P.31 EFFECTS OF BRANCHED CHAIN ENRICHED AMINO ACID SOLUTIONS IN SEPSIS C.Chiarla, I.Giovannini, J.H.Siegel, G.Boldrini, B.Coleman, M.Castagneto. Centro Studio Fisiopatologia Shock CNR, Rome Italy, and MIEMSS, Univ.of Maryland,Baltimore, USA.

Data from 220 measurements performed in 56 septic patients undergoing TPN with mixed (MAA) or branched chain enriched (BCAA 50%) amino acid solutions were analyzed.

The measurements included the determination of serial SMA-12 profiles, of urinary urea, creatinine, and 3-methyl-histidine (3MH), of an endogenous proteolysis index (EPI), of total body and lower limb respiratory quotient (RQ), 0, extraction (O,EX), metabolic ra- te, of an SMA-derived peripheral energy defect index (PEDI), and of other variables.

Regression and covariance analysis demonstrated for the BCAA group, with respect to MAA, for comparable rates of total calories and nitrogen intake, a lower urea production (20 vs. 24 g/24 hr) which was related (t-=.83) to a lower 3MH and EPI (126 vs. 139 g/24 hr) (p&O1 for all statements). Significant decreases in total body and peripheral RQ va- lues, increases in 0,EX and improvements in PEDI were related to the absolute dose of

BCAA (~D.01 for all statements).

These data demonstrate that BCAA, for comparable rates of total calorie and nitrogen in- take, are more efficacious than MAA in reducing endogenous proteolysis and in improving nitb-ogen balance in sepsis. They provide additional evidence of a direct impact of 3CAA on energy metabolism, with a favourable effect on the deficit of peripheral energy sub- strate of sepsis.

p.32 IMPCIIRED HEPATIC PROTEIN SYNTHESIS - A CONSEQUENCE ot= GLN DEFICIENCY. G.Ollenschl~ser, W.Linkesch',A.Simmel~, E.Roth=. Medical Dep. II, Univ. of Cologne, FRG; Medical Dep. II' and Surg. Dep. I", Univ. of Vienna, FIustria

GLN deficiency impaires protein synthesis in cultured hepatocytes. In order to evaluate, whether this is also the fact in the intact organism, plasma levels of GLN and hepatic proteins were studied during application of asparaginase - glutaminase CAGase). Methods: 5 pat. with acute lymphat. leukemia have been treated with AGase for 14 days. Daily, fibrinogen, AT III, liver enzymes, body weight were correlated with free amino acids. Results: 1 hour after AGase infusion, GLN decreased to 4,5%fO - 39 /me- dians,range) of the initial values CO.41-0.74 mM/l) with a slow rise up to levels, which were lower after 24 hours than initially. On day 14, fasting GLN was decreased to 63% of the day 0 levels,indicating a deple- tion of the body GLN pool. Fibr.,AT III, body wght. were 45 C3O-52),57 141-63),94 (88-100) % of day 0 values at day 14. After the end of therapy (day 16) proteins and GLN increased to the pretherapeutic ranges. This was not the fact for ASN, which was undetectable from day 1 till 17. Conclusion: Hepatic synthesis of plasma proteins is impaired, following the application of AGase. The protein kinetics parallel the course of ptasma GLN, but not of ASN. Therefore a link between GLN - supply to the liver and hepatic protein synthesis has to be assumed. GLN seems to beco- me a" essential amino acid for ma" under specific conditions.High dosage GLN application after the end of AGase therapy might be useful1 to resto- re the body GLN pools, and to stimulate the hepatic protein synthesis.

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