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Clinical Chemistry 47: 525-531, 2001;
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(Clinical Chemistry. 2001;47:525-531.)
© 2001 American Association for Clinical Chemistry, Inc.


Articles

Development of a Stable-Isotope Dilution Assay for {gamma}-Aminobutyric Acid (GABA) Transaminase in Isolated Leukocytes and Evidence That GABA and ß-Alanine Transaminases Are Identical

Danielle S.M. Schor1, Eduard A. Struys1, Boris M. Hogema1,2, K. Michael Gibson2 and Cornelis Jakobs1,a

1 Metabolic Unit, Department of Clinical Chemistry, University Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.

2 Department of Molecular and Medical Genetics, Biochemical Genetics Laboratory, Oregon Health Sciences University, Portland, OR 97201.
a Author for correspondence. Fax 31-20-4440305; e-mail C.Jakobs{at}azvu.nl.


   Abstract
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Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
Background: Several methods have been published for measuring {gamma}-aminobutyric acid transaminase (GABA-T) activity, but these methods are either impracticable because of the use of radioisotopes or insufficiently sensitive to determine small enzyme activities in leukocyte extracts. We developed a direct and sensitive enzyme method.

Methods: We developed a stable-isotope dilution method for the measurement of [15N]glutamic acid derived from [15N]GABA and {alpha}-ketoglutaric acid, catalyzed by GABA-T. The method for analysis of [15N]glutamic acid comprised a solid-phase extraction procedure to isolate this analyte from incubation samples. After derivatization, [15N]glutamic acid was quantified by gas chromatography–mass spectrometry relative to its 2H5-labeled internal standard. In addition to [15N]GABA, [15N]ß-alanine was a cosubstrate.

Results: GABA-T-deficient lymphoblasts showed diminished enzyme activity, with both [15N]GABA and [15N]ß-alanine as substrate. Vigabatrin inhibited the enzyme activity for both substrates.

Conclusions: The activity of GABA-T can be accurately determined by our procedure using 15N-labeled substrate, measuring the formation of [15N]glutamic acid. Our results with [15N]ß-alanine indicate that GABA and ß-alanine transaminases are identical.


   Introduction
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Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
{gamma}-Aminobutyric acid (GABA)1 is found predominantly in brain where it is an important inhibitory neurotransmitter. However, GABA is also detected in the peripheral system, endocrine, and several nonneural tissues where it plays a role in oxidative metabolism (1). The enzymes responsible for GABA metabolism in the brain are the GABA synthetic enzyme glutamate decarboxylase (EC 4.1.1.15) and the GABA catabolic enzymes GABA transaminase (GABA-T; EC 2.6.1.19) and succinic semialdehyde (SSA) dehydrogenase (EC 1.2.1.24).

GABA-T is the enzyme that mediates the conversion of GABA to SSA, using {alpha}-ketoglutarate ({alpha}KG) as nitrogen acceptor, yielding glutamic acid (Fig. 1 ).



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Figure 1. Formation of glutamic acid during the degradation of GABA by GABA-T, using {alpha}KG as nitrogen acceptor.

In addition to glutamic acid, SSA is produced in the GABA-T reaction.

Only two patients have been described with GABA-T deficiency. These two patients had similar clinical findings, and both had increased concentrations of free and total GABA in plasma and cerebrospinal fluid (CSF). In the first patient, reported by Jaeken et al. in 1984 (2), the enzyme defect was documented in liver tissue by a radiometric assay (3). Subsequently, the GABA-T deficiency was demonstrated in lymphocytes and lymphoblasts derived from the same patient, also by a radiometric method (4). The second patient was documented in 1999 (5). Mean GABA-T activity in extracts of leukocytes of this patient was 27% of control, measured by the same method used to measure activity in leukocytes of the first patient (0.9% of control). In addition to these two patients, there were two other patients who manifested increased CSF GABA but were diagnosed as having hyper-ß-alaninemia (6)(7). This disease is named after another accumulating compound in their plasma and CSF, namely ß-alanine (ßALA). ßALA was also increased in the plasma and CSF from the first GABA-T patient (no results known for the second patient). There remains the problem of distinguishing between GABA-T deficiency and hyper-ß-alaninemia and whether they involve different enzymes or the same affected enzyme with different disease phenotypes (8).

