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Plasma levels of free tryptophan in compensated and decompensated liver cirrhosis during exogenous triglyceride infusion
0.1 PLASMA LEVELS OF FREE TRYPTOPHAN IN COMPENSATED AND DECOMPENSATED LIVER CIRRHOSIS DURING M. Muscaritoli, A.Cascino, C.Cangiano, F.Ceci, EXOGENOUS TRIGLYCERIDE INFUSION. M.Familiari and F.Rossi Fanelli. Lab. Fin. sity 'La Sapienza', Rome, Italy.
Nutr., III
Dept. Internal Medicine, Univer-
Free tryptophan (FTRP) may play a central role in the pathogenesis of Hepatic Encephalopathy (HE). FTRP represents 10% of the total plasma TRP, the remaiql'ng90% is in fact bound to albumin (ALB). Free fatty acids (FFA) compete with TRP for the same binding sites on ALB. The administration of exogenous triglycerides (E TG) emulsions, by increasing serum FFA levels, as a result of peripheral TG hydrolysis, may indirectly increase plasma and brain levels of FTRP. The use of E TG could thus precipitate HE in CP. In the present study plasma FTRP modifications during i.v infusion of TG were investigated in CP. Ten compensated (CLC), 9 decompensated (DLC) CP and 10 healthy volunteers (HV) were studied. 350 ml of 10% Intralipid were administered during three hours and the levels of FTRP (pmoles/dl) and FFA (mEq/l) determined before and after the infusion. Serum ALB (mg/dl) levels were determined before the test. Results (mean values + S.D.): FFA 0' ALB FTRP 0' FTRP 180' FFA 180' HV 0.62kO.24 4.2920.61 0.4520.14 0.46tO.07 0.95+0.50 CLC 0.87fO.34* 1.27+0.61& 0.5820.27 0.9320.37 3.6920.39 DLC 1.26f0.77*$ 1.7OiO.74& 1.13+0.45*$ 1.3520.41 3.11+0.33*$ Significantly different: * vs HV; $ vs CLC; & vs time 0' During E TG infusion FTRP rose significantly in both CLC and DLC. Since no correlation was found between FFA and FTRP, ALB seemed to be the major determinant of FTRP levels in CP. Although none of CP showed signs of neurological impairment during the three hours of infusion, CP receiving E TG for prolonged periods, should be carefully monitored.
0.2 INFLUENCE OF INTRAVENOUS (IV) FAT INFUSION ON SERUM TOTAL BILE ACIDS (STBA) LEVEL IN HEALTHY VOLUNTEERS AND DURING TPN - E. Lerebours, C. Duhamel, JM. Thorel, H. FouinFortunet, Ph. Denis, R. Colin - GBPDN, 76031 ROUEN Cedex, FRANCE. Intraduodenal fat infusion induces an increase in STBA level which seems to be related to a gallbladder contraction and to an increase in biliary secretion. The aim of the study was to investigate the influence of an IV fat infusion a) on STBA level and gallbladder contraction in healthy volunteers (HV), b) on STBA level in patients during TPN. 8 healthy volunteers (4 F, 4 M, Mean age 28 yrs) received in a random order, after a 16 hour overnightJ?st, during 2 separated studies, either a 4 hour infusion of Intralipids 20 % (100 m1.h ) or a 5 % glucose infusion. STBA level was determined before infusion and after 30, 60, 90, 120, 180 and 240 minutes. Gallbladder volume was assessed with echotomography, according to Everson's technique, every 15 minutes. ,#n 7 patients (5 F, 2 M, age 35 yrs) receiving TPN for 28 days (7-41), Intralipids infusion and STBA determination were performed according to the same protocol than HV group. Gallbladder volume was not determined in the patients group. All patients had normal liver function tests. Results : 1) No modification of gallbladder volume was noted in the HV group during eitherfat or glucose infusion, 2) STBA level was not modified by glucose infusion in HV an increase in STBA level, no different in the patient group, 3) Fat infusion Qduced group + 3.6 2 0.8 umol.1 and in the HV group + 3.1 + 1.0 lmol.l- . Conclusion : Intravenous infusion induces an increase in STBA which is not related to a gallbladder contraction. This STBA increase could be due to an enhanced biliary secretion or to a mobilization of the intestinal bile acid pool. This STBA increase could explain the very low incidence of hepatic alterations associated with the fat infusion on a short lenght of time during cyclic TPN (1). (1) J Parent Ent Nutr 1987, 11, suppl 1, 4 S.
