This work was supported by training grants by the Department of Obstetrics and Gynecology, Baylor College of Medicine (ALG) and R-01 research grant (Grant # DK114689) for CSB, SC and JM from National Institutes of Health.

All animal procedures were approved by the Institutional Animal Care and Use Committee (IACUC) of the Baylor College of Medicine.
1. Preparation of [6,6-2H2]glucose
<ol>
	<li>One day before the procedure, prepare the stable isotope glucose tracer in normal saline. For this experiment, [6,6-2H2]glucose was used as a tracer to measure plasma glucose appearance rate. 
	NOTE: In this experiment, glucose production during fasting a...

<ol>
	<li>March, W. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+prevalence+of+polycystic+ovary+syndrome+in+a+community+sample+assessed+under+contrasting+diagnostic+criteria.">The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria.</a> Human Reproduction. 25 (2), 544-551 (2009).</li><li>Yildiz, B. O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence,+phenotype+and+cardiometabolic+risk+of+polycystic+ovary+syndrome+under+different+diagnostic+criteria.">Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria.</a> Human Reproduction. 27 (10), 3067-3073 (2012).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Revised+2003+consensus+on+diagnostic+criteria+and+long-term+health+risks+related+to+polycystic+ovary+syndrome.">Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.</a> Fertility and Sterility. 81 (1), 19-25 (2004).</li><li>Goodarzi, M. O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Polycystic+ovary+syndrome:+etiology,+pathogenesis+and+diagnosis.">Polycystic ovary syndrome: etiology, pathogenesis and diagnosis.</a> Nature Reviews. Endocrinology. 7 (4), 219-231 (2011).</li><li>Azziz, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Introduction:+Determinants+of+polycystic+ovary+syndrome.">Introduction: Determinants of polycystic ovary syndrome.</a> Fertility and Sterility. 106 (1), 4-5 (2016).</li><li>Baskind, N. E., Balen, A. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hypothalamic-pituitary,+ovarian+and+adrenal+contributions+to+polycystic+ovary+syndrome.">Hypothalamic-pituitary, ovarian and adrenal contributions to polycystic ovary syndrome.</a> Best Practice and Research. Clinical Obstetrics &amp; Gynaecology. 37, 80-97 (2016).</li><li>Burghen, G. A., Givens, J. R., Kitabchi, A. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correlation+of+hyperandrogenism+with+hyperinsulinism+in+polycystic+ovarian+disease.">Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease.</a> The Journal of Clinical Endocrinology and Metabolism. 50 (1), 113-116 (1980).</li><li>Bremer, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Polycystic+ovary+syndrome+in+the+pediatric+population.">Polycystic ovary syndrome in the pediatric population.</a> Metabolic Syndrome and Related Disorders. 8 (5), 375-394 (2010).</li><li>Dunaif, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Excessive+insulin+receptor+serine+phosphorylation+in+cultured+fibroblasts+and+in+skeletal+muscle.+A+potential+mechanism+for+insulin+resistance+in+the+polycystic+ovary+syndrome.">Excessive insulin receptor serine phosphorylation in cultured fibroblasts and in skeletal muscle. A potential mechanism for insulin resistance in the polycystic ovary syndrome.</a> The Journal of Clinical Investigation. 96 (2), 801-810 (1995).</li><li>H&#248;jlund, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impaired+insulin-stimulated+phosphorylation+of+Akt+and+AS160+in+skeletal+muscle+of+women+with+polycystic+ovary+syndrome+is+reversed+by+pioglitazone+treatment.">Impaired insulin-stimulated phosphorylation of Akt and AS160 in skeletal muscle of women with polycystic ovary syndrome is reversed by pioglitazone treatment.</a> Diabetes. 57 (2), 357-366 (2008).</li><li>Moghetti, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Divergences+in+insulin+resistance+between+the+different+phenotypes+of+the+polycystic+ovary+syndrome.">Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome.</a> The Journal of Clinical Endocrinology and Metabolism. 98 (4), 628-637 (2013).</li><li>Ovalle, F., Azziz, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Insulin+resistance,+polycystic+ovary+syndrome,+and+type+2+diabetes+mellitus.">Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus.</a> Fertility and Sterility. 77 (6), 1095-1105 (2002).</li><li>Dunaif, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Profound+peripheral+insulin+resistance,+independent+of+obesity,+in+polycystic+ovary+syndrome.">Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome.</a> Diabetes. 38 (9), 1165-1174 (1989).</li><li>Hutchison, S. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+exercise+on+insulin+resistance+and+body+composition+in+overweight+and+obese+women+with+and+without+polycystic+ovary+syndrome.">Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome.</a> The Journal of Clinical Endocrinology Metabolism. 96 (1), 48-56 (2011).</li><li>Stepto, N. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Women+with+polycystic+ovary+syndrome+have+intrinsic+insulin+resistance+on+euglycaemic-hyperinsulaemic+clamp.">Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp.</a> Human Reproduction. 28 (3), 777-784 (2013).</li><li>Basu, R., Schwenk, W. F., Rizza, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Both+fasting+glucose+production+and+disappearance+are+abnormal+in+people+with+&amp;#34;mild&amp;#34;+and+&amp;#34;severe&amp;#34;+type+2+diabetes.">Both fasting glucose production and disappearance are abnormal in people with &amp;#34;mild&amp;#34; and &amp;#34;severe&amp;#34; type 2 diabetes.</a> American Journal of Physiology, Endocrinology and Metabolism. 287 (1), 55-62 (2004).</li><li>Blesson, C. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sex+dependent+dysregulation+of+hepatic+glucose+production+in+lean+Type+2+diabetic+rats.">Sex dependent dysregulation of hepatic glucose production in lean Type 2 diabetic rats.</a> Frontiers in Endocrinology. 10, 538 (2019).</li><li>Caldwell, A. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+reproductive,+metabolic,+and+endocrine+features+of+polycystic+ovary+syndrome+in+female+hyperandrogenic+mouse+models.">Characterization of reproductive, metabolic, and endocrine features of polycystic ovary syndrome in female hyperandrogenic mouse models.</a> Endocrinology. 155 (8), 3146-3159 (2014).</li><li>Chappell, N. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prenatal+androgen+induced+lean+PCOS+impairs+mitochondria+and+mRNA+profiles+in+oocytes.">Prenatal androgen induced lean PCOS impairs mitochondria and mRNA profiles in oocytes.</a> Endocrine Connections. 9 (3), 261-270 (2020).</li><li>Chacko, S. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+gluconeogenesis+using+glucose+fragments+and+mass+spectrometry+after+ingestion+of+deuterium+oxide.">Measurement of gluconeogenesis using glucose fragments and mass spectrometry after ingestion of deuterium oxide.</a> Journal of Applied Physiology. 104 (4), 944-951 (2008).</li><li>Bier, D. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measurement+of+&amp;#34;true&amp;#34;+glucose+production+rates+in+infancy+and+childhood+with+6,6-dideuteroglucose.">Measurement of &amp;#34;true&amp;#34; glucose production rates in infancy and childhood with 6,6-dideuteroglucose.</a> Diabetes. 26 (11), 1016-1023 (1977).</li><li>Chacko, S. K., Sunehag, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gluconeogenesis+continues+in+premature+infants+receiving+total+parenteral+nutrition.">Gluconeogenesis continues in premature infants receiving total parenteral nutrition.</a> Archives of Disease in Childhood. Fetal and Neonatal Edition. 95 (6), 413-418 (2010).</li><li>Chacko, S. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+ghrelin+on+glucose+regulation+in+mice.">Effect of ghrelin on glucose regulation in mice.</a> American Journal of Physiology, Endocrinology and Metabolism. 302 (9), 1055-1062 (2012).</li><li>Marini, J. C., Lee, B., Garlick, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-surgical+alternatives+to+invasive+procedures+in+mice.">Non-surgical alternatives to invasive procedures in mice.</a> Laboratory Animals. 40 (3), 275-281 (2006).</li><li>Jacobs, J. D., Hopper-Borge, E. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Carotid+artery+infusions+for+pharmacokinetic+and+pharmacodynamic+analysis+of+taxanes+in+mice.">Carotid artery infusions for pharmacokinetic and pharmacodynamic analysis of taxanes in mice.</a> Journal of Visualized Experiments: JoVE. (92), e51917 (2014).</li><li>Ayala, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hyperinsulinemic-euglycemic+clamps+in+conscious,+unrestrained+mice.">Hyperinsulinemic-euglycemic clamps in conscious, unrestrained mice.</a> Journal of Visualized Experiments: JoVE. (57), e3188 (2011).</li><li>Kmiotek, E. K., Baimel, C., Gill, K. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methods+for+Intravenous+Self+Administration+in+a+Mouse+Model.">Methods for Intravenous Self Administration in a Mouse Model.</a> Journal of Visualized Experiments: JoVE. (70), e3739 (2012).</li><li>Marini, J. C., Lee, B., Garlick, P. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+urea+kinetic+studies+in+conscious+mice.">In vivo urea kinetic studies in conscious mice.</a> The Journal of Nutrition. 136 (1), 202-206 (2006).</li><li>Choukem, S. -. P., Gautier, J. -. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+to+measure+hepatic+insulin+resistance.">How to measure hepatic insulin resistance.</a> Diabetes Metabolism. 34 (6), 664-673 (2008).</li></ol>

