1
|
Stonoga ETS, Bueno RZ, Nagano TA, Martins V, Rocha SL. EFFECTS OF INTRAPERITONEAL GLUTAMINE IN THE TREATMENT OF EXPERIMENTAL SEPSIS. ACTA ACUST UNITED AC 2019; 32:e1431. [PMID: 31038556 PMCID: PMC6488273 DOI: 10.1590/0102-672020190001e1431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/16/2019] [Indexed: 11/22/2022]
Abstract
Background: Sepsis is an important public health issue and is associated with high treatment costs and high mortality rates. Glutamine supplementation has proven to be beneficial to the functions of the immune system, acting beneficially in the evolution of patients in severe catabolic states. Aim: To evaluate the effect of glutamine supplementation via intraperitoneal in rats, induced sepsis, considering the following organs: intestines, liver, kidneys and lungs. Methods: Male Wistar rats subjected to sepsis by ligature and cecal puncture were divided into two groups: control C (n=6) and glutamine G (n=11), in which were administered dipeptiven 20% at a dose of 2 ml/kg/day (equivalent to 0.4g N(2)-L-alanyl-L-glutamine/kg) intraperitoneally 48 h prior to sepsis induction. After 48 h they were euthanized and intestine, liver, lung and kidney were removed for histological analysis. Results: Intestinal epithelial desquamation of the control group was more intense compared to the glutamine group (p=0.008). In the kidneys, degenerative tubular epithelial changes were less severe in the animals that received glutamine (p=0.029). Regarding to the liver, glutamine group showed lower levels of cell swelling than the control group (p=0.034). In the lung there were no results with statistical significance. Conclusion: Prior intraperitoneal supplementation with glutamine in experimental animals is able to reduce the damage to the intestinal mucosa, to the kidneys and liver’s histoarchitecture.
Collapse
Affiliation(s)
| | - Roberta Zawadzki Bueno
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Thais Ayumi Nagano
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Vanessa Martins
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Sérgio Luiz Rocha
- Department of Operative Technique and Experimental Surgery of the Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| |
Collapse
|
2
|
Heyland DK, Wischmeyer P, Jeschke MG, Wibbenmeyer L, Turgeon AF, Stelfox HT, Day AG, Garrel D. A RandomizEd trial of ENtERal Glutamine to minimIZE thermal injury (The RE-ENERGIZE Trial): a clinical trial protocol. Scars Burn Heal 2017; 3:2059513117745241. [PMID: 29799545 PMCID: PMC5965329 DOI: 10.1177/2059513117745241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Burn injury represents a significant public health problem worldwide. More
than in any other injury, the inflammation and catabolism associated with
severe burns can exacerbate nutrient deficiencies resulting in impaired
immune function and increased risk of developing infection, organ
dysfunction and death. Consequently, over the last few decades numerous
trials have evaluated the impact of different nutritional strategies in
severe burn injury. Glutamine is of particular interest, as it appears vital
for a number of key stress-response pathways in serious illness. The purpose
of the current manuscript is to provide the rationale and protocol for a
large clinical trial of supplemental enteral glutamine in 2700 severe
burn-injured patients. Methods: We propose a multicentre, double-blind, pragmatic, randomized, clinical trial
involving 80 tertiary intensive care unit (ICU) burn centres worldwide. We
aim to enrol patients with deep second- and/or third-degree burns at
moderate or high risk for death. We will exclude patients admitted > 72 h
before screening and patients with advanced liver and kidney disease. The
study intervention consists of enteral glutamine 0.5 g/kg/day vs. isocaloric
maltodextran control delivered enterally. Primary outcome will be six-month
mortality. Key secondary outcomes include time to discharge alive from
hospital, ICU and hospital mortality, length of stay and health-related
quality of life at six months. Significance: This study will be the first large international multicentre trial examining
the effects of glutamine in burn patients. Negative or positive, the results
of this trial will inform the clinical practice of burns care worldwide. Clinicaltrials.gov ID #NCT00985205 Patients with severe burns need to recover in a hospital burn unit for a long
time and are at high risk of developing infections and dying. Proper nutrition
and certain nutrients may improve survival in these patients and shorten their
stay in the burn unit. Glutamine is a building block of protein that is normally
made in the body and is found in different foods we eat. It is of great interest
because it has several beneficial effects on the body during serious illness,
such as with burn injury. In this study, we will look at the effect of glutamine
supplementation on survival and time spent in hospital. A total of 80 burn units
around the world will enrol 2700 patients with 2nd or 3rd degree burns over 4
years. Patients will receive either glutamine powder or a placebo through a
feeding tube or mixed with food, from admission to the burn unit, until a week
after the burn wound has healed. The main outcome for this study is survival at
6 months. Other outcomes include the time taken to be discharged from hospital
alive and duration of stay in the burn unit. This study will be the first large
international multicentre trial examining the effects of glutamine in burn
patients. Glutamine may lead to better survival and less complications in burn
patients, who have a devastating and disabling burn injury. If the trial is
positive, the results will be used to inform how nutrition should be given to
such patients worldwide.