Several methods for measuring GABA-T activity have been published (9)(10)(11), but all of these methods are indirect, nonspecific, and/or not sensitive enough to be used in a crude tissue preparation. The radiometric assay, using 14C-labeled {alpha}KG and unlabeled GABA as substrates, is nonspecific, indirect, and determines the radioactive glutamate formed by measuring the 14CO2 released by a coupled assay using a bacterial glutamate decarboxylase (12). An alternative method is a modification of the procedure of White (13). [U-14C]GABA is used as substrate, and the [U-14C]SSA formed during incubation is measured as the methoxime derivative, which is separated from radiolabeled GABA by reversed-phase HPLC (4). This method is impracticable in many laboratories because it uses considerable amounts of radioactivity. We developed a new method, exploiting the role of {alpha}KG as nitrogen acceptor in the GABA degradative pathway. We used [15N]GABA as substrate and analyzed [15N]glutamate (after derivatization) by gas chromatography–mass spectrometry (GC-MS) using [2,3,3,4,4-2H5]glutamic acid as internal standard.

Other studies report that the mammalian enzyme GABA-T reacts with ßALA to the same extent as with GABA, whereas ßALA is poorly transaminated by the enzyme derived from bacteria or yeast (14)(15). To investigate whether this compound is metabolized by the enzyme GABA-T in human leukocytes (especially in cells of a GABA-T-deficient patient), the applicability of our new method was expanded by the use of [15N]ßALA as substrate. We applied this method to measure enzyme activity in lysates of lymphoblast lines of six control individuals and one patient, and in lysates of lymphocytes of six control individuals.


   Materials and Methods
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Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
biological samples
Whole venous blood from six control individuals was added to 1.5 mL of acid-citrate dextrose and stored at room temperature up to 48 h. Written consent was obtained from each subject. Lymphoblast lines derived from six control individuals and the patient were maintained in RPMI-1640 medium supplemented with 100 mL/L fetal bovine serum. The lymphoblast lines used in this study as controls were originally obtained for carrier screening. No defect was found, and the samples were anonymized. Blood obtained from the GABA-T-deficient patient for production of lymphoblasts was obtained with informed parental consent. Clinical details of the patient have been reported (2).

chemicals
Unless otherwise stated, all chemicals and reagents were purchased from Sigma, Merck, or Baker. [15N]GABA was obtained from ISOTEC, [15N]ßALA from Witega, and [2,3,3,4,4-2H5]glutamic acid from MSD Isotopes.

preparation of the complete buffer
The complete buffer was a 50 mmol/L potassium phosphate buffer (pH 8.0), supplemented with 0.25 mmol/L dithiothreitol, 0.05 mmol/L disodium EDTA, and 0.1 mmol/L pyridoxal-5-phosphate.

isolation and preparation of lymphocytes and lymphoblasts
Lymphocytes were isolated from whole blood using AccuspinTM tubes with Histopaque® (Sigma) and washed twice with Hanks’ Balanced Salt Solution (HBSS; Life Technologies) supplemented with 1 g/L bovine serum albumin and one time with HBSS. Lymphoblasts were harvested by centrifugation, and the cells were washed twice with HBSS. Pellets were resuspended in complete buffer on ice. Cells were lysed by sonic disruption (three times 10 s at standard capacity) using a Soniprep 150 Ultrasonic Desintegrator (MSE). Lysates were centrifuged for 5 min at 4 °C and 8800g. After the protein concentration was measured (bicinchoninic acid protein assay; Sigma), the supernatant was used for the enzyme assay.

enzyme assay
GABA-T activity was assayed using a modification of the procedure of Gibson et al. (4). After optimization, the enzymatic assay was performed as follows: in a total volume of 100 µL of complete buffer, each incubation contained 135 nmol of {alpha}-ketoglutaric acid monopotassium salt, 500 nmol of [15N]GABA or [15N]ßALA, and an aliquot of lymphocyte or lymphoblast lysate corresponding to 50 µg of protein. The incubation was carried out in a capped 1-mL vial for 4–20 h at 37 °C. The incubation was terminated by the addition of 10 µL of 4.2 mol/L perchloric acid. The solution was neutralized by the addition of 7 µL of 6 mol/L potassium hydroxide. After 2 nmol of [2,3,3,4,4-2H5]glutamic acid was added as internal standard, the denatured protein and insoluble potassium perchlorate were removed by centrifugation. The resulting supernatant was prepared as described below for analysis of glutamic acid by GC-MS.

