Utilisation of enterally delivered glutamine and glutamate: Stable isotope tracer study in healthy humans

Long-term effects of postoperative total parenteral nutrition supplemented with glycylglutamine on subjective fatigue and muscle protein synthesis

Seventeen patients undergoing elective open cholecystectomy were given conventional total parenteral nutrition either with (nine patients) or without (eight) glutamine supplementation of 20 g/day for 3 days after surgery and thereafter ordinary food for the following 27 days. Muscle protein synthesis, as assessed by the total concentration of ribosomes, decreased in control patients on day 3 following surgery and remained low on days 10, 20 and 30 (P < 0.05). In patients who received glutamine the total ribosome concentration was maintained on the third day after operation. Concurrently, the subjective feeling of fatigue increased on days 3 and 10 after surgery and the nitrogen balance was negative after operation in both groups, without any difference related to glutamine supplementation. Intravenous glutamine after surgery counteracts a decline in muscle protein synthesis only for as long as it is provided.

Long-term effect of glycyl-glutamine after elective surgery on free amino acids in muscle

In order to evaluate the long-term effect of total parenteral nutrition supplemented with glutamine after surgery, patients (n = 17) undergoing elective abdominal surgery were randomized into two groups and studied for 30 days after surgery. During the 3 days immediately after surgery, one group (n = 8) was given total parenteral nutrition including a conventional amino acid solution (control group). The other group (n = 9) was given isocaloric and isonitrogenous total parenteral nutrition including the same amino acid solution supplemented with the dipeptide, glycyl-glutamine (GLN group). Oral food intake started on the third postoperative day and was gradually increased at will. The concentration of free amino acids in percutaneous muscle biopsy specimens was determined preoperatively and on days 3, 10, 20, and 30 after the operation. Free glutamine decreased in skeletal muscle in the control group on days 3 and 10 by 32.2 +/- 5.4% (p < .01) and 20.1 +/- 6.9% (p < .05), respectively. In the glycyl-glutamine group, the decrease in glutamine was delayed until day 10 when it was 22.1 +/- 8.1% (p < .05). The glutamine levels were restored on days 20 and 30 in both groups. Total parenteral nutrition supplemented with glutamine maintained the free glutamine levels in skeletal muscle after surgery, but when treatment was discontinued, the glutamine concentration in muscle dropped, despite a normal enteral dietary intake.

Enteral glutamine spares endogenous glutamine in chronic acidosis

Metabolic acidosis associated with the catabolic state mobilizes muscle nitrogen and releases it into blood as glutamine (GLN) targeted for renal consumption and base generation. Because GLN removed by the kidneys during acidosis is a major drain on the GLN available to other sites, subsequent deprivation may lead to impaired organ function. Conversely, GLN supplementation may spare endogenous supplies and restore organ function. To test this, Sprague-Dawley rats weighing between 250 and 350 g were pair-fed elemental diets supplemented with GLN 4.9 g/L (GLN-ED) or an equivalent mixture of neutral amino acids substituted for GLN (ED). Acid loading was effected by adding hydrochloric acid to the liquid diet (110 mmol/L). Animals were studied in metabolic cages for five consecutive 24-hour urine collection periods and then anesthetized for short-term studies of interorgan fluxes and tissue GLN content. Acidosis effected an increase in ammonium nitrogen excretion (fivefold) and a reciprocal decrease (24%) in urea nitrogen excretion. Enteral GLN had no effect on the acidosis-effected ammonium (2170 +/- 71 vs 2059 +/- 361 mumol/100 g, ED vs GLN-ED, respectively) or urea excretion (5522 +/- 95 vs 5915 +/- 984 mumol/100 g, ED vs GLN-ED, respectively). Although arterial blood GLN was not increased in the GLN-ED group (531 +/- 58 vs 438 +/- 51 nmol/mL, p = .10), both liver and muscle GLN were elevated (11,650 +/- 1137 nmol/g vs 7063 +/- 578 and 5503 +/- 489 and 4742 +/- 333 nmol/g, respectively, each p < .05).(ABSTRACT TRUNCATED AT 250 WORDS)