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Clinical Science (1982) 63,81-92 87 Activation by exercise of human skeletal muscle pyruvate dehydrogenase in vivo G. R . W A R D * , J . R . S U T T O N , N . L. J O N E S A N D C . J . T O E W S Department of Medicine, McMaster University Health Science Centre, Hamilton, Ontario, Canada (Received 9 November 1981; accepted 12 February 1982) Summary 1. The activity of pyruvate dehydrogenase in its active and inactive forms was measured in biopsy samples obtained from the vastus lateralis muscle of healthy subjects before and after exercise. 2. At rest, 40 ? 4% (mean & SEM) of the enzyme was in the active form. 3. After progressive aerobic exercise to exhaustion (n = 3,88 ? 2.3% was in the active form. 4. After intermittent supramaximal short-term exercise (1 min exercise, 3 min rest) to exhaustion (n = 6), 60 k 2.2% was in the active form. 5 . After isometric maximal exercise of 65 f 3.6 s duration (n = 3), only 39 1% of the enzyme was in the active form. 6. Muscle glycogen depletion was greatest with intermittent exercise and least with isometric maximal exercise; in contrast, the increase in muscle lactate was least with progressive exercise (1.3 to 9.4 pmollg), intermediate in intermittent maximal exercise (1 2 to 13 1 pmol/g) and greatest after isometric exercise (1.8 to 17.6 pmol/g). There were no significant differences between the three studies in the changes in lactate/pyruvate ratios. 7. In three subjects who exercised with one leg, activation of the enzyme was twice as great in the exercised as in the inactive leg. - * Present address: Variety Village Sport Training and Fitness Centre, 3701 Danforth Avenue, Scarborough, Ontario, Canada. Correspondence: Professor C. J. Toews, Department of Medicine, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario L8S 459, Canada. 8. The ratio of active to total enzyme in biopsies of resting muscle was greater in four well-trained athletes than in four untrained control subjects (70% compared with 41% respectively). 9. The activation of pyruvate dehydrogenase appears to play an important part in regulating the use of glycogen and glucose during exercise in man. Key words: adenosine diphosphate, adenosine triphosphate, aerobic exercise, anaerobic exercise, creatine, glycogen, lactate, phosphocreatine, pyruvate. Introduction The use of glycogen and glucose for fuels in muscular exercise is regulated by a number of nonequilibrium enzymes. The pyruvate produced by glycolysis undergoes oxidation in the mitochondria to acetyl-CoA, the reaction being catalysed by the pyruvate dehydrogenase complex: Pyruvate + CoA + NAD+ acetyl-CoA + NADH + H+ + CO, + The enzyme complex is subject to two types of regulation: product inhibition (acetyl-CoA and reduced nicotinamide-adenine dinucleotide, NADH) 111 and by the interconversion of an inactive phosphorylated form and an active non-phosphorylated form [21. Linn and colleagues [31 showed that the interconversion between the two forms is regulated by an Mg-ATP-linked kinase and a specific phosphatase. The activation of the inactive form of the enzyme is probably brought about by a 0143-5221/82/070087-06$01.50 @ 1982 The Biochemical Society and the Medical Research Society 88 G . R . Ward et al. combination of stimulation of the phosphatase and inhibition of the kinase. In mitochondria1 preparations of heart and skeletal muscle, both Mgz+ and CaZ+are important activators of the enzyme [41, among other metabolites [21. The energy required for the regeneration of ATP during heavy exercise is largely derived from muscle glycogen, with only a minor proportion coming from fats and amino acids [5,61. The major metabolic end point for glycogenolysis in muscle is pyruvate, which is then metabolized to lactate or decarboxylated to acetyl-CoA. Thus the pyruvate dehydrogenase reaction is the flux generating step in pyruvate oxidation; also, because the lactate dehydrogenase reaction is always near-equilibrium, the rate of pyruvate oxidation assumes importance through its indirect effect on lactate production in exercise. In rats, skeletal muscle contraction, induced by sciatic nerve [71 or direct [81 stimulation, is associated with activation of the enzyme and in increases in lactate oxidation without an increase in pyruvate concentration [ 71, indicating that activation plays an important role