Renal Handling Of Amino Acids Research Articles

Plasma Levels and Renal Handling of Amino Acids Contribute to Determination of Risk of Mortality or Feed of Ventilation in Patients with COVID-19.

COVID-19 infection may lead to serious complications, e.g., need for mechanical ventilation or death in some cases. A retrospective analysis of patients referred to our COVID Emergency Department, indiscriminately, was performed. A routine lab analysis measured amino acids in plasma and urine of patients. Data of surviving and deceased patients and those requiring or not requiring mechanical ventilation were compared, and logistic regression analyses have been performed. Deceased patients were older, had higher blood glucose, potassium, AST, LDH, troponin, d-dimer, hsCRP, procalcitonin, interleukin-6 levels (p < 0.05 for all). They had lower plasma serine, glycine, threonine, tryptophan levels (p < 0.01), higher tyrosine and phenylalanine levels (p < 0.05), and higher fractional excretion of arginine, methionine, and proline (p < 0.05) than survivors. In a regression model, age, severity score of COVID-pneumonia, plasma levels of threonine and phenylalanine were predictors of in-hospital mortality. There was a difference in ventilated vs. non-ventilated patients in CT-scores, glucose, and renal function (p < 0.001). Using logistic regression, CT-score, troponin, plasma level, and fractional excretion of glycine were predictors of ventilation. Plasma levels and renal excretion of certain amino acids are associated with the outcome of COVID-19 infection beside other parameters such as the CT-score or age.

Advanced glycation endproducts, dityrosine and arginine transporter dysfunction in autism - a source of biomarkers for clinical diagnosis

BackgroundClinical chemistry tests for autism spectrum disorder (ASD) are currently unavailable. The aim of this study was to explore the diagnostic utility of proteotoxic biomarkers in plasma and urine, plasma protein glycation, oxidation, and nitration adducts, and related glycated, oxidized, and nitrated amino acids (free adducts), for the clinical diagnosis of ASD.MethodsThirty-eight children with ASD (29 male, 9 female; age 7.6 ± 2.0 years) and 31 age-matched healthy controls (23 males, 8 females; 8.6 ± 2.0 years) were recruited for this study. Plasma protein glycation, oxidation, and nitration adducts and amino acid metabolome in plasma and urine were determined by stable isotopic dilution analysis liquid chromatography-tandem mass spectrometry. Machine learning methods were then employed to explore and optimize combinations of analyte data for ASD diagnosis.ResultsWe found that children with ASD had increased advanced glycation endproducts (AGEs), Nε-carboxymethyl-lysine (CML) and Nω-carboxymethylarginine (CMA), and increased oxidation damage marker, dityrosine (DT), in plasma protein, with respect to healthy controls. We also found that children with ASD had increased CMA free adduct in plasma ultrafiltrate and increased urinary excretion of oxidation free adducts, alpha-aminoadipic semialdehyde and glutamic semialdehyde. From study of renal handling of amino acids, we found that children with ASD had decreased renal clearance of arginine and CMA with respect to healthy controls. Algorithms to discriminate between ASD and healthy controls gave strong diagnostic performance with features: plasma protein AGEs—CML, CMA—and 3-deoxyglucosone-derived hydroimidazolone, and oxidative damage marker, DT. The sensitivity, specificity, and receiver operating characteristic area-under-the-curve were 92%, 84%, and 0.94, respectively.ConclusionsChanges in plasma AGEs were likely indicative of dysfunctional metabolism of dicarbonyl metabolite precursors of AGEs, glyoxal and 3-deoxyglucosone. DT is formed enzymatically by dual oxidase (DUOX); selective increase of DT as an oxidative damage marker implicates increased DUOX activity in ASD possibly linked to impaired gut mucosal immunity. Decreased renal clearance of arginine and CMA in ASD is indicative of increased arginine transporter activity which may be a surrogate marker of disturbance of neuronal availability of amino acids. Data driven combination of these biomarkers perturbed by proteotoxic stress, plasma protein AGEs and DT, gave diagnostic algorithms of high sensitivity and specificity for ASD.