sample preparation for gc-ms measurement of glutamic acid
Glutamic acid was converted to its N-carbamyl derivative by the addition of 900 µL of H2O, 800 µL of 1 mol/L sodium phosphate buffer (pH 11.5), and 50 µL of methyl chloroformate to the supernatant. The mixture was incubated for 10 min at room temperature. The solution was acidified with 210 µL of 6 mol/L HCl and applied to an OASIS solid-phase extraction column (60 mg, 3 mL; Waters) that was conditioned with 1 mL of methanol followed by 1 mL of 0.5 mol/L HCl. After the sample was passed through by gravity, the column was rinsed with 500 µL of 0.5 mol/L HCl. The glutamic acid-N-carbamyl derivative was eluted from the column with two 500-µL aliquots of methanol and methylated directly by the addition of 20 µL of 6 mol/L HCl and heating for 1 h at 120 °C. After evaporation, the residue was dissolved in 50 µL of ethyl acetate. From this fraction, 1 µL was used for GC-MS analysis of glutamic acid.

gc-ms
GC-MS analyses were performed on a Hewlett Packard system consisting of a Hewlett Packard 5890 series II gas chromatograph and Hewlett Packard Engine 5989B mass spectrometer. GC separation of the di-methyl-N-carbamyl derivative was achieved on a very polar column (BPX70; 25 m x 0.32 mm; film thickness, 0.25 µm; Scientific Glass Engineering) using helium as carrier gas. The injector temperature was 240 °C, and the injection volume was 1 µL. After 1 min at 100 °C, the column temperature was increased at 20 °C/min to 280 °C. The interface temperature was set at 290 °C, the source temperature was 200 °C. The mass spectrometer was used in the electron-impact (EI) mode. Selected-ion monitoring of the m/z 174, 175, and 179 ions was performed for glutamic acid, [15N]glutamic acid, and the labeled internal standard, respectively.


   Results
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Materials and Methods
Results
Discussion
References
 
ei mass spectra
The EI mass spectra of the di-methyl-N-carbamyl derivatives of glutamic acid and its deuterated analog are given in Fig. 2 . The [M - 59] fragment (m/z 174) in the EI mass spectrum of the unlabeled compound is most likely attributable to the loss of -COOCH3 from the carbamyl moiety. The m/z 175 fragment in this spectrum is derived from the naturally occurring isotope of the unlabeled glutamic acid (8.44%) and interferes with the ion peak area of [15N]glutamic acid in the samples. In the mass spectrum of the labeled internal standard, the [M - 59] fragment (m/z 179) is of the same origin as the m/z 174 fragment in the unlabeled analog. A small m/z 175 fragment is visible, the origin of which is not clear, but we have observed it as a constant amount of 2.98% from the ion peak area of the m/z 179 fragment. Selected-ion monitoring mass fragmentograms obtained from a control lymphoblast line and from the GABA-T-deficient patient are shown in Fig. 3 .



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Figure 2. EI mass spectra of di-methyl-N-carbamyl derivatives of glutamic acid (top) and [2,3,3,4,4-2H5]glutamic acid (bottom).



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Figure 3. Mass fragmentograms of glutamic acid from a control lymphoblast line (A) and from a GABA-T-deficient patient (B).

m/z 174 ([M - 59]), m/z 175 ([M - 59]), and m/z 179 ([M - 59]) were monitored for the methyl esters of unlabeled glutamic acid, [15N]glutamic acid, and the internal standard, respectively.

calculations
Enzyme activity is directly related to the formation of [15N]glutamic acid during the incubation with [15N]GABA or [15N]ßALA. To quantify the amount of [15N]glutamic acid formed during the assay, it was necessary to correct the area of the m/z 175 peak for interference of the internal standard (2.98% of the area from the m/z 179 peak) and of the natural occurring isotope abundance (8.44% of area from the m/z 174 peak). Hereafter, [15N]glutamic acid was quantified relative to its 2H5-labeled internal standard.

assay conditions
Although we started from the procedure of Gibson et al. (4) to assay GABA-T, it seemed to be worthwhile to optimize the assay conditions; formation of a different reaction product was measured ([15N]glutamic acid instead of [U-14C]SSA) and other conditions required optimization to determine maximum activity of the enzyme. Moreover, [15N]ßALA was introduced as a new substrate, and optimal assay conditions needed to be established.