Collapse
Affiliation(s)
- Daren K Heyland
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada
| | - Paul Wischmeyer
- Department of Anesthesiology and Surgery, Duke Clinical Research Institute. Duke University School of Medicine, Durham, NC, USA
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Department of Surgery, Division of Plastic Surgery, Department of Immunology University of Toronto, Toronto, ON, Canada
| | | | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Andrew G Day
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Dominique Garrel
- Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| |
Collapse
|
3
|
Alanyl-glutamine but not glycyl-glutamine improved the proliferation of enterocytes as glutamine substitution in vitro. Amino Acids 2017; 49:2023-2031. [PMID: 28861626 DOI: 10.1007/s00726-017-2460-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
The synthetic dipeptides alanyl-glutamine (Ala-Gln) and glycyl-glutamine (Gly-Gln) are used as Gln substitution to provide energy source in the gastrointestinal tract due to their high solubility and stability. This study aimed to investigate the effects of Gln, Ala-Gln and Gly-Gln on mitochondrial respiration and protein turnover of enterocytes. Intestinal porcine epithelial cells (IPEC-J2) were cultured for 2 days in Dulbecco's modified Eagle's-F12 Ham medium (DMEM-F12) containing 2.5 mM Gln, Ala-Gln or Gly-Gln. Results from 5-ethynyl-2'-deoxyuridine incorporation and flow cytometry analysis indicated that there were no differences in proliferation between free Gln and Ala-Gln-treated cells, whereas Gly-Gln treatment inhibited the cell growth compared with Gln treatment. Significantly lower mRNA expressions of Sp1 and PepT1 were also observed in Gly-Gln-treated cells than that of Ala-Gln treatment. Ala-Gln treatment increased the basal respiration and ATP production, compared with free Gln and Gly-Gln treatments. There were no differences in protein turnover between free Gln and Ala-Gln-treated cells, but Gly-Gln treatment reduced protein synthesis and increased protein degradation. Ala-Gln treatment stimulated mTOR activation whereas Gly-Gln decreased mTOR phosphorylation and increased the UB protein expression compared with free Gln treatment. These results indicate that Ala-Gln has the very similar functional profile to free Gln in porcine enterocytes in vitro and can be substituted Gln as energy and protein sources in the gastrointestinal tract.
Collapse
|
4
|
Kratochwill K, Boehm M, Herzog R, Gruber K, Lichtenauer AM, Kuster L, Csaicsich D, Gleiss A, Alper SL, Aufricht C, Vychytil A. Addition of Alanyl-Glutamine to Dialysis Fluid Restores Peritoneal Cellular Stress Responses - A First-In-Man Trial. PLoS One 2016; 11:e0165045. [PMID: 27768727 PMCID: PMC5074513 DOI: 10.1371/journal.pone.0165045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/01/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Peritonitis and ultrafiltration failure remain serious complications of chronic peritoneal dialysis (PD). Dysfunctional cellular stress responses aggravate peritoneal injury associated with PD fluid exposure, potentially due to peritoneal glutamine depletion. In this randomized cross-over phase I/II trial we investigated cytoprotective effects of alanyl-glutamine (AlaGln) addition to glucose-based PDF. METHODS In a prospective randomized cross-over design, 20 stable PD outpatients underwent paired peritoneal equilibration tests 4 weeks apart, using conventional acidic, single chamber 3.86% glucose PD fluid, with and without 8 mM supplemental AlaGln. Heat-shock protein 72 expression was assessed in peritoneal effluent cells as surrogate parameter of cellular stress responses, complemented by metabolomics and functional immunocompetence assays. RESULTS AlaGln restored peritoneal glutamine levels and increased the primary outcome heat-shock protein expression (effect 1.51-fold, CI 1.07-2.14; p = 0.022), without changes in peritoneal ultrafiltration, small solute transport, or biomarkers reflecting cell mass and inflammation. Further effects were glutamine-like metabolomic changes and increased ex-vivo LPS-stimulated cytokine release from healthy donor peripheral blood monocytes. In patients with a history of peritonitis (5 of 20), AlaGln supplementation decreased dialysate interleukin-8 levels. Supplemented PD fluid also attenuated inflammation and enhanced stimulated cytokine release in a mouse model of PD-associated peritonitis. CONCLUSION We conclude that AlaGln-supplemented, glucose-based PD fluid can restore peritoneal cellular stress responses with attenuation of sterile inflammation, and may improve peritoneal host-defense in the setting of PD.
