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The Cahill cycle, also known as the alanine cycle or glucose-alanine cycle, [1] is the series of reactions in which amino groups and carbons from muscle are transported to the liver. [2] It is quite similar to the Cori cycle in the cycling of nutrients between skeletal muscle and the liver. [ 1 ]
Cori cycle. The Cori cycle (also known as the lactic acid cycle), named after its discoverers, Carl Ferdinand Cori and Gerty Cori, [1] is a metabolic pathway in which lactate, produced by anaerobic glycolysis in muscles, is transported to the liver and converted to glucose, which then returns to the muscles and is cyclically metabolized back to lactate.
In similar manner, in muscles the use of pyruvate for transamination gives alanine, which is carried by the bloodstream to the liver (the overall reaction being termed glucose-alanine cycle). Here other transaminases regenerate pyruvate, which provides a valuable precursor for gluconeogenesis.
It catalyzes the two parts of the alanine cycle. Serum ALT level, serum AST (aspartate transaminase) level, and their ratio (AST/ALT ratio) are routinely measured clinically as biomarkers for liver health. [2] The half-life of ALT in the circulation approximates 47 hours. [3] Aminotransferase is cleared by sinusoidal cells in the liver. [3]
Glutamate in the liver enters mitochondria and is broken down by glutamate dehydrogenase into α-ketoglutarate and ammonium, which in turn participates in the urea cycle to form urea which is excreted through the kidneys. [23] The glucose–alanine cycle enables pyruvate and glutamate to be removed from muscle and safely transported to the liver.
The two organs most commonly affected are the liver and the skeletal muscle. Glycogen storage diseases that affect the liver typically cause hepatomegaly and hypoglycemia; those that affect skeletal muscle cause exercise intolerance, progressive weakness and cramping. [1] Glucose-6-phosphate isomerase deficiency affects step 2 of glycolysis.
Acute liver failure is the appearance of severe complications rapidly after the first signs (such as jaundice) of liver disease, and indicates that the liver has sustained severe damage (loss of function of 80–90% of liver cells).
Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Two forms are recognised, acute and chronic (cirrhosis). [ 1 ] Recently, a third form of liver failure known as acute-on-chronic liver failure ( ACLF ) is increasingly being recognized.