Energy utilization associated with regular activity breaks and continuous physical activity: A randomized crossover trial.

AIMS: To quantify and compare energy utilization associated with prolonged sitting alone, or interrupted with regular activity breaks and/or an additional bout of continuous physical activity. METHODS AND RESULTS: Thirty six adults (11 males, BMI 24.1 ± 4.6) completed four interventions: (1) prolonged sitting (SIT), (2) sitting with 2-min of walking every 30 min (RAB), (3) prolonged sitting with 30-min of continuous walking at the end of the day (SIT + PA), (4) a combination of the activities in (2) and (3) above (RAB + PA). All walking was at a speed and incline corresponding to 60% V̇O2max. Energy utilization over 7 h for each intervention was estimated using indirect calorimetry. Compared to SIT, SIT + PA increased total energy utilization by 709 kJ (95% CI 485-933 kJ), RAB by 863 kJ (95% CI 638-1088 kJ), and RAB + PA by 1752 kJ (95% CI 1527-1927 kJ) (all p < 0.001). There was no difference in total energy utilization between SIT + PA and RAB, however, post-physical activity energy utilization in RAB was 632 kJ greater than SIT + PA (95% CI 561-704 kJ; p < 0.001). CONCLUSIONS: Short frequent activity, results in greater accumulation of elevated post-physical activity energy utilization compared to a single bout of continuous activity; however the total energy utilization is similar. Combining activity breaks with a longer continuous bout of activity will further enhance energy utilization, and in the longer term, may positively affect weight management of a greater magnitude than either activity pattern performed alone. TRIAL REGISTRATION: ANZCTR12614000624684.

Homolanthionine excretion in homocystinuria.

Patients with homocystinuria excrete in their urine small amounts of an amino acid indistinguishable from authentic L-homolanthionine. This compound could be formed from homocysteine and homoserine by a condensation analogous to that normally leading to cystathionine. The only other known occurrence of homolanthionine in nature is in a methionine-requiring mutant strain of Escherichia coli.

Homocystinuria: excretion of a new sulfur-containing amino Acid in urine.

An unusual homocysteine-containing compound, 5-amino-4-imidazolecarboxamide-5'-S-homocysteinylriboside, was isolated from the urine of a child with homocystinuria and detected in the urines of six homocystinurics. Its metabolic origin is not clear, and the data suggest the existence in man of now unknown alternate pathways for the metabolism of methionine and of purines.

Schizophrenia, tardive dyskinesia, and brain GABA.

We measured the contents of gamma-aminobutyric acid (GABA) and of other amino compounds in five regions of autopsied brain from 18 patients with schizophrenia and from a large group of adult control subjects dying without any neurological or psychiatric disorder. In addition, concentrations of GABA were measured in the cerebrospinal fluid (CSF) of living schizophrenic patients and control subjects. No deficiency of GABA was found in the frontal cortex, caudate nucleus, putamen, nucleus accumbens, or medial dorsal thalamus of patients dying with schizophrenia, nor were GABA concentrations low in the CSF of living schizophrenic patients. These results do not confirm our earlier report of low levels of GABA in the nucleus accumbens and thalamus of some schizophrenic patients. We do not find neurochemical evidence favoring an involvement of GABAergic neuronal hypofunction in the etiology either of schizophrenia or of neuroleptic-induced tardive dyskinesia.

Hyperasparaginemia in a schizophrenic patient.

A man with a chronic schizophrenia-like psychotic disorder had fasting plasma asparagine concentrations that were consistently 4 to 8 SD above the normal level. Asparagine levels were also high in his cerebrospinal fluid (CSF) and erythrocytes. Ornithine, proline, and glutamate concentrations were irregularly high in fasting plasma, and gamma-aminobutyric acid (GABA) concentrations were elevated in CSF. Whether or not these biochemical abnormalities were related to the psychotic disorder is unclear. However, increased asparagine concentrations, possibly due to an enzymatic deficiency of asparaginase, could lead to deregulation of polyamine biosynthesis and to excessive production of GABA from putrescine. These biochemical changes could in turn cause disordered brain function. A search in mentally ill patients for metabolic abnormalities involving asparagine, or other amino acids, might hasten elucidation of the biochemical basis of the schizophrenias.

Amino compounds and organic acids in CSF, plasma, and urine of autistic children.