Hyperglycemia and abnormal glucose metabolism/homeostasis are features of PCOS. Blood glucose level is maintained by a combination of glucose from diet and glucose production via glycogenolysis and gluconeogenesis and glycogenesis, under the control of hormone and enzymes. Hepatic glucose production is suppressed by the presence of increased circulating glucose levels. In disorders of abnormal glucose metabolism, regulation of the suppression of glucose production is compromised leading to hyperglycemia. While m...

Polycystic ovary syndrome (PCOS) is a common disorder occurring in 12%-20% of reproductive-aged women1,2. It is a complex disease resulting in variable phenotypes involving polycystic ovaries, irregular menses and clinical or laboratory evidence of hyperandrogenemia, and is typically diagnosed when a woman meets two of the three criteria3. A predominant aspect of PCOS, and a key factor in its pathogenesis, is metabolic derangements that are found in women who have the disease. Women with PCOS have higher incidences of insulin resistance, glucose intolerance, obesity, and metabolic syndrome3,4,5,6. Insulin resistance is not only a manifestation of the disease, but it is thought to contribute to its pathogenesis by potentiating the action of luteinizing hormone in the ovary thereby leading to increased androgen production7,8. Insulin resistance is thought to have several possible origins but studies suggest it may be due to abnormal patterns of insulin receptor signaling9,10. Studies have evaluated insulin resistance in PCOS patients using the gold standard technique of hyperinsulinemic-euglycemic clamp11,12,13,14,15. Women with PCOS, irrespective of BMI, have higher levels of insulin resistance compared with controls. Insulin control over glucose production is impaired in disorders of insulin resistance leading to excess glucose production. For example, diabetic patients have increased rates of gluconeogenesis and impaired suppression of glycogenolysis16. Furthermore, impaired suppression of glucose production has been observed in diabetic rats17. Although clamp studies can give a measurement of insulin resistance, few studies in PCOS focus on direct measurement of glucose production in fasting and fed states. This requires the use of a non-radioactive isotopic glucose tracer infusion and measurement via mass spectrometry.
Animal models have been extensively used in PCOS research. Both lean and obese-type PCOS murine models have been created by administering androgens prenatally, prepubertally, or post-pubertally18. Rodent PCOS models also demonstrate metabolic differences compared with their respective controls. Previous data from our lab demonstrated abnormal glucose tolerance tests (GTT) in PCOS mouse models (lean and obese), consistent with human PCOS literature19. Use of a lean and obese animal model allows further investigation into metabolic differences. Specifically, this model allows evaluation of the rate of glucose production directly using isotopic glucose tracers. One of the most commonly used stable isotopic glucose tracer is [6,6-2H2]glucose. The [6,6-2H2]glucose enrichment can be measured using a pentaacetate derivative as previously described20.
In this study, our aim was to measure the rate of hepatic glucose production in fasting and glucose-rich state in PCOS mice using isotopic glucose infusion. These techniques can be applied to a wide range of experiments involving glucose kinetics.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% sodium chloride solution</td>
