Biomedical subjects

K R Feingold

Publications and source records attributed to K R Feingold.

At least 253 records · Page 14Linked to original sources

PubMed1988

Lipid-related barriers and gradients in the epidermis.

The stratum corneum, once regarded as a degenerate, inconsequential tissue, is now respected as a structurally heterogeneous and metabolically active tissue. The segregation of lipids into intercellular domains, and the shift in composition from a mixture of polar lipids and neutral lipids to sphingolipids and neutral lipids have important implications for both barrier function and desquamation. Metabolic studies demonstrate the capacity of epidermis to synthesize lipids, the relative autonomy of such synthesis from extracutaneous influences, and the regulation of epidermal lipogenesis by local barrier requirements. Abundant lipid biosynthesis appears to occur in the stratum granulosum, consistent with the rapid recovery of barrier function following solvent treatment. Whereas nonpolar lipids, including sterol esters and hydrocarbons, provide a superficial barrier, sphingolipids and free sterols provide a more profound barrier. In parallel with the synthesis of lipids for barrier function, hydrolysis of phospholipids, glycolipids, and cholesterol sulfate occurs in the outer epidermis leading to a more hydrophobic lipid mixture with the evolution of broad membrane bilayers that may regulate both transcutaneous water loss and desquamation.

Animals↗

PubMed1988

Endocrine-skin interactions. Cutaneous manifestations of adrenal disease, pheochromocytomas, carcinoid syndrome, sex hormone excess and deficiency, polyglandular autoimmune syndromes, multiple endocrine neoplasia syndromes, and other miscellaneous disorders.

Endocrinologic disorders occasionally manifest themselves by their associated and/or induced cutaneous abnormalities. In some instances, the initial and most prominent complaints of the patient are related to alterations in the skin, and therefore the dermatologist will at times be the first physician consulted. In this review we describe the cutaneous lesions that occur in patients with Cushing's syndrome, adrenal insufficiency, pheochromocytomas, carcinoid syndrome, sex hormone excess or deficiency, polyglandular autoimmune syndromes, and multiple neoplasia syndromes. Additionally, we discuss the relationship of acanthosis nigricans and xanthomas to endocrinologic disorders and the skin lesions that occur in association with the spotty pigmentation, myxoma, endocrine overactivity syndrome, and the polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes (POEMS) syndrome.

Adrenal Gland Diseases↗

PubMed1988

Mechanisms by which tumor necrosis factor stimulates hepatic fatty acid synthesis in vivo.

We have previously shown that bolus intravenous administration of tumor necrosis factor (TNF) to normal rats results in a rapid (within 90 min) stimulation of hepatic fatty acid synthesis, which is sustained for 17 hr. We now demonstrate that TNF stimulates fatty acid synthesis by several mechanisms. Fatty acid synthetase and acetyl-CoA carboxylase (measured after maximal stimulation by citrate) were not higher in livers from animals that had been treated with TNF 90 min before study compared to controls. In contrast, 16 hr after treatment with TNF, fatty acid synthetase was slightly elevated (35%) while acetyl-CoA carboxylase was increased by 58%. To explain the early rise in the hepatic synthesis of fatty acids, we examined the regulation of acetyl-CoA carboxylase. The acute increase in fatty acid synthesis was not due to activation of acetyl-CoA carboxylase by change in its phosphorylation state (as calculated by the ratio of activity in the absence and presence of 2 mM citrate). However, hepatic levels of citrate, an allosteric activator of acetyl-CoA carboxylase, were significantly elevated (51%) within 90 min of TNF treatment. TNF also induces an acute increase (within 90 min) in the plasma levels of free fatty acids. However, hepatic levels of fatty acyl-CoA, which can inhibit acetyl-CoA carboxylase, did not rise 90 min following TNF treatment and were 35% lower than in control livers by 16 hr after TNF. These data suggest that TNF acutely regulates hepatic fatty acid synthesis in vivo by raising hepatic levels of citrate.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetyl-CoA Carboxylase↗

PubMed1988

Localization of sites of lipid biosynthesis in mammalian epidermis.

