Lars Sundblad

Insulin uptake by the human alcoholic cirrhotic liver

Insulin uptake by the human cirrhotic liver was studied in six patients with Laennecs cirrhosis, and the result was compared with that found in ten control patients with varying diseases affecting the biliary system. All patients had portal catheters for diagnostic purposes. The fractional hepatic uptake of insulin was calculated from the clearance rates for insulin obtained after a constant rate infusion into a peripheral vein and the portal vein in each patient. The fractional hepatic extraction of insulin was 13% +/- 5 in cirrhotic patients and differed significantly from the fractional hepatic extraction found in controls (51% +/- 5;P less than 0.001).

Characterization of alkaline phosphatase isoenzymes in serum by agar gel electrophoresis

Abstract A simple method of characterizing alkaline phosphatase isoenzymes in serum by agar gel electrophoresis is described. By using sera from cases of obstructive jaundice as markers in the electrophoresis reproducible β2-phosphatase could be obtained. Combining the electrophoretic tests with heat stability tests at 56° bile, liver, bone, intestinal, and placental isoenzymes could be assessed for routine clinical purposes. Results obtained with 221 normal subjects are given and the clinical use of the method is briefly discussed.

Affinity electrophoresis of human serum alkaline phosphatase isoenzymes in agarose gel containing lectin

Separation of alkaline phosphatase isoenzymes using affinity electrophoresis in agarose gel containing lectin is described. The bone and biliary isoenzymes precipitate during electrophoresis and are clearly separated from the liver isoenzyme. The liver, intestinal and placental alkaline phosphatases are essentially not affected by the lectin. The migration distances of the precipitating bone and biliary fractions vary with their alkaline phosphatase activity. The bone isoenzyme is more heterogeneous than the biliary isoenzyme with respect to interaction with lectin forming both insoluble and soluble complexes. Affinity electrophoresis in agarose gel containing lectin can be used for quantitation by densitometry of liver and bone isoenzymes in sera containing only these two fractions but must be combined with conventional electrophoresis, preferably in agar gel, if biliary, intestinal, or placental isoenzymes are also present.

Electrophoretic Determination of Orosomucoid

A method of determining the orosomucoid content of serum is described, based on electrophoretic separation at pH 4.4 and staining with bromophenol blue after removal of the sialic acid residues of the orosomucoid. Normal values for orosomucoid in serum are given, and the clinical value of electrophoresis at pH 4.4 is discussed.

Studies on alkaline phosphatase isoenzymes. relation to γ-glutamyltransferase and lactate dehydrogenase isoenzymes

Gamma-Glutamyltransferase (GT) and isoenzymes of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) have been studied in 282 cases with increased S-ALP and in 18 chronic alcoholics with normal routine liver tests. There was a high degree of correlation between S-GT and the bile (alpha 1) and liver (alpha 2) fractions of S-ALP. Fractionation of alkaline phosphatases sometimes yielded clinical information, which could not be obtained by determinations of S-ALP and S-GT only. The presence of alpha 1-ALP and increased S-GT appeared to be more sensitive indicators of ethanol-induced liver involvement than other liver tests, including LDH-5/LDH-4 ratios.

Characterization of serum alkaline phosphatase isoenzymes by affinity electrophoresis in agarose gel containing lectin combined with agar gel electrophoresis

The combined use of affinity electrophoresis in agarose gel containing lectin and of agar gel electrophoresis for the quantitation of liver, bone, biliary and intestinal alkaline phosphatase isoenzymes is described. Sera from patients with various diseases and from normal subjects (blood donors) have been analyzed. Data from normal subjects show that the bone isoenzyme is the predominant fraction (about 62%) in adults. The relative proportions of the alkaline phosphatase isoenzymes are similar in both sexes in adulthood (21-50 years). The higher alkaline phosphatase activity found in men than in women (ages 21-50 years) is due to higher values for both liver and bone isoenzymes. The difference between men and women tends to decrease after the age of 50 mainly due to an increase of the bone isoenzyme in women.

Forearm glucose uptake during glucose tolerance tests in chronic alcoholics

In twelve chronic alcoholics the glucose uptake in a forearm segment was studied during glucose tolerance tests. The tests were performed twice in each case, on the 3rd and on the 10th to 14th days after admission to hospital in an intoxicated state after a period of excessive alcohol intake. The total forearm glucose uptake following an oral glucose load almost doubled from the first to the second examination. Arterial glucose and insulin concentrations were similar on the two occasions. The findings indicate that the disposal of an oral glucose load is altered during the recovery after a period of excessive alcohol intake. The contribution made by muscle tissue increases twofold while that of the liver decreases.

The effect of glipizide on extraction of insulin by the human cirrhotic and noncirrhotic liver

The effect of glipizide on hepatic uptake of insulin was studied in five patients with liver cirrhosis and five patients with varying diseases in the biliary system and pancreas. All patients had portal catheters for diagnostic purposes. The hepatic uptake of insulin was estimated from the clearance rate for insulin obtained after a constant rate infusion into a peripheral vein and the portal vein. Each patient was examined on two consecutive mornings, the second investigation carried out one hour after oral glipizide administration. The fractional hepatic uptake was significantly lower in cirrhotic patients (17% +/- 6%) than in the other patients (52% +/- 7%; P less than .01). After glipizide, an increase in the estimated uptake of insulin occurred in cirrhotic patients (from 17% +/- 6% to 39% +/- 6%; P less than .01), whereas an insignificant decrease was observed in the other patients (from 52% +/- 7% to 43% +/- 11%).