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Unbound Amino Acids in the Plasma and Erythrocytes of Children with Various Anemias and with Erythroblastosis Fetalis
MARIA NICOLAIDOU, CHARLES C. LUND and RAPIER H. MCMENAMY
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Unbound of
Amino Children
Acids with
in the Various
Plasma Anemias
and
Erythroblastosis
By
MARIA NICOLAIDOU, CHARLES
Fetalis
C.
LUND AND RAPIER
H. MCMENAMY in the been acid plasma published values from whether peculiar to and
STUDY
erythrocytes
of
the
unbound
of normal
acid current
as a function
has
in
an
earlier
communication.1
bloods
to determine general or
The
analyses
were
conducted
in
the
same
manner
as
those
reported
for
normal
chil-
present.
tions
as were
were
also
not
determined.
serine plus
Leucine
glycine. Each
and value
paper chromatograms using a chromatograms, visual comparison zones were made to obtain the and plasma tryptophan concentra-
determined
in
as combined
triplicate, i.e., at
zones
three
analyzed
different method
covery
concentrations,
averaged
and
a mean
taken.
The
coefficient
of amino
essentially
7 per cent, but varied somewhat for acids added to plasma and erythrocytes complete.2
RESULTS
with this different amino acids.2 The rewas found by this method to be
of variation
In
earlier
studies
it
was
the the
was
in
satisfactory and as
the
erythrocytes patients,
values erythrocytes
children.
for
with the
distribution
reported plasma
median
unbound
the the
hereditary spherocytosis, and erythroblastosis normal distribution the antilog of the logarithmic the the linearized median for cord data. values bloods. or
as
for figure
)
for the 0.05)
For
comparison,
there
have
been to
t over
normal cord
are
1 to the
and
of
Concentrations
icantly
of normal
children
significance
according
to the legend
in the footnote.
Table
1 list 6 pa-
From the Departments of Pediatrics, Biological Chemistry and Surgery, Harvard Medical School, The Childrens Hospital Medical Center and the Fifth Surgical [Harvard] Service of the Boston City Hospital, Boston, Massachusetts. Support for this work was received from Grant #C-2497 of the National Institute of
Health,
Submitted
Bethesda,
Oct.
Maryland.
2, 1964; accepted
for
publication
91
Nov.
20, 1964.
BLOOD,
VOL.
26,
No.
(JuLY),
1965
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92
I. .
NICOLAIDOU,
LUND
AND
MCMENAMY
{ g; I
I
ALANN
I- r
ii!I!fillI!
I
480 a-ANINO-#{248}-SUTYRIC ACID 20
flJj JJ
ik11l
LYSPIt METNIONIIC
I
ISO
-
I
ARGIMN
I-
PI#{128}NYLALANNC
#{149}
I
4p
I:__:_
2400
1500
I
:
;
-
::
+
-#{149}
.
-
_ _
#{149}
--
i.
4t
NIThS#{128}
1.
.&+
0L__
480 360
S.UTAMIC
ACID I
I2001
1 FAN
1I
cs
240
#{176}:Lk
1600
20 SLUTAMl
400
300P
HISTIoII t40
.
flE0NI 450h1
isoI:J;
Izoft+4A*
360F
Fig.
1.-Concentrations
substances in the
(M./Kg.
erythrocytes
water-vertical
(continuous
axis)
lines)
of unbound
and plasma
amino
(dotted
acids
lines)
median concentrations are noted by a the range of concentrations. An A over and erythroblastosis fetalis patients inchdifferent from the median of 10 normal in the fifth column). A B over the graph spherocytosis patients indicates that the value was significantly different from the median value of 15 normal children aged 1 to 12 years (reported in the sixth column). A C over the graph of the erythroblastosis fetalis patients indicates that the value was significantly different from the medium values of cord bloods (reported in seventh column). The normal values and cord blood values are taken from reference 1. The letters H and L identify
the high and low median values, respectively.
with different anemias. The horizontal bar on the lines. The lines mark the graphs for the iron deficiency anemia cates that the median value was significantly children aged 4 days to 1 year (reported for the sickle cell anemia and hereditary
Glutamic
acid,
ergothioneine,
and
taurine
concentrations
were
very
low
or absent
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UNBOUND
AMINO
ACIDS
IN PLASMA
AND
ERYTHROCYTES
93
v...
).
I
-
1110
4 R
I-
rz
-
z v.
o1l
Itilt!
60 FAH
!II I!
TRtPTOPHAN 64E1 48 321
;
-
d
IAH
;.,
SERINE+OLYCINE
x IO
4#{176}E1
+ 1
200 150L1 I00F,
j
TAURINE
TYROSINE
: i 5#{176}L.I.
