Helicobacter pylori in vivo diagnosis after food intake: results of simultaneous [15N]urea urine and [13C]acetate breath tests

The protocols for 13C and 15N H. pylori tests stipulate that the diagnostic agent should be taken on an empty stomach. It is presumed that food intake prior to the tests leads to less reliable test results due to a prolongation of the gastric residence time of the diagnostic agent urea. This might allow the bacteria to split a higher proportion of urea, resulting in an increased number of false positives. 12 probands received 150mg [15N]urea and 75 mg sodium [13C]acetate in 75 ml orange juice as a test drink. [15N]Urea served as an agent to diagnose gastric H. pylori colonization. The 15N tests were evaluated using a urine sample of the second hour after test start. [13C]Acetate served as a marker of the gastric emptying of water-soluble food including the urea under the influence of food intake. Breath air samples were taken to calculate the gastric emptying half life (EHL) and the apparent resorption time (RT) of the urea. The double tests were carried out four times within four weeks using identical test protocols but different standardized time periods of pretest fasting: overnight, two hours prior to test, one hour prior to test, and no fasting at all. The food intake amount was standardized. Five probands testing positive in the overnight fasting test were also found to be positive in the other test variants with more or less empty stomachs. Seven other probands testing negative after overnight fasting tested negative in the other test variants as well. It is concluded that food intake prior to the test drink does not have much of an influence on the gastric residence time of urea and so on the qualitative H. pylori test results. Due to identical behaviour of [13C]urea and [15N]urea in the stomach, this influence is believed to be independent on the labelling isotope. For survey purpose, no fasting conditions are required for the H. pylori tests.     

[13C]Aminopyrine and [13C]Caffeine Breath Test: Influence of Gender,Cigarette Smoking and Oral Contraceptives Intake

Abstract

The [¹³C]aminopyrine breath test ([¹³C]ABT) measures the global activity of cytochrome P450 in vivo and is a sensitive indicator of liver metabolic dysfunction. The present study aims to determine whether gender and cigarette smoking influence the results of [¹³C]ABT as well as to confirm the effect of oral contraceptive steroids (OCS) intake on this metabolic test. Hundred and ten healthy subjects, including men and women, smoker and non-smoker, women taking OCS or not, were phenotyped for CYP1A2 using the [¹³C]caffeine breath test and underwent a [¹³C]ABT. Both tests showed large inter-individual variations in accordance with that of CYP450 liver content. [¹³C]ABT was sensitive enough to point out a significant induction or inhibition related to cigarette smoking habits or OCS. The combined effect of smoking and OCS resulted in an overall unchanged metabolic activity. Consequently, the impact of the studied conditions on the [¹³C]ABT parameters must be considered by clinicians or clinical investigators.     

Significance of Diagnostic Parameters in [13C]Octanoic Acid Gastric Emptying Breath Tests*

Abstract

Two novel characteristic parameters, the latency time (t _lat) and the ascension time (t _asc), are proposed for evaluation of non-invasive [¹³C]octanoic acid breath tests for assessment of the gastric emptying of solids. In breath tests performed in control subjects (n = 30) and diabetic patients (n = 100), the usefulness of these parameters was compared to conventional parameters, i.e., gastric half emptying-time t _1/2,b ) and lag phase (t _lag,b ). The proposed parameters were only loosely correlated (controls, r = 0.199; diabetics, 0.616). A strong correlation was found between the conventional parameters (controls, r = 0.891; diabetics, r = 0.962). Based on the conventional method, 36 patients were suspicious of delayed gastric emptying including 24 patients which exhibited a simultaneous delay in both parameters. Using the new parameters, a total of 46 patients were suspicious of delayed gastric emptying with 15 and 20 having isolated delay in t _lat and t _asc, respectively. We conclude that the novel parameters may be more appropriate for examination of the different phases of gastric emptying and for evaluation of gastric emptying disturbances in diabetic patients than the parameters conventionally used for this purpose.     

