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Shriners Burns Hospital and Trauma Services, Massachusetts General Hospital, Boston 02114; and Laboratory of Human Nutrition and Clinical Research Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142
Compromised glutathione homeostasis is
associated with increased morbidity in various disease states. We
evaluated the kinetics of L-5-oxoproline, an intermediate
in the
-glutamyl cycle of glutathione production, in fourteen
severely burned adults by use of a primed, constant intravenous
infusion of L-5-[1-13C]oxoproline. In nine of
these patients, whole blood glutathione synthesis and plasma kinetics
of glycine and leucine were also measured with
[15N]glycine and
L-[2H3]leucine tracers. Patients
were studied under a "basal" condition that provided a low dose of
glucose and total parenteral nutrition. For comparison with control
subjects, whole blood glutathione synthesis was estimated in six
healthy adults. Burn patients in a basal condition showed
significantly higher rates of plasma oxoproline clearance and urinary
D- and L-oxoproline excretion compared with
fasting healthy control subjects. Whole blood glutathione concentration
and absolute synthesis rate in the basal state were lower than for
control subjects. Total parenteral feeding without cysteine but with
generous methionine did not affect oxoproline kinetics or whole blood
glutathione synthesis. The estimated rate of glycine de novo synthesis
was also lower in burn patients, suggesting a possible change in
glycine availability for glutathione synthesis. The roles of precursor
amino acid availability, as well as alterations in metabolic capacity,
in modulating whole blood glutathione production in burns now require investigation.
flux; glycine; de novo synthesis; clearance; urinary excretion
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