			<td>McKesson</td>
			<td>275595</td>
			<td></td>
		</tr>
		<tr>
			<td>10 mL BD Luer-Lok tip syringe</td>
			<td>VWR</td>
			<td>75846-756</td>
			<td>Two syringes per animal (one for isotopic glucose solution, one for glucose-rich isotopic solution)</td>
		</tr>
		<tr>
			<td>1-inch clear transpore tape</td>
			<td>3M</td>
			<td>70200400169</td>
			<td></td>
		</tr>
		<tr>
			<td>1-inch Labeling tape</td>
			<td>Fisher</td>
			<td>GS07F161BA</td>
			<td>Brand is example</td>
		</tr>
		<tr>
			<td>5 mL syringe containing heparanized saline flush</td>
			<td>McKesson</td>
			<td>191-MIH-2235</td>
			<td>One can also prepare a heparin flush solution (10 units/mL heparin in 0.9% sodium chloride)</td>
		</tr>
		<tr>
			<td>5 mm Medipoint Goldenrod animal lancets</td>
			<td>Fisher Scientific</td>
			<td>NC9891620</td>
			<td>5 mm if animal is between 2 and 6 months</td>
		</tr>
		<tr>
			<td>Acetone</td>
			<td>Sigma-Aldrich</td>
			<td>650501</td>
			<td></td>
		</tr>
		<tr>
			<td>Advanced hot plate stirrer</td>
			<td>VWR</td>
			<td>97042-602</td>
			<td>Brand is example</td>
		</tr>
		<tr>
			<td>BD 27 gauge 0.5 inch needles</td>
			<td>Health Warehouse</td>
			<td>A283952</td>
			<td></td>
		</tr>
		<tr>
			<td>BD 30 gauge 0.5 inch needles</td>
			<td>Medvet</td>
			<td>305106</td>
			<td></td>
		</tr>
		<tr>
			<td>BD Intramedic Polyethylene (PE) tubing 0.28 mm ID x 0.61 mm</td>
			<td>VWR</td>
			<td>63019-004</td>
			<td></td>
		</tr>
		<tr>
			<td>BD Intramedic Polyethylene (PE) tubing 0.28 mm ID x 0.61 mm</td>
			<td>VWR</td>
			<td>63019-004</td>
			<td></td>
		</tr>
		<tr>
			<td>Beaker, 1000 mL</td>
			<td></td>
			<td></td>
			<td>Any brand</td>
		</tr>
		<tr>
			<td>Caging pellets</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Clear VOA glass vials with closed-top cap</td>
			<td>Fisher Scientific</td>
			<td>05-719-120</td>
			<td>For storage of acetone and blood draw samples</td>
		</tr>
		<tr>
			<td>Copper toothless alligator clamp for tourniquet</td>
			<td>Amazon</td>
			<td></td>
			<td>Any Brand; smooth toothless alligator clips made of solid copper</td>
		</tr>
		<tr>
			<td>D-(+)-glucose &#62;99.5%</td>
			<td>Sigma-Aldrich</td>
			<td>G8270</td>
			<td></td>
		</tr>
		<tr>
			<td>D-glucose (6,6-D2, 99%)</td>
			<td>Cambridge Isotope Laboratories, Inc.</td>
			<td>DLM-349-PK</td>
			<td></td>
		</tr>
		<tr>
			<td>Dow Corning silastic tubing 0.3 mm ID x 0.64 mm OD</td>
			<td>VWR</td>
			<td>62999-042</td>
			<td></td>
		</tr>
		<tr>
			<td>Magnifying glass</td>
			<td>Amazon</td>
			<td></td>
			<td>Any brand; similar to LANCOSC Magnifying Glass with Light and Stand</td>
		</tr>
		<tr>
			<td>Microbalance</td>
			<td>Ohaus Adventurer Pro</td>
			<td>AV264C</td>
			<td>Any similar model with 0.0001g accuracy can be used</td>
		</tr>
		<tr>
			<td>Nalgene bottle, 500 mL</td>
			<td>Sigma-Aldrich</td>
			<td>B0158-12EA</td>
			<td>Or any Similar brand; saw in half (including lid) and cut tail-sized notch in the bottom</td>
		</tr>
		<tr>
			<td>PHD Ultra multi-syringe pump</td>
			<td>Harvard Apparatus</td>
			<td>70-3024A</td>
			<td></td>
		</tr>
		<tr>
			<td>Plexiglass sheet</td>
			<td></td>
			<td></td>
			<td>Any brand; to stabalize mouse during catheter insertion</td>
		</tr>
		<tr>
			<td>Plexiglass sheets and dividers</td>
			<td></td>
			<td></td>
			<td>Any brand; used to cage mice during infusion</td>
		</tr>
	</tbody>
</table>