in the regulation of energy metabolism in exercise. The purpose of the present study was to examine the part played by pyruvate dehydrogenase activation in the control of energy metabolism in human skeletal muscle. We have measured the total activity of the pyruvate dehydrogenase complex and the extent of activation of the enzyme, in samples of muscle obtained by needle biopsy in normal subjects before and immediately after three types of exhaustive exercise associated with different metabolic responses (aerobic, intermittent anaerobic and isometric anaerobic). biopsies [ 101 were taken immediately before and within 5 s of stopping exercise. Progressive incremental aerobic exercise Five subjects exercised on a cycle ergometer, with an initial power output of 17 W, and the workload was increased by 33 W every 2 min, the subjects exercising until exhaustion. During the study inspired ventilation was measured by a dry gas meter (Parkinson-Cowan CD-4) and mixed expired gas was continuously analysed for CO, (Godart Capnograph) and 0, (Godart Rapox). Oxygen intake and CO, output were calculated [91. The total duration of the studies was 20 k 3 min (mean k SD). Intermittent maximal exercise Six subjects exercised intermittently for 1 min with periods of 3 min rest between each exercise bout. The power output was calculated to be 140% of Vo, max. The study was continued until the subject could no longer complete 1 min of exercise. The average number of exercise bouts was nine, the total duration being 35 2 6 min. Maximal isometric contraction In seven subjects maximal voluntary isometric contraction of the quadriceps muscle group was measured [ 111 by using an isokinetic dynamometer (Cybex 2, Lumex Isokinetic Systems); 50% of the maximal voluntary contraction was used for the experiments. The time to exhaustion at this constant isometric power output was 65-73 S. Materials and methods Supplementary studies The subjects were 14 healthy males, age 19-25 years, height 179 k 6 cm, weight 79 k 9 kg. The subjects gave their informed consent after a complete description of the studies and the attendant risks, and the project was approved by the university's Ethics Committee. One week before each study a progressive incremental exercise test was carried out on a cycle ergometer [9]. The oxygen intake measured during the highest work load that could be sustained for 1 min was taken to be the maximal oxygen intake ( V o , rnax.). Three series of experiments were carried out. In each, the subjects came to the laboratory after a 12-16 h fast. Two small skin incisions were made over one vastus lateralis muscle, 4 cm apart, under local anaesthesia. Needle muscle To amplify the findings of the main studies, two additional studies were carried out. In the first, three subjects pedalled the cycle ergometer with one leg for 10 min at a power output of 133 W; needle biopsies were taken immediately afterwards from the vastus lateralis muscle of both legs. In the second study, vastus lateralis muscle biopsies were taken at rest in four elite athletes [two oarsmen and. two distance runners 4 ml who had high values for Vo, max. (71 min-' kg-I)] and in four subjects of similar age and size, who were untrained (VO, max. 47 k 3 ml min-I kg-I). The biopsy samples were frozen in liquid N, within 2 s and stored in liquid N, for up to 1 week before analysis. The muscle biopsy was dissected free of fat, blood and connective tissue in a Activation of human muscle pyruvate dehydrogenase -2OOC cold room. The biopsy was weighed and homogenized for 40 s (Polytron PT10) in 30 vol. of ice-cold extraction solution containing potassium phosphate (10 mmol/l), dithiothreitol (1 mmol/l), sodium EDTA (1 mmol/l) and 1 g of crystalline bovine serum albumin/l, at pH 7.4. After homogenization, pyruvate dehydrogenase activity was measured immediately. Separate experiments indicated that both active and total pyruvate dehydrogenase remained stable for several weeks when frozen in liquid N, before homogenization and for up to 12 h at O°C after homogenization. The enzyme was assayed by a modification of the method described by Taylor & Jungas [121. The assay solution for the active enzyme contained potassium phosphate (1 1 mmol/l), sodium EDTA (2.5 mmol/l), magnesium chloride (2-5 mmol/l), coenzyme A (0.5 mmol/l), dithiothreitol (2.5 mmol/l), NAD+ (30 mmol/l, thiamine pyrophosphate (1 5 mmol/l), sodium pyruvate (0.6 mmol/l), sodium [ l-I4Clpyruvate (4 pCi/ml) and 2 g of crystalline bovine serum albumin/l, at pH 7.6. The assay was carried out in rubbersealed 10 ml Erlenmeyer flasks with a centre well. Before the assay 0.24 ml of incubation buffer was added to the flask, 0.2 ml of Hyamine hydroxide (1 mol/l) was placed in the centre well, and the flask was stored on ice. For the assay the flasks were warmed to 37OC for 3 rnin and the reaction was started by addition of 0 - 2 ml of ice-cold muscle homogenate. The reaction was carried out at 37°C for 2 rnin in a Dubnoff incubator, and was stopped by the addition of 0.8 ml of citric acid (80 mmol/l)/phosphoric acid (40 mmol/l) at pH 3.0 under sealed conditions. The flasks were further incubated at 37OC for 60 rnin to allow release of 14C0, and trapping by the Hyamine hydroxide. After incubation, the Hyamine hydroxide was removed and I4C measured by scintillation counting. Counting efficiency was determined by the channels-ratio method. Enzyme dependent 14C02 production was measured as above, but with the extraction buffer solution and muscle extract only. The assay for total pyruvate dehydrogenase activity was identical with that outlined above, except that 0.3 mi of homogenate was incubated with magnesium chloride (10 mmol/l) and calcium chloride (10 mmol/l) for 6 rnin at 37"C, before addition of homogenate to the incubation flask. A sample (0.2ml) was used for the assay of total pyruvate dehydrogenase activity by the procedure above. A number of preliminary experiments were carried out to establish the validity of the assay procedures. As pyruvate dehydrogenase is pre- 89 sent in mitochondria, a variety of procedures has been used to liberate the enzyme from mitochondria; studies with rat mitochondria and muscle homogenates showed that freezing and thawing, ultrasonication and Triton X-100 treatment yielded equally improved enzyme activity over untreated preparations Il31. Under the incubation conditions we used, repeated analyses established that enzyme activity reached a maximum after 2 min, which was maintained for 15 min. Of the initial biopsy, at least 30 mg was used for enzyme analysis. The remainder was used for the analysis of lactate, pyruvate, ATP, ADP, phosphocreatine, creatine, glycogen and glucose by standard enzymic fluorimetric techniques [ 141. Results Progressive incremental aerobic work After an average of 20 min exercise, total pyruvate dehydrogenase activity was unchanged compared with rest (Fig. 1). At rest, the activity of the active pyruvate dehydrogenase was 41 & SEM 3.0% of the total activity; however, at exhaustion the activity of the active pyruvate dehydrogenase accounted for 88 ? 2.4%. This type of exercise was associated with a decrease in muscle glycogen to 43% of the resting value (Table l), and an increase in lactate from 1.29 to 9.41 pmol/g. There was a small increase in pyruvate concentration and the lactate/pyruvate ratio increased from 18.4 to 47.0. There was a small decrease in ATP, a small increase in ADP and a fall in the ATP/ADP ratio. Phosphocreatine concentration decreased markedly. = 4001 300 M C 'Z -.- 2* v x .-> .- 9 100 0 R E Aerobic R E Anaerobic R E Isometric Fig. 1. Pyruvate dehydrogenase activity in three types of exercise, showing total and active (cross-hatched) forms. R, Rest; E, exercise. Bars are f SEM. G . R . Ward et al. 90 TABLE 1. Effect of various types of exercise on tissue metabolite concentrations in human skeletal muscle at rest and after exhaustive exercise Results are means f SEM. The subjects in each type of work were exercised to exhaustion as outlined in the Materials and methods section. The values are in pmol/g wet weight of muscle. Progressive exercise Rest Time (min) . . . Glycogen Lactate Pyruvate ATP ADP Phosphocreatine Creatine Exercise Intermittent exercise Rest Exercise 36.4 f 2.56 9.4 f 0.30 0 . 2 0 f 0.03 4.29f0.18 1.38 f 0.09 3.3 ? 0.88 18.3 f 1.55 5 5 No. of observations Intermittent maximal exercise After 35 & 6 min, the activity of active pyruvate dehydrogenase was increased from 38 f 3% at rest to 60 t 3.0% at exhaustion, but the total pyruvate dehydrogenase activity remained unchanged. The exercise was associated with greater glycogen depletion, compared with the aerobic work study, glycogen falling to 30% of resting values. This was associated with a greater increase in lactate, but similar changes in pyruvate, ATP, ADP and phosphocreatine concentrations (Table 1). Rest 35 ? 