Estimation of Urea Production Rate With [15N2]Urea and [13C]Urea to Measure Catabolic Rates in Diabetes Mellitus

Abstract

For verifying catabolic states in insulin-dependent patients and dogs the method estimating urea production rates with ¹³C and with doubly ¹⁵N labeled urea, respectively, has been established. For a fast steady state of urea tracer dilution, a prime of 600 times the continuous infusion rate had to be injected. Urea was isolated from plasma samples by protein precipitation and cation exchange chromatography with a consecutive derivatization of the dried urea fraction (trimethylsilyl derivatives). The masses of the fragment ions m/z 189 (¹⁴N¹⁴N), 190 (¹⁴N¹⁵N) and 191 (¹⁵N¹⁵N) urea are monitored to estimate the [¹⁵N₂]urea frequency in the overall body urea pool in mol percent excess (MPE). 1 to 15 ng of derivatized urea were measured efficiently. An excellent correlation between expected standard and measured MPE (r = 0.9977) was achieved from solutions containing 1 to 7% [¹⁵N₂]urea. The interassay coefficient of variation amounted to < 10% for a [¹⁵N₂]urea portion of ≥ 3%.

Normoglycemic diabetic patients who were treated with insulin overnight showed significantly higher urea production compared to healthy controls (9.22 ± 2.07 vs. 5.4 ± 0.32 μmol·kg^?1 · min^?1; p < 0.05). Measurements in chronic diabetic dogs proved an increased rate of amino acid catabolism (+ 20% urea production) in systemic versus portal application of insulin in paired studies. This increased nitrogen load in diabetics may accelerate progression of diabetic nephropathy. - Thus, the established stable isotope technique may serve as a sensitive and useful indicator of amino acid catabolism in clinical and experimental research.     

Investigation of Enterohepatic Bile Acid Circulation with [15N]Taurocholate

Abstract

[¹⁵N]Taurocholate has been prepared and used as a simple urine test substrate as a substitute for ¹⁴C- and ¹³C breath test substrates. [¹⁵N]Taurocholate was administered instead of [¹⁵N] glycocholate assuming that taurine is mainly used in the cholate cycle. Differences were found between healthy and diseased subjects, although deconjugated [¹⁵N]taurine was recovered in urine much less than expected. To get additional information on the actual excess of free taurine, [¹⁵N]taurine was administered orally in parallel investigations. Apparently, large fluctuations in the whole body taurine metabolism are responsible for the unexpected results.     

Towards an Inhalative 13C Breath Test Method

Abstract

Customary ¹³CO₂ breath tests—and also ¹⁵N urine tests—always start with an oral administration of a test substrate. The test person swallows a stable isotope labelled diagnostic agent. This technique has been used to study several pathophysiological changes in gastrointestinal organs. However, to study pathophysiological changes of the bronchial and lung epithelium, the inhalative administration of a stable isotope labelled agent appeared more suitable to us. [1-¹³C]Hexadecanol and [1-¹³C]glucose were chosen. Inhaled [1-¹³C]hexadecanol did not yield ¹³CO₂ in the exhaled air, but [1-¹³C]glucose did. To study the practicability of the [1-¹³C]glucose method and the reproducibility of the results, 18 inhalation tests were performed with healthy subjects. In 6 self-tests, the optimum inhalative dose of [¹³C]glucose was determined to be 205 mg. Using the APS aerosol provocation system with the nebulizer ‘Medic Aid’ (Erich Jaeger Würzburg), a 25% aqueous solution was inhaled. Then, breath samples were collected at 15 min. intervals and analysed for ¹³CO₂. 75–120min after the end of inhalation a well-reproducible maximum δ¹³C value of 6‰ over baseline (DOB) was detected for 12 healthy probands.

Speculating that the pulmonary resorption of the [¹³C]glucose is the rate-limiting step of elimination, decompensations in the epithelium ought to be reflected in changed [1-¹³C]glucose resorption rates and changed ¹³CO₂ output.

