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Comparative Studies In Vivo and In Vitro

Szymon Rosenblatt, MD; George H. A. Clowes, Jr, MD; Barbara C. George, MD; Erwin Hirsch, MD; Bengt Lindberg, MD

Arch Surg. 1983;118(2):167-175.

Abstract
• The amino acid "central fractional clearance rate" (CFCR), the ratio of the rate of amino acid entry into the extracellular pool to the size of the pool, is a measure of amino acid uptake and clearance by liver and other visceral tissues. In nine normal postabsorptive persons, the mean CFCR was 5%, compared with 21% in 31 seriously infected patients. For comparative purposes, biopsy specimens of liver and muscle were obtained for incubation. In infected patients, the rate of hepatic incorporation of tyrosine into protein was three times that in noninfected patients and correlated well with the CFCR. There was no significant difference in hepatic tyrosine oxidation. In muscle from infected patients, net protein degradation was six times that in noninfected patients. Incubated tissues from rats behaved similarly. Thus, accelerated transfer of amino acid from muscle to viscera for protein synthesis occurs in humans with sepsis, as it does in animals. The CFCR demonstrated the importance to survival of visceral amino acid uptake; it was 35% in surviving patients, and only 19% in those who died.

(Arch Surg 1983;118:167-175)

Author Affiliations
From the Departments of Surgery, Harvard Medical School (Boston) (Drs Rosenblatt and Clowes) and Boston University School of Medicine at the New England Deaconess Hospital (Drs Rosenblatt, Clowes, George, and Lindberg) and the Boston City Hospital (Drs Rosenblatt, Clowes, and Hirsch).

Footnotes
Accepted for publication Sept 30, 1982.

Read before the second annual meeting of the Surgical Infection Society, Boston, April 19, 1982.

Reprint requests to Department of Surgery, New England Deaconess Hospital, 185 Pilgrim Rd, Boston, MA 02215 (Dr Clowes).

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