VALINE ERGOTHIONEINE
1
AH UREA xIO
300 96 72 48 2:
_i1
4
6
k
RETICULOCYTES (S)
4
3OO
+
LEUCWIE
ISOLEUCINE +
T
+
(Fig.
1.-Contd.)
I2
+1 TI
32 (GRAMS
AN 1
__i
HEMOOLO&N PER lOOmI. BLOOD)
OH
.+
200
+.
.k
OL 0
!
plasma and
!
erythrocytes,
I 1
erythrocytes. fetalis
respec-
in
the
plasma.
Arginine
concentrations
in two ,M./Kg.
of
were the
at
water
Histories
Iron
of Patients
deficiency
anemia. The patients were 6-19 months old, weighed 5.6 to 11.3 Kg., pallid, but in fair to good nutritional state. The serum iron averaged 24 ,g./100 ml. blood (range 18-36) . Analyses were conducted on 6 patients before Fe+ + treatment with Imferon#{174}. The other 2 patients had treatment with Imferon#{174} for 10 days and 4 months prior to the analyses, but with slow response. Sickle cell anemia. The subjects were 10-12 years old, pallid, but in fair to good nutritional state. A hemolytic crisis preceded the analyses by 1 to 4 days. Hereditary spherocytosis. The subjects were nine months to 6.5 years old, pallid, but in good nutritional state. Analyses were taken 1 to 5 days after hemolytic crises. Erythroblastosis fetalis. The subjects were 1 to 45 hours old, jaundiced, Coombs positive. Two babies were full term (4.5 and 3.6 Kg.), two were premature (1.4 and 1.9 Kg.).
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94
Table
Plasma TMI TMA UHGS
NICOLAIDOU,
LUND
AND
MCMENAMY
1.-Patients
(SM/Kg. AHA Water)
with
Other
Anemias
Erythrocytes (MM/Kg. Water)
AIHA
SFHb
TMI
TMA
UHGS
AHA 1
AIHA 1
SFHb 1
t
nacid
acid
t
I
1
I I
t
I I
I
pius
Leucine isoleucine Lysine Methionine Phenylalanine Ornithine Proline Threonine Tryptophan Tyrosine Valine
I t t C C C I I I I I C C
I I I C
I I I I I I C I
I I C C C C I I I I C I I
36.2 9.7 age group. median; median. 1.3 6.4 The the The I
I
I (/ of erythrocytes (Gm./100 were ml. blood) against indicates to
female,
17.1 9.1
patients
children it it is
of significantly
the
I I
is
:
normal normal
median
TMI: TMA
the according
minor; major;
Thalassemia Thalassemia
years.
years,
good
pale,
nutritional
hepatosphenomegaly. ; male,
hepatosphenomegaly.
U HGS : Unstable
of
good years,
naphthalene
poisoning) hemolytic
recent
years,
to
AIHA fever,
good
: on
nutritional and
Autoimmune prednisone,
anemia
lead poisoning. rheumatic
(due
naphthalene
hemolytic
anemia;
(+ female,
+ + ), age
16
years,
pallid,
pains
in
ex-
aortic
insufficiency.
tients
umns children Except
where
identify
only
amino
1 patient
acids
per
whose
anemia
type
was
studied.
differ from
Arrows
those
in the
of
col-
concentrations
normal
by
for
than two standard deviations. babies with erythroblastosis amino Five of acid the when when the concentrations plasma compared the plasma substances
and
several high in
in
table essentially
1, the
normal.
erythroblastosis
because
tions were
of the
found
very
lytic
anemia.
or
( This
microfilm
under
data for
considerable
each patient
at
obtained
the
of
#{176}Photostat
cost
American
Documentation
Institute,
Library
of
Congress,
Document
No.
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UNBOUND
AMINO due to
ACIDS
IN PLASMA
AND
ERYTHIIOCYTES
95 It seems probable other subjects amino subjects. age in in evaluated major 17 were groups, sickle erythroblasagainst anemia, high in a high high acid that had conWhen 15 cell the a
analysis,
the related
advanced to this
state stress
of state.
anemia.