Profiling at mRNA, protein, and metabolite levels reveals alterations in renal amino acid handling and glutathione metabolism in kidney tissue ofPept2−/−mice

PEPT2 is an integral membrane protein in the apical membrane of renal epithelial cells that operates as a rheogenic transporter for di- and tripeptides and structurally related drugs. Its prime role is thought to be the reabsorption of filtered di- and tripeptides contributing to amino acid homeostasis. To elucidate the role of PEPT2 in renal amino acid metabolism we submitted kidney tissues of wild-type and a Pept2(-/-) mouse line to a comprehensive transcriptome, proteome and metabolome profiling and analyzed urinary amino acids and dipeptides. cDNA microarray analysis identified 147 differentially expressed transcripts in transporter-deficient animals, and proteome analysis by 2D-PAGE and MALDI-TOF-MS identified 37 differentially expressed proteins. Metabolite profiling by GC-MS revealed predominantly altered concentrations of amino acids and derivatives. Urinary excretion of amino acids demonstrated increased glycine and cysteine/cystine concentrations and dipeptides in urine were assessed by amino acid analysis of urine samples before and after in vitro dipeptidase digestion. Dipeptides constituted a noticeable fraction of urinary amino acids in Pept2(-/-) animals, only, and dipeptide-bound glycine and cystine were selectively increased in Pept2(-/-) urine samples. These findings were confirmed by a drastically increased excretion of cysteinyl-glycine (cys-gly). Urinary loss of cys-gly together with lower concentrations of cysteine, glycine, and oxoproline in kidney tissue and altered expression of mRNA and proteins involved in glutathione (GSH) metabolism suggests that PEPT2 is predominantly a system for reabsorption of cys-gly originating from GSH break-down, thus contributing to resynthesis of GSH.

Renal amino acid transport in immature and adult rats during chromate and cisplatinum-induced nephrotoxicity.

The effects of sodium dichromate (chromate; 1 mg/100 g b. wt. s.c.) and cisdiamminedichloroplatinum(II) (CP; 0.6 mg/100 g b. wt. i. p.) on renal amino acid excretion and plasma amino acid composition were investigated in 10- and 55-day-old anaesthetised rats. On the basis of diuresis experiments on conscious rats the mentioned doses and times (1st day after chromate in both age groups and in 10-day-old rats after CP and 3rd day after CP in adult rats) were found out to be optimal for the characterisation of amino acid transport after heavy metal poisoning. Interestingly, in conscious 10-day-old rats chromate nephrotoxicity is not detectable after 1 mg/100 g b. wt. whereas all of the other experimental groups showed nephrotoxic effects of chromate and CP in conscious rats. Urine volumes are lower, but not significantly, in anaesthetised immature rats, independently of the administered nephrotoxin. But GFR is significantly lower in 10-day-old rats, both in controls and after CP, whereas after chromate GFR is significantly reduced only in adult rats and age differences disappeared. In principle the renal fractional excretion (FE) of amino acids was distinctly higher in immature rats as a sign of lower amino acid reabsorption capacity. Nevertheless, the amino acid plasma concentrations were relatively high in immature rats. However, both chromate and CP did not distinctly influence amino acid plasma concentrations. But in both age groups the administration of chromate and CP significantly decreased amino acid reabsorption capacity (increase in FE) as a sign of nephrotoxicity, most pronounced in adult rats after CP. The investigation of renal amino acid handling confirms (1) that both CP and chromate are nephrotoxins, (2) that CP was more nephrotoxic in 55-day-old animals compared to immature rats as could be demonstrated before using other parameters for nephrotoxicity testing and showed (3) that determination of renal amino acid handling is a highly sensitive marker for nephrotoxicity testing, especially in immature rats.

Renal handling of amino acids in 5/6-nephrectomized rats: stimulation of renal amino acid reabsorption after treatment with triiodothyronine or dexamethasone under amino acid load.