6 20 f 3 84.1 k 12.39 1.3 f 0.06 0.07 f 0.01 5.23k0.16 0.92 k 0.07 15.6 f 1.30 10.6 f 0.50 Maximal isometric exercise 80.3 f 3.34 1 . 2 f 0.16 0.07 f 0.003 4.99 f 0.24 0 . 5 3 f 0.02 16.1 f 0 . 7 9 9.7f0.48 Exercise 1.2 f 3 2 4 . 2 k 5.33 1 3 . 1 f 0.48 0.19 f 0.02 3.51 ? 0.18 0.61 ? 0.03 5 . 1 k 1.01 21.5-t 1 . 1 1 71.9 f 8.88 1.8 f 0.39 0.08 k 0.02 5.06 f 0.19 0.57 f 0 . 0 4 17.13 f 1.00 9 . 2 0.42 + 44.3 f 13.55 17.6 f 0.99 0.54 ? 0.04 2.90 f 0 . 1 3 0.75 f 0.03 2.85 f 0.31 20.3 f 0.81 6 6 6 6 leg. Active pyruvate dehydrogenase was twice as high in the active leg (225 t 6 nmol min-' g-I) as the inactive leg (1 12 f 2 nmol rnin-' g-I). The total pyruvate dehydrogenase activity in the resting muscle of four athletes was similar to that in four untrained subjects (309 f 7 compared with 304 f 4 nmol min-' g-I respectively) but 70% of the enzyme was in the active form in the athletes compared with 41% in the untrained subjects (215 k 15 compared with 124 t 9 nmol min-I g-' respectively) (P< 0.001). Discussion Maximal isometric exercise After 65 ? 3 s of this type of exercise, the activity of active pyruvate dehydrogenase was 39 & 1.2%, a value not significantly different from that at rest (37 f 1.0%). This type of exercise was associated with a fall in glycogen concentration to 61% of the resting value (Table l), a marked increase in lactate and pyruvate concentrations, marked falls in phosphocreatine concentration and a significant fall in ATP and the ATP/ADP ratio. The proportion of the total pyruvate dehydrogenase activity accounted for by the active form was significantly greater with progressive aerobic exercise than with intermittent exercise and both were significantly greater than values after isometric exercise (P< 0.00 I). Supplementary studies In a comparison between the active and inactive leg after one-legged exercise in three subjects, the pyruvate dehydrogenase activity was the same, 305 f 4 nmol min-' gg' in the active and 302 5 nmol min-' g-' in the inactive Heavy aerobic exercise greatly increases skeletal muscle 0, consumption and CO, production, mainly owing to increased oxidation of carbohydrate derived from muscle glycogen and blood glucose 1151. In relatively light exercise of long duration, on the other hand, there is increase in lipolysis and increased skeletal muscle oxidation of non-esterified fatty acids [161, with a relatively small increase in carbohydrate oxidation. The increase in free fatty acid oxidation in this type of exercise exerts a sparing effect on glycogen, which is probably mediated in part by an inhibition of phosphofructokinase by citrate [ 171, and of pyruvate dehydrogenase by changes in the acetyl-CoA/CoA and NADH/NAD ratios [ 18, 191. Studies in rat heart have shown a strong inhibitory effect of palmitoylcarnitine in the presence of Ca2+ [20], which may depend on a specific Ca2+ transporting system into the mitochondrion 1211. Thus changes in Ca2+may play a part in the activation of pyruvate dehydrogenase which occurs in exercising muscle. The results of the present study suggest that almost all the pyruvate dehydrogenase is in the active form during aerobic exercise and that much less is in Activation of human muscle pyruvate dehydrogenase the active form during very heavy short term or isometric exercise, in which lactate production is much greater. The reason for this finding is not clear, but may indicate that H+ may influence the enzymes controlling the interconversion between the two forms of pyruvate dehydrogenase. The finding cannot be explained by delay in the activation processes beyond the duration (1 min) of the exercise; in stimulated rat skeletal muscle activation reaches maximum values within 20 s, which are then maintained for several minutes 18, 131. The ratio of active to total pyruvate dehydrogenase activity found in the present study in human resting vastus lateralis muscle is higher than previously found in rat muscle [81. Studies in our laboratory, with methods similar to those used in the present work [131, showed total pyruvate dehydrogenase activity to be 831 +_ 28 nmol min-' g-' with 31 f 3% in the active form in resting rat gastrocnemius muscle (n = 20); corresponding values for rat heart were 5210 f 480 nmol min-' g-' and 21 f 