evaluation of hepatic glucose production in a polycystic ovary syndrome mouse model

Polycystic ovary syndrome (PCOS) is a common disease that results in disorders of glucose metabolism, such as insulin resistance and glucose intolerance. Dysregulated glucose metabolism is an important manifestation of the disease and is the key to its pathogenesis. Therefore, studies involving evaluation of glucose metabolism in PCOS are of utmost importance. Very few studies have quantified hepatic glucose production directly in PCOS models using non-radioactive glucose tracers. In this study, we discuss step-by-step instructions for the quantification of the rate of hepatic glucose production in a PCOS mouse model by measuring M+2 enrichment of [6,6-2H2]glucose, a stable isotopic glucose tracer, via gas chromatography - mass spectrometry (GCMS). This procedure involves creation of stable isotopic glucose tracer solution, use of tail vein catheter placement and infusion of the glucose tracer in both fasting and glucose-rich states in the same mouse in tandem. The enrichment of [6,6-2H2]glucose is measured using pentaacetate derivative in GCMS. This technique can be applied to a wide variety of studies involving direct measurement of the rate of hepatic glucose production.

Using previously described isotope dilution equations, the total plasma glucose rate (glucoseRa) was calculated from M+2 enrichment of [6,6-2H2]glucose in fasting and glucose-rich conditions using the pentaacetate derivative21. Under steady-state conditions, it is assumed that rate of appearance of glucose is equal to the rate of disappearance of glucose. In the control group, the total glucoseRa was 19.98 &#177; 2.53 mg/(kg&#183;min) after 6 h fasting a...

Watch this Scientific Journal Video about Evaluation of Hepatic Glucose Production in a Polycystic Ovary Syndrome Mouse Model at JoVE.com

Evaluation of Hepatic Glucose Production in a Polycystic Ovary Syndrome Mouse Model

This study describes the direct measurement of hepatic glucose production in a polycystic ovary syndrome mouse model by using a stable isotopic glucose tracer via tail vein in both fasting and glucose-rich states in tandem.

Polycystic ovary syndrome (PCOS) is a common disease that results in disorders of glucose metabolism, such as insulin resistance and glucose intolerance. ...