The end-product of epidermal differentiation is a stratified layer of corneocytes whose extracellular lipid bilayers provide a permeability barrier. It is generally accepted that the epidermis synthesizes most if not all of the lipids found in this tissue and that extra-epidermal tissues contribute very little to this lipid content. Moreover, the individual epidermal strata in which epidermal lipid biosynthesis occurs are not known. To address this question, we examined [3H]H2O incorporation into nonsaponifiable and saponifiable lipids in individual epidermal cell layers 3 hr after intraperitoneal injection into neonatal mice, and compared this to protein and DNA synthesis using intraperitoneal [3H]leucine and [3H]thymidine incorporation, respectively. Lipid biosynthesis was also assessed by [14C]acetate incorporation into lipid fractions in organ cultured skin and in epidermal subpopulations. The in vivo studies demonstrated that the biosynthetic activity of both saponifiable and nonsaponifiable lipids was comparable to, if not greater, in the stratum granulosum (SG) than in basal/spinous (SB + SS) layer, despite significantly lower levels of both protein and DNA synthesis in the SG. On a mass basis, the SG accounts for about four times the biosynthetic activity of the combined SB + SS layers. The lipid biosynthetic activity in vitro also was two- to fivefold higher in the SG, regardless of whether the epidermis was separated into individual cell layers before or after incubations with radiolabel. Moreover, this difference could not be ascribed to increased acetate pools or to elevated metabolism in the SG versus the SB + SS since the rates of CO2 production were much lower in the SG fraction. The increase in lipid biosynthesis in SG over SB + SS was greatest for phospholipids, followed by glycosphingolipids, and free sterols but was observed in almost all lipid classes. These studies show not only that mammalian epidermis is an active site of de novo lipid biosynthesis, but also that this activity remains high in the stratum granulosum, while other forms of metabolic activity are diminishing. These observations are consistent with the knowledge that lipids extruded from the stratum granulosum layer provide the hydrophobic permeability barrier, and further suggest that elevated synthetic activity in the stratum granulosum would allow rapid replenishment in the event that the barrier is damaged.

Animals↗

PubMed1987

The effect of vitamin D status on cutaneous sterologenesis in vivo and in vitro.

Recent studies have shown that cutaneous sterologenesis is autonomous from the influence of circulating sterols, and that the epidermis is an important site of sterologenesis which is regulated by permeability barrier requirements. In addition to barrier function, an additional, important function of the epidermis is to synthesize sterol precursors of vitamin D3. The present study was designed, first, to determine whether vitamin D status and/or circulating levels of 1,25-dihydroxyvitamin D3 might play a role in regulating cutaneous sterol synthesis in vivo and, second, whether 1,25-dihydroxyvitamin D3 modulates sterologenesis in cultured human keratinocytes. Hairless mice were maintained on a vitamin D-deficient diet in the dark and supplemented with various doses of vitamin D3/day. Despite demonstrating serum 25-hydroxyvitamin D3 levels ranging from less than 10 to 343 ng/ml, the incorporation of tritiated water into cholesterol and total nonsaponifiable lipids in both the epidermis and dermis was similar in the four groups of animals. Likewise, administration of various doses of 1,25-dihydroxyvitamin D3 to vitamin D-deficient mice resulted in serum levels of 1,25-dihydroxyvitamin D3 ranging from less than 10 to 85 pg/ml; yet, cholesterol and total nonsaponifiable lipid synthesis was similar in both the dermis and epidermis in all groups of animals. Moreover, administration of 0.6 micrograms/kg per day of 1,25-dihydroxyvitamin D3 to 'normal' vitamin D-replete mice also had no effect on cutaneous sterol synthesis. Furthermore, conversion of 7-dehydrocholesterol to cholesterol in vitamin D-deficient vs. supplemented animals did not differ. Finally, addition of 1,25-dihydroxyvitamin D3 to cultured keratinocytes over a concentration range of 10(-12)-10(-7) M did not affect sterologenesis, except at supraphysiologic doses (10(-7) M). Together, these results suggest that vitamin D status does not influence sterol synthesis in the skin.

Animals↗

PubMed1987

Endocrine-skin interactions. Cutaneous manifestations of pituitary disease, thyroid disease, calcium disorders, and diabetes.

Endocrinologic disorders occasionally manifest themselves by their associated or induced cutaneous abnormalities. In some instances the initial and most prominent complaints of the patient are related to alterations in the skin, and thus the dermatologist will at times be the first physician consulted. In this article we describe the cutaneous lesions that occur in patients with acromegaly, hypopituitarism, hypothyroidism, hyperthyroidism, diabetes mellitus, glucagonomas, hypercalcemia, hypoparathyroidism, and fibrous dysplasia. In addition, we also discuss the role of the skin in vitamin D metabolism. Whenever possible and where known, we have attempted to point out the pathophysiologic mechanisms that account for the cutaneous changes.