high few
In
values high
contrast
Some
low
amino acid values. values the erythrocyte differed of deficiency high when iron were markedly approximately anemia, the spherocytosis,
normal same
children in in hereditary
2 were (4
substances
cord erythrocytes , 7 were high in a patient with 11 were high in a patient with acquired hemolytic patient with autoimmune with S & F hemoglobinopathy. observed and in the erythrocytes minor. amino also hemoglobin either the unbound acid thalassemia The unbound were the blood between or each the index level the hemolytic No of anemia, abnormally with and
thalassemia anemia,
3 were high in the patient high amino acid values were unstable reduced of glutathione the anemia count
patients
in the
erythrocytes the
patients and tion counts, when where function better 2. The to the
these
investigated
between
reticulocyte
checks showed poor correlaconcentrations and reticulocyte and hemoglobin content An analysis expressed content of the data as a multiple gave a much in table relating that amino
concentrations
acid concentrations 15 per cent of count and 26 per relationship to analytic of the
analyses (2)
( see
total cent negative. patients
several
exceptions
could approximately
be
On
the
to
hemoglobin average as
was anemia
( the
is taken logarithmic
0.04, distribution
or simple
substances
individual
Taurine,
glutamic
serine
concentrations
and
ergothioneine
the
other
appreciably
with glycine
content. higher amino acids For were amino studies. in the They
increased
other amino
more acids.3
erythrocytes
patients in the
the
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96 Table
2.-Effect of Reticulocyte Content and
NICOLAIDOU,
LUND
AND
MCMENAMY
Hemoglobin
Content
on
the
Unbound
Proportion
Amino
Acid
Concentrations
Regression Equation
(x 1000)
in the
Constants*
Erythrocytes
of Anemic
Level of
Children
of Variances
Sig.(%) Anal. of
%
b2 95
99 99.9 95 95
SE.
SE.
b 13
14 -1 13 3
b, 4
5 5 4 4
b -34
-53 -79 -29 -29
b 16
19 16 13 15
Var.t 0.99
0.99 0.99 0.995 0.90
b1 99
98 10 99 50
bi 24
24 10 34 2
b2 17
20 59 14 17
butyrate
8 14 16 9 6 8
11
-44
16
0.975
90
99
13
24
4 6 5 5 4
5
15 20 17 19 16
17
99 99 90 70 90
95
99.9 98 99 95 98
99
29 20 13 7 13
16
30 22 24
iS
21
34
2 11 7 16 8 38
2
4 5 4 8 5 14
4
15 18 14 27 19 50
14
30 95 90 95 85 99
30
1 20 14 11 7 22
1
13 15 21 45 41 30
3
relate amino
to
acid
the
regression
equation.
x, is
a
count,
xibi
and
S.E.
x is
+
the
S.E.,
where
in
is the
ml.
concentration,
reticulocyte
hemoglobin
Gm./i00
is the standard error. All subjects in figure 1 and table erythroblastosis fetalis patients were included in this study performed by the IBM 7094 computer at the Computer Center was
BIMED 29, of the UCLA Medical Center.
I except the normal (20 patients total) of this University. that (bi, distribution te)
the
values of bi
in and
this b2
only
using
One would
standard
dif
coefficient.
variance apply regression. obtain
proportions
ferent were
b, each
and
b2
if
the
regressions as one
with independent
the
reticulocyte variable.
counts
and
blood
hemoglobin
contents
determined
separately
of
.
a patient
acid
with
and
a severe
serine plus
kidney
glycine
infection
were also
( unreported
somewhat
experunique
Glutamic
the adults.1 be
only
amino Ergothioneine of be
higher of less
erythrocytes value ill. broken expected point be patients lower concentrafound than corIt 106). as its has in to of in with presumably
of children
b2 value
a reflection to type
larger
hemoglobin,
Patients
complex
amounts
have interest
higher
leukemia.3
it is nevertheless frequently have lower hemoglobin levels regard were to not the reticulocyte as good as the counts,
lymphocytic
concentrations
hemoglobin
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UNBOUND
AMINO
ACIDS
IN PLASMA
AND
ERYTHBOCYTES
97
levels.
for regression
correlations ornithine,
studies since it
were and or
negligible tryptophan.
for Urea
no
glutamic functions
concentration
acid as
and
rather in
a control
correlation
demonstrated
the
levels
hemoglobin
content. DIscussIoN
In
ship tions ficiency
none
between in
of
either anemia
the the
the counts
studies disease
plasma usually characteristically
did
or not
there the
to
be unbound
any The
relationconcentrairon
the
category
acid with
dewith
hemoglobin
In other
concentrations counts
these
reticulocyte
elevated
much.
hemo-
globin
than anemia tent or
content
those found
was
in
usually
iron
not
deficiency
so low identified
but by
was
the
reticulocyte
Despite
were
anemia
subjects.
differences,
per
elevated
se,
that
of
either
low
always
blood This
hemoglobin latter
reticulocyte
reticulocyte
counts,
almost
accompanied
acids
in the studies
hemoglobin
erythrocytes. where
content,
by
amino been time
the
multiple
acid
relationships
and
concentrations, to
amino
acid
concentrations
reported
be
on
adult
hemoglobin
erythrocytes.4
elevated in reticulocytes, There does not appear the unbound that elevated, This acid
major,
when compared to be a previous acid concentrations amino the individual from deficiency
anemia, for every
to be the 1 and
noted were
unbound all
acid the
erythrocytes to
of
tributed
similarities
2.