The goal of this procedure is to determine hepatic glucose production in a polycystic ovary syndrome, or PCOS mouse model. Dysregulated glucose metabolism is an important manifestation of PCOS and is key to its pathogenesis. Therefore, studies involving evaluation of glucose metabolism in PCOS are of utmost importance.In this study, we discuss step-by-step instructions for the quantification of the rate of hepatic glucose production in a PCOS mouse model by measuring the M plus two enrichment of six six deuterated glucose, a stable isotopic glucose tracer, via gas chromatography, mass spectrometry, or GCMS. This procedure of involves creation of a stable isotopic glucose tracer solution, use of tail vein catheter placement and infusion of the glucose tracer in both fasting and glucose-rich states in the same mouse in tandem. One day before the procedure, prepare the stable isotope glucose tracer in normal saline.For this experiment, glucose production during fasting in glucose-rich conditions were measured so the glucose isotope was prepared in two different preparations. The tracer was prepared under sterile conditions by dissolving sterile and pyrogen-free six six deuterated glucose and sterile 0.9%sodium chloride solution with or without glucose. The first infusate was prepared with only the tracer.The second infusate contained both the tracer along with the nonisotopic glucose. Once the solutions were prepared, they were sterile filtered with the 0.22 micron filter and stored at four degrees Celsius. The solutions were prepared in such a way that the final infusing dose was close to one milligram per kilogram and minute and two milligrams per kilogram and minute respectively.For the glucose appearance rate measurement during basal condition in glucose-rich condition, a primed average constant rate infusion of six six deuterated glucose at 1.08 milligrams per kilogram and minute and 1.9 milligrams per kilogram in minute respectively were used. In order to mimic fed state, we employed an average D-glucose infusion rate of 18.8 milligrams per kilogram and minute during glucose-rich condition. Remove the mice from their home cages, and place them in their fasting cages three hours prior to the start of the experiment.For this experiment, we used four month-old female mice from the C57BL6J strain. Assemble the caging equipment by grouping the mice into a set number of mice per insulin pump. Place partitions on top of a flat, stable base to make individual stalls for the mice.Cages are clear and made out of plexiglass. There is a flat, stable base upon which the partitions sit. The door to the cage slides to close and has a notch at the bottom to allow the tail to fit through.Assemble the syringes containing one milliliter of basal infusate, then connect to infusion pump tubing using the polyethylene tubing. Prepare the infusion pump by setting the rate to 150 microliters an hour, which is the basal rate. Heat a water bath to 48 degrees Celsius.Prepare the catheter insertion station adjacent to the water bath containing the 30 gauge half-inch needles, silastic tubing, and one-inch, clear transport tape. Select one mouse and place it in a secure holder with access to the tail. Place a piece of tape over the proximal portion of the tail to allow space for the catheter insertion more distally.Bring the mouse to the water bath, and insert the tail in the water bath for approximately 30 to 45 seconds. This helps to dilate the tail vasculature for catheter placement. The catheter insertion must be done under sterile conditions.Once the tail's warmed, clean the tail, and place a small copper toothless alligator clamp as a tourniquet at the proximal end of the tail. Visualize the lateral tail vein under a magnifying glass. Then, carefully insert the catheter into the tail vein, and flush the solution gently to ensure patency of the catheter.Wrap a piece of transport tape around insertion site to secure the catheter, and remove the small tourniquet from the tail. Place the mouse in its individual cage and close the sliding door, ensuring that the tail's protruding through the notch and remains outside of the cage. Place an additional piece of tape over the whole catheter and the tail to secure it to the base plate of the cage.Disconnect the flush from the tail vein catheter, and place the small clamp on the catheter's silastic tubing to prevent backflow while connecting the infusate line from the pump. Once securely connected, remove the clamp and flush the priming solution which consists of the infusate. Ensure that the solution is clear in the tube and not blood-stained.Once infusion lines are noted to be functioning properly, remove the cover from the mouse. Place standard bedding