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Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-0615
We previously reported that simulation of the
chronic hyperglucagonemia seen during infection was unable to recreate
the infection-induced increase in hepatic glucose production. However,
chronic hyperglucagonemia was accompanied by a fall in the arterial
levels of gluconeogenic precursors as opposed to a rise as is seen
during infection. Thus our aim was to determine whether an infusion of
gluconeogenic precursors could increase hepatic glucose production in a
setting of hyperglucagonemia. Studies were done in 11 conscious
chronically catheterized dogs in which sampling (artery and portal and
hepatic veins) and infusion catheters (splenic vein) were implanted 17 days before study. Forty-eight hours before infusion of gluconeogenic (GNG) precursors, a sterile fibrinogen clot was placed into the peritoneal cavity. Glucagon was infused over the subsequent 48-h period
to simulate the increased glucagon levels (~500 pg/ml) seen during
infection. On the day of the experiment, somatostatin was infused
peripherally, and basal insulin and simulated glucagon were infused
intraportally. After a basal period, a two-step increase in lactate and
alanine was initiated (120 min/step; n = 5). Lactate (
479 ± 25 and
1,780 ± 85 µM; expressed as
change from basal in periods I and
II, respectively) and alanine (
94 ± 13 and
287 ± 44 µM) levels were increased. Despite
increases in net hepatic GNG precursor uptake (
0.7 ± 0.3 and
1.1 ± 0.4 mg
glucose · kg
1 · min
1),
net hepatic glucose output did not increase. Because nonesterified fatty acid (NEFA) levels fell, in a second series of studies, the fall
in NEFA was eliminated. Intralipid and heparin were infused during the
two-step substrate infusion to maintain the NEFA levels constant in
period I and increase NEFA
availability in period II (
29 ± 29 and
689 ± 186 µM;
n = 6). In the presence of similar increases in net hepatic GNG precursor uptake and despite increases in
arterial glucose levels (
17 ± 5 and
38 ± 12 mg/dl), net
hepatic glucose output increased (
0.6 ± 0.1 and
0.7 ± 0.2 mg · kg
1 · min
1).
In summary, a chronic increase in glucagon, when combined with an acute
increase in gluconeogenic precursor and maintenance of NEFA supply,
increases hepatic glucose output as is seen during infection.
alanine; lactate; lipolysis; inflammation; gluconeogenesis
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