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Lorrey SJ, Waibl Polania J, Wachsmuth LP, Hoyt-Miggelbrink A, Tritz ZP, Edwards R, Wolf DM, Johnson AJ, Fecci PE, Ayasoufi K. Systemic immune derangements are shared across various CNS pathologies and reflect novel mechanisms of immune privilege. Neurooncol Adv 2023; 5:vdad035. [PMID: 37207119 PMCID: PMC10191195 DOI: 10.1093/noajnl/vdad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Background The nervous and immune systems interact in a reciprocal manner, both under physiologic and pathologic conditions. Literature spanning various CNS pathologies including brain tumors, stroke, traumatic brain injury and de-myelinating diseases describes a number of associated systemic immunologic changes, particularly in the T-cell compartment. These immunologic changes include severe T-cell lymphopenia, lymphoid organ contraction, and T-cell sequestration within the bone marrow. Methods We performed an in-depth systematic review of the literature and discussed pathologies that involve brain insults and systemic immune derangements. Conclusions In this review, we propose that the same immunologic changes hereafter termed 'systemic immune derangements', are present across CNS pathologies and may represent a novel, systemic mechanism of immune privilege for the CNS. We further demonstrate that systemic immune derangements are transient when associated with isolated insults such as stroke and TBI but persist in the setting of chronic CNS insults such as brain tumors. Systemic immune derangements have vast implications for informed treatment modalities and outcomes of various neurologic pathologies.
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Affiliation(s)
- Selena J Lorrey
- Department of Immunology, Duke University, Durham, NC, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, USA
| | - Jessica Waibl Polania
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, USA
- Department of Pathology, Duke University, Durham, NC, USA
| | - Lucas P Wachsmuth
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, USA
- Department of Pathology, Duke University, Durham, NC, USA
- Medical Scientist Training Program, Duke University, Durham, NC, USA
| | - Alexandra Hoyt-Miggelbrink
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, USA
- Department of Pathology, Duke University, Durham, NC, USA
| | | | - Ryan Edwards
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, USA
| | - Delaney M Wolf
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter E Fecci
- Department of Immunology, Duke University, Durham, NC, USA
- Brain Tumor Immunotherapy Program, Duke University, Durham, NC, USA
- Department of Pathology, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University, Durham, NC, USA
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Kuçi O, Verlaan D, Vicente C, Nubret E, Le Plenier S, De Bandt JP, Cynober L. Citrulline and muscle protein homeostasis in three different models of hypercatabolism. Clin Nutr 2019; 39:917-927. [PMID: 31010700 DOI: 10.1016/j.clnu.2019.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/24/2019] [Accepted: 03/26/2019] [Indexed: 01/23/2023]
Abstract
Supplementation of enteral nutrition (EN) by specific amino acids (AAs) has been proposed to prevent muscle protein loss in intensive care unit (ICU) patients. Citrulline (Cit), which has been shown to stimulate muscle protein synthesis in other situations, may be of interest in this setting. Our aim was to assess the effect of Cit in three catabolic models relevant to critical illness: endotoxemia (LPS), traumatic brain injury (TBI), and TBI with infectious complications (TBI-Ec), which are characterized by different alterations in protein homeostasis. Fifty-eight male Sprague-Dawley rats (200-220 g) were randomized to receive a standard diet ad libitum (CON, n = 9) or to undergo catabolic injuries on day 0 (D0, n = 49), and EN (Sondalis HP energy® 290 kcal/kg/d) from day 1 (D1) combined with Cit (2 g/kg/d) or isonitrogenous non-essential AAs (NEAAs) until day 3 (D3). Endotoxemia was induced by IP injection of LPS from E. coli (3 mg/kg), TBI by hydraulic percussion, and infectious complications (TBI-Ec) by administration of luminescent E. coli on D1. Nitrogen balance (ΔN) and 3-methylhistidine (3-MHis) were measured daily. Muscle protein synthesis (MPS, measured by the SUnSET method) and mTORC1 activation (S6K-1 and 4E-BP1 phosphorylation) were measured on D3 2 h after the arrest of enteral nutrition in