Collapse
Affiliation(s)
- Klaus Kratochwill
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Zytoprotec GmbH, Vienna, Austria
| | - Michael Boehm
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Rebecca Herzog
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Zytoprotec GmbH, Vienna, Austria
| | - Katharina Gruber
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Anton Michael Lichtenauer
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Zytoprotec GmbH, Vienna, Austria
| | - Lilian Kuster
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Zytoprotec GmbH, Vienna, Austria
| | - Dagmar Csaicsich
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Seth L. Alper
- Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christoph Aufricht
- Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
5
|
Magalhães CR, Malafaia O, Torres OJM, Moreira LB, Tefil SCDSG, Pinherio MDR, Harada BA. Liver regeneration with l-glutamine supplemented diet: experimental study in rats. Rev Col Bras Cir 2016; 41:117-21. [PMID: 24918725 DOI: 10.1590/s0100-69912014000200008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/08/2013] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess liver regeneration in rats after 60% hepatectomy with and without supplementation of L-glutamine through liver weight changes, laboratory parameters and histological study. METHODS 36 male rats were divided into two groups: glutamine group and control group. Each group was subdivided into three subgroups, with death in 24h, 72h and seven days. The glutamine group received water and standard diet supplemented with L-glutamine, and the control recieved 0.9% saline. In all subgroups analysis of liver regeneration was made by the Kwon formula, study of liver function (AST, ALT, GGT, total bilirubin, indirect and indirect bilirubin and albumin) and analysis of cell mitosis by hematoxylin-eosin. RESULTS In both groups there was liver regeneration by weight gain. Gamma-GT increased significantly in the control group (p < 0.05); albumin increased in the glutamine group. The other indicators of liver function showed no significant differences. Histological analysis at 72h showed a higher number of mitoses in the glutamine group, with no differences in other subgroups. CONCLUSION Diet supplementation with L glutamine is beneficial for liver regeneration.
Collapse
Affiliation(s)
| | - Osvaldo Malafaia
- Medical Research Institute, Evangelical Faculty of Paraná, Evangelical University Hospital
| | | | | | | | | | - Bruna Ayumi Harada
- Hospital Universitário Evangélico de Curitiba, Faculdade Evangélica do Paraná, PR, Brasil
| |
Collapse
|
6
|
Nassiri Moghaddam H, Alizadeh-Ghamsari AH. Improved performance and small intestinal development of broiler chickens by dietary L-glutamine supplementation. JOURNAL OF APPLIED ANIMAL RESEARCH 2013. [DOI: 10.1080/09712119.2012.738214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
7
|
Affiliation(s)
- Milan Holecek
- Charles University in Prague, Hradec Kralove, Czech Republic
| |
Collapse
|
8
|
Bartell SM, Batal AB. The effect of supplemental glutamine on growth performance, development of the gastrointestinal tract, and humoral immune response of broilers. Poult Sci 2007; 86:1940-7. [PMID: 17704382 DOI: 10.1093/ps/86.9.1940] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Two experiments were conducted to evaluate the effect of supplemental Gln on growth performance, development of the gastrointestinal tract, and humoral immune response of broilers. Immediately after hatch 6 replicate pens of 6 chicks were randomly assigned to 1 of 7 (experiment 1) or 5 (experiment 2) dietary treatments for 21 d. On d 4, 7, 14, and 21, twelve chicks per treatment (2 chicks/pen) were killed for thymus, spleen, bursa, duodenum, jejunum, ileum, bile, and blood sample collections and weights. In experiment 1, the effect of 1 or 4% Gln addition to the feed, water, or both was compared with a corn-soybean meal (SBM) control diet. All diets were formulated to be isocaloric and isonitrogenous. Weight gain improved significantly (P < 0.05) when chicks were fed diets with 1% Gln as compared with chicks fed the control diet (11% average improvement). The addition of 4% Gln to the diet or water depressed (P < 0.05) growth performance. Based on the results from experiment 1, 1% Gln supplementation to the diet was determined to be ample and most practical. Thus in experiment 2, diets supplemented with 1% Gln were fed for 4, 7, 14, or 21 d after which time chicks were fed the corn-SBM control diet until the experiment was terminated at 21 d. Weight gain improved significantly (P < 0.05) when chicks were fed diets supplemented with 1% Gln throughout the 21-d study. In both experiments, chicks fed diets supplemented with 1% Gln for 21 d had higher concentrations of bile, intestinal, and sera IgA and sera IgG (P < 0.05). Chicks fed diets with 1% Gln had heavier intestinal relative weights and longer intestinal villi (P < 0.05) as compared with the chicks fed the corn-SBM diet. Our results indicate that the addition of 1% Gln to the diet of broiler chicks improves growth performance and may stimulate development of the gastrointestinal tract and humoral immune response.