Amino compounds were measured with an amino acid analyzer in the fasting plasma of 34 patients with childhood psychoses (28 having infantile autism) and 40 control children, and in the cerebrospinal fluid (CSF) of 19 of the psychotic children and 23 control children. Organic acids were determined by gas chromatography in urine, plasma, and CSF of the psychotic patients. The mean concentration of ethanolamine in CSF was significantly higher in psychotic children than in control subjects. A subgroup of autistic children may possibly have a brain disorder involving ethanolamine metabolism. None of the known inherited diseases of organic acid metabolism was found in any of the psychotic children, but future studies utilizing sophisticated gas chromatography--mass spectrometry--computer techniques might disclose abnormal organic acid content in the CSF of such patients.

Use of the polyethylene glycol adduct of L-asparaginase for the treatment of hyperasparaginemia in a schizophrenic patient.

A man with hyperasparaginemia, presumably due to chronic deficiency of asparaginase activity, had been schizophrenic and unresponsive to antipsychotic drugs for at least 22 years. He was given repeated injections of bacterial L-asparaginase rendered relatively nonimmunogenic by covalent binding to polyethylene glycol (PEG). PEG-asparaginase lowered plasma asparagine concentrations from 4 to 5 SD above normal down to undetectable levels, and eliminated asparagine from the cerebrospinal fluid. Despite biochemical correction lasting at least 55 days, the patient did not improve psychiatrically. Experience limited to this single patient suggests that PEG-asparaginase therapy is relatively innocuous, but does not clarify whether there is an etiological relationship between hyperasparaginemia and psychiatric illness.

Stereoselective disposition of racemic E-10-hydroxynortriptyline in human beings.

The disposition and elimination kinetics of the enantiomers of E-10-hydroxynortriptyline (E-10-OH-NT) were studied in six rapid and four slow hydroxylators of debrisoquin after a single oral dose of 75 mg racemic E-10-OH-NT hydrogen maleate. The plasma levels and the AUC of unconjugated (-)E-10-OH-NT were two to five times higher than those of (+)E-10-OH-NT. The plasma half-lives of both enantiomers were 8 to 9 hours. A significantly higher proportion of the given dose of (+)E-10-OH-NT (64.4% +/- 12.1%) than of (-)E-10-OH-NT (35.3% +/- 9.7%) was recovered in urine as glucuronide conjugate, but more (-)E-10-OH-NT was recovered unchanged in urine. The total oral plasma clearance and the metabolic clearance by glucuronidation were significantly (p less than 0.0001) higher for (+)E-10-OH-NT than for (-)E-10-OH-NT. The findings indicate that first-pass glucuronidation of E-10-OH-NT is enantioselective in human beings in vivo, with preference for (+)E-10-OH-NT. The renal clearance of unbound (-)E-10-OH-NT (0.57 +/- 0.16 L.kg-1.hr-1), on the other hand, exceeded that of (+)E-10-OH-NT (0.44 +/- 0.14 L.kg-1.hr-1) (p less than 0.005), which suggests enantioselective tubular secretion. The debrisoquin hydroxylation status was not associated with any of the investigated kinetic processes that relate to E-10-OH-NT.

Morphometric studies in dominant olivopontocerebellar atrophy. Comparison of cell losses with amino acid decreases.

We present a correlation of the morphometric cell density analysis with previous biochemical findings for the inferior olivary nucleus and Purkinje cell layer of the cerebellum from 10 patients (three kindreds) with dominant olivopontocerebellar atrophy. We have analyzed brain amino compounds of these patients and found a decrease of aspartic acid and glutamic acid in the cerebellar cortex and of aspartic acid in the inferior olives. The cell density analysis revealed decreased cell counts, with a mean of 34% of olivary cells and 42% of Purkinje cells surviving when compared with 10 control brains. The cell counts were then correlated with the amino acid analyses. The correlation coefficient for aspartic acid content and surviving neurons in the inferior olive was .87 and that for aspartic acid content and Purkinje cell density was .86. Comparison of glutamic acid content and Purkinje cell density yielded a correlation coefficient of .75. The correlations appear to indicate a relationship between these particular cells or the area they occupy and the decreased content of the two amino acids.

Amino acids in human epileptogenic foci.