Calcium Metabolism Disorders↗

PubMed1987

Localization of cholesterol synthesis along villus-crypt axis in diabetic rats.

In diabetic animals cholesterol synthesis is increased in the small intestine, and this increase occurs in all segments along the duodenal-ileal axis. In the present study we have determined the sites along the villus-crypt axis in which cholesterol synthesis is increased. In diabetic animals cholesterol synthesis is increased in the proximal small intestine, and this is chiefly due to an increased synthesis in the crypt cells. In the midintestine cholesterol synthesis is increased in all cell fractions, but again the crypt cells are the major site accounting for the increase. In the distal small intestine synthesis is increased in all cell fractions, but the increase is greatest in the upper villus cells. Thus the basis for the increase in intestinal cholesterol synthesis in diabetic animals is dependent on location. Additionally, in the proximal small intestine the increase in synthesis is due to an increased mass of cells, whereas in the distal small intestine the increase is due to an increased synthesis per unit of tissue. In cholesterol-fed diabetic animals we observed a decrease in cholesterol synthesis in the proximal and midintestine that was due to a decrease in synthesis in all cell fractions. This decrease in synthesis is accounted for by a decrease in synthesis per unit of tissue. Restricting food intake in the diabetic animals decreased cholesterol synthesis in all cell layers, and this decrease is due to a decrease in cell mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaline Phosphatase↗

PubMed1987

Tumor necrosis factor-alpha stimulates hepatic lipogenesis in the rat in vivo.

The hyperlipidemia accompanying infection has been attributed to production of tumor necrosis factor. This cytokine inhibits adipose tissue lipoprotein lipase, which could decrease clearance of lipoproteins. Infections also increase hepatic lipogenesis. We now have demonstrated that tumor necrosis factor-alpha stimulates lipid synthesis in vivo. 2 h after administration of tumor necrosis factor (25 micrograms/200 g), plasma triglycerides increase 2.2-fold and remain elevated for 17 h. Plasma cholesterol also increases, but this effect appears after 7 h. Tumor necrosis factor rapidly stimulates incorporation of tritiated water into fatty acids in the liver (1-2 h), which persists for 17 h. Also, tumor necrosis factor stimulates hepatic sterol synthesis. Of note, tumor necrosis factor treatment does not stimulate lipid synthesis in other tissues, including adipose tissue. Labeled fatty acids rapidly increase in the plasma, raising the possibility that stimulation of hepatic lipogenesis by tumor necrosis factor contributes to the hyperlipidemia of infection.

Animals↗

PubMed1987

The disappearance from the circulation of chylomicrons obtained from control and diabetic rats.

Previous studies have demonstrated that cholesterol synthesis is increased in the small intestine of diabetic animals and that there is an increased transport of this newly synthesized cholesterol from the small intestine into the circulation. Chylomicrons play an important role in the transport of cholesterol from the small intestine into the circulation, and the present study compared the rates of disappearance from the circulation and the fate of chylomicron cholesterol obtained from control and diabetic animals when administered to either intact control or diabetic rats. Thoracic duct lymph was collected from normal and diabetic rats after the administration of [14C]cholesterol and [3H]vitamin A1. The labeled chylomicrons were isolated by centrifugation and then administered to either control or diabetic rats. The major observation of this study is that chylomicron-associated sterols obtained from diabetic animals were cleared from the circulation in a normal manner. If one compares the rate of disappearance of either [3H]vitamin A1 or [14C] cholesterol-labeled normal chylomicrons administered to control animals with that of labeled diabetic chylomicrons administered to diabetic animals, the half-times in the circulation are almost identical (control: [3H]vitamin A1 t 1/2, 3.6 min; [14C]cholesterol t 1/2, 5.7 min; diabetic: [3H]vitamin A1 t 1/2, 3.5 min; [14C]cholesterol t 1/2, 4.4 min). In both experimental situations the rapid disappearance of [14C]cholesterol was associated with the appearance of [14C]cholesterol in the liver. Very little [14C]cholesterol was present in tissues other than liver, indicating that the rapid removal of labeled chylomicron remnants from the circulation was accounted for by hepatic uptake. These results demonstrate that in diabetic animals chylomicron-associated sterols are cleared from the circulation normally and that the bulk of intestinally derived cholesterol carried in the chylomicron lipoprotein fraction is rapidly delivered to the liver, where it could potentially influence lipoprotein metabolism.

