Enteral glutamine spares endogenous glutamine in chronic acidosis

Glutamine metabolism in advanced age

Glutamine, reviewed extensively in the last century, is a key substrate for the splanchnic bed in the whole body and is a nutrient of particular interest in gastrointestinal research. A marked decrease in the plasma glutamine concentration has recently been observed in neonates and adults during acute illness and stress. Although some studies in newborns have shown parenteral and enteral supplementation with glutamine to be of benefit (by decreasing proteolysis and activating the immune system), clinical trials have not demonstrated prolonged advantages such as reductions in mortality or risk of infections in adults. In addition, glutamine is not able to combat the muscle wasting associated with disease or age-related sarcopenia. Oral glutamine supplementation initiated before advanced age in rats increases gut mass and improves the villus height of mucosa, thereby preventing the gut atrophy encountered in advanced age. Enterocytes from very old rats continuously metabolize glutamine into citrulline, which allowed, for the first time, the use of citrulline as a noninvasive marker of intestinal atrophy induced by advanced age.

Amino acid kinetics in patients with sepsis

BACKGROUND

In patients with sepsis and systemic inflammatory response syndrome, amino acid extraction by the liver is enhanced, resulting in decreased plasma amino acid concentrations. Systematic investigations of the elimination of intravenously infused amino acids have not been performed.

OBJECTIVE

The objective of this study was to compare the elimination of 17 amino acids in patients with sepsis and in healthy control subjects.

DESIGN

Elimination of amino acids was evaluated in 9 patients with sepsis and in 8 healthy control subjects by using a combined loading and maintenance infusion of 375 mg amino acids/kg body wt for 60 min. Pharmacokinetic variables were analyzed from plasma curves.

RESULTS

With the exception of lysine, methionine, glutamate, ornithine, phenylalanine, and tyrosine, plasma concentrations of amino acids were lower in the patients with sepsis than in the control subjects; phenylalanine was the only amino acid whose plasma concentration increased (P < 0.001). In patients with sepsis, whole-body clearance (Cl(tot)) of total amino acids was 74% higher than in control subjects (x +/- SEM: 13,161 +/- 1659 and 7566 +/- 91 mL/min, respectively; P < 0.01), the Cl(tot) of essential amino acids was 64% higher (P < 0.02), that of nonessential amino acids was 82% higher (P < 0.01), and that of both branched-chain amino acids and glucogenic amino acids was 97% higher (P < 0.001). With the exception of phenylalanine, ornithine, proline, and glutamate, the Cl(tot) of all amino acids was elevated. The Cl(tot) of phenylalanine and ornithine decreased slightly (NS).

CONCLUSIONS

In patients with sepsis, plasma concentrations of most amino acids are greatly decreased and the elimination of amino acids from the intravascular space during intravenous infusion is greatly enhanced.

Inter-organ substrate exchanges in the critically ill

Metabolic inter-organ exchange is a major field of research for improving the treatment of the critically ill. Adapting regional blood flows is the first regulatory step, although the relationships between hypoperfusion and metabolic disorders are matter of controversy. Metabolic steady state results from a vast inter-organ interplay and several nutrients or metabolites are signalling molecules in the regulation of gene transcription. Inter- or intra-organ substrate recycling shares or delays the mandatory need for aerobic ATP synthesis in some conditions. Nitrogen metabolism is highly compartmentalised in an inter-organ co-operation and liver, muscle, kidney and gut are the most important organs. By remodelling the amino acid mixture delivered to peripheral cells after intestinal absorption, the liver plays a determinant role in whole body protein synthesis. Albumin turnover increases after brain injury. Since the location of synthesis is different to that of breakdown this turnover can be viewed as an inter-organ exchange. The metabolic side of pH homeostasis is also an inter-organ exchange mainly shared by liver, kidney and muscle.

Changes in glutamine and glutamate concentrations for tracking training tolerance

PURPOSE

The purpose was to monitor high-performance athletes throughout training macrocycles and competitions and examine the changes in plasma glutamine (Gm) and glutamate (Ga) concentrations in order to develop a model of tolerance to training.

METHODS

Plasma glutamine and glutamate concentrations of 52 National team athletes (31 male and 21 female) divided into male and female groups of speed skating, swimming, and cross-country skiing were measured in an early season rested condition to determine highest Gm and lowest Ga concentrations and over 2-4 macrocycles, which included heavy training to establish lowest Gm and highest Ga concentrations.