In anaesthetized adult female rats, the renal amino acid handling was measured six days after 5/6 nephrectomy (5/6NX). The distinct rise in blood urea nitrogen as well as the significant reduction in urine flow and GFR indicate an impairment of kidney function. In principle, in 5/6NX rats amino acid plasma concentrations were comparable to those of control animals with two intact kidneys, whereas the fractional excretions (FEAA) of most endogenous amino acids measured were significantly enhanced. After bolus injection of leucine or taurine (each 20 mg/100 g b.wt.) or glutamine (90 mg/ 100 g b.wt.), dissolved in 2 ml normal saline per 100 g b.wt., the FEAA of both the amino acids administered and the endogenous amino acids increased as a sign of overloaded amino acid reabsorption capacity. This effect was more pronounced in 5/6NX rats than in controls. As early as one hour after amino acid load, plasma concentrations and FEAA returned to baseline values of 5/6NX rats. A pretreatment with triiodothyronine (20 micrograms/100 g b.wt.) or dexamethasone (60 micrograms/100 g b.wt.), both given intraperitoneally once daily for 3 days, stimulated the renal amino acid transport capacity in 5/6NX rats: the increase in FEAA after amino acid load was significantly lower compared to non-pretreated animals. This stimulation could be shown for the bolus amino acids and the endogenous amino acids and was more distinct in 5/6NX rats than in controls with two intact kidneys.

Epidermal growth factor (EGF) increases the renal amino acid transport capacity in amino acid loaded rats.

In anaesthetized adult female rats, the influence of epidermal growth factor (EGF) on renal amino acid handling was investigated in glutamine, arginine (both 50 mg/100 g b.wt. per hour), or alanine (90 mg/100 g b.wt. per hour) loaded animals. Continuous infusions of the three amino acids were followed by an increase in the fractional excretion (FE) of the administered amino acids as well as of the other endogenous amino acids. Under load conditions (alanine, arginine or glutamine), EGF pretreatment (8 micrograms/100 g b.wt. subcutaneously for 8 days, twice daily 8 a.m. and 4 p.m.) was followed by a stimulation of renal amino acid reabsorption. The increase in the fractional excretion of the administered amino acids was significantly lower than in non-EGF-treated rats. These changes in amino acid transport were connected with a significant reduction of GFR after EGF pretreatment (0.96 +/- 0.10 vs. 0.62 +/- 0.07 ml/min x 100 g b.wt.) and a distinct increase in sodium excretion (2.98 +/- 0.55 vs. 4.97 +/- 0.71 muval/100 g b.wt. x 20 min). After loading with p-aminohippurate (PAH; 200 mg/100 g b.wt.), PAH excretion in EGF rats was increased by about 20%, whereas urinary protein excretion was lower in EGF pretreated rats (control: 0.45 +/- 0.04 vs. EGF: 0.18 +/- 0.03 mg/100 g b.wt. x 20 min). The PAH load reduced amino acid reabsorption as a sign of overloading of renal tubular transport capacity, but in EGF pretreated animals the amino acid excretion was only slightly increased under these conditions. Furthermore, EGF pretreatment depressed normal kidney weight gain significantly (874 +/- 18 vs. 775 +/- 32 mg/100 g b.wt.). EGF can improve the renal tubular transport capacity, but, compared to well-known stimulators of renal transport like dexamethasone or triiodothyronine, its effect is only of a moderate degree.

The hepato-renal syndrome: Renal amino acid transport in bile duct ligated rats (DL) — influence of treatment with triiodothyronine or dexamethasone on renal amino acid handling in amino acid loaded rats

The influence of triiodothyronine or dexamethasone on renal amino acid handling was investigated in anaesthetized, bile duct-ligated (DL) adult female rats. 3 days after DL, glomerular filtration rate (GFR) was unchanged whereas urine flow was decreased. Plasma concentrations of 5 out of 16 amino acids were significantly enhanced after DL. On the other hand, the fractional excretion (FE) of 11 out of 16 amino acids was significantly reduced as a sign of improved reabsorption capacity. Bolus injections of leucine (20 mg/100 g b.wt.), glutamine (45 mg/100 g b.wt.), or taurine (45 mg/100 g b.wt.) were followed by a temporary increase in the FE of the administered amino acids as well of the endogenous amino acids which were not administered. This phenomenon was more pronounced in DL than in control rats. Under load conditions, dexamethasone (60 microg/100 g b.wt.) or triiodothyronine (20 microg/100 g b.wt.) treatment for 3 days, i.p. once daily, was followed by a stimulation of renal amino acid reabsorption in DL rats. The increase in fractional amino acid excretion after amino acid load was significantly lower than in untreated rats. This effect was also more pronounced in DL rats.