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Nutr., III
Dept. Internal Medicine, Univer-
Free tryptophan (FTRP) may play a central role in the pathogenesis of Hepatic Encephalopathy (HE). FTRP represents 10% of the total plasma TRP, the remaiql'ng90% is in fact bound to albumin (ALB). Free fatty acids (FFA) compete with TRP for the same binding sites on ALB. The administration of exogenous triglycerides (E TG) emulsions, by increasing serum FFA levels, as a result of peripheral TG hydrolysis, may indirectly increase plasma and brain levels of FTRP. The use of E TG could thus precipitate HE in CP. In the present study plasma FTRP modifications during i.v infusion of TG were investigated in CP. Ten compensated (CLC), 9 decompensated (DLC) CP and 10 healthy volunteers (HV) were studied. 350 ml of 10% Intralipid were administered during three hours and the levels of FTRP (pmoles/dl) and FFA (mEq/l) determined before and after the infusion. Serum ALB (mg/dl) levels were determined before the test. Results (mean values + S.D.): FFA 0' ALB FTRP 0' FTRP 180' FFA 180' HV 0.62kO.24 4.2920.61 0.4520.14 0.46tO.07 0.95+0.50 CLC 0.87fO.34* 1.27+0.61& 0.5820.27 0.9320.37 3.6920.39 DLC 1.26f0.77*$ 1.7OiO.74& 1.13+0.45*$ 1.3520.41 3.11+0.33*$ Significantly different: * vs HV; $ vs CLC; & vs time 0' During E TG infusion FTRP rose significantly in both CLC and DLC. Since no correlation was found between FFA and FTRP, ALB seemed to be the major determinant of FTRP levels in CP. Although none of CP showed signs of neurological impairment during the three hours of infusion, CP receiving E TG for prolonged periods, should be carefully monitored.
0.2 INFLUENCE OF INTRAVENOUS (IV) FAT INFUSION ON SERUM TOTAL BILE ACIDS (STBA) LEVEL IN HEALTHY VOLUNTEERS AND DURING TPN - E. Lerebours, C. Duhamel, JM. Thorel, H. FouinFortunet, Ph. Denis, R. Colin - GBPDN, 76031 ROUEN Cedex, FRANCE. Intraduodenal fat infusion induces an increase in STBA level which seems to be related to a gallbladder contraction and to an increase in biliary secretion. The aim of the study was to investigate the influence of an IV fat infusion a) on STBA level and gallbladder contraction in healthy volunteers (HV), b) on STBA level in patients during TPN. 8 healthy volunteers (4 F, 4 M, Mean age 28 yrs) received in a random order, after a 16 hour overnightJ?st, during 2 separated studies, either a 4 hour infusion of Intralipids 20 % (100 m1.h ) or a 5 % glucose infusion. STBA level was determined before infusion and after 30, 60, 90, 120, 180 and 240 minutes. Gallbladder volume was assessed with echotomography, according to Everson's technique, every 15 minutes. ,#n 7 patients (5 F, 2 M, age 35 yrs) receiving TPN for 28 days (7-41), Intralipids infusion and STBA determination were performed according to the same protocol than HV group. Gallbladder volume was not determined in the patients group. All patients had normal liver function tests. Results : 1) No modification of gallbladder volume was noted in the HV group during eitherfat or glucose infusion, 2) STBA level was not modified by glucose infusion in HV an increase in STBA level, no different in the patient group, 3) Fat infusion Qduced group + 3.6 2 0.8 umol.1 and in the HV group + 3.1 + 1.0 lmol.l- . Conclusion : Intravenous infusion induces an increase in STBA which is not related to a gallbladder contraction. This STBA increase could be due to an enhanced biliary secretion or to a mobilization of the intestinal bile acid pool. This STBA increase could explain the very low incidence of hepatic alterations associated with the fat infusion on a short lenght of time during cyclic TPN (1). (1) J Parent Ent Nutr 1987, 11, suppl 1, 4 S.
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