3% (n = 8). These results emphasize the variation in pyruvate dehydrogenase activity in different species and different muscles of the same species. High levels of muscle 0, consumption and CO, production were reached in the incremental aerobic exercise study (means of 3.6 l/min and 4.1 l/min respectively). This in our subjects, 150200 mmol of O,/min was being used, equivalent to a flux of 50-65 mmol of pyruvate/min into the tricarboxylic acid cycle. Assuming the active muscle mass to be about 25 kg, these values imply a flux of at least 2000 nmol min-' g-' through the pyruvate dehydrogenase reaction. Although considerable caution is required in applying enzyme activity measurements in the reaction flask or cuvette to the activity in exercising muscle in vivo I221, it is of interest to calculate the extent to which our measurements might account for the flux into the tricarboxylic acid cycle in exercise. The highest value for active pyruvate dehydrogenase activity was about 300 nmol of pyruvate min-' g-l. However, assays were carried out at a pyruvate concentration of 20 pmolll; as the K, for pyruvate is 0.1 pmol/ml and the pyruvate concentration in muscle after heavy exercise was 0.2 pmol/g we may calculate, using the Michaelis-Menten relationships, that the flux could be increased to about lo00 nmol min-I g-'. Although this is only half the calculated flux in heavy exercise, we lack precise information regarding active muscle mass, mitochondrial NADH/NAD+ and acetyl-CoA/CoA ratios, and of other factors known to modulate the activity of the active enzyme [2, 20, 211. 91 Changes in these factors and in muscle pH presumably account for the differences seen between the three types of exercise we employed. The lack of change in pyruvate dehydrogenase activity in inactive muscle supports the dominant role of intramuscular factors in the control of the interconversion between the two forms of the enzyme, although in adipose tissue hormonal control may be important [231. The increase in muscle pyruvate concentration in all forms of exercise, particularly the maximal isometric activity, indicates that the enzyme is rate limiting, particularly in view of the fact that the increase in pyruvate concentration bore an inverse relationship to the degree of pyruvate dehydrogenase activation (Table 1). Conversion of the inactive into the active form of the enzyme may be of obvious importance in athletic events in which a rapid increase in aerobic processes is required, and anaerobic metabolism is kept to a minimum. Whipp & Wasserman [241 studied the kinetics of oxygen uptake at the onset of exercise, and suggested that well trained athletes increase oxygen uptake more rapidly at the onset of exercise than do untrained individuals. Although they suggested that this difference is due to a more rapid adaptation of oxygen delivery mechanisms at the onset of exercise, it is also possible that highly trained individuals are capable of increasing the flux through the pyruvate dehydrogenase reaction, and thus oxygen utilization, more rapidly than untrained subjects. Our demonstration of a difference between athletes and untrained subjects is consistent with an adaptive change occurring as a result of training. The production of lactate by muscle at the onset of exercise, or in heavy 'anaerobic' exercise, may not be due entirely to the classical concept of 'oxygen debt' but to an imbalance between the rate of glycolysis, controlled by phosphorylase and phosphofructokinase, and the rate of pyruvate incorporation into the tricarboxylic acid cycle, controlled by active pyruvate dehydrogenase. Acknowledgments Excellent technical assistance was provided by Rheal Leveille and Elizabeth Head. We thank Dr Robert Jungas for his invaluable advice in setting up the experimental technique. References [I1 GARLAND,P.B. & RANDLE,P.J. (1964) Control of pyruvate dehydrogenase in the perfused heart by the intracellular concentration of acetyl-coenzyme A. Biochemical Journal,91. 6C-IC. [21 DENTON,R.M., RANDLE,P.J., BRIDGES,B.J., COOPER,R.H., D.L., STANSSIE, D. & KERFIEY,A.L., PASSH.T.,SEVERSON, WHITEHOUSE, S. (1975) Regulation of mammalian pyruvate 92 G. R . Ward et al. dehydrogenase. Molecular and Cellular Biochemistry, 9, 27-53. 