soleus, extensor digitorum longus (EDL), gastrocnemius and tibialis muscles. ΔN was lower (p < 0.001) in all three models of injury compared with basal and CON from D1 to D3, and more negative in the LPS-CIT (p < 0.05) than in the LPS group. The 3-MHis/creatinine ratio was significantly increased on D1 in all groups compared with CON, and on D2 only in the LPS and TBI groups (p < 0.0001, LPS and TBI vs. CON). MPS was similar in all groups in soleus and tibialis but significantly higher in EDL in LPS-CIT [LPS-CIT: 4.5 ± 1.7 (mean ± SD) vs. CON: 2.3 ± 1.2; and vs. LPS-NEAA: 3.1 ± 2.3] and in gastrocnemius (LPS-CIT vs. CON; p = 0.05). S6K-1 phosphorylation in the EDL was also higher in LPS-CIT vs. CON (LPS-CIT: 0.94 ± 0.51 CON: 0.42 ± 0.28), but not in gastrocnemius. IL-6 plasma level was significantly higher in all the catabolic groups vs. CON (p < 0.005) with no difference between treatments (Cit or NEAAs). In conclusion, the TBI model showed only a rise in muscle proteolysis, whereas the LPS model displayed a rise in both protein synthesis and proteolysis. Secondly, our results show that the Cit effect varies according to the type of injury and to the muscle under study. The stimulation of MPS rate and the mTOR pathway in LPS-treated rats contrasts with degraded ΔN, suggesting that the Cit effect on protein metabolism in critically ill rats is limited at the whole-body level.
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Affiliation(s)
- O Kuçi
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France
| | - D Verlaan
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France
| | - C Vicente
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France
| | - E Nubret
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France
| | - S Le Plenier
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France
| | - J P De Bandt
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France; Service de Biochimie, Hôpital Cochin, HUPC, AP-HP, Paris, France
| | - L Cynober
- Laboratoire de Biologie de la Nutrition, EA 4466 PRETRAM, Université Paris Descartes, Sorbonne Paris Cité, France; Service de Biochimie, Hôpital Cochin, HUPC, AP-HP, Paris, France.
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Ventura G, Bortolotti M, Neveux N, Gusmini X, Nakib S, Sarfati G, Cynober L, De Bandt JP. Influence of an ω3-fatty acid-enriched enteral diet with and without added glutamine on the metabolic response to injury in a rat model of prolonged acute catabolism. Nutrition 2017; 42:75-81. [PMID: 28870483 DOI: 10.1016/j.nut.2017.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/29/2017] [Accepted: 06/02/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In critically ill patients, acute injury alters gut function, causing greater risk for sepsis and malnutrition. Peptide-enriched diets may promote nitrogen absorption, whereas ω3-enriched diets reduce alterations in gut barrier function. The aim of this study was to assess the effectiveness of a peptide- and ω3-enriched diet on the metabolic response to injury and the gut barrier function in a model of prolonged catabolism in the rat. Given the intestinal trophic effect of glutamine, we tested for a synergistic effect of glutamine. METHODS We randomized 40 male Sprague-Dawley rats (250 g) into four groups to enterally receive a standard high-protein diet (S), or a peptide- and ω3-enriched diet either alone (IMN) or supplemented with glutamine and alanine supplied as dipeptide (DIP) or as free amino acids (AAs) for 4 d. Metabolic response to injury was induced by turpentine injections on days 1 and 3. At sacrifice, nutritional and inflammatory biomarkers and intestinal and liver function were assessed. RESULTS Weight gain (+45-62%) and nitrogen balance (+33-56%) were significantly higher in all groups than in the S group. In jejunal mucosa, total glutathione was significantly higher (+20-30%) and myeloperoxidase activity significantly lower in all groups compared with the S group. Hepatic triacylglycerol content was significantly lower in the AA (0.30 ± 0.04 μM/g) and DIP (0.43 ± 0.08 μM/g) groups than in the S group (0.71 ± 0.08 μM/g). CONCLUSIONS In this model of prolonged catabolism, compared with a standard diet, a peptide- and ω3-enriched diet improved metabolic response to injury, with better nitrogen balance and weight recovery, and decreased intestinal myeloperoxidase activity. Only marginal additional effects of glutamine supplementation were observed with decreased hepatic fat content.