RESULTS

In the rested condition, there were no differences within and between the male and female groups, excluding five athletes (OTA) who became overtrained in heavy training. The mean (+/-SD) Gm concentration was 585 +/- 54 micromol x L(-1), Ga concentration 101 +/- 16 micromol x L(-1), and Gm/Ga ratio 5.88 +/- 0.84 micromol x L(-1). The OTA had a significantly higher Ga concentration of 128 +/- 16 micromol x L(-1) and lower Gm/Ga ratio of 4.43 +/- 0.49 micromol x L(-1) than all the other groups. In heavy training, there was a significant decrease (P < 0.05) in Gm concentration to 522 +/- 53 micromol x L(-1), significant increase in Ga concentration to 128 +/- 19 micromol x L(-1) and significant decrease in Gm/Ga ratio to 4.15 +/- 0.57 micromol x L(-1). The OTA Gm concentration of 488 +/- 31 micromol x L(-1) was significant lower than only the male speed skating and swimming groups. However, the Ga concentration of 171 +/- 17 micromol x L(-1) and Gm/Ga ratio of 2.88 +/- 0.27 micromol x L(-1) were significantly higher and lower respectively than all other groups.

CONCLUSIONS

Based on the changes in Gm and Ga concentration under different training conditions, we propose an athlete tolerance to training model where glutamine concentration reflects tolerance to volume of work and glutamate concentration reflects tolerance to high intensity training. We suggest that the Gm/Ga ratio may globally represent overall tolerance to training.

Dietary glutamine suppresses endogenous glutamine turnover in the rat

Plasma glutamine turnover was determined using 1-14C-labeled glutamine in rats that consumed crystalline amino acid diets containing the equivalent of 16% protein with 25% of the amino acids as glutamine or a control diet containing no glutamine (or glutamate) for 10 days. Glutamine turnover in glutamine-fed animals was 66% of the rate in the control group. Glutamine feeding caused 20% higher levels of arterial plasma glutamine. Arterial-portal differences across the portal-drained viscera showed net glutamine uptake in control animals but no net uptake or release in the glutamine-fed group. Skeletal muscle glutamine synthetase activity was similar in both groups. The results indicate that long-term consumption of relatively large amounts of dietary glutamine decreases the turnover of plasma glutamine and thus reduces the need for endogenous glutamine synthesis.

Glutamine-antioxidant supplementation increases body cell mass in AIDS patients with weight loss: a randomized, double-blind controlled trial

Loss of body cell mass, the active functioning tissue of the body, commonly occurs in patients with human immunodeficiency virus (HIV) infection, and the extent of wasting is related to the length of survival. We evaluated the anabolic role of the amino acid L-glutamine (GLN) and antioxidants in a double-blind, placebo-controlled trial in 26 patients with > 5% weight loss since disease onset. Subjects received GLN-antioxidants (40 g/d) in divided doses or glycine (40 g/d) as the placebo for 12 wk. Throughout the study, the subjects were seen weekly by a nutritionist, and body weight, bioelectric impedance assessment, and nutritional counseling were performed. Twenty-one subjects completed the study, and the groups were well matched. The 5 patients excluded from analysis all met a priori exclusion criteria. Over 3 mo, the GLN-antioxidant group gained 2.2 kg in body weight (3.2%), whereas the control group gained 0.3 kg (0.4%, P = 0.04 for difference between groups). The GLN-antioxidant group gained 1.8 kg in body cell mass, whereas the control group gained 0.4 kg (P = 0.007). Intracellular water increased in the GLN-antioxidant group but not in the control group. In conclusion, GLN-antioxidant nutrient supplementation can increase body weight, body cell mass, and intracellular water when compared with placebo supplementation. GLN-antioxidant supplementation provides a highly cost-effective therapy for the rehabilitation of HIV+ patients with weight loss.

Glutamine

Glutamine is the most abundant free amino acid in the circulation. It is a primary fuel for rapidly dividing cells and plays a key role in the transport of nitrogen between organs. Although glutamine is absent from conventional regimens aimed at nutritional support, glutamine deficiency can occur during periods of metabolic stress; this has led to the reclassification of glutamine as a conditionally essential amino acid. Experiments with various animal models have demonstrated that the provision of glutamine can result in better nitrogen homoeostasis, with conservation of skeletal muscle. There is also considerable evidence that glutamine can enhance the barrier function of the gut. This review concludes by discussing the clinical evidence that supports the inclusion of stable forms of glutamine in solutions of nutrients.