The glucose-alanine cycle

Alanine is quantitatively the primary amino acid released by muscle and extracted by the splanchnic bed in postabsorptive as well as prolonged fasted man. The hepatic capacity for conversion of alanine to glucose exceeds that of all other amino acids. Insulin inhibits gluconeogenesis by reducing hepatic alanine uptake. In contrast, in diabetes, an increase in hepatic alanine extraction is observed in the face of diminished circulating substrate. In prolonged fasting, diminished alanine release is the mechanism whereby gluconeogenesis is reduced. In circumstances in which alanine is deficient, such as pregnancy and ketotic hypoglycemia of infancy, fasting hypoglycemia is accentuated. Augmented glucose utilization in exercise and hyperpyruvicemia consequent to inborn enzymatic defects are accompanied by increased circulating levels of alanine. These data thus suggest the existence of a glucose-alanine cycle in which alanine is formed peripherally by transamination of glucose-derived pyruvate and transported to the liver where its carbon skeleton is reconverted to glucose. The rate of recycling of glucose carbon skeletons in this pathway appears to occur at approximately 50% of that observed for the Cori (lactate) cycle.