Influence of an extracellular volume expansion (ECVE) on renal amino acid- and sodium handling in patients with autosomal dominant polycystic kidney disease (ADPKD)

Although ADPKD is one of the first kidney diseases to be understood from the gene to the pathogenesis of clinical abnormalities, there were no data concerning the renal handling of amino acids and possible disorders of amino acid (AA) pattern in these patients. Therefore, in 9 patients suffering from ADPKD and in 8 healthy normal persons (NP) renal amino acid excretion was measured before and after extracellular volume expansion (ECVE) (21 of physiological electrolyte solution). Renal function was stable in both groups (serum creatinine: ADPKD: 85.1 ± 18.4 vs. NP 84.4 ± 13.5 μmol/l; GFR: 93.8 ± 16.4 vs. 104.4 ± 9.4 ml/min/1.73 m2). Mean blood pressure was higher in ADPKD patients than in NP (99.4 ± 2.6 vs. 85.5 ± 2.4 mmHg), but did not change after ECVE. After ECVE in both groups, urine volume increased distinctly, whereas GFR was only slightly enhanced. The plasma concentrations of leucine, glycine, valine, threonine, glutamine, and alanine were significantly higher in controls than in ADPKD patients. The amino acid reabsorption capacity was reduced in ADPKD patients in 12 of 21 amino acids before ECVE. After ECVE, the fractional excretion of amino acids (FEAA) increased only in NP. In parallel with changes in amino acid handling, the FENa (%) after ECVE increased both in ADPKD patients and in NP (before ECVE - ADPKD: 1.22 ± 0.23 vs. NP: 1.53 ± 0.23; after ECVE: 3.17 ± 0.25 (ADPKD) vs. 2.74 ± 0.22/NP; (ADPKD p ≤ 0.01, NP p ≤ 0.02) whereas FELi (%) increased significantly only in ADPKD (p ≤ 0.045) range (before ECVE - ADPKD: 25.8 ± 8.9 vs. NP: 20.5 ± 4.0; after ECVE: 41.4 ±15.4 vs. 25.2 ± 3.9). Furthermore, concentrations of cGMP (pmol/ml) in plasma increased after ECVE (before ECVE - ADPKD: 5.31 ± 0.56 vs. NP: 6.65 ±0.79; after ECVE: 11.31 ± 1.66 vs. 11.30 ± 1.91; p ≤ 0.05). Na+-dependent and, perhaps, NO-mediated processes in the reabsorption of AA in the proximal tubule seem to be different in ADPKD and may be related to different distributions of receptors and ATP-dependent transport systems with pathogenetic impact on abnormal transtubular fluid transport in ADPKD.

Stimulation of renal amino acid reabsorption after treatment with triiodothyronine or dexamethasone in amino acid loaded rats

In adult female anaestetized rats, the influence of triiodothyronine or dexamethasone on renal amino acid handling was investigated in leucine (20mg/100g b.wt.) or glutamine (45mg/100g b.wt.) loaded animals. Bolus injections of both amino acids were followed by temporary increase in fractional excretion of the administered amino acids as well of the endogenous amino acids which were not administered.

Influence of triiodothyronine and dexamethasone on renal amino acid handling in rats loaded with various amino acid mixtures

In adult female rats, the influence of dexamethasone or triiodothyronine on renal amino acid handling was investigated in amino acid loaded animals. Amino acids were administered intravenously as two mixtures, each containing four amino acids to overload amino acid reabsorption capacity. Bolus injections of both mixtures were followed by temporary increase in fractional excretion of the administered amino acids as well of the amino acids which were not covered in the mixtures. The administration of the two mixtures was followed by different interactions between various amino acid carriers.After dexamethasone pretreatment (60µg/100g b.wt. for 3 days, once daily) a stimulation of the renal amino acid handling could be shown. Triiodothyronine (20µg/100g b.wt. for 3 days, once daily) did not increase tubular reabsorption capacity for amino acids. It even increased fractional amino acid excretion in amino acid loaded rats as a sign of enhanced amino acid metabolism in the kidney and/or increased amino acid uptake into the tubular cells from the luminal site.