Therefore, we speculate that the inhalation of suitable ¹³C-labelled substrates will pave the way for a new group of ¹³CO₂ breath tests aiding investigations of specific pathophysiological changes in the pulmonary tract, such as inflammations of certain sections and decompensations of cell functions.     

The Influence of Feeding Frequency on Nitrogen Turnover and Whole Body Protein Synthesis in Adult Rats (Estimation using [14C]- and [15N]- Labelled Leucine)

Abstract

Male Wistar rats (17 wks. old, body weight ～400 g), fitted with an intra gastric cannula and with a catheter in the vena jugularis were divided into 3 groups and given a marginal ration of the feeding solution Nutrison Standard (1g protein and 350 kJ ME per day). Group 1 had ad lib. access to the drinking bottle, the groups 2 and 3 were pair fed by gastric infusion, splitted up into 2 greater meals for group 2 respectively into 6 smaller meals for group 3. After adaptation all animals get an i.p. injection of doubly labelled tracer solution (200μl) containing 2.5mg L-[¹⁵N]leucine (72 atom% ¹⁵N) combined with either [1-¹⁴C]- or [U-¹⁴C] leucine (37 kBq).

The course of ¹⁴CO₂ expiration was estimated by breath test over 4h in intervals of 15 min and the course of urinary ¹⁵N excretion over 24h in intervals of 45 resp. 90 min. An infusion of saline (0.9% 5ml/h) into the vena jugularis was used to provoke sustained urine production of the animals during the experiment.

From the parameters of the excretion curves of breath ¹⁴CO₂ resp. urine ¹⁵N (cumulative end value) and from the N balance the portions of leucine-C and leucine-N used for protein synthesis, transamination decarboxylation and total oxidation as well as the kinetic parameters for whole body protein metabolism were computed.

The following conclusions were drawn:

6 x feeding regime produces a small but measurable amino acid economy effect in comparison to 2 x feeding regime.

Protein gain for 2 x feeding group was significant smaller than for 6 x feeding group, though protein synthesis rate was higher, but was overcompensated by a greater increase of protein breakdown rate for the 2 x feeding group. Energy storage in form of fat and glycogen built from decarboxylation was unaffected by feeding frequency. The amount of leucine oxidized for heat production was 4% higher for the 6 x feeding group. Transamination rate for leucine was estimated to 8–15%. Absolute values for protein flux, protein synthesis and protein breakdown may be overestimated or underestimated because the metabolism of [¹⁵N] leucine does not exactly agree with that of total N; but the proportions of them and therefore also the conclusions will be true. Better results for absolute values will be obtained using a mixture of ¹⁵N labelled AA, ¹⁵N labelled protein or hydrolysate of ¹⁵N labelled protein (yeast) as the tracer source.     

The First in Vivo Observation of C–N Coupling in Mammalian Brain

[5-¹³C,¹⁵N]Glutamine, with ¹J(¹³C–¹⁵N) of 16 Hz, was observed in vivo in the brain of spontaneously breathing rats by ¹³C MRS at 4.7 T. The brain [5-¹³C]glutamine peak consisted of the doublet from [5-¹³C,¹⁵N]glutamine and the center [5-¹³C,¹⁴N]glutamine peak, resulting in an apparent triplet with a separation of 8 Hz. The time course of formation of brain [5-¹³C,¹⁵N]glutamine was monitored in vivo with a time resolution of 20–35 min. This [5-¹³C,¹⁵N]glutamine was formed by glial uptake of released neurotransmitter [5-¹³C]glutamate and its reaction with ¹⁵NH₃ catalyzed by the glia-specific glutamine synthetase. The neurotransmitter glutamate C5 was selectively¹³C-enriched by intravenous [2,5-¹³C]glucose infusion to ¹³C-label whole-brain glutamate C5, followed by [¹²C]glucose infusion to chase ¹³C from the small and rapidly turning-over glial glutamate pool, leaving ¹³C mainly in the neurotransmitter [5-¹³C]glutamate pool, which is sequestered in vesicles until release. Hence, the observed [5-¹³C,¹⁵N]glutamine arises from a coupling between ¹³C of neuronal origin and ¹⁵N of glial origin. Measurement of the rate of brain [5-¹³C,¹⁵N]glutamine formation provides a novel noninvasive method of studying the kinetics of neurotransmitter uptake into glia in vivo, a process that is crucial for protecting the brain from glutamate excitotoxicity.     

