title: Hyperinsulinemic-normoglycemic clamp administered together with amino acids induces anabolism after cardiac surgery.
abstract: Cardiac surgery triggers an inflammatory stress response, leading to protein catabolism, a process that even high-dose insulin therapy alone cannot reverse. To determine whether hyperinsulinemic-normoglycemic clamp and perioperative amino acid (AA) supplementation improves whole body protein balance, 20 patients scheduled for elective coronary artery bypass grafting surgery were randomly assigned to have intra- and postoperative hyperinsulinemic-normoglycemic clamp, with or without intravenous AA supplementation. Primed continuous infusions of [6,6-2H2]glucose and l-[1-13C]leucine were used to quantify whole body protein and glucose metabolism before and after surgery. Adipose tissue and serum cytokines were also analyzed to measure their responsiveness to the anabolic effect of AA administration. During hyperinsulinemic-normoglycemic clamp, AA supplementation successfully stimulated whole body protein synthesis, resulting in a positive whole body protein balance after surgery (insulin: -13.6 ± 4.5 vs. insulin + AA: 2.1 ± 5.4 μmol·kg-1·h-1, P < 0.001). Endogenous glucose production was equally suppressed in both groups (insulin: 0.0 ± 3.8 vs. insulin + AA 1.6 ± 1.6 μmol·kg-1·min-1, P = 0.230). AA supplementation led to significant changes in serum and tissue IL-6 (insulin: 246.6 ± 111.2 vs. insulin + AA: 124.5 ± 79.3 pg/ml, P = 0.011). In conclusion, hyperinsulinemic-normoglycemic clamp technique, together with AA supplementation, can induce an anabolic state after open-heart surgery, as quantified by a positive whole body protein balance.
authors.affiliation: Department of Anesthesia, McGill University, Montreal, Quebec, Canada; takumi.coderemaruyama@mcgill.ca.
authors.forename: Takumi
authors.initials: T
authors.lastname: Codère-Maruyama
authors.affiliation: Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schricker
authors.affiliation: Department of Cardiovascular Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Dominique
authors.initials: D
authors.lastname: Shum-Tim
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada; and.
authors.forename: Linda
authors.initials: L
authors.lastname: Wykes
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada; and.
authors.forename: Evan
authors.initials: E
authors.lastname: Nitschmann
authors.affiliation: Departments of Critical Care and Medicine (Respiratory Division), McGill University Health Centre and Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada.
authors.forename: Céline
authors.initials: C
authors.lastname: Guichon
authors.affiliation: Departments of Critical Care and Medicine (Respiratory Division), McGill University Health Centre and Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada.
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Kristof
authors.affiliation: Department of Anesthesia, McGill University, Montreal, Quebec, Canada.|Departments of Critical Care and Medicine (Respiratory Division), McGill University Health Centre and Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada.
authors.forename: Roupen
authors.initials: R
authors.lastname: Hatzakorzian
mesh_terms: D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism* / Q000517:prevention & control; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008660:Metabolism / Q000187:drug effects / Q000502:physiology; D011182:Postoperative Care / Q000379:methods; D014176:Protein Biosynthesis / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D007328:Insulin
keywords: amino acids; cardiac surgery; insulin; interleukin-6; protein breakdown; protein synthesis