the
regression 1 where,
the acquired median
in table
It is also
and
anemia,
amino
the
of between
median the
our
value erythrocyte
results
for
and
normal amino
those
children. acids
of Iyer5
This
or
former, rocyte
serine
studying concentrations
to the
iron
deficiency of alanine,
anemia
reported glutamine,
in eryth-
glutamic patient
found methionine,
and
Coombs
valine.
erythroblastosis
thalassemia amino
were
negative
acids
elevated
( glycine,
in the
leucine,
The
considerably
blood
amino
different of
acid
from lysine
pattens
ornithine
high values
for the
in
the found
which
plasma. concentrations
was
similar
Furthermore, were
to
the
high
although elevated
erythrocyte
relation
somewhat
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NICOLAIDOU,
LUND
AND
MCMENAM1
aged
to
normal. more
of this
that
It is perbirth, were
blood within
the first
acid 45
or
erythroblastosis
fetalis
for
hours
2 of
SUMMARY
amino with
in types
the have
plasma been
erythrocytes by anemiasubthalassemia
hemolytic
the
salt-saturated cell
( iron
1 subject
glutathione,
erythroblastosis
major,
Anemia
although a marked increase acid determined was found. the unbound amino acid the he a function of both tent, with a somewhat
distinction as to the
in the erythrocyte concentrations of In multiple regression and correlation concentrations in the erythrocytes and the blood on the latter.
evident in the
were
disease
patterns elevations
of
the
patients. was
The largely
extent
of
the of
in the with
as those
fetalis amino
during
IN
were acid
different were
hours after
those
l)ly
anemia.
Their
of
erythrocyte
normal babies
SUMMARIO
INTERLINCUA
le
de con post de
amino-acidos de
vane
in
typos.
le
Le
salin. 3 subjectos
Le con
casuistica anemia
8 subjectos
de reducite glutathiona, hemolytic, e hemoglobinopathia anemia ben per que se ha pauc un marcate de omne
erythrocytic
regression
amino-acidos
e correlation
ligate amino-acidos in le erythrocytos reticulocytic como etiam del contento superioritate del secunde de iste duo correlation differential inter
function tanto del numeration de hemoglobina, con un certe Esseva recognoscite nulle de non-ligate amino-acidos e
le configurationes
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UNBOUND
AMINO
ACIDS
IN
PLASMA
AND
ERYTHEOCYTES
99
le vane
non-ligate fiexion Le
typos del
de
anemia.
in
Le le anemia.
grado
del
elevationes esseva
formava
in in
un
le
concentration mesura
separate
amino-acidos
erythrocytos
fetal
grande
categoria
severitate
con
del
subjectos
erythroblastosis
anemia. identic
erythrocytic infantes
ACKNOWLEDGMENT
J. L. Oncley, Harvard Medical School, Dr. H. ShwachChildrens Hospital Medical Center for their interest and encouragement in this work. Appreciation is also expressed to Dr. F. X. Fellers, Childrens Hospital Medical Center, and Dr. J. F. Des Forges, Boston City Hospital, for assistance in recruiting children for this study. Acknowledgment is also expressed to Mr. Joseph van Marcke for technical assistance and to Mr. Roger Canipbell and Mr. I)avid I)idising of the Computer Center for assistance in programing.
The authors wish to thank Dr.
man
and
Dr.
C.
A.
Janeway,
REFERENCES
1. Nicolaidan Lund, cytes blood. 613, 2. McMenamy, C. of in and concentrations of Arch. 1962. R. and H., amino erythrocyes, of normal human Lund, D. acid C. F. C., Neville, normal ,M.,\lc C. C. : in Menmy, Unbound plasma children Biocheni. R. amino and and Biophys. H., and acid erythrocord 96: 5. amino erytbrocytes,
patients
acid
in
leukemia.
J.
amino
Clin.
39:1688, Iyer, C.
Free
level
in re-
normal \Vallach, H. : Studies distributions leukocytes, subjects. 6. lation ysis 24, Allen,
anemia
Arch.
erythrocytes content
J.,
potassium
Biochem.
Biophys.
74:
acid
by
J. Clin.
3.
-, -,
Invest. Wallach,
39:1675, D. F.
human
1960.
reticulocytes.
of PediHospital Patisson
C. and Hospital,
Professor Surgical
Harvard
Mass. Present Address, tion, Boston, Mass. Research Harvard of University J3uffqlo N.
Y,
H.
of