Effect of alcohol consumption on the liver detoxication capacity as measured by [13C]methacetin- and [methyl-13C]methionine-breath tests

The aim of this study was to investigate the hepatic microsomal and mitochondrial functions by using the ¹³CO₂-breath test in healthy subjects either before or after the consumption of red wine. Fourteen adults received [¹³C]methacetin and [methyl-¹³C]methionine together with a standardised dinner. Expired air samples were taken over 6 h. After a wash-out period, the subjects consumed 0.4 ml ethanol/kg/day together with dinner over a 10-day period. Thereafter, ¹³C-tracer administration was repeated under identical conditions. The ¹³CO₂-enrichments were measured by isotope ratio mass spectrometry. The mean cumulative percentage ¹³C-dose recovery (CPDR) after administration of [¹³C]methacetin and [methyl-¹³C]methionine either without or with red wine consumption amounted to 38.2±6.3 vs. 36.3±6.7% (p=0.363) and 9.5±3.3 vs. 8.8±2.5% (p=0.47), respectively. Moderate alcohol consumption does not induce significant short-term changes of the microsomal and the mitochondrial functions of the human liver in healthy subjects.     

Estimation of protein synthesis rates using the flooding method and [15N] lysine

After injection of a single dose of double labelled lysine (1 MBq L-[u-¹⁴C]lysine and 150 μmol L-[α¹⁵N]lysine (95 atom% ¹⁵N)) to growing rats the fractional protein synthesis rates (FSR) of some organs were estimated by the “large dose-” or “flooding method”. Data obtained with both substances were compared and the following conclusions can be drawn:

—In principle lysine is suited as a flooding substance.

—In flooding experiments [¹⁴C]lysine and [¹⁵N]lysine gave identical FSR-values for the investigated organs.

—By application of [¹⁵N]lysine instead of the ¹⁴C labelled amino acid as flooding substance this method is suited for larger animals (pigs, sheep, ruminants) too, because of the absence of any radioactive burden.

Nach einmaliger Verabfolgung von doppelt markiertem Lysin (1 MBq L-[u-¹⁴C]Lysin und 150 μmol L-[α¹⁵N]Lysin (95 Atom% ¹⁵N)) an wachsende Ratten wurden nach der “Large dose-” oder “Flooding-Methode” die fraktionellen Proteinsyntheseraten (FSR) einiger Organe bestimmt und die für beide Substanzen erhaltenen Werte verglichen. Es ergaben sich folgende Schlußfolgergungen:

—Lysin ist grundsätzlich als Flooding-Substanz geeignet.

—[¹⁴C]Lysin und [¹⁵N]Lysin ergeben im Floodingversuch am gleichen Tier für die FSR der Organe identische Werte.

—Durch den Fortfall der radioaktiven Belastung bei Einsatz von [¹⁵N]Lysin anstelle von [¹⁴C]Lysin als Flooding-Substanz ist die Methode auch bei Croßtieren anwendbar.     

Is there an advantage in normalising the results of the Helicobacter Pylori [13C]Urea breath test for CO2 production rate in children?