Collapse
Affiliation(s)
- S M Bartell
- Department of Poultry Science, University of Georgia, Athens GA 30602, USA
| | | |
Collapse
|
9
|
Zhou J, Li Y, Liu F, Cao Y, Li J. Tumor necrosis factor α attenuates glutamine-enhanced skeletal muscle protein synthesis in rats. Nutr Res 2007. [DOI: 10.1016/j.nutres.2007.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
10
|
Yeh SL, Lai YN, Shang HF, Lin MT, Chen WJ. Effects of glutamine supplementation on innate immune response in rats with gut-derived sepsis. Br J Nutr 2007; 91:423-9. [PMID: 15005828 DOI: 10.1079/bjn20031069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The present study examined the effect of glutamine (Gln)-enriched diets before sepsis or Gln-containing total parenteral nutrition (TPN) after sepsis, or both, on the phagocytic activity and blood lymphocyte subpopulation in rats with gut-derived sepsis. Rats were assigned to a control group or one of four experimental groups. The control group and groups 1 and 2 were fed a semipurified diet; groups 3 and 4 had part of casein replaced by Gln. After feeding the diets for 10d, sepsis was induced by caecal ligation and puncture (CLP); TPN was maintained for 3d after CLP. The control group and groups 1 and 3 were infused with conventional TPN and groups 2 and 4 were supplemented with Gln in the TPN solution. All rats were killed 3d after CLP or sham operation to examine their immune responses. The results showed that compared with the control group, the phagocytic activities of peritoneal macrophages were enhanced in groups 3 and 4, but not in groups 1 and 2. The proportion of CD3+ cells in group 1 was significantly lower (P<0·05) than that of the control group, whereas no differences were observed among the control and Gln-supplemented groups. The CD4+ cell proportion was significantly lower (P<0·05) in group 1 compared with the control group and groups 3 and 4. These findings suggest that Gln-enriched diets before CLP significantly enhanced peritoneal macrophage phagocytic activity, preserved CD4+ cells and maintained blood total T lymphocytes in gut-derived sepsis. However, parenteral Gln administration after caecal ligation and puncture had no favourable effects on modulating immune response in septic rats.
Collapse
Affiliation(s)
- Sung-Ling Yeh
- Institute of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan, Republic of China
| | | | | | | | | |
Collapse
|
11
|
Heyland DK, Dhaliwal R, Day AG, Muscedere J, Drover J, Suchner U, Cook D. REducing Deaths due to OXidative Stress (The REDOXS Study): Rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients. Proc Nutr Soc 2007; 65:250-63. [PMID: 16923310 DOI: 10.1079/pns2006505] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Critically-ill patients experience an extent of hyperinflammation, cellular immune dysfunction, oxidative stress and mitochondrial dysfunction. Supplementation with key nutrients, such as glutamine and antioxidants, is most likely to have a favourable effect on these physiological derangements, leading to an improvement in clinical outcomes. The results of two meta-analyses suggest that glutamine and antioxidants may be associated with improved survival. The purpose of the present paper is to report the background rationale and study protocol for the evaluation of the effect of high-dose glutamine and antioxidant supplementation on mortality in a large-scale randomized trial in 1200 mechanically-ventilated, critically-ill patients. Patients admitted to an intensive care unit (ICU) with clinical evidence of severe organ dysfunction will be randomized to one of four treatments in a 2 x 2 factorial design: (1) glutamine; (2) antioxidant therapy; (3) glutamine and antioxidant therapy; (4) placebo. The primary outcome for this study is 28 d mortality. The secondary outcomes are duration of stay in ICU, adjudicated diagnosis of infection, multiple organ dysfunction, duration of mechanical ventilation, length of stay in hospital and health-related quality of life at 3 and 6 months. A novel design feature is the combined use of parenteral and enteral study nutrients dissociated from the nutrition support. The therapeutic strategies tested in the randomized trial may lead to less morbidity and improved survival in critically-ill patients. The trial will be conducted in approximately twenty tertiary-care ICU in Canada and the first results are expected in 2009.