around the mouse. Start the infusion with the infusate containing the tracer, and run it for three hours continuously.For the duration of the infusion, continue to check mice well-being, as well as the infusion lines. Ensure that the infusion tubing is properly secured and that there's no leaks from the line connection points. After the first infusion has completed, stop the infusion and place a clamp on the tubing of the catheter to prevent backflow.Gently removed the mice from their enclosures without disturbing the catheter in order to collect blood. For this experiment, the mice underwent cheek vein puncture using a four millimeter lancet. Collect approximately 75 microliters of blood into your desired vial.To deproteinize samples in preparation for mass spectrometry, add approximately 15 microliters of blood to 500 microliters of acetone. Remaining blood can be used to check blood glucose level via glucometer and/or a centrifuge to separate plasma for future hormone assays. Remove the infusate from the syringe pumps by disconnecting the tubing from the syringes, and replace it with the second infusate containing tracer along with glucose.Repeat previous infusion steps using the glucose-rich isotopic glucose infusion. To reach steady state, run a bolus of the second infusate at 600 microliters an hour for 15 minutes. Note the starting time for each group of cages.Decrease the infusion rate to 150 microliters an hour to complete the three hours of total infusion time. Repeat blood sampling as previously described. Disconnect infusions, apply pressure at the catheter sites until the bleeding stops, and return the mice to their home cages.Next, the samples are sent for GCMS. Calculate the isotopic enrichment of the glucose isotope under glucose peak by GCCMS using the pentaacetate derivative. Briefly, this method involves preparation of the pentaacetate derivative of glucose, followed by sample analysis using GCMS in the positive chemical ionization mode.Selective ion monitoring of the mass-to-charge ratio, 171 to 169, is performed to determine the M plus two enrichment of the glucose isotope. All kinetic measurements are performed assuming steady state conditions. Calculate total plasma glucose appearance rate from the M plus two enrichment of the glucose isotope and plasma using established isotope dilution equations.Under steady state conditions, it is assumed that the rate of appearance of glucose is equal to the rate of disappearance of glucose. Rate of endogenous glucose production equals total plasma glucose rate minus exogenous glucose. Table one includes the representative results from the study.All units are expressed as milligram per kilogram and minute. Using previously described isotope dilution equations, total plasma glucose rate was calculated. In the control group, the mean glucose rate of appearance was 19.98 in the fasting state.In glucose-rich conditions, the glucose rate of appearance was 25.8. Glucose production rate was 19.08 in the fasting state and 8.56 in the glucose-rich state. Abnormal glucose metabolism and homeostasis are common in PCOS.In disorders of abnormal glucose metabolism, regulation of the suppression of glucose production is compromised leading to hyperglycemia. In this study, we describe a straightforward way to measure the rate of hepatic glucose production in multiple mice at the same time. The critical components of this experiment are the catheter insertion and defining the exact measurements of the glucose isotope and natural glucose in order to adequately perform GCMS.The advantages of the study is accomplishing the infusion in a minimally invasive fashion due to tail vein catheter insertion, as well as use of an easily attainable, stable glucose tracer. There are some limitations to the study, including the technical demand of the procedure and need for possible additional skills. Overall, we describe a straightforward, accurate way to measure the rate of total hepatic glucose production in a PCOS mouse model.This technique could serve as the foundation for multiple studies involving glucose metabolism of mouse models.

evaluation-hepatic-glucose-production-polycystic-ovary-syndrome-mouse

Research

JoVE Journal

Medicine

2.8K visualizações.  Baylor College of Medicine. O objetivo deste procedimento é determinar a produção de glicose hepática em uma síndrome do ovário policístico, ou modelo de rato PCOS. O metabolismo de glicose disregulado é uma manifestação importante do SPC e é a chave para sua patogênese. Portanto, estudos envolvendo avaliação do metabolismo da glicose no PCOS são de extrema importância.Neste estudo, discutimos instruções passo a passo para a quantificação da taxa de produção de glicose hepática em um modelo...