The urea breath test (UBT) is a non-invasive diagnostic test to detect the presence of Helicobacter pylori in the stomach, and is the simplest way to confirm eradication after treatment. The test is based on the capacity of H. pylori to secrete the enzyme urease, which hydrolyses urea to ammonia and carbon dioxide. The aim of this study was to determine whether there is an advantage in expressing the results of UBTs in terms of urea hydrolysis rate (UHR), rather than breath ¹³C enrichment alone. Retrospective analysis of data collected between 1995 and 2002 from 260 patients undergoing UBTs was performed. The cut-offs for positive tests using breath 30-minute enrichment (E30), UHR calculated using VCO₂ estimated from height and weight (H/WT) and VCO₂ estimated from weight only were determined using two-graph receiver operator characteristic (TG-ROC) analysis. The cut-off points were 3.5‰ or 38.7?ppm ¹³C excess, 7.04?µmol/h and 7.08?µmol/h, respectively. There was no advantage in expressing the results as UHR (θ₀, Theta-zero, where sensitivity?=?specificity?=?0.97 (UHR H/WT), 0.98 (UHR WT) and 1.00 (E30)) rather than breath ¹³CO₂ enrichment alone. Differences in the extent of H. pylori colonisation and urease activity are more important than variation in VCO₂ in determining breath ¹³CO₂ enrichment in the UBT.     

Comparison of two dosage regimens of the substrate for the [13C]methacetin breath test

The [¹³C]methacetin breath test ([¹³C]MBT) – a valuable non-invasive tool dedicated to the assessment of the liver metabolic capacity – still needs standardisation. The aim of this study was to check whether currently used dosage regimens of [¹³C]methacetin provide concordant [¹³C]MBT results in subjects with an atypical body constitution. Healthy volunteers: low body mass<55 kg (eight women), and high body mass>95 kg (eight large body frame men) were recruited. They underwent [¹³C]MBT on separate days, taking in random order [¹³C]methacetin: a fixed 75 mg dose (FX75), or a 1 mg kg^?1 body mass-adjusted dose (BMAD). Samples of expiratory air for ¹³CO₂ measurement were collected over 3 h. The maximum momentary ¹³C elimination in breath air occurred earlier and was higher following BMAD than with FX75 in the low body mass females (T _max 14.6±1.0 min vs. 22.1±2.4 min, p=0.019; D _max 41.9±2.9 % dose h^?1 vs. 36.6±3.6 % dose h^?1, p=0.071). In the high body mass men, T _max remained unchanged, whereas D _max was slightly higher with BMAD compared to FX75 (21.5±3.2 min vs. 23.0±3.0 min; 38.5±2.9 % dose h^?1 vs. 32.3±2.5 % dose h^?1). It is concluded that in subjects with a body constitution outside the general population average, the dosage of the substrate may affect some results of the [¹³C]MBT. The dosage-related differences appear, however, to be insignificant if the result of the [¹³C]MBT is reported as a cumulative ¹³C recovery in breath air.     

Messung der Leberschädigung durch Perchlorethen mit Hilfe des in vivo [15N]Methacetin-Urintests

Es wird gezeigt, daß der [¹⁵N]Methacetin-Urintest ein empfindliches, einfaches und nicht belastendes Verfahren ist, mit dem hepatozelluläre Schädigungen als Folge bestimmter Umwelteinflüsse am Arbeitsplatz gemessen werden können.

Die Methode wird an 13 Textilreinigerinnen demonstriert, die bis zu 39 Jahre in ihrem Betrieb Perchlorethendämpfen ausgesetzt waren.

Mit zunehmenden Expositionszeiten der Arbeiterinnen nehmen die ¹⁵N-Eliminations-geschwindigkeiten absinkenden hepatozellulären Monooxygenasen-Kapazitäten. Dies entspricht.

It is shown that the [¹⁵N]methacetin urine test is a sensitive, simple, and non-distressing tool to measure hepatocellular injury as a consequence of certain environmental factors at the workplace.

The method is demonstrated with 13 female textile cleaners who have been exposed to perchlorethylene for up to 39 years in their shop.

Decreasing ¹⁵N elimination rates – equal to decreasing monooxygenase capacities – are seen to be correlated with increasing exposure times of the workers.     