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Affiliation(s)
- Gabrielle Ventura
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Murielle Bortolotti
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Nathalie Neveux
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Clinical Chemistry Department, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France
| | - Xavier Gusmini
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Samir Nakib
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Clinical Chemistry Department, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France
| | - Gilles Sarfati
- Clinical Chemistry Department, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France
| | - Luc Cynober
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Clinical Chemistry Department, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France
| | - Jean-Pascal De Bandt
- Laboratory of Nutrition Biology, Faculty of Pharmacy, Paris Descartes University, Sorbonne Paris Cité, Paris, France; Clinical Chemistry Department, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, AP-HP, Paris, France.
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Evaluation of a new concept of immune-enhancing diet in a model of head-injured rat with infectious complications: A proof of concept study. Clin Nutr 2016; 35:1291-1300. [DOI: 10.1016/j.clnu.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 11/20/2022]
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"Immunonutrition" Has Failed to Improve Peritonitis-Induced Septic Shock in Rodents. PLoS One 2016; 11:e0147644. [PMID: 26808822 PMCID: PMC4726599 DOI: 10.1371/journal.pone.0147644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/06/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Immunonutrition in sepsis, including n-3 poly-unsaturated fatty acids (PUFAs) or L-arginine supplementation, is a controversial issue that has yielded a great number of studies for the last thirty-five years, and the conclusions regarding the quantity and quality of this support in patients are deceiving. The aim of the present experimental study is to investigate the effects of a pretreatment with enteral nutrition enriched with n-3 PUFAs or L-arginine on vascular dysfunctions, inflammation and oxidative stress during septic shock in rats. DESIGN Rats were fed with enteral Peptamen® HN (HN group), Peptamen® AF containing n-3 PUFAs (AF group) or Peptamen® AF enriched with L-arginine (AFA group). On day 4, peritonitis by cecal ligation and puncture (CLP) was performed. Rats were resuscitated (H18) once septic shock was established. After a 4-hour resuscitation, vessels and organs were harvested to assess inflammation, superoxide anion, nitric oxide and prostacyclin levels. Ex-vivo vascular reactivity was also performed. RESULTS Compared to CLP-AF or CLP-HN groups, 47.6% of CLP-AFA rats died before the beginning of hemodynamic measurements (vs. 8.0% and 20.0% respectively, p<0.05). AF and AFA rats required significantly increased norepinephrine infusion rates to reach the mean arterial pressure objective, compared to CLP-HN rats. Both CLP-AF and CLP-AFA reduced mesenteric resistance arterial contractility, decreased vascular oxidative stress, but increased NF-κB (0.40±0.15 in CLP-AF and 0.69±0.06 in CLP-AFA vs. 0.09±0.03 in SHAM rats and 0.30±0.06 in CLP-HN, ß-actin ratio, p<0.05) and pIκB expression (0.60±0.03 in CLP-AF and 0.94±0.15 in CLP-AFA vs. 0.04±0.01 in SHAM rats and 0.56±0.07 in CLP-HN, ß-actin ratio, p<0.05), nitric oxide and prostacyclin production in septic rats. CONCLUSIONS Although n-3 PUFAs or L-arginine supplementation exhibited an antioxidant effect, it worsened the septic shock-induced vascular dysfunction. Furthermore, mortality was higher after L-arginine supplementation.