Animals↗

PubMed1987

Effect of hypocholesterolemia on cholesterol synthesis in small intestine of diabetic rats.

Studies by our and other laboratories have demonstrated that cholesterol synthesis is increased in the small intestine of insulinopenic diabetic animals. In normal animals, many factors have been shown to regulate cholesterol synthesis in the small intestine, including changes in plasma cholesterol levels. The purpose of this study was to determine the effect of lowering plasma cholesterol levels on small intestine cholesterol synthesis in streptozocin-induced diabetic rats. In diabetic rats, 4-aminopyrazolo[3,4-d]pyrimidine (4-APP)-induced hypocholesterolemia (plasma cholesterol levels less than 20 mg/dl) resulted in a 2.5-fold increase in small intestine cholesterol synthesis, which was most marked in the distal small intestine, decreasing proximally. In the distal small intestine the incorporation of 3H2O into cholesterol was 0.28 +/- 0.04 mumol.h-1.g-1 in diabetic rats versus 1.60 +/- 0.38 in diabetic rats administered 4-APP (P less than .01). This stimulation of cholesterol synthesis occurred in the upper villus, middle villus, and crypt cells isolated from the middle intestine of the 4-APP-treated diabetic animals. In agreement with these observations, "functional hypocholesterolemia" due to Triton WR-1339 administration also stimulated cholesterol synthesis 2.5-fold in the small intestine of normal and diabetic animals. In the distal small intestine, cholesterol synthesis was 0.43 +/- 0.10 mumol.h-1.g-1 in the diabetic rats versus 1.08 +/- 0.21 in diabetic rats treated with Triton WR-1339 (P less than .05). In both the 4-APP and Triton WR-1339 experiments, the response of the diabetic rats was similar to that observed in normal rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine↗

PubMed1987

Effects of cholesterol sulfate on lipid metabolism in cultured human keratinocytes and fibroblasts.

Effects of cholesterol sulfate on acetate incorporation into lipid fractions were examined in normal human fibroblast and keratinocyte cultures. Inhibition of sterologenesis in normal fibroblast cultures by cholesterol sulfate was less profound than that produced by either lipoprotein-containing serum or 25-hydroxycholesterol. Cholesterol sulfate also inhibited sterologenesis in low density lipoprotein receptor-deficient fibroblasts and inhibited both sterologenesis and 3-hydroxy-3-methylglutaryl coenzyme A reductase activity in keratinocytes. Cholesterol sulfate increased incorporation of acetate into fatty acid-containing lipids in preconfluent cultures of both cell types in lipoprotein-depleted media. Similar effects were not observed either in response to lipoprotein-containing serum or 25-hydroxycholesterol. Cholesterol sulfate had no effect on oleic acid incorporation into diglycerides, triglycerides, or phospholipid fractions; neither did it inhibit acid lipase activity; nor did it inhibit fatty acid oxidation, indicating that cholesterol sulfate does not inhibit catabolism of acyl lipids. Because cholesterol sulfate had similar effects on fatty acid metabolism in steroid sulfatase-deficient fibroblasts lines, desulfation to cholesterol is not a prerequisite. Cholesterol sulfate did not significantly affect incorporation of oleic acid into sterol esters in fibroblast cultures, but in contrast, inhibited sterol esterification in keratinocyte cultures. These data suggest a novel role for cholesterol sulfate as a modulator of cellular lipid biosynthesis.

Acetates↗

PubMed1987

Relationship of epidermal lipogenesis to cutaneous barrier function.