In vivo measurement of normal rat intracellular pyruvate and lactate levels after injection of hyperpolarized [1-(13)C]alanine

Hyperpolarized technology utilizing dynamic nuclear polarization has enabled rapid and high-sensitivity measurements of ¹³C metabolism in vivo. The most commonly used in vivo agent for hyperpolarized ¹³C metabolic imaging thus far has been [1-¹³C]pyruvate. In preclinical studies, not only is its uptake detected, but also its intracellular enzymatic conversion to metabolic products including [1-¹³C]lactate and [1-¹³C]alanine. However, the ratio of ¹³C-lactate/¹³C-pyruvate measured in this data does not accurately reflect cellular values since much of the [1-¹³C]pyruvate is extracellular depending on timing, vascular properties, and extracellular space and monocarboxylate transporter activity. In order to measure the relative levels of intracellular pyruvate and lactate, in this project we hyperpolarized [1-¹³C]alanine and monitored the in vivo conversion to [1-¹³C]pyruvate and then the subsequent conversion to [1-¹³C]lactate. The intracellular lactate-to-pyruvate ratio of normal rat tissue measured with hyperpolarized [1-¹³C]alanine was 4.89±0.61 (mean±S.E.) as opposed to a ratio of 0.41±0.03 when hyperpolarized [1-¹³C]pyruvate was injected.     

Effects of ergot alkaloids on liver function of piglets can be detected by the [13C]methacetin breath test irrespective of oral or intramuscular route of tracer administration

Ergot alkaloids (sum=total alkaloids, TA) originate from the phyto-pathogenic fungus Claviceps purpurea and might exert feed intake depressing and hepatotoxic effects on animals. The aim of the study was to evaluate TA effects on performance and liver function of piglets with the [¹³C]methacetin breath test and two routes of tracer administration (orally, p.o.; intramuscularly, i.m.). Two ergot batches were mixed into piglet diets resulting in 21 and 17 mg TA kg^?1 (Ergot-5 and -12, respectively) and compared with an ergot-free control diet. Feed intake was significantly depressed after feeding the ergot containing diets (p=<0.001). The time at maximum ¹³CO₂ exhalation (t _max) and the half-life (t _0.5) were not influenced by treatments and varied between 25 and 68 min after the p.o., and 28 and 62 min after the i.m. administration of [¹³C]methacetin, respectively. The cumulative ¹³C recovery (cPDR₃₀) was significantly lower due to feeding the diet Ergot-5 (6.6 %) compared with the Ergot-12 (8.8 %) and the control diet (9.7 %) irrespective of the route of tracer administration (p=0.044). As a discrimination of the diet effects through both tracer administration routes is possible, the i.m. application should be preferred in piglets as this causes less stress than the oral forced administration.     

Liver function assessment with three 13C breath tests by two-point measurements

In this study, we performed three breath tests – l-[1-¹³C ]phenylalanine breath test (PBT), l-[1-¹³C ] methionine breath test, and [¹³C]methacetin breath test (MethaBT) – in patients with chronic liver disease to determine the optimal timing of expired air collection for diagnosing chronic liver disease and evaluating the grade of fibrosis. The subjects were 61 adults with normal livers, 98 chronic hepatitis patients, and 91 liver cirrhosis patients. We investigated the relationships of breath test results with routine biochemical tests and the Child–Pugh score, as well as the diagnostic capacities of the breath tests for liver dysfunction/cirrhosis and grade of liver fibrosis. For the diagnosis of liver cirrhosis and correlations with liver fibrosis, the accuracy of the PBT at 30 min (PBT30) was similar to that of the MethaBT at 15 min (Metha15). For liver function assessment by two-point measurement with ¹³C breath tests, we recommend the PBT30 and the Metha15.     

The Fate of [15N]Ammonium and [15N]Nitrate in the Soil of a 140-Year-Old Spruce Stand (Picea Abies) in the Fichtelgebirge (NE-Bavaria)

Abstract

A ¹⁵N tracer-experiment was carried out in a 140-year-old spruce stand (Picea abies (L.) Karst.) in the Fichtelgebirge (NE-Bavaria, Germany). Highly enriched (98 at%) [¹⁵N]ammonium and [¹⁵N]nitrate were applied as tracers by simulation of a deposition of 41.3 mol N ha^?1 with 11 water m^?2. To examine seasonal variations of uptake by spruce and understorey vegetation, different plots were labelled in spring, summer and autumn 1994.