131 LI”, T.C., PEITIT, F.H. & REED,LJ. (1969) u-Keto acid dehydrogenase. wmplexes. X.Regulation of the activity of the pyruvate dehydrogenase complex from beef kidney mitochondria by phosphorylation and dephosphorylation. Proceedings of the National Academy of Sciences U.Sd., 62, 234-241. [4l DENTON,R.M., RANDLE,P.J. & MARTIN,B.R. (1972) Stimulation by calcium ions of pyruvate dehydrogenase phosphate phosphatase, Biochemical Journal, 128,161-163. I51 HAVEL,RJ. (1971) Influences of intensity and duration of exercise on supply and use of fuels. In: Muscle Metabolism During Exercise, pp. 315-325, Ed. Pernow, B. & Saltin, B. Plenum Press, New York. 161 WAHREN, J., FELIG,P., AHLBORG, G. & JORPELDT, L. (1971) Glucose metabolism during leg exercise in man. Journal of Clinical Investigation, 50,2715-2725. 171 HAGG, S.A., TAYLOR, S.I. & RUDERMAN,N.B. (1976) Glucose metabolism in perfused skeletal muscle. Pyruvate dehydrogenase activity in starvation, diabetes and exercise. Biochemical Journal, 158,203-210. IS1 HENNIG,G., L~PFLER,G. & WIELAND,O.H. (1975) Active and inactive forms of pyruvate dehydrogenase in skeletal muscle as related to the metabolic and functional state of the muscle cell. FEBS Letters, 59, 142-145. ELM. (1981) Clinical Exercise (91 JONES,N.L. & CAMPBELL, Testing, 2nd edn, pp. 139-144. W.B. Saunders Co., Philadelphia. J. (1962) Muscle electrolytes in man determined [lo1 BERGSTR~M, by neutron activation analysis on needle biopsy speciments. A study on normal subjects, kidney patients, and patients with chronic diarrhea. Scandinavian Journal of Clinical and Laboratory Investigation, 68,1-110. [ l l l EDWARDS, R.H.T., HARRIS,R.C., HULTMAN, E.,KALJSER, L., HOG, D. & NORDESJO, L.-0. (1972) Effect of temperature on muscle energy metabolism and endurance during successive isometric contractions, sustained to fatigue, of the quadriceps muscle in man. Journal of Physiology (London), 220, 335-352. [ 121 TAYLOR, S.I. & JUNGAS,R.L. (1974) Regulator of lipogenesis in adipose tissue: the significance of the activation of pyruvate dehydrogenase by insulin. Archives of Biochemistry and Biophysics, 164.12-19. [131 WARD, G.R. (1979) The regulation of pyruvate dehydrogenase in skeletal muscle in vivo and perfused heart. Ph.D. Thesis, McMaster University. 1141 TOEWS,C.J., Low, C. & RUDERMAN,N.B. (1970) The regulation of gluconeogenesis. The effect of pent-4cnoic acid on gluconeogenesis and on the gluwneogenesis metabolite concentrations of isolated perfused rat liver. Journal of Biological Chemistry, 245,s 18-824. J. & HULTMAN, E. (1966) The effect of exercise [151 BERGSTR~M, on muscle glycogen and electrolytes in normals. Scandinavian Journal of Clinical and Laboratory Investigation, 18.16-20. B. & JONES, N.L. (1967) Uptake and [161 HAVEL,R.J., PERNOW, release of free fatty acids and other metabolites in the legs of exercising men. Journal of Applied Physiology, 23,9&96. 1171 RANDLE,P.J., GARLAND,P.B., HALES,C.M., NEWSHOLME, E.A., DENTON,R.M. & POGSON,C.I. (1966) Protein hormones. Interactions of metabolism and the physiological role of insulin. Recent Progress in Hormone Research, 22,1-48. [181 P E ~ I TF.H., , PELLEY,J.W.& REED,L J . (1975) Regulation of pyruvate dehydrogenase kinase and phosphatase by acetyl-CoAlCoA and NADHINAD ratios. Biochemical and Biophysical Research Communications,65,575-582. 1191 COOPER,R.H., RANDLE,P.J. & DENTON, R.M. (1975) Stimulation of phosphorylation and inactivation of pyruvate dehydrogenase by physiological inhibitors of the pyruvate dehydrogenase reaction. Nature (London), 257,808-809. I201 HANSPORD, R.G. & COHEN,L. (1978) Relative importance of pyruvate dehydrogenase interconversion and feed-back inhibition in the effect of fatty acids on pyruvate oxidation by rat heart mitochondria. Archives of Biochemistry and Biophysics, 191,65-81. 1211 DENTON,R.M., MCCORMACK, J.G. & EDGELL,N.J. (1980) Role of calcium ions in the regulation of intramitochondrial metabolism. Biochemical Journal, 190,107-1 17. [221 NEWSHOLME, E.A., ZAMMIT, V.A. & CRABTREE,B. (1978) The role of glucose and glycogen as fuels for muscle. Biochemical Sociery Transactions, 6,5 12-520. [231 JIJNGAS,R.L. (1970) The effect of insulin on fatty acid synthesis from pyruvate, lactate, or endogenous sources in adipose tissue: evidence for the hormonal regulation of pyruvate dehydrogenase.Endocrinology, 86.1368-1375. K. (1972) Oxygen uptake 1241 WHIPP, BJ. & WASSEXMAN, kinetics for various intensities of constant-load work. Journal OfApplied Physiology, 33,351-356.