Although the lipids of mammalian stratum corneum are known to be important for the cutaneous permeability barrier, the factors that regulate epidermal lipid biosynthesis are poorly understood. Recent studies suggest that cutaneous sterol synthesis is regulated by cutaneous barrier requirements, while the levels of circulating sterols do not play a role. Whether cutaneous barrier requirements regulate epidermal lipogenesis in general and the nature of the signal that activates the lipid biosynthetic apparatus are unknown. We determined whether alterations of the cutaneous permeability barrier, induced by treatment with a solvent (acetone), a surfactant, sodium dodecyl sulfate (SDS), or essential fatty acid deficiency (EFAD), provoked a discrete versus global stimulation of epidermal and dermal lipid biosynthesis. Acetone treatment increased epidermal, but not dermal, sterol and fatty acid biosynthesis approximately threefold over controls at 1-4 hr, which returned to normal after 12 hr. SDS treatment likewise stimulated epidermal sterol and fatty acid biosynthesis, but the increase was less dramatic than in acetone-treated animals. Since plastic occlusion blocked the expected increase in de novo lipid biosynthesis in acetone-treated animals, it is possible that water flux provides the molecular signal for de novo synthesis. Finally, EFAD mice also demonstrated enhanced epidermal sterol and fatty acid biosynthesis in comparison to normals, an effect that also was abolished when transepidermal water loss was normalized by occlusion, despite the presence of ongoing EFAD. These results demonstrate that disruption of the cutaneous permeability barrier stimulates a parallel, global boost in both sterol and fatty acid biosynthesis that is limited to the epidermis. Since such stimulation is reversed by restoration of barrier function, transcutaneous water gradients may regulate epidermal lipogenesis.

Acetone↗

PubMed1987

Ichthyosis induced by cholesterol-lowering drugs. Implications for epidermal cholesterol homeostasis.

Ichthyosis and other disorders of cornification may occur as side effects of treatment with several hypocholesterolemic agents. Recent progress in understanding of the functional role of lipids in stratum corneum provides a new pathophysiologic basis for these earlier clinical observations. In stratum corneum, lipids are segregated within intercellular membranes, where they appear to regulate permeability barrier function and desquamation. Cholesterol is an important constituent of these membranes and may be essential to both of these functions. Perturbation of barrier function induces cholesterologenesis locally within the epidermis. Polar sterol metabolites, such as cholesterol sulfate, may also regulate epidermal sterologenesis under normal or pathologic circumstances. Cholesterol homeostasis may also modulate desquamation. For example, hairless mice fed azacosterol hydrochloride (20,25-diazacholesterol) develop a generalized scaling disorder without loss of barrier function. In these mice, total stratum corneum sterol content is markedly decreased, and topical or systemic repletion with cholesterol can correct the scaling abnormalities.

Animals↗

PubMed1986

The effect of substrates and competitive inhibitors on the phosphatase-dependent activation of hepatic hydroxymethylglutaryl CoA reductase.

Previous studies have demonstrated that the in vitro activation of microsomal hepatic hydroxymethylglutaryl (HMG) CoA reductase by dephosphorylation is inhibited by HMG CoA or NADPH, the substrates of HMG CoA reductase (13). In the present study the effect of three competitive inhibitors of HMG CoA reductase on the activation of HMG CoA reductase was investigated. Adenosine-2'-monophospho-5'-diphosphoribose, a competitive inhibitor for the NADPH binding site, blocked the phosphatase-mediated activation of HMG CoA reductase. By contrast, neither compactin nor mevinolin, competitive inhibitors for the HMG CoA binding site, altered the activation of HMG CoA reductase. Moreover, the HMG CoA-mediated inhibition of the activation of HMG CoA reductase was not blocked even by very high concentrations of either compactin or mevinolin. These observations suggest that HMG CoA can bind to two sites on HMG CoA reductase. One site of HMG CoA binding serves as a catalytic site and is competitively blocked by compactin or mevinolin, and the second binding site is an allosteric site to which only HMG CoA is capable of binding. The binding of HMG CoA to this second site inhibits the activation of HMG CoA reductase by phosphatases.

Adenosine Diphosphate Ribose↗

PubMed1986

Effect of essential fatty acid deficiency on cutaneous sterol synthesis.

The fact that the skin is a major site of total body sterologenesis, coupled both with the apparent absence of low density lipoprotein receptors on keratinocytes and with the lack of influence of serum cholesterol on epidermal sterologenesis, has created the impression that epidermal lipid synthesis might be autonomous, i.e., nonregulatable. Recent studies have shown, however, that disruption of cutaneous barrier function with acetone or detergents stimulates epidermal sterologenesis (J Lipid Res 26:418-427, 1985). To correlate further sterologenesis with barrier function, we measured de novo synthesis of cholesterol and total nonsaponifiable lipids in essential fatty acid-deficient (EFAD) hairless mice. Animals with defective barrier function, manifested by abnormal transepidermal water loss, demonstrated a 2-fold increase in epidermal cholesterol and total nonsaponifiable lipid synthesis over controls while synthesis in the dermis was unchanged. Epidermal sterologenesis in EFAD animals, repleted with linoleic acid either systematically or topically, returned toward normal as barrier function improved. Moreover, plastic occlusion of EFAD mouse skin normalized epidermal sterologenesis at 1 and 3 days. These results provide further evidence that epidermal sterologenesis is not entirely autonomous, and can be regulated by water barrier requirements.