Collapse
Affiliation(s)
- Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario K7L 2V7, Canada.
| | | | | | | | | | | | | |
Collapse
|
12
|
Safránek R, Holecek M, Sispera L, Muthný T. Aspects of Protein and Amino Acid Metabolism in a Model of Severe Glutamine Deficiency in Sepsis. ANNALS OF NUTRITION AND METABOLISM 2006; 50:361-7. [PMID: 16809904 DOI: 10.1159/000094300] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Accepted: 02/19/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Growth hormone (GH) could have the potential to improve protein metabolism in sepsis but glutamine deficiency has been reported after GH treatment. The aim was to investigate the effects of glutamine deficiency in sepsis with and without GH treatment on protein and amino acid metabolism. METHODS Cecal ligation and puncture (CLP) was used as a model of sepsis. Serious glutamine deficiency was induced by administration of glutamine synthetase inhibitor, methionine sulfoximine (MSO). Young Wistar rats were divided into 5 groups: control; CLP; CLP+MSO; CLP+GH, and CLP+MSO+GH. Parameters of protein metabolism were measured on incubated soleus and extensor digitorum longus muscles: [1-14C]leucine was used to estimate protein synthesis and leucine oxidation, tyrosine release was used to evaluate protein breakdown. Amino acid concentrations in plasma, skeletal muscle and incubation media were measured by HPLC. RESULTS/CONCLUSIONS A reduced muscle glutamine concentration after MSO treatment is not associated with changes in the rates of protein synthesis or breakdown. MSO treatment decreased glutamine release from skeletal muscle and plasma glutamine concentration. Severe glutamine deficiency in GH-treated septic rats resulted in increased release of branched-chain amino acids from skeletal muscle.
Collapse
Affiliation(s)
- Roman Safránek
- Department of Physiology, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic.
| | | | | | | |
Collapse
|
13
|
Curi R, Lagranha CJ, Doi SQ, Sellitti DF, Procopio J, Pithon-Curi TC, Corless M, Newsholme P. Molecular mechanisms of glutamine action. J Cell Physiol 2005; 204:392-401. [PMID: 15795900 DOI: 10.1002/jcp.20339] [Citation(s) in RCA: 309] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Glutamine is the most abundant free amino acid in the body and is known to play a regulatory role in several cell specific processes including metabolism (e.g., oxidative fuel, gluconeogenic precursor, and lipogenic precursor), cell integrity (apoptosis, cell proliferation), protein synthesis, and degradation, contractile protein mass, redox potential, respiratory burst, insulin resistance, insulin secretion, and extracellular matrix (ECM) synthesis. Glutamine has been shown to regulate the expression of many genes related to metabolism, signal transduction, cell defense and repair, and to activate intracellular signaling pathways. Thus, the function of glutamine goes beyond that of a simple metabolic fuel or protein precursor as previously assumed. In this review, we have attempted to identify some of the common mechanisms underlying the regulation of glutamine dependent cellular functions.
Collapse
Affiliation(s)
- R Curi
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Immunonutrition. Clin Nutr 2005. [DOI: 10.1016/b978-0-7216-0379-7.50023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
15
|
Lai YN, Yeh SL, Lin MT, Shang HF, Yeh CL, Chen WJ. Glutamine supplementation enhances mucosal immunity in rats with Gut-Derived sepsis. Nutrition 2004; 20:286-91. [PMID: 14990270 DOI: 10.1016/j.nut.2003.11.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Supplemental glutamine (Gln) has been demonstrated to improve the immunologic response and reduce mortality in rodents with sepsis. However, the effects of Gln on gut-associated lymphoid tissue function after infection and sepsis are not clear. We investigated the effects of Gln-supplemented diets before sepsis, Gln-enriched total parenteral nutrition (TPN) after sepsis, or both on the intestinal immunity in rats with gut-derived sepsis. METHODS Male Wistar rats were assigned to control and four experimental groups. The control and experimental groups 1 and 2 were fed a semi-purified diet; in experimental groups 3 and 4, part of the casein in the diets was replaced with Gln. After feeding rats the respective diets for 10 d, sepsis was induced by cecal ligation and puncture (CLP) in the experimental groups, whereas the control group underwent a sham operation; at the same time, the internal jugular vein of all rats was cannulated. All rats were maintained on TPN for 3 d. The control group and groups 1 and 3 were infused with conventional TPN, and groups 2 and 4 were given a TPN solution supplemented with Gln, which provided 25% of total amino acid nitrogen. All rats were killed 3 d after the sham operation or CLP. Intestinal immunoglobin A levels, total lymphocyte yields, and lymphocyte subpopulations in Peyer's patches were analyzed. RESULTS Total Peyer's patch lymphocyte numbers were significantly higher in the Gln-supplemented groups than in the control group. Distributions of CD3+ and CD4+ in group 1 were significantly lower than those in the control group, whereas no differences were observed among the control and Gln-supplemented groups. Plasma immunoglobulin A levels were higher in the Gln-supplemented groups than the control group and group 1. Intestinal immunoglobulin A levels were significantly higher in groups 2 and 4 than in the control group and group 1. CONCLUSIONS Preventive use of a Gln-supplemented enteral diet before CLP or intravenous Gln supplementation after CLP have similar effects in promoting proliferation of total lymphocyte in gut-associated lymphoid tissue, enhancing IgA secretion, and maintaining T-lymphocyte populations in Peyer's patches. Gln administered before and after CLP did not seem to have a synergistic effect on enhancing mucosal immunity in rats with gut-derived sepsis.
