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This Article Full Text Full Text (PDF) All Versions of this Article: 286/1/E129    most recent 00486.2002v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (11) Citing Articles via Google Scholar Google Scholar Articles by Battezzati, A. Articles by Luzi, L. Search for Related Content PubMed PubMed Citation Articles by Battezzati, A. Articles by Luzi, L.

Nonhepatic glucose production in humans

¹International Center for the Assessment of Nutritional Status, DiSTAM, Università degli Studi di Milano, 20133 Milano; ²Department of Medicine, Istituto Scientifico H San Raffaele, 20132 Milano; and ³Liver Transplantation Unit, Istituto Nazionale dei Tumori, 20133 Milano, Italy; and ⁴University of Vermont, Burlington, Vermont 05405

Submitted 7 November 2002 ; accepted in final form 30 May 2003

Extrahepatic glucose release was evaluated during the anhepatic phase of liver transplantation in 14 recipients for localized hepatocarcinoma with mild or absent cirrhosis, who received a bolus of [6,6-²H₂]glucose and L-[3-¹³C]alanine or L-[1,2-¹³C₂]glutamine to measure glucose kinetics and to prove whether gluconeogenesis occurred from alanine and glutamine. Twelve were studied again 7 mo thereafter along with seven healthy subjects. At the beginning of the anhepatic phase, plasma glucose was increased and then declined by 15%/h. The right kidney released glucose, with an arteriovenous gradient of -3.7 mg/dl. Arterial and portal glucose concentrations were similar. The glucose clearance was 25% reduced, but glucose uptake was similar to that of the control groups. Glucose production was 9.5 ± 0.9 µmol·kg^-1· min^-1, 30% less than in controls. Glucose became enriched with ¹³C from alanine and especially glutamine, proving the extrahepatic gluconeogenesis. The gluconeogenic precursors alanine, glutamine, lactate, pyruvate, and glycerol, insulin, and the counterregulatory hormones epinephrine, cortisol, growth hormone, and glucagon were increased severalfold. Extrahepatic organs synthesize glucose at a rate similar to that of postabsorptive healthy subjects when hepatic production is absent, and gluconeogenic precursors and counterregulatory hormones are markedly increased. The kidney is the main, but possibly not the unique, source of extrahepatic glucose production.

kidney; intestines; amino acids

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