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P.113 Leucine kinetics and fibrinogen synthesis are increased after vaccination M. Cayol , L Tauveron, F. Rambourdin, P. Thieblot, J. Grizard and C. Obled Centre de Recherche de Nutrition Humaine d'Auvergne, INRA Clermont-Ferrand, France. The ability of diphtheria-tetanus-poliomyelitis-typhoid (DTPT) vaccination to induce an acute-phase response and to stimulate protein turnover and liver protein synthesis was investigated in healthy male volunteers. Methods: Subjects (n = 7) were studied first in a control state (C), then vaccinated 7 days later and studied again 2 days after vaccination (V). Primed constant intravenous infusions of L-[113C]leucine were performed during 4 hours at each occasion. Plasma acute-phase protein concentrations, leucine fluxes and, albumin and fibrinogen synthesis were measured both in C and V states. Fractional synthesis rate (FSR; %/d) and absolute synthesis rate (ASR; mg/kg.d) of albumin and fibrinogen were calculated from the incorporation rate of the label into proteins and from the KIC enrichment as precursor. Results: (mean + SE). Plasma concentrations of oq-antitrypsin, fibrinogen, orosomucoid and haptoglobin were significantly higher (15, 23, 36 and 49% respectively) in the V state than in the C state (P 0.05). However, in 5 subjects, body temperature was increased from 0.4 to 2.2°C after vaccination. In these volunteers, protein synthesis and breakdown were significantly enhanced by 27 and 16%, respectively (synthesis: V: 1.12 _+ 0.13; C: 0.88 _+ 0.08 p, mol/kg.min. P < 0.05; breakdown: V: 1.63 _+ 0.12; C: 1.40 + 0.08 #mol/kg.min P < 0.05). Albumin and fibrinogen synthesis rates were

Lymphocytotoxins (LCT) have been recently reported in the serum of patients with inflammatory disease of the bowel, but up to now these antibodies have shown no specificity for B or T lymphocyte subpopulations. A 32-year-old patient with chronic ulcerative colitis, primary hypogammaglobulinemia and a very low number (0.5 to 1.5%) of B lymphocytes in peripheral blood is described. The presence in the serum of a LCT reacting specifically with B cells was demonstrated by cytotoxicity and direct immunofluorescence experiments. Intestinal immunofluorescence studies indicated a dichotomy between blood and gut immunoglobulins, and showed a heterogeneous distribution of plasma cells of the three major classes from the jejunum to the rectum. The significance of the association of hypogammaglobulinemia, chronic ulcerative colitis, and anti-B LCT is discussed. To explain the dissociation between blood and gut immunoglobulins, it is suggested that the intestine was, in this patient, a privileged site for differentiation of B cells.

In 10 patients with active gastroenterological disease and protein-malnutrition (weight: 77.3 +/- 2.6 (mean +/- SEM) percent of ideal body weight, serum-albumin levels: 2.59 +/- 0.17 mg/100 ml) a randomized crossover study was performed to assess the effects of two energy:nitrogen ratios on body cell replenishment. After at least 3 days for equilibration, the total parenteral nutrition (TPN) study carried out with 354 +/- 5 mg of casein hydrolysate-nitrogen/kg/day, divided in two 7-day periods during which two nonprotein calorie supplies of 47 +/- 1 kcal/kg/day and 81 +/- 4 kcal/kg/day were given. The same 50 +/- 5% dextrose and fat emulsion energy sources were used in the two periods. Nitrogen (Kjeldahl method) and potassium retention, and weight and serum albumin concentration gains were all significantly better (Student t test) during the hypercaloric regimen than during the normocaloric regimen. In the 10 patients, the protein-sparing effect of nonprotein calories "added" during the hypercaloric regimen was demonstrated and represented 17% of the constant infused nitrogen. The more catabolic patient was prior to TPN, the more energy-dependent was the protein-sparing effect observed (r = +0.638). Preliminary data obtained with 3-methylhistidine urine determination suggests that the protein-sparing effect of "added" calories was due to an increased protein synthesis. Finally, body cell replenishment was better with the higher 230 +/- 6 energy:nitrogen ratio than with the lower 132 +/- 4 energy:nitrogen ratio, which suggests that the hypercaloric TPN regimen was useful in such patients.

In order to assess the metabolic efficacy of cyclic nocturnal parenteral nutrition (C-TPN) in hospitalized patients, a prospective study was carried out with 14 patients having a protein calorie malnutrition due to severe gastrointestinal diseases. Patients population was divided into two groups: one group received 1 milligram per kilogram per day of prednisolone with induced hypercatabolism (n = 4); the second group was not under corticosteroid therapy (n = 10). Patients selected for the study were unaffected by cardiac, hepatic, renal or pulmonary failure, diabetes or bacteriemia. C-TPN was compared to standard or continuous TPN (S-TPN) and each type of TPN was 1 week with 24 hours between change over. During C-TPN, parenteral perfusion was discontinued for 9.1 ± 0.4 hours per day (mean ± SEM). Intravenous regimens were strictly the same during C-TPN and S-TPN and provided 192 ± 10 milligram nitrogen per kilogram per day plus mixed energy-sources equivalent to 50 ± 2 kilocalories per kilogram per day wi...