Collapse
Affiliation(s)
- Yu-Ni Lai
- Institute of Nutrition and Health Sciences, Department of Microbiology and Immunology, Taipei Medical University, Taipei, Taiwan, Republic of China
| | | | | | | | | | | |
Collapse
|
16
|
Fürst P, Alteheld B, Stehle P. Why should a single nutrient—glutamine—improve outcome? ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.clnu.2004.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
17
|
Passos de Jesus Mazza R, Bertevello PL, Matos de Miranda Torrinhas R, Nonogaki S, Avancini Ferreira Alves V, Gama Rodrigues J, Waitzberg DL. Effect of glutamine dipeptide on hepatic regeneration in partially hepatectomized malnourished rats. Nutrition 2003; 19:930-5. [PMID: 14624941 DOI: 10.1016/s0899-9007(03)00177-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Glutamine promotes hepatic regeneration in nourished (N) rats. The aim of the present study was to evaluate the effects of glutamine-enriched total parenteral nutrition (TPN) on liver regeneration in malnourished (MN) rats.Seventy-two male Wistar rats ( congruent with 270 g) were assigned to one of two groups: N and MN. Each group was then subdivided into three groups: the first underwent partial hepatectomy (PH) and received standard TPN enriched with L-alanyl-L-glutamine (Ala-Gln); the second also underwent PH and received standard TPN, but enriched with a solution containing proline and alanine (Ala-Pro); and the third underwent no surgical procedure (control group). All experimental groups received isocaloric (188 kcal. kg(-1). d(-1)) and isonitrogenous (1.12 g of nitrogen. kg(-1). d(-1)) TPN for 96 h. All animals were injected with bromodeoxyuridine 2 h before death. The hepatic regeneration index (HRI), hepatic growth percentage (HG) and hepatic morphology were analyzed. In MN rats, HRI and HG were higher with glutamine enrichment (HRI = 81 and HG = 190) than with proline-containing TPN (HRI = 66 and HG = 154; P < 0.05) and HRI was 100 times higher in animals that underwent PH than in control animals. Morphologic analysis of hepatic tissue showed no difference among the six groups.Glutamine-enriched TPN promoted growth of the remnant liver in MN rats after PH, maintained cellular proliferation in the various experimental groups after surgery, and maintained hepatic morphology of MN rats after surgery.
Collapse
Affiliation(s)
- Rosângela Passos de Jesus Mazza
- Laboratory of Surgical Metabiology and Nutrition, Department of Gastroenterology, University of São Paulo Medical School, and the Department of Pathology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
18
|
Novak F, Heyland DK, Avenell A, Drover JW, Su X. Glutamine supplementation in serious illness: a systematic review of the evidence. Crit Care Med 2002; 30:2022-9. [PMID: 12352035 DOI: 10.1097/00003246-200209000-00011] [Citation(s) in RCA: 536] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the relationship between glutamine supplementation and hospital length of stay, complication rates, and mortality in patients undergoing surgery and experiencing critical illness. DATA SOURCES Computerized search of electronic databases and search of personal files, abstract proceedings, relevant journals, and review of reference lists. STUDY SELECTION We reviewed 550 titles, abstracts, and articles. Primary studies were included if they were randomized trials of critically ill or surgical patients that evaluated the effect of glutamine vs. standard care on clinical outcomes. DATA EXTRACTION We abstracted relevant data on the methodology and outcomes of primary studies in duplicate, independently. DATA SYNTHESIS There were 14 randomized trials comparing the use of glutamine supplementation in surgical and critically ill patients. When the results of these trials were aggregated, with respect to mortality, glutamine supplementation was associated with a risk ratio (RR) of 0.78 (95% confidence interval [CI], 0.58-1.04). Glutamine supplementation was also associated with a lower rate of infectious complications (RR, 0.81; 95% CI, 0.64-1.00) and a shorter hospital stay (-2.6 days; 95% CI, -4.5 to -0.7). We examined several -specified subgroups. Although there were no statistically significant subgroup differences detected, there were some important trends. With respect to mortality, the treatment benefit was observed in studies of parenteral glutamine (RR, 0.71; 95% CI, 0.51-0.99) and high-dose glutamine (RR, 0.73; 95% CI, 0.53-1.00) compared with studies of enteral glutamine (RR, 1.08; 95% CI, 0.57-2.01) and low-dose glutamine (RR, 1.02; 95% CI, 0.52-2.00). With respect to hospital length of stay, all of the treatment benefit was observed in surgical patients (-3.5 days; 95% CI, -5.3 to -1.7) compared with critically ill patients (0.9 days; 95% CI, -4.9 to 6.8). CONCLUSION In surgical patients, glutamine supplementation may be associated with a reduction in infectious complication rates and shorter hospital stay without any adverse effect on mortality. In critically ill patients, glutamine supplementation may be associated with a reduction in complication and mortality rates. The greatest benefit was observed in patients receiving high-dose, parenteral glutamine.
