Channeling of Citrulline for the Renal Synthesis of Guanidino Acetate
Juan C Marini The Journal of Nutrition, 23 December 2019
Although protein synthesis dominates the requirements for dietary amino acids, the need for amino acids to meet demand for synthesis of other compounds is not negligible. This is especially true of production of creatine, which requires substantial amounts of arginine and methionine. Synthesis of guanidino acetate[b] (GAA), the precursor for creatine, constitutes the main pathway for the obligatory irreversible loss of arginine consuming an equivalent to ∼20% of the dietary intake[/b] (1). In turn, methylation of GAA to make creatine can represent up to 75% of all methylation reactions imposing a heavy burden on methionine and 1-carbon metabolism (2).
The unique role of the kidney as the source for GAA, a reaction catalyzed by L-arginine: glycine amidinotransferase (AGAT), has been questioned since high AGAT activity was first identified in the pancreas of dogs (3) and extra-renal sources for GAA production were shown in nephrectomized rats (4). In this issue of The Journal of Nutrition, Dinesh et al. (5) studied the role of kidney, pancreas, and gut on the synthesis of GAA in a neonatal pig model. They also investigated the effect of acute supplementation with different precursors on the GAA output by these organs. The rapid accretion of protein by the neonatal piglets and their high demand for arginine and methionine, make the piglet the ideal model to study supplementation with various creatine precursors.
Dinesh et al. demonstrated that up to ∼90% of the GAA produced can originate in the kidney (5). Despite the high in vitro specific AGAT activity reported previously (1, 3), the contribution of the pancreas to whole body GAA synthesis was modest although not negligible. The determination of enzyme activity in vitro provides optimized conditions (precursor and cofactor concentrations, pH, no end product inhibition, etc.), which can be very different in an intact cell (6). For these reasons the direct measurements made by Dinesh et al. (5) provide a better estimate of the actual production and contribution of each organ. Not surprisingly, [b]arginine supplementation increased GAA production by both the kidney and pancreas; citrulline supplementation, however, was even more effective at increasing renal GAA output, but had no effect on pancreatic production.[/b]
Because of extensive arginine extraction during first pass metabolism, oral citrulline supplementation is considered more effective at increasing arginine availability than arginine supplementation itself (7). Dinesh et al. (5) provided arginine parenterally (circumventing first pass extraction) and plasma arginine concentrations were similar in the arginine and citrulline supplemented groups, and these results seem to suggest that citrulline is more effective at providing arginine at the site of GAA synthesis than arginine itself. These new data by Dinesh et al. (5) are an addition to the mounting body of evidence suggesting that citrulline is more effective at providing intracellular arginine and fueling different processes that require this amino acid (8–10). The ubiquitous presence of argininosuccinate synthase and lyase (ASS and ASL), enzymes responsible for the conversion of citrulline into arginine, is able to catalyze the conversion of citrulline into arginine in many (if not all) cell types. We have shown in mice (11, 12) and pigs (Marini, unpublished) that this pathway is able to provide sufficient intracellular arginine to sustain most cell processes despite total plasma arginine depletion (<1 µmol/L).
In addition to providing intracellular arginine, the high renal expression of ASS and ASL is responsible for most of the de novo circulating arginine (13). In this process known as the “intestinal-renal” axis for arginine synthesis, the citrulline produced in the gut is converted into arginine by the kidney. The existence of this axis in newborns has been questioned because during the neonatal period the expression of ASS and ASL is lower than later in life (14). Recently, we have shown that the “intestinal-renal” axis is present and functional in neonatal pigs (15), which is supported by the present observations of Dinesh et al. (5). They also demonstrated that not only can citrulline be used by the neonatal kidney for arginine synthesis, but also that the neonatal kidney has excess capacity to use exogenous citrulline (16).
In conclusion, the study by Dinesh et al. (5) confirms the central role in GAA production, furthers the concept that citrulline supplementation is a more effective way to increase arginine availability than arginine itself, and confirms the ability of the neonatal kidney to use citrulline.