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Moinard C, Delpierre E, Loï C, Neveux N, Butel MJ, Cynober L, Charrueau C. An oligomeric diet limits the response to injury in traumatic brain-injured rats. J Neurotrauma 2013. [PMID: 23186230 DOI: 10.1089/neu.2012.2707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adequate nutritional support is a major challenge in brain injury patients, because malnutrition cannot be reversed by standard enteral nutrition. We hypothesized that an oligomeric formula could improve nutritional status by restoring intestinal trophicity. Eighteen male Sprague-Dawley rats (300-330 g) underwent gastrostomy on day-7 (D-7) and traumatic brain injury (TBI) by hydraulic percussion (D0) and were then fed for 4 days with either a polymeric formula (Sondalis® HP, TBIP, n = 9), or an oligomeric formula (Peptamen® HN, TBIO, n = 9). In addition, a control group of healthy gastrostomized rats was fed the polymeric diet (control, n = 8). All rats were weighed daily. On D+4, the rats were euthanized. Blood was collected for plasma amino acid determination. Organs were removed and weighed. Intestinal morphometry was studied. Protein content was assessed on intestine and muscles. Enterobacterial translocation and dissemination were evaluated. Results were expressed as means ± SEM and compared using analysis of variance+Newman-Keuls test. TBI induced a significant decrease in whole body weight (TBIP vs. control, p < 0.05) that was totally blunted by the oligomeric diet (TBIP vs. TBIO, p < 0.01). Thymus weight significantly decreased after TBI (TBIP vs. control, p < 0.05) and was restored by the oligomeric formula (TBIO vs. TBIP, p < 0.05). Glutamine (GLN) concentration was improved by the oligomeric diet in both plasma (TBIO: 688 ± 19 vs. control: 591 ± 45 and TBIP: 615 ± 42 μmol/L, p < 0.05) and soleus muscle. These results show that the use of an oligomeric diet may limit response to injury after brain injury and could be a simple nutritional strategy in this setting.
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Affiliation(s)
- Christophe Moinard
- Laboratoire de Biologie de la Nutrition, EA 4466, Université Paris Descartes , Faculté des Sciences Pharmaceutiques et Biologiques, Sorbonne Paris Cité, Paris, France
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Moinard C, Butel MJ, Bureau MF, Choisy C, Waligora-Dupriet AJ, Moulis J, Marc J, Cynober L, Charrueau C. In VivoBioluminescent Imaging of a New Model of Infectious Complications in Head-Injury Rats. J Neurotrauma 2012; 29:335-42. [DOI: 10.1089/neu.2011.1862] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christophe Moinard
- Laboratoire de Biologie de la Nutrition EA 4466, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Marie-José Butel
- Laboratoire de Microbiologie EA 4065, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Michel Francis Bureau
- CNRS UMR 8151, INSERM U 1022, Laboratoire d'Imagerie Optique du Petit Animal (LIOPA), Platforme Université Paris Descartes (PIPAS), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
| | - Caroline Choisy
- Laboratoire de Biologie de la Nutrition EA 4466, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Anne-Judith Waligora-Dupriet
- Laboratoire de Microbiologie EA 4065, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Julie Moulis
- Laboratoire de Biologie de la Nutrition EA 4466, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Julie Marc
- Laboratoire de Biologie de la Nutrition EA 4466, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Luc Cynober
- Laboratoire de Biologie de la Nutrition EA 4466, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Service de Biochimie bi-site Cochin et Hôtel-Dieu, Paris, France
| | - Christine Charrueau
- Laboratoire de Pharmacie Galénique EA 4466, Plateforme Université Paris Descartes (PIPA5), Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris, France
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Xue H, Sawyer MB, Wischmeyer PE, Baracos VE. Nutrition modulation of gastrointestinal toxicity related to cancer chemotherapy: from preclinical findings to clinical strategy. JPEN J Parenter Enteral Nutr 2011; 35:74-90. [PMID: 21224434 DOI: 10.1177/0148607110377338] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chemotherapy-induced gut toxicity is a major dose-limiting toxicity for many anticancer drugs. Gastrointestinal (GI) complications compromise the efficacy of chemotherapy, promote overall malnutrition, aggravate cancer cachexia, and may contribute to worsened prognosis. The GI tract is an attractive target for nutrition modulation, owing to its direct exposure to the diet, participation in uptake and metabolism of nutrients, high rate of cell turnover, and plasticity to nutrition stimuli. Glutamine, ω-3 polyunsaturated fatty acids, and probiotics/prebiotics are therapeutic factors that potentially modulate GI toxicity related to cancer treatments. Preclinical and clinical evidence are reviewed to critically define plausible benefits of these factors and their potential development into adjuncts to cancer chemotherapy. Mechanisms underlying the action of these nutrients are being unraveled in the laboratory. Optimal strategies to translate these findings into clinical care still remain to be elucidated. Key questions that remain to be answered include the following: which nutrient or combination of nutrients is selected for which patient and chemotherapy regimen? What mechanisms are responsible for modulation, and how are nutrient(s) administered in a clinically optimal manner? Research exploring interactions between different nutrients in GI protection is ongoing and demands further understanding. How nutrition preparations given to chemotherapy-treated patients are formulated in terms of component selection and dose optimization should be carefully studied and justified.