Collapse
Affiliation(s)
- Frantisek Novak
- Department of Medicine, Queens University, Kingston General Hospital, Ontario, Canada
| | | | | | | | | |
Collapse
|
19
|
Yeh SL, Yeh CL, Lin MT, Lo PN, Chen WJ. Effects of glutamine-supplemented total parenteral nutrition on cytokine production and T cell population in septic rats. JPEN J Parenter Enteral Nutr 2001; 25:269-74. [PMID: 11531218 DOI: 10.1177/0148607101025005269] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study was designed to investigate the effects of total parenteral nutrition (TPN) enriched with glutamine (GLN) on in vivo cytokine production and cellular immune response in early and late septic stages of rats. METHODS Male Wistar rats were divided into 2 experimental groups and received TPN solution at an energy level of 270 kcal/kg body weight. The TPN solutions were isonitrogenous and identical in nutrients composition except for differences in amino acid content. One group received 2% GLN, whereas the other group received glycine (Gly) instead. TPN was maintained for 5 or 6 days according to the sacrifice schedule of the rats. On day 5, sepsis was induced by cecal ligation and puncture (CLP). Respective groups of rats were sacrificed 2, 4, 6, and 24 hours after CLP. RESULTS Sepsis resulted in a negative nitrogen balance in both groups, and nitrogen loss was significantly lower in the GLN than the Gly group. Interleukin (IL)-2 and interferon (IFN)-gamma in most of the samples collected at various time points were not detectable in plasma or peritoneal lavage fluid. No differences in plasma IL-6 and TNF-alpha concentrations were observed between the GLN and Gly groups. Also, there were no significant differences in IL-1beta, IL-6, and TNF-alpha concentrations in peritoneal lavage fluid between the 2 groups at various time points. The CD4+/CD8+ ratio was significantly higher in the GLN group than in the Gly group only at 4 hours after CLP, and no difference was observed at 24 hours after CLP. CONCLUSIONS TPN preinfused with a GLN-supplemented solution had a beneficial effect in ameliorating the extent of negative nitrogen balance in septic rats. However, parenterally administered GLN did not reduce the production of inflammatory mediators systemically or at the site of injury, and the influence on enhancing cellular immunity was not obvious.
Collapse
Affiliation(s)
- S L Yeh
- Institute of Nutrition and Health Science, Taipei Medical University, Taiwan, Republic of China
| | | | | | | | | |
Collapse
|
20
|
Scharte M, Baba HA, Van Aken H, Schulzki C, Meyer J, Goeters C, Bone HG. Alanyl-glutamine dipeptide does not affect hemodynamics despite a greater increase in myocardial heat shock protein 72 immunoreactivity in endotoxemic sheep. J Nutr 2001; 131:1433-7. [PMID: 11340095 DOI: 10.1093/jn/131.5.1433] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The possible beneficial effect of supplemental glutamine (Gln) in critically ill patients has been suggested to be mediated by the induction of the cytoprotective heat shock proteins (HSP)32 and HSP72. There is evidence that HSP72 and HSP32 have opposite effects on the hemodynamic situation during endotoxemia. Therefore, the effect of Gln supplementation on the cardiovascular system is not clear. We investigated the effect of alanyl-Gln (Ala-Gln) dipeptide on cardiovascular function in healthy and endotoxemic sheep. Ten sheep catheterized for chronic studies received Ala-Gln 700 mg/(kg x d) [equal to 470 mg/(kg x d)Gln] on 4 consecutive days, and 10 sheep received NaCl (9 g/L) as the control solution. On d 4, four sheep of each group were killed and myocardial samples were taken for immunohistochemistry. The remaining sheep received a continuous infusion of endotoxin [Salmonella typhosa, 10 ng/(kg x min)]. Hemodynamic parameters were measured before application of Ala-Gln or the control solution, and during endotoxemia. Myocardial HSP72 immunoreactivity was determined by immunohistochemistry. After 24 h of endotoxemia, the sheep exhibited a hyperdynamic circulation. No difference was found in the hemodynamic parameters between treatment and control group. Ala-Gln treated sheep had a greater increase in myocardial HSP72 immunoreactivity compared with controls after (P < 0.05) but not before endotoxemia. In summary, Ala-Gln increased HSP72 immunoreactivity after endotoxemia, but did not alter hemodynamic parameters. Thus, Ala-Gln supplementation does not seem to aggravate the hyperdynamic circulation in endotoxemic shock.