Free amino compounds were measured in 16 rapidly frozen epileptogenic foci excised from temporal or frontal cortex of nine patients with focal epilepsy, and in single cortical biopsy specimens obtained from 16 nonepileptic patients. Unlike the findings of a previous study, glutamic and aspartic acids were not diminished in the foci, nor was there a decrease in gamma-aminobutyric acid (GABA) or taurine levels. Glycine content was markedly elevated in two of 16 epileptogenic foci. These results do not suggest that deficiencies of GABA or of taurine, amino acids that may act physiologically as inhibitory neurotransmitters or modulators of inhibition, are causes of focal epilepsy, nor do they provide a logical basis for clinical trials of taurine in treatment of human epilepsy.

Hereditary mental depression and Parkinsonism with taurine deficiency.

An unusual neuropsychiatric disorder inherited in autosomal dominant fashion occurred in three successive generations of a family. Symptoms commenced late in the fifth decade in six affected patients and led to death in four to six years. The earliest and most prominent symptom was mental depression not responsive to antidepressant drugs or electroconvulsive therapy. This was accompanied by exhaustion, sleep disturbances, and marked weight loss. Later in the disease, symptoms of parkinsonism appeared, and respiratory failure occured terminally. The most recently affected family member was investigated biochemically late in his illness. Concentrations of taurine were greatly diminished in plasma and cerebrospinal fluid, and at autopsy, all regions of brain examined had a markedly reduced taurine content. Since taurine is a putative inhibitory synaptic transmitter, deficiency of brain taurine may possibly have caused the psychiatric and neurological manifestations of this disorder.

What excitotoxin kills striatal neurons in Huntington's disease? Clues from neurochemical studies.

Amino acid analyses of both caudate nucleus and putamen obtained at autopsy from patients dying with Huntington's disease (HD), and from control subjects, showed significantly decreased mean glutamate contents in the HD patients. In addition, the mean glutamate concentration was significantly increased in the CSF of living HD patients as compared with controls. Neurochemical studies also showed that neither aspartic acid, proline, 5-oxoproline, nor homocysteic acid is likely to act as a causative excitotoxin in HD. Excessive striatal glycine content, or deficient glutathione content, is unlikely to contribute to the effects of a causative excitotoxin in HD. We suggest that glutamic acid may be the proximate causative neurotoxin in the striatum in HD, as a result of an unexplained failure in the reuptake mechanism for glutamate released there as an excitatory neurotransmitter.

Amino acid abnormalities in epileptogenic foci.

We compared amino acid contents of 54 epileptogenic foci removed neurosurgically from temporal or frontal cortex of 35 patients with focal epilepsy with those of biopsies from the same cortical regions of 14 nonepileptic patients. Neither taurine nor GABA content was reduced in epileptogenic foci. Glycine content was elevated markedly in some foci, whereas aspartic acid content was normal. Mean glutamic acid content was significantly higher in epileptogenic foci than in control cortex, and six foci contained amounts of glutamate more than 2 SD above the control mean. Our findings do not support hypotheses that deficiencies of taurine or GABA are involved in the pathogenesis of focal epilepsy but do suggest a possible etiologic role for the excitatory neurotransmitter, glutamic acid.

Dominantly inherited apathy, central hypoventilation, and Parkinson's syndrome: clinical, biochemical, and neuropathologic studies of 2 new cases.

We describe 2 new patients from a family in which 10 persons in 3 successive generations had a dominant neuropsychiatric disorder characterized by apathy, central hypoventilation, and parkinsonism. Neuropathologically, both patients showed severe neuronal loss and reactive gliosis in the substantia nigra. Neurochemical studies showed a marked depletion of dopamine in substantia nigra, putamen, and caudate nucleus, as well as reduction in serotonin content in the substantia nigra. Glutamate contents were low in frontal cortex and thalamus, and gamma-aminobutyric acid (GABA) contents were low in thalamus and substantia nigra of both patients. In addition, phosphoethanolamine contents were reduced in all brain regions of both patients, especially in the substantia nigra. One patient with severe symptoms had low levels of homovanillic acid, 5-hydroxyindoleacetic acid, and GABA in his CSF repeatedly for 3 years before death (aged 58), while the 2nd patient died (aged 51) of an unrelated cause before developing any symptoms of the familial disorder. Because brain deficiencies of multiple neurotransmitters appear to be involved, this disorder is unlikely to respond to treatment; however, neurochemical studies of CSF may make presymptomatic diagnosis feasible.

Brain amino acids and glutathione in progressive supranuclear palsy.

