Glutamine metabolism drives succinate accumulation in plasma and the lung during hemorrhagic shock.

Background: Metabolomic investigations have consistently reported succinate accumulation in plasma after critical injury. Succinate receptors have been identified on numerous tissues, and succinate has been directly implicated in post-ischemic inflammation, organ dysfunction, platelet activation and the generation of reactive oxygen species, which may potentiate morbidity and mortality risk to patients. Metabolic flux (heavy isotope labeling) studies demonstrate that glycolysis is not the primary source of increased plasma succinate during protracted shock. Glutamine is an alternative parent substrate for ATP generation during anaerobic conditions; a biochemical mechanism that ultimately supports cellular survival but produces succinate as a catabolite. We hypothesize that succinate accumulation during hemorrhagic shock is driven by glutaminolysis. Methods: Sprague-Dawley rats were subjected to hemorrhagic shock for 45 min (Shock, n=8), and compared to normotensive shams (Sham, n=8). At 15 min, animals received intravenous injection of 13C515N2-glutamine solution (iLG). Blood, brain, heart, lung and liver tissues were harvested at defined time points. Labeling distribution in samples was determined by ultra high pressure liquid chromatography-mass spectrometry (UHPLC-MS) metabolomic analysis. Repeated measures ANOVA with Tukey comparison determined significance of relative fold-change in metabolite level from baseline. Results: Hemorrhagic shock instigated succinate accumulation in plasma and lungs tissues (8.5 vs. 1.1 fold increase plasma succinate level from baseline, Shock vs. Sham, p=0.001; 3.2 fold higher succinate level in lung tissue, Shock vs. Sham, p=0.006). Metabolomic analysis identified labeled glutamine and labeled succinate in plasma (p=0.002) and lung tissue (p=0.013), confirming glutamine as the parent substrate. Kinetic analyses in shams showed constant total levels of all metabolites without significant change due to iLG. Conclusion: Glutamine metabolism contributes to increased succinate concentration in plasma during hemorrhagic shock. The glutaminolytic pathway is implicated as a therapeutic target to prevent the contribution of succinate accumulation in plasma and the lung to post-shock pathogenesis. (C) 2016 Lippincott Williams & Wilkins, Inc.

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