein synthesis measurement 49 2.5 Tracer dose protocol 50 2 .6 Flooding dose protocol 52 2.7 Summary 54 3. METHODS: STABLE ISOTOPE SAMPLE PREPARATION. BIOCHEMICAL ANALYSES AND MEASUREMENT OF RESTING ENERGY EXPENDITURE 3.1 Introduction 55 3 .2 The isolation of free amino acids from plasma and tissues prior to amino acid separation 56 3.2.1 Removal of protein and interfering compounds 57 3 .2 .2 Protein hydrolysis 58 3 .3 Amino acid separation 3.3.1 Introduction 60 3.3.2 Ion exchange chromatography 62 3.3.3 Separation of derivatised amino acids 64 3 .3 .4 Separation of amino acids using ion exchange with a volatile buffer: Development work 65 3.3.5 Summary 72 3.4 Sample preparation for isotope analysis 73 3 PAGE 3.4.1 Plasma sample preparation 73 3.4.2 Tissue sample preparation 74 3 .4 .3 Amino acid separation 76 3.4.4 Urine sample preparation 77 3 .4 .5 Breath C 02 sample preparation 78 3.5 Biochemical analyses 79 3.5.1 Urine analyses 79 3 .5 .2 Blood analyses 80 3 .5 .3 Tissue analyses 81 3.6 Resting energy expenditure measurement 3.6.1 Introduction 85 3 .6 .2 Direct calorimetry 85 3.6.3 Indirect calorimetry 86 3 .6 .4 Resting energy expenditure 86 3.6.5 Indirect calorimetry technique 87 4. METHODS: STABLE ISOTOPE MEASUREMENT AND STUDY PROTOCOL VALIDATION 4.1 Introduction 91 4.1.1 Nuclear Magnetic Resonance 92 4 .1 .2 Emission Spectroscopy 93 4 .1 .3 Infra-red Spectroscopy 93 4 .1 .4 Other techniques 94 4.1.5 Mass Spectrometry 95 4.2 Continuous Flow-lsotope Ratio Mass Spectrometry 100 4.2.1 Sample combustion 105 4 PAGE 4 .2 .2 Carbon isotope analysis by Continuous Flow- lsotope Ratio Mass Spectrometry 106 4.2.3 Nitrogen isotope analysis by Continuous Flow- lsotope Ratio Mass Spectrometry 107 4.2.4 Calculation of carbon and nitrogen isotope enrichment of leucine and glycine following amino acid separation 108 4 .2 .5 Sample recovery; precision and accuracy of isotope analysis 110 4.3 Study protocol validation 113 4.4 Statistical methods 119 5. THE SIMULTANEOUS MEASUREMENT OF WHOLE BODY. FIXED LIVER AND MUSCLE PROTEIN SYNTHETIC RATES IN NORMAL SUBJECTS USING M 5N1GLYC1NE AND M3C1LEUCINE 5.1 Introduction 120 5.2 Material and Methods 5.2.1 Subjects 123 5 .2.2 Experimental design 123 5.2.3 Analytical methods 125 5.2.4 Calculations 126 5.3 Results 129 5.4 Discussion 132 5 PAGE 6. THE SIMULTANEOUS MEASUREMENT OF WHOLE BODY. FIXED LIVER AND MUSCLE PROTEIN SYNTHETIC RATES IN WEIGHT-LOSING CANCER PATIENTS USING f15N1GLYCINE 6.1 Introduction 141 6.2 Material and Methods 6.2.1 Subjects 144 6 .2 .2 Experimental design, analytical methods and calculations 145 6.3 Results 145 6 .4 Discussion 148 7. GENERAL DISCUSSION OF CLINICAL STUDIES 7.1 Introduction 153 7.2 Whole body protein synthesis 7.2.1 Comparison with other published work 154 7.2.2 Limitations of the model 156 7.3 Liver protein synthesis 160 7.4 Muscle protein synthesis 162 7.4.1 Increased muscle protein synthesis: Effect of acute phase protein synthesis 167 7.4.2 Increased muscle protein synthesis: Effect of collagen synthesis 171 7.4.3 Increased muscle protein synthesis: Summary 173 7.5 Apparently elevated whole body protein synthesis rates in weight-losing cancer patients: A hypothesis 174 6 PAGE 7.6 The mediators of increased fibrinogen synthesis in weight-losing cancer patients 177 7.6.1 The influence of cortisol and lnterleukin-6 on fibrinogen synthesis 178 7.6.2 Comparison with other work 180 7.7 Summary 182 8. CONCLUSION 8.1 Introduction 183 8.2 Aim 1 183 8.3 Aim 2 184 8.4 Aim 3 185 REFERENCES 188 7 LIST OF TABLES FOLLOWING PAGE Table 3.1 : Recovery of plasma [14C]glycine after sample preparation procedures 90 Table 3.2 : Recovery of plasma free amino acids after ultrafiltration 90 Table 3.3 : The effect of temperature and pyridine formate concentration on amino acid separation 90 Table 3 .4 : Amino acid separation of plasma using pyridine formate 90 Table 4.1 : Precision and accuracy of 13C and 15N isotope ratio analysis of plasma free leucine and glycine 119 Table 4 .2 : Urinary [15N]ammonia kinetics during a primed constant infusion of [15N]glycine 119 Table 4 .3 : Plasma glycine kinetics during a primed constant infusion of [15N]glycine 119 Table 4 .4 : Calculation of [15N]glycine and [13C]leucine isotope enrichment 119 Table 4.5 : The recovery of expired 13C 0 2 119 Table 5.1 : Characteristics of patients studied as 'healthy' individuals 140 8 LIST OF TABLES FOLLOWING PAGE Table 5.2 : Whole body protein kinetics and resting energy expenditure in healthy subjects 140 Table 5.2a: Resting energy expenditure and respiratory quotient in healthy subjects 140 Table 5.3 : Liver protein synthetic rates in healthy subjects measured using [15N]glycine 140 Table 5.3a: W et weights of liver and skeletal muscle biopsies taken from healthy subjects 140 Table 5.4 : Muscle protein synthetic rates in healthy subjects measured using [15N]glycine 140 Table 5.5 : Liver protein synthetic rates in healthy subjects measured using [13C]leucine 140 Table 5.6 : Plasma free [15N]glycine and [13C]leucine enrichment of healthy subjects in the period prior to biopsy 140 Table 5.7 : Plasma free amino acid concentrations in healthy subjects at 5 hours prior to and at the time of operation 140 9 LIST OF TABLES FOLLOWING PAGE Table 5.8 : Liver and muscle free amino acid concentrations in healthy subjects 140 Table 5.9 : Urinary creatinine and 3-methylhistidine excretion in healthy subjects 140 Table 5.10: Liver and muscle RNA concentration in healthy subjects 140 Table 5.11: Comparison of rates of skeletal muscle protein synthesis in normal subjects as determined by different investigators 140 Table 5.12: Whole body and tissue protein synthetic rate measurements in normal subjects using [15N]glycine 140 Table 5.13: Whole body and tissue protein synthetic rate measurements in normal subjects using [13C]glycine 140 Table 6.1 : Characteristics of cancer patients 152 Table 6.2 : Whole body protein kinetics and resting energy expenditure in weight-losing cancer patients 152 Table 6.2a: Resting energy expenditure and respiratory quotient in weight-losing cancer patients 152 10 LIST OF TABLES FOLLOWING PAGE Table 6.3 : Liver protein synthetic rates in weight-losing cancer patients measured using [15N]glycine 152 Table 6.3a: W et weights of liver and skeletal muscle biopsies taken from weight-losing cancer patients 152 Table 6.4 : Muscle protein synthetic rates in weight-losing cancer patients measured using [15N]glycine 152 Table 6.5 : Liver free amino acid concentrations in normal subjects compared with those of weight-losing cancer patients 152 Table 6.6 : Muscle free amino acid concentrations in normal subjects compared with those of weight-losing cancer patients 152 Table 6.7 : Tumour free amino acid concentrations in weight-losing cancer patients 152 Table 6.8 : Urinary creatinine and 3-methylhistidine excretion in weight-losing cancer patients 152 Table 6.9 : Liver and muscle RNA concentration in weight-losing cancer patients 152 11 LIST OF TABLES FOLLOWING PAGE Table 6.10: Whole body and tissue synthetic rate measurements in weight-losing cancer patients using [15N]glycine 152 Table 7.1 : Changes in plasma protein concentrations in normal subjects and weight-losing cancer patients 182 Table 7.2 : Comparison of whole body protein turnover in normal subjects and cancer patients as determined by different investigators 182 Table 7.3 : Whole body, liver and skeletal muscle protein synthesis in normal subjects and weight-losing cancer patients 182 Table 7.4 : Rates of protein synthesis and potential mediators in normal subjects and weight-losing cancer patients 182 Table 7.5 : Urinary hydroxyproline excretion in normal subjects and weight-losing cancer
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