Renal amino acid transport in immature and adult rats during thallium-induced nephrotoxicity

The effect of Tl 2SO 4 (Tl, 2 mg/100 g b.wt.) on renal amino acid excretion and plasma amino acid composition was investigated in 10- and 55-day-old rats. Tl decreased glomerular filtration rate only in adult rats. On the other hand, the renal fractional excretion (FE) of amino acids was distinctly higher in adult rats as a sign of lower amino acid reabsorption capacity after Tl. In immature animals FE was increased only for a few amino acids. However, in both age groups Tl administration significantly decreased plasma amino acid concentrations, and was more pronounced in immature rats. The investigation of renal amino acid handling (1) confirms that Tl was more nephrotoxic in 55-day-old animals as demonstrated before using other parameters for nephrotoxicity testing and (2) showed that determination of renal amino acid handling is a suitable marker for nephrotoxicity in adult rats.

Renal amino acid transport in immature and adult rats during thallium-induced nephrotoxicity

The effect of Tl2SO4 (Tl, 2 mg/100 g b.wt.) on renal amino acid excretion and plasma amino acid composition was investigated in 10- and 55-day-old rats. Tl decreased glomerular filtration rate only in adult rats. On the other hand, the renal fractional excretion (FE) of amino acids was distinctly higher in adult rats as a sign of lower amino acid reabsorption capacity after Tl. In immature animals FE was increased only for a few amino acids. However, in both age groups Tl administration significantly decreased plasma amino acid concentrations, and was more pronounced in immature rats. The investigation of renal amino acid handling (1) confirms that Tl was more nephrotoxic in 55-day-old animals as demonstrated before using other parameters for nephrotoxicity testing and (2) showed that determination of renal amino acid handling is a suitable marker for nephrotoxicity in adult rats.

EFFECT OF CYCLOSPORINE ON THE RENAL TUBULAR AMINO ACID HANDLING AFTER KIDNEY TRANSPLANTATION

The renal tubular handling of free amino acids was studied 5-6 weeks after successful renal transplantation (tx) in 20 children treated with CsA and in 10 children treated with azathioprine (Aza). The results were compared with those of 34 control children. The amino-acid clearance studies were performed in combination with short-term inulin clearance. The CsA group revealed a mean inulin clearance of 49 +/- 16.8 ml/min/1.73 m2, the Aza group of 76.9 +/- 18.2, and the controls of 114 +/- 15.6. The plasma amino-acid concentrations were not different between CsA- and Aza-treated groups; however, most of the essential amino acids were lower in transplanted children than in controls. The decrease was correlated with the GFR. The amino-acid-clearance rates were statistically not different between both transplanted groups, but lower values than in controls were found for alanine, glycine, histidine, lysine, and phenylalanine, and significantly higher values for methionine. The fractional clearance rates of most amino acids were significantly elevated in transplanted children compared to controls. In CsA-treated patients, the fractional clearance rates of arginine, glycine, and serine were higher than in Aza-treated patients. No influence of CsA blood levels or rejection episodes on the amino-acid handling were detectable. We conclude that CsA has no specific influence on the renal handling of amino acids. Most disturbances observed depend on the graft function or may be caused by injuries to the graft following the tx procedure.

Contraluminal uptake of serine in the proximal nephron

Rabbit proximal nephron segments were microperfused in vitro to determine whether active contraluminal uptake of serine occurs in the renal proximal tubule during bath-to-lumen transport (influx) of the L- and D-isomers in the convoluted (pars convuluta) and straight (pars recta) segments. It is known that several amino acids are actively reabsorbed in the proximal nephron by a mechanism involving co-transport with sodium at the luminal membrane. There is some evidence that certain amino acids may also be accumulated across the contraluminal membrane by an energy-dependent mechanism, indicating that net reabsorption is the result of two oppositely directed active transport processes. During in vitro microperfusion of rabbit proximal nephron segments in this study, inward movement of L- and D-serine occurred in a bath-to-cell direction against a concentration gradient in the range 305–2735:1, indicating active uptake at the contraluminal membrane. The concentration gradients were maintained during influx of both isomers of serine in the proximal tubule. L-Serine accumulation by tubular cells was similar in the pars convoluta and recta, and significantly greater than that of D-serine, which was the same in both regions of the proximal tubule. The data support the conclusion that renal handling of serine involves active contraluminal uptake of the L- and D-isomers in both regions of the proximal tubule, and suggest that contraluminal events play an important role in renal handling of amino acids.

Abnormal amino acid concentrations in plasma and urine of experimentally diabetic dogs.