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Affiliation(s)
- Hongyu Xue
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
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Hamani D, Kuhn M, Charrueau C, Waligora-Dupriet AJ, Neveux N, Butel MJ, Cynober L, Moinard C. Interactions between ω3 polyunsaturated fatty acids and arginine on nutritional and immunological aspects in severe inflammation. Clin Nutr 2010; 29:654-62. [PMID: 20392549 DOI: 10.1016/j.clnu.2010.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 02/22/2010] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS Immune-enhancing diets (IEDs) contain a mixture of nutrients claimed to have immunological properties. Therefore, it seemed relevant to determine the effect of each of their components. The aim of this study was to examine the role of arginine (Arg) and ω3 polyunsaturated fatty acids (ω3 PUFAs) in the effect of an IED (Crucial(®)) in a validated rat model of inflammation induced by turpentine (TI). METHODS Forty-two rats were randomized into five groups: AL (ad libitum), TI-EN (TI+standard enteral nutrition (EN): Sondalis(®)HP), TI-EN-Arg (TI+standard EN+Arg in equimolar concentration to Arg in the IED), TI-M-IED (TI+modified IED containing the same ω6/ω3 ratio as in standard EN) and TI-IED (TI+Crucial(®)). Blood was sampled to determine CD25 receptor density on lymphocytes. TNF-α, IL-6 and NO (production and expression) were evaluated on isolated macrophages. Mesenteric lymph nodes, spleen and liver were cultured for analysis of enterobacterial translocation and dissemination. RESULTS CD25 density was decreased after TI and was corrected in the TI-EN-Arg, TI-M-IED and TI-IED groups (p<0.05). TI induced an alteration of macrophage mRNA expression of IL-6, TNF-α and iNOS, corrected in the TI-EN-Arg and TI-M-IED groups (p<0.05), but not by the IED. Enterobacterial translocation was observed in all treated groups, nevertheless the amount tended (p=0.054) to be lower in the TI-EN-Arg group. CONCLUSIONS Arg and ω3 PUFAs make a major contribution to IED effects, but our study shows interaction between them on macrophage reactivity. This indicates that the individual properties of each pharmaconutrient are not additive in IEDs.
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Affiliation(s)
- Djamel Hamani
- Laboratoire de Biologie de la Nutrition EA2498, Faculté de Pharmacie, Université Paris Descartes, 4 avenue de l'Observatoire, 75270 Paris, Cedex 06, France
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Abstract
PURPOSE OF REVIEW Glutamine and arginine are conditionally essential amino acids because depletion occurs in stressed conditions. Intravenous glutamine supplementation reduces morbidity and mortality in critically ill patients fed parenterally. In surgical patients, arginine-enriched diets have beneficial effects, but the use of supplemental arginine in critically ill patients should be avoided in most cases. RECENT FINDINGS In addition to its role as a fuel, glutamine regulates gut barrier function, immuno-inflammatory response and antioxidant status. Arginine metabolism leads to nitric oxide and/or polyamines and thus modulates the immuno-inflammatory response and wound healing. Glutamine and arginine metabolism are closely related, and therefore may give additive or antagonist effects on several pathways. The effects of combined arginine and glutamine are still poorly documented. Combined administration of arginine and glutamine resulted in additive or synergistic effects on gut barrier function and inflammatory response but arginine reduced glutamine protection against oxidative stress. Preliminary data indicate that the combination may be beneficial during intestinal inflammation, whereas data in surgical or critically ill patients are still lacking. SUMMARY Mostly speculative effects of combined infusion of arginine and glutamine are discussed. Future studies are needed in specific pathophysiological conditions to assess whether this combination is beneficial or detrimental.
