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The Effect of Hyperglycemic Hyperinsulinemia on Small-Intestinal Mucosal Protein Synthesis in Patients After Surgical Stress

Peter Rittler, MD^*, Beatrice Schiefer, MD^*, Hans Demmelmair, PhD, Berthold Koletzko, MD, Michael Vogeser, MD, David H. Alpers, MD, Karl-Walter Jauch, MD^* and Wolfgang H. Hartl, MD^*

From the ^* Department of Surgery, Department of Clinical Chemistry, Klinikum Grosshadern; Department of Pediatrics, Dr.v. Haunersches Kinderspital, Ludwig-Maximilian University Munich, Germany; and Washington University School of Medicine, Department of Medicine, St. Louis, Missouri

Correspondence: Wolfgang H. Hartl, MD, Chirurgische Klinik, Klinikum Grosshadern, Marchioninistr. 15, D-81377 Munich, Germany. Electronic mail may be sent to whartl{at}med.uni-muenchen.de.

Hyperglycemic hyperinsulinemia cannot stimulate intestinal protein synthesis in healthy individuals but does so in conditions characterized by an altered somatotropic axis such as diabetes. Only in a state of growth hormone resistance (high growth hormone but low insulin like growth factor [IGF-1] concentrations), extra insulin may acutely reverse the impaired, growth-hormone-induced IGF-1 release, thereby exerting anabolic actions at the intestinal tract. Growth hormone resistance can be also found in patients after surgical stress. Therefore, we wanted to test the hypothesis whether hyperglycemic hyperinsulinemia would stimulate ileal protein synthesis in the latter condition. Mass spectrometry techniques (capillary gas chromatography/combustion isotope ratio mass spectrometry) were used to directly determine the incorporation rate of 1-[¹³C]-leucine into ileal mucosal protein. All subjects had an ileostomy, which allowed easy access to the ileal mucosa, and consecutive sampling from the same tissue was performed during continuous isotope infusion (0.16 µmol/kg min). Isotopic enrichments and fractional protein synthesis were determined at baseline (period I) and after a 4-hour glucose infusion (170 mg/kg/h) or after infusion of saline (control group) (period II). In controls, ileal protein synthesis declined significantly during prolonged isotope infusion (period I: 1.11 ± 0.14%/h, period II: 0.39 ± 0.13%/h, p < .01). In contrast, ileal protein synthesis remained constant during glucose infusion (period I: 1.32 ± 0.35%/h, period II: 1.33 ± 0.21%/h, n.s. vs period I, but p < .005 vs the corresponding value at the end of period II in the control group). Using the continuous tracer infusion technique, ileal protein synthesis seemingly declines over a short time in control subjects. We found evidence that this artificial decline was due to mass effects of a rapidly turning over mucosa protein pool in which an isotopic plateau was reached during the experiment and of which the size amounted to approximately 4% of the total mixed protein pool. Maintenance of ileal protein synthesis during glucose infusion therefore indicates a rise of ileal protein synthesis in a slowly turning over protein pool. This effect in postsurgical patients would be compatible with the concept of intestinal insulin action to depend on the specific clinical state (eg, growth hormone resistance).

Journal of Parenteral and Enteral Nutrition, Vol. 30, No. 2, 97-107 (2006)
DOI: 10.1177/014860710603000297


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