Free amino acid concentrations have been determined in plasma and urine of nonketotic, severely diabetic dogs and age-matched normal controls. Plasma from fasted (as well as fed) diabetics contained supranormal concentrations of several amino acids, including the branched-chain amino acids. In contrast to other species, however, the concentration of only one plasma amino acid (tryptophan) was subnormal in fasted diabetic dogs. Urine collected at the same time showed that the excretion of most amino acids was not abnormal in diabetes. Urinary concentrations of some amino acids were not abnormal despite supranormal levels in plasma. Nevertheless, eight of the 21 amino acids studied reached concentrations significantly greater than normal in the urine of diabetic dogs. Six of the eight amino acids (arginine, histidine, phenylalanine, tyrosine, tryptophan, glutamic acid) showed elevated concentrations in urine even though their plasma concentrations were not elevated. The observed disturbance in the urine/plasma ratio of certain amino acids suggests a possible defect in the renal handling of amino acids in diabetes.

Functional adaptation to reduction in renal mass: renal handling of amino acids by isolated perfused remnant rat kidneys.

To date, the renal handling of amino acids by remnant kidneys remains undefined. We have determined the renal handling of eight amino acids using the isolated perfused rat kidney. 6 normal and 22 partially infarcted rat kidneys (16 stage III [contralateral kidney removed], and 6 stage II [contralateral kidney left intact] were evaluated at perfusate amino acid concentrations approximately ten times normal plasma levels. Despite the reduction in glomerular filtration rate, the urinary excretion of most amino acids in remnant kidneys tended to exceed that of controls. Fractional amino acid excretion by both stage II and III kidneys tended to be or was higher than that of controls. The findings indicate that the fractional reabsorption of amino acids by residual nephrons of remnant kidneys is decreased. Our observations suggest that the changes are unrelated to a functional adaptation to the uremic environment.

Vitamin D-dependent rickets in the pig: renal handling of amino acids.

Vitamin D-dependent rickets in the pig: renal handling of amino acids.

Endogenous amino acid clearance by the rat kidney.

SummaryAlthough studies on the clearance of endogenously circulating amino acids had been published for several mammalian and non‐mammalian vertebrate species, few data were available for the rat. Since micropuncture studies on the renal handling of amino acids are most conveniently performed on this species, endogenous clearance studies have now been undertaken using automated, ion‐exchange chromatographic techniques for amino acid analysis. Endogenous plasma amino acid concentrations were remarkably similar to those in man but renal clearances of most amino acids were considerably smaller, indicating highly efficient reabsorptive mechanisms; the urinary excretion patterns, also, were very similar to those of man, although a striking exception was observed in the case of taurine, which was cleared in the rat at rates approaching 40% of the glomerular filtration rate. It was concluded that the renal handling of amino acids, with the exception of taurine, was very similar in rat and man, so that conclusions drawn from micropuncture experiments in rats would seem likely to hold also for man.

Pyroglutamic aciduria: Studies on the enzymic block and on the metabolic origin of pyroglutamic acid

A 20-year-old mentally retarded male with pyroglutamic aciduria has recently been described. The laboratory findings in this disorder are a high pyroglutamic acid (pyrrolidone-2-carboxylic acid) excretion (25–35 g/24 h), low excretion of urea (5–10 g/24 h) and metabolic acidosis. The serum and the cerebrospinal fluid contain 5 and 30 mg/100 ml, respectively, of pyroglutamic acid. The serum level of proline is 3 times the normal. Biochemical studies of the disorder show that (a) the patient converts ammonia to urea in a normal manner and responds normally to a high-calorie, low-protein diet. (b) A correlation exists between urinary ammonia and pyroglutamic acid, the excretion of both being independent of urinary pH. (c) Neither glutamine nor glutamic acid are direct precursors of pyroglutamic acid. (d) The patient, in contrast to normals, is unable to hydrolyze pyroglutamic acid to glutamic acid, (e) That i.v. infusion of amino acids to the patient is the only condition found which significantly increases the excretion of pyroglutamic acid. These studies indicate that pyroglutamate is involved in the renal handling of amino acids, and that the patient has a block in one of the steps (pyroglutamic acid to glutamic acid) of the γ-glutamyl cycle proposed by Orlowski and Meister.