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Affiliation(s)
- Moïse Coëffier
- Department of Nutrition, Rouen University Hospital and ADEN EA4311, Institute for Biomedical Research, Institute for Peptides Research (IFRMP23), Medical School, Rouen University, Rouen, France
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Charrueau C, Belabed L, Besson V, Chaumeil JC, Cynober L, Moinard C. Metabolic Response and Nutritional Support in Traumatic Brain Injury: Evidence for Resistance to Renutrition. J Neurotrauma 2009; 26:1911-20. [DOI: 10.1089/neu.2008.0737] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Christine Charrueau
- Laboratoire de Pharmacie Galénique, EA2498, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Linda Belabed
- Laboratoire de Biologie de la Nutrition, EA2498, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Valérie Besson
- Laboratoire de Pharmacologie de la Circulation Cérébrale, EA2510, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Jean-Claude Chaumeil
- Laboratoire de Pharmacie Galénique, EA2498, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - Luc Cynober
- Laboratoire de Biologie de la Nutrition, EA2498, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
- Service de Biochimie Interhospitalier Cochin-Hôtel-Dieu, APHP, Paris, France
| | - Christophe Moinard
- Laboratoire de Biologie de la Nutrition, EA2498, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
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Single and combined supplementation of glutamine and n-3 polyunsaturated fatty acids on host tolerance and tumour response to 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin (CPT-11)/5-fluorouracil chemotherapy in rats bearing Ward colon tumour. Br J Nutr 2009; 102:434-42. [PMID: 19250573 DOI: 10.1017/s0007114508199482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Prior reports suggest that during irinotecan (7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin; CPT-11) chemotherapy in laboratory rats, the anti-tumour efficacy and diarrhoea toxicity could be modulated by n-3 PUFA and glutamine, respectively. We further examined how these two dietary elements, when provided individually and in combination, would affect the efficacy of a cyclical regimen of CPT-11/5-fluorouracil (5-FU), an accepted combination regimen for colorectal cancer. Prior to initiating chemotherapy, diets enriched either with glutamine (2 %, w/w total diet) or n-3 PUFA (0.88 %, w/w total diet) alone, inhibited Ward colon tumour growth (P < 0.05). These diets also completely or partially normalized the changes in peripheral leucocyte counts associated with the tumour-bearing state (e.g. neutrophil proportion/concentration and lymphocyte proportion). During chemotherapy, either glutamine- or n-3 PUFA-enriched diet enhanced tumour chemo-sensitivity, and reduced body weight loss, anorexia and muscle wasting (v. animals fed control diet, P < 0.05). Surprisingly, providing both glutamine and n-3 PUFA together did not confer a greater benefit on tumour inhibition either in the presence or absence of chemotherapy; individual benefits associated with single treatments, particularly in respect to host nutritional status (i.e. body weight, food intake and muscle weight) and immune (peripheral leucocyte counts) features were instead partially or completely lost when these two nutrients were combined. These results draw into question the common assumption that there are additive or synergistic benefits of combinations of nutrients, which are beneficial on an individual basis, and suggest that co-supplementation with glutamine and n-3 PUFA is not indicated during chemotherapy with CPT-11 and 5-FU.
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Increasing plasma glutamine in postoperative patients fed an arginine-rich immune-enhancing diet—A pharmacokinetic randomized controlled study*. Crit Care Med 2009; 37:501-9. [DOI: 10.1097/ccm.0b013e3181958cba] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Groeneveld J, Hedenstierna G, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Metnitz P, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine, 2007. I. Experimental studies. Clinical studies: brain injury and neurology, renal failure and endocrinology. Intensive Care Med 2008; 34:229-42. [PMID: 18175106 PMCID: PMC2228383 DOI: 10.1007/s00134-007-0981-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/10/2007] [Indexed: 01/20/2023]
Affiliation(s)
- Massimo Antonelli
- Università Cattolica del Sacro Cuore, Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Largo A. Gemelli, 8, 00168 Rome, Italy.
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