One aim of the present study was to perfect a method of preparation of soil extracts for isotope ratio mass spectrometry (IRMS) measurements. Ammonium and nitrate from soil extracts were prepared for IRMS measurements by steam distillation and subsequent freeze drying. Additionally, tracer distribution and transformations in the soil nitrogen pools were examined. Ammonium, nitrate and total nitrogen were examined in the organic layer and the upper 10 cm of the mineral soil during 3 months after the first tracer application in spring 1994.

In July 1994, three months after tracer application, 40% of the [¹⁵N]ammonium label and 29% of the [¹⁵N]nitrate label, respectively, were recovered in the total N pool of the investigated soil horizons. In the organic layer the L/Of horizon retained most of the recovered tracers. Nitrification, immobilisation and mineralisation occurred even under the conditions of high soil acidity at the study site.     

Leucine Oxidation in vivo: Inter-and Intraindividual Variation in Healthy Subjects as Assessed by Oral L-[1-13C]Leucine Loads

Interindividual variability of leucine catabolism was studied in eight overnight fasted healthy volunteers by means of a controlled oral L-[1-¹³C]leucine loading test (5 mg/kg body weight). With the exception of total CO² expiration (CV = 5%),a considerable variation (CV generally < or ?10%)was observed with all other metabolic parameters: increase of leucine/2-oxoisocaproate in serum, ¹³C-enrichment in serum metabolites and ¹³CO² in expired air, and estimated oxidation rates. The degree of variation was only partially referable to individual differences. A comparable high degree of variability was found when two probands underwent multiple loading tests (n = 4). Possible reasons and implications are discussed.     

L-[1-13C]phenylalanine breath test in patients with chronic liver disease of different etiologies

The aim of this study was to compare the oxidation of l-[1-¹³C]phenylalanine (¹³C-PheOx) in patients with chronic liver failure due to different etiologies using l-[1-¹³C]phenylalanine breath test. Breath samples were collected before the administration of 100 mg l-[1-¹³C]phenylalanine, and every 10 min thereafter until completion of 1 h. Control subjects (n=9) presented a larger cumulative percentage of ¹³C dose recovery (CPDR) than patients (n=124) with chronic liver disease, regardless of the etiology (7.5±0.7 vs. 4.2±0.2, p=0.001). No differences in CPDR were found considering the Child-Pugh (CP) class or etiology: alcoholic (CP A=7.7±0.7, CP B=4.1±0.5, CP C=2.0±0.3), hepatitis C virus (CP A=5.4±0.5, CP B=4.0±0.2, CP C=2.2±0.3), hepatocellular carcinoma (CP A=5.5±1.6, CP B=3.6±1.8, CP C=2.2±1.0); or cryptogenic cirrhotic patients (CP A=7.4±1.5, CP B=4.4±0.4, CP C=2.1±0.7). Results confirm that ¹³C-PheOx decreases in patients with cirrhosis with respect to controls, notwithstanding the etiology.     

Evidence for Increased Microsomal Hepatic Function in Thalassaemic Children as Detected by [13C]Aminopyrine Breath Test

Abstract

[¹³C] aminopyrine breath tests (AP-BT) were performed in 19 children suffering from homozygous β-thalassaemia major. In contrast to expectations an increased ¹³C elimination representing an increased AP demethylation was found in initial breath tests. Repeated AP-BT over several years indicated a significant decrease by time. Hypothyreoidism was proved to delay AP demethylation. Though some of the patients show slightly disturbed coagulation and most of them elevated transaminases and definite hepatic iron storage, no correlation of these laboratory parameters to ¹³C elimination in ¹³C AP-BT was found.