We measured amino acid contents in autopsied brains of seven patients with progressive supranuclear palsy (PSP) and in control subjects dying without brain disease. Glutathione was also quantitated in rapidly frozen brains of PSP patients, Parkinson's disease (PD) patients, and controls. In PSP, we found glutamic acid markedly increased in the nucleus accumbens; taurine significantly increased in nucleus accumbens, substantia nigra, and globus pallidus; and gamma-aminobutyric acid significantly increased in nucleus accumbens and putamen. Glycerophosphoethanolamine contents were significantly increased in most regions. Glutathione, which is significantly decreased in substantia nigra in PD, was increased in this brain region in PSP, suggesting that different mechanisms may be responsible for destruction of dopaminergic nigrostriatal neurons in these two disorders.

Brain glutamate deficiency in amyotrophic lateral sclerosis.

Amino acid contents were measured in autopsied brains of eight patients with the sporadic form of amyotrophic lateral sclerosis (ALS) and in brains of control subjects dying without neurologic or psychiatric disease. Glutamic acid content was reduced in most brain regions and in the cervical cord in the ALS patients, while glutamine contents were normal. Taurine contents were increased, and gamma-aminobutyric acid contents were decreased in some brain regions in the ALS patients. The brain glutamate deficiency in ALS is unexplained, but insufficient production or release of this excitatory neurotransmitter might have important secondary effects on motor neurons.

Brain amino compounds in a Huntington's disease patient on isoniazid therapy.

We describe biochemical abnormalities in autopsied brain of a patient with early Huntington's disease (HD) who died of pentobarbital overdosage while under treatment with isoniazid (INH). The brain contained hydrazine, a terminal metabolite of INH, which inhibits gamma-aminobutyric acid (GABA) aminotransferase. GABA content in the basal ganglia was higher than expected for HD, and GABA content was supranormal in some brain regions. Homocarnosine (GABA-histidine) content was greatly elevated in all brain regions, suggesting chronic GABA elevation in life. Therefore, the increase in brain GABA content observed in experimental animals given INH or hydrazine also occurs in human patients.

Isoniazid therapy of Huntington disease.

We describe clinical and biochemical changes in seven patients with Huntington disease given isoniazid (INH) in dosages three to five greater than normally used in tuberculosis. Because INH inhibits the enzyme gamma-aminobutyric acid aminotransferase (GABA-T), and increases GABA content in the brains of experimental animals, it might correct the brain GABA deficiency characteristic of Huntington disease. Of six patients treated long enough to be clinically evaluated, one showed marked and two others showed signifciant improvement. High-dose INH therapy carries serious toxic risks, which are influenced by patients' acetylator phenotypes. Nevertheless, results are sufficiently promising to warrant further controlled trials of INH or other GABA-T inhibitors in Huntington disease.

Amyotrophic lateral sclerosis: fasting plasma levels of cysteine and inorganic sulfate are normal, as are brain contents of cysteine.

Recent reports suggest that amyotrophic lateral sclerosis (ALS) is caused by one or more unidentified neurotoxins that are poorly metabolized in patients to less toxic and more readily excreted compounds, and that a genetically determined defect in cysteine degradation and in inorganic sulfate production is the mechanism underlying a failure to metabolize xenobiotics normally in ALS. We measured concentrations of total cysteine and of inorganic sulfate in the plasma of age-matched groups of ALS patients and healthy control subjects and found no differences. L-Cysteine, a putative endogenous neurotoxin in ALS, was present in equal concentrations in autopsied brain from ALS patients and controls.

Puppet-like syndrome of Angelman: a pathologic and neurochemical study.

We present the first pathologic descriptions of the puppet-like syndrome of Angelman based on autopsy studies of a 21-year-old woman. The noteworthy findings were a small brain with mild cerebral atrophy but normal gyral development. There was marked cerebellar atrophy with loss of Purkinje and granule cells and extensive Bergmann's gliosis. Study of dendrite morphology using Golgi impregnations of the visual cortex revealed a prominent decrease in dendritic arborization of layer 3 and layer 5 pyramidal neurons. Quantitative Golgi analysis also revealed a significant decrease in the numbers of dendritic spines in apical layer 3 dendrites and both apical and basal layer 5 dendrites. Neurochemical studies of frozen brain tissue demonstrated markedly reduced gamma-aminobutyric acid content in the cerebellar cortex, as well as elevated glutamate content in the frontal and occipital cortices. Although there are no definite morphologic correlates of many of the clinical signs, the pronounced dendritic pathology and neurochemical abnormalities in cerebral cortex may provide a physiologic basis for mental retardation.