Animals↗

PubMed1986

Effect of food intake on intestinal cholesterol synthesis in rats.

The mechanism by which diabetes results in an increase in small intestinal cholesterol synthesis is unknown. Previous studies have demonstrated that limiting food intake prevents the increase in intestinal cholesterol synthesis, and it has therefore been proposed that the stimulation of cholesterol synthesis in the small intestine is secondary to the hyperphagia that is associated with poorly controlled diabetes. To shed further light on the role of hyperphagia we have studied the effect on cholesterol synthesis of a variety of conditions that increase food intake. In third-trimester pregnant animals, lactating animals, obese animals, and in animals infused intragastrically with 16 g glucose/day vs. 8 g glucose/day, we have observed that an increase in food intake is associated with an increase in small intestinal cholesterol synthesis. Furthermore, these findings support the hypothesis that hyperphagia is the chief stimulus for the increase in cholesterol synthesis in the small intestine of diabetic animals. Additional studies have demonstrated that simply increasing the bulk of food ingested by adding Alphacel to the diet does not alter cholesterol synthesis in the small intestine. Lastly, in animals in whom Thiry fistulas were surgically constructed we observed that cholesterol synthesis is increased in the diabetic animals in both the segment of the small intestine in contact with the food stream and the segment of the small intestine that is excluded from contact. This observation suggests that the direct contact of the intestinal mucosa with caloric sources is not the sole trigger for increasing small intestinal cholesterol synthesis in hyperphagic diabetic animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1986

Muscle capillary basement membrane width in patients with vacor-induced diabetes mellitus.

Muscle capillary basement membrane width is a sensitive marker for the presence of diabetic microangiopathy. Studies have indicated that genetic factors and alterations in glucose metabolism influence muscle capillary basement membrane width. To define the role of these factors we have measured muscle capillary basement membrane thickness in controls, insulin dependent diabetics, and individuals with diabetes secondary to the ingestion of Vacor, a rat poison, which results in hyperglycemia. Hemoglobin A1 concentrations were increased in both diabetic groups, but hemoglobin A1 levels and the duration of diabetes were similar in the two diabetic groups. The muscle capillary basement membrane width was increased to a similar extent in the insulin-dependent diabetics (control, 1,781 +/- 46 vs. IDD, 2,287 +/- 144 A, P less than 0.001) and in the Vacor diabetic group (2,320 +/- 149 A, P less than 0.001). In the insulin-dependent diabetic group, 63% of the patients had a muscle capillary basement membrane width greater than two standard deviations above the mean of the controls, while in the Vacor diabetic group this figure was 56%. Despite the relatively short duration of diabetes (6.2 +/- 0.3 yr), 44% of the Vacor diabetic patients had retinopathy and 28% had proteinuria. The present study provides strong evidence that even in the absence of genetic diabetes mellitus, hyperglycemia or some other abnormality related to insulin lack can cause microvascular changes.

Adult↗

PubMed1986

Role of the kidneys in the metabolism of circulating mevalonate in humans.

Previous studies in several animal species have demonstrated that the kidneys are the primary site of mevalonate metabolism by the oxidative or shunt pathway. To determine the role of the human kidney in mevalonate oxidation, we studied mevalonate shunt activity in patients undergoing hemodialysis for varying degrees of renal failure. Surprisingly, at least half of the uremic patients and even anephric patients had normal ability to oxidize mevalonate by the shunt pathway. In addition, we found a strong negative correlation (R = -0.94) between mevalonate shunt activity and serum phosphorus levels in uremic patients. The resulting inhibition of mevalonate oxidation by high serum phosphorus levels was reversed by lowering the serum phosphorus in one patient. Finally, a positive correlation was found between mevalonate oxidation and serum PTH levels. The results of this study suggest that, in humans, extrarenal tissues can be major contributors to mevalonate oxidation. It is therefore probable that in humans, in contrast to other animals, the kidney is not the primary site of mevalonate metabolism by this oxidative pathway. Finally, the strong negative correlation between serum phosphorus levels and the ability of uremic patients to oxidize mevalonate suggests a regulatory role for the phosphate ion in the mevalonate shunt pathway.

Adult↗