Collapse
Affiliation(s)
- M Scharte
- Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Gerhard-Domagk-Institut für Pathologie, Westfälische Wilhelms-Universität Münster, Germany.
| | | | | | | | | | | | | |
Collapse
|
21
|
Fürst P. A thirty-year odyssey in nitrogen metabolism: from ammonium to dipeptides. JPEN J Parenter Enteral Nutr 2000; 24:197-209. [PMID: 10885713 DOI: 10.1177/0148607100024004197] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Fürst
- University of Hohenheim, Institute for Biological Chemistry and Nutrition, Stuttgart, Germany.
| |
Collapse
|
22
|
|
23
|
Abstract
Glutamine is utilised at a high rate by cells of the immune system in culture and is required to support optimal lymphocyte proliferation and production of cytokines by lymphocytes and macrophages. Macrophage-mediated phagocytosis is influenced by glutamine availability. Hydrolysable glutamine dipeptides can substitute for glutamine to support in vitro lymphocyte and macrophage functions. In man plasma and skeletal muscle glutamine levels are lowered by sepsis, injury, burns, surgery and endurance exercise and in the overtrained athlete. The lowered plasma glutamine concentrations are most likely the result of demand for glutamine (by the liver, kidney, gut and immune system) exceeding the supply (from the diet and from muscle). It has been suggested that the lowered plasma glutamine concentration contributes, at least in part, to the immunosuppression which accompanies such situations. Animal studies have shown that inclusion of glutamine in the diet increases survival to a bacterial challenge. Glutamine or its precursors has been provided, usually by the parenteral route, to patients following surgery, radiation treatment or bone marrow transplantation or suffering from injury. In most cases the intention was not to stimulate the immune system but rather to maintain nitrogen balance, muscle mass and/or gut integrity. Nevertheless, the maintenance of plasma glutamine concentrations in such a group of patients very much at risk of immunosuppression has the added benefit of maintaining immune function. Indeed, the provision of glutamine to patients following bone marrow transplantation resulted in a lower level of infection and a shorter stay in hospital than for patients receiving glutamine-free parenteral nutrition.
Collapse
Affiliation(s)
- P C Calder
- Institute of Human Nutrition, University of Southampton, United Kingdom.
| | | |
Collapse
|
24
|
Wells SM, Kew S, Yaqoob P, Wallace FA, Calder PC. Dietary glutamine enhances cytokine production by murine macrophages. Nutrition 1999; 15:881-4. [PMID: 10575665 DOI: 10.1016/s0899-9007(99)00184-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To examine the effects of dietary glutamine on cytokine production by macrophages, mice were fed for 2 wk on a control diet that included 200.0 g casein/kg providing 19.6 g glutamine/kg or a glutamine-enriched diet that provided 54.8 g glutamine/kg partly at the expense of casein. There were no differences in weight gain between animals fed the two diets. The plasma concentrations of a number of amino acids differed according to the diet fed; this variation largely reflected the variation in the levels of the different amino acids in the diets. Plasma glutamine concentration was not significantly affected by dietary glutamine level. The production of three cytokines, tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6, was greater for lipopolysaccharide-stimulated macrophages from mice fed the glutamine-enriched diet. Thus, increasing the amount of glutamine in the murine diet enhances the ability of macrophages to respond to stimulation, at least in terms of cytokine production. These observations suggest that increasing the availability of glutamine orally could promote immune responses involving macrophage-derived cytokines.
Collapse
Affiliation(s)
- S M Wells
- Institute of Human Nutrition, University of Southampton, UK
| | | | | | | | | |
Collapse
|
25
|
Abstract
New strategies for immunonutritional support include administration of special nutrients such as glutamine. Glutamine is important in several key metabolic processes of immune cells and enterocytes. Exogenous glutamine augments the functions of lymphocytes and macrophages. Neutrophils also reportedly utilize glutamine at a significant rate. Our recent studies demonstrated that glutamine enhances neutrophil function. This article focuses on the effects of glutamine on neutrophil function in surgical stress. Enteral glutamine administration enhanced peritoneal and hepatic bacterial clearance in our rat peritonitis model. Furthermore, IV glutamine supplementation improved the outcome of animals with severe surgical stress. Our in vitro study revealed that supplemental glutamine augmented the bacterial killing function of neutrophils from postoperative patients. Glutamine increased phagocytosis of the neutrophils. In addition, glutamine dose-dependently increased production of reactive oxygen intermediates (ROI) by neutrophils. Thus, our studies suggest that glutamine supplementation may improve bactericidal function of neutrophils by increasing both phagocytosis and ROI production. In conclusion, glutamine plays an important role in neutrophil function. Glutamine may