With the assay conditions described in Materials and Methods, the production of [15N]glutamic acid after incubation with 500 nmol of [15N]GABA or [15N]ßALA was linear up to 100 µg of protein, linear with time up to 20 h, and optimal at pH 8.0 (not shown). For the dependence of the enzyme activity on the amount of [15N]GABA or [15N]ßALA, it was found that full activity was achieved when at least 5 mmol/L [15N]GABA was used, whereas incubating with 12 mmol/L [15N]ßALA was not sufficient to attain optimal activity (Fig. 4 ). The mathematical treatment of the direct linear plot (16) yielded apparent Michaelis constants (Kms) of 1.7 and 4.4 mmol/L for [15N]GABA and [15N]ßALA, respectively. Both substrates had similar activities at 500 nmol, the amount used for standard reaction conditions. Formation of [15N]glutamic acid was optimal at an {alpha}KG concentration of 1.35 mmol/L. Pyridoxal 5-phosphate at a concentration of 0.1 mmol/L was sufficient. Higher concentrations of {alpha}KG inhibited the reaction (results not shown). On the basis of the experiments described above, we selected the standard reaction conditions described in Materials and Methods. In addition to differences in optimal substrate concentrations, both substrates required similar conditions to achieve optimal enzyme activity.



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Figure 4. Dependency of GABA-T activity on the concentrations of [15N]GABA and [15N]ßALA.

Full activity for [15N]GABA was achieved at concentration of 5 mmol/L, whereas for [15N]ßALA, >12 mmol/L was needed. The apparent Kms were 1.7 and 4.4 mmol/L for [15N]GABA and [15N]ßALA, respectively.

gaba-t activity measurements in lysates of lymphoblasts and lymphocytes
The results of assays with [15N]GABA and [15N]ßALA for GABA-T are shown in Table 1 . The mean activity in extracts of six control lymphoblast lines, three assayed on two different occasions, was 46 ± 13 pmol·min-1·mg protein-1. The activity in lysates of lymphocytes obtained from six control individuals was approximately threefold higher. No difference in enzyme activity was measured between the two substrates [15N]GABA and [15N]ßALA (see controls C and G–L in Table 1 ) because 500 nmol of each was used. Lymphoblasts derived from the index patient showed deficient activity with both substrates; <0.5% of control enzyme activity was observed.


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Table 1. GABA-T activity with [15N]GABA and [15N]ßALA as substrates in cell sonicates derived from controls and patient.

effect of vigabatrin on gaba-t activity
Vigabatrin ({gamma}-amino-5-hexenoic acid) is known to irreversibly inhibit GABA-T activity of bacterial origin (17). To investigate the effect of vigabatrin on our assay, we performed the assay in the presence of 22, 44, and 220 µmol/L vigabatrin. As shown in Fig. 5 , degradation of [15N]GABA and [15N]ßALA in lymphoblasts is almost fully inhibited at a concentration of 220 µmol/L vigabatrin. Vigabatrin was more inhibitory in the reaction using [15N]ßALA than [15N]GABA.



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Figure 5. Effect of vigabatrin on GABA-T activity.

The enzyme was almost fully inhibited for both substrates at a vigabatrin concentration of 220 µmol/L.

effect of unlabeled gaba and ßala on gaba-t activity
To investigate the difference in affinity of GABA-T for both substrates, we incubated lymphoblast lysates with 400 nmol of [15N]GABA and 400 nmol of unlabeled ßALA, and with 400 nmol of [15N]ßALA and 400 nmol of unlabeled GABA. The effect of unlabeled ßALA on [15N]GABA degradation was minor (remaining activity, 88% of control), whereas the effect of unlabeled GABA on [15N]ßALA metabolism was significant (remaining activity, 34% of control; Table 2 ).


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Table 2. Effect of unlabeled GABA and ßALA on GABA-T activity in lymphoblasts.


   Discussion
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Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
We have developed a stable-isotope dilution method for measuring GABA-T activity in homogenates of lymphoblasts and lymphocytes. The fact that no source other than the 15N-labeled substrates for [15N]glutamate formation is possible, combined with the use of the deuterated internal standard [2,3,3,4,4-2H5]glutamic acid, produced a specific and very sensitive method to measure GABA-T activity. The activities measured in the lymphoblast lines of six controls were comparable to the activities in the same cell type presented earlier using a radiometric method (4). In the prior study, the results for lymphocytes were identical to the activities in lymphoblasts (4), whereas our findings were that the activities in extracts of lymphocytes were approximately three times higher. This difference in results can be explained by the duration of storage of the blood samples before isolation the lymphocytes. We stored the blood samples for at most 48 h, whereas the blood samples used in the previous study were stored 72 h at room temperature before lymphocyte isolation (4). It is possible that cell viability declined during storage of the whole blood. This would suggest the prudence of sending a parallel control with any diagnostic specimen. Although the results of both methods were comparable, we believe that the stable-isotope dilution method is preferable to the radiometric method. The stable-isotope dilution method obviates the use of considerable amounts of radioactive material, which is expensive, hazardous, and difficult to dispose.

The similarity in substrate utilization, including [15N]GABA and [15N]ßALA, by the enzyme GABA-T is an important finding in our work. For both patient and controls, there was no difference in enzyme activity for [15N]ßALA compared with [15N]GABA. Optimal conditions were approximately the same for both substrates. Vigabatrin inhibited enzyme activity, decreasing enzyme activity with both substrates. Unlabeled GABA and ßALA decreased the degradation of [15N]ßALA and [15N]GABA, respectively. These results, especially the finding that the patient was deficient for both substrates, add additional evidence to the concept that GABA-T and ßALA transaminase are identical enzymes. Hopefully, more patients will be diagnosed in the future, which will help us to determine whether GABA-T deficiency and hyper-ß-alaninemia are the same disorder.

In contrast to the similarities in substrate utilization by the enzyme GABA-T, there are some remarkable differences. The dependency of enzyme activity on the amounts of [15N]GABA and [15N]ßALA was different. At <500 nmol, the activity with [15N]GABA was higher, whereas at higher substrate amounts, the activity with [15N]ßALA was higher. In addition, although vigabatrin inhibited the degradation of both substrates, it appeared that there was still residual enzyme activity with [15N]GABA. Finally, from the experiment with unlabeled substrates, we conclude that GABA-T has higher affinity for [15N]GABA than for [15N]ßALA. This was confirmed by the finding that GABA-T had a lower Km for [15N]GABA than for [15N]ßALA.

In conclusion, we present a sensitive and accurate enzymatic assay for GABA-T. This new method can also be used to measure the activity of any transaminase that uses {alpha}KG as nitrogen acceptor, provided that optimal conditions are determined.


   Acknowledgments
 
We thank Jolanda Keek for supplying the control lymphoblast lines. Birthe Roos is gratefully acknowledged for technical assistance. We thank Dr. Nanda Verhoeven for helpful discussions on the manuscript.


   Footnotes
 
1 Nonstandard abbreviations: GABA, {gamma}-aminobutyric acid; GABA-T, GABA transaminase; SSA, succinic semialdehyde; {alpha}KG, {alpha}-ketoglutarate; CSF, cerebrospinal fluid; ßALA, ß-alanine; GC-MS, gas chromatography–mass spectrometry; HBSS, Hanks’ Balanced Salt Solution; and EI, electron impact.


   References
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Abstract
Introduction
Materials and Methods
Results
Discussion
References
 

  1. Tillakaratne NJK, Medina-Kauwe L, Gibson KM. {gamma}-Aminobutyric acid (GABA) metabolism in mammalian neural and nonneural tissues [Review]. Comp Biochem Physiol 1995;112:247-263.
  2. Jaeken J, Casaer P, De Cock P, Corbeel L, Eeckels R, Eggermont E, et al. {gamma}-Aminobutyric acid-transaminase deficiency: a newly recognized inborn error of neurotransmitter metabolism. Neuropediatrics 1984;15:165-169.[ISI][Medline] [Order article via Infotrieve]
  3. Wu J-Y, Moss LG, Chude O. Distribution and tissue specificity of 4-aminobutyrate-2-oxoglutarate aminotransferase. Neurochem Res 1978;3:207-219.[ISI][Medline] [Order article via Infotrieve]
  4. Gibson KM, Sweetman L, Nyhan WL, Jansen I. Demonstration of 4-aminobutyric acid aminotransferase deficiency in lymphocytes and lymphoblasts. J Inherit Metab Dis 1985;8:204-208.[ISI][Medline] [Order article via Infotrieve]
  5. Medina-Kauwe LK, Tobin AJ, De Meirleir L, Jaeken J, Jakobs C, Nyhan WL, Gibson KM. 4-Aminobutyrate aminotransferase (GABA-transaminase) deficiency. J Inherit Metab Dis 1999;22:414-427.[ISI][Medline] [Order article via Infotrieve]
  6. Scriver CR, Pueschel S, Davies E. Hyper-ß-alaninemia associated with ß-aminoaciduria and {gamma}-aminobutyricaciduria, somnolence and seizures. N Engl J Med 1966;274:636-643.
  7. Higgins JJ, Kaneski CR, Bernardini I, Brady RO, Barton NW. Pyridoxine-responsive hyper-ß-alaninemia associated with Cohen’s syndrome. Neurology 1994;44:1728-1732.[Abstract/Free Full Text]
  8. Gibson KM, Jakobs C. Disorders of ß- and {gamma}-amino acids in free and peptide-linked forms. In: Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The metabolic and molecular bases of inherited disease, 9th ed. New York: McGraw-Hill, in press..
  9. Pitts FN, Quick C, Robins E. The enzymatic measurement of {gamma}-aminobutyric-{alpha}-oxoglutaric transaminase. J Neurochem 1965;12:93-101.[ISI][Medline] [Order article via Infotrieve]
  10. Schousboe A, Wu J-Y, Roberts E. Purification and characterization of the 4-aminobutyrate-2-ketoglutarate transaminase from mouse brain. Biochemistry 1973;12:2868-2873.[Medline] [Order article via Infotrieve]
  11. Jung MJ, Lippert B, Metcalf BW, Schechter PJ, Bohlen P, Sjoerdsma A. The effect of 4-aminohex-5-ynoic acid ({gamma}-acetylenic GABA, {gamma}-ethynyl GABA) a catalytic inhibitor of GABA transaminase, on brain GABA metabolism in vivo. J Neurochem 1977;28:717-723.[ISI][Medline] [Order article via Infotrieve]
  12. Gonnard P, Wicker A, Kouyoumdjian J-C, Bloch-Tardy M. Méthode radio-isotopque rapide de mesure de l’activité 4-aminobutyrate: 2-oxoglutarate aminotransferase (GABA-transaminase). Biochimie 1973;55:509-510.[Medline] [Order article via Infotrieve]
  13. White HL. 4-Aminobutyrate:2-oxoglutarate aminotransferase in blood platelets. Science 1979;205:696-698.[Abstract/Free Full Text]
  14. Der Garabedian A, Lotti A-M, Vermeersch JJ. Aminobutyrate: 2-oxoglutarate aminotransferase from Candida. Eur J Biochem 1986;156:589-596.[ISI][Medline] [Order article via Infotrieve]
  15. Buzenet AM, Fages C, Bloch-Tardy M, Gonnard P. Purification and properties of 4-aminobutyrate 2-ketoglutarate aminotransferase from pig liver. Biochim Biophys Acta 1978;522:400-411.[Medline] [Order article via Infotrieve]
  16. Henderson PJF. Statistical analysis of enzyme kinetic data. Eisenthal R Danson MJ eds. Enzyme assays, 4th ed 1998:277-316 Oxford University Press Oxford. .
  17. Jung MJ, Metcalf BW. Catalytic inhibition of {gamma}-aminobutyric acid-{alpha}-ketoglutarate transaminase of bacterial origin by 4-aminohex-5-ynoic acid, a substrate analog. Biochem Biophys Res Commun 1975;67:301-306.[ISI][Medline] [Order article via Infotrieve]
  18. Gibson KM, Lee CF, Chambliss KL, Kamali V, Francois B, Jaeken J, Jakobs C. 4-Hydroxybutyric aciduria: application of a fluorometric assay to the determination of succinic semialdehyde dehydrogenase activity in extracts of cultured human lymphoblasts. Clin Chim Acta 1991;196:219-222.[ISI][Medline] [Order article via Infotrieve]



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