Effect of Euglycemic Insulin Infusion on Plasma Levels of Branched-Chain Amino Acids in Cirrhosis

Authors

  • Giulio Marchesini,

    Corresponding author
    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    • Giulio Marchesini, M.D., Istituto di Patologia Medica 1, Università di Bologna, Policlinico S. Orsola, 9, Via Massarenti, 1–40138 Bologna, Italy.
    Search for more papers by this author
  • Gabriele Forlani,

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author
  • Marco Zoli,

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author
  • Cristina Dondi,

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author
  • Glampaolo Blanchi,

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author
  • Vlncenzo Bua,

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author
  • Pletro Vannini,

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author
  • Emilio Plsi

    1. Istituto di Patologia Speciale Medica 1 and Cattedra di Malattie del Ricambio, Università di Bologna, Bologna, Italy
    Search for more papers by this author

  • Parts of this work were presented at the Second Italian Week on Digestive Diseases, July 7 to 11, 1981, Bologna, Italy, and at the XVI Meeting of the European Association for the Study of the Liver (EASL), September 3 to 5, 1981, Lisbon, Portugal

Abstract

To test the hypothesis that hyperinsulinism is responsible for reduced branched-chain amino acids in cirrhotics, plasma amino acids were sequentially determined in 8 controls and 8 matched cirrhotics during continuous i.v. insulin infusion. An artificial endocrine pancreas which infused glucose was used to sustain euglycemia. Basal plasma insulin levels were high and branched-chain amino acids were reduced in cirrhotics. Insulin infusion raised insulin levels to 3 to 4 times basal values. During the test, the decline in branched-chain amino acids was markedly higher in controls who had similar steady-state insulin levels. Not only did the level of branched-chain amino acids in controls reach the values seen in cirrhotics after 60 min, but the levels continued to fall at a significantly higher rate throughout the second hour. Glucose consumption and the ratio of glucose infused/steady-state insulin—a measure of tissue sensitivity to insulin—were markedly reduced in cirrhotics and positively correlated with the decline in branched-chain amino acids. In cirrhotics, insulin effects on carbohydrate and branched-chain amino acid metabolism were reduced. Low branched-chain amino acid levels in cirrhotics are not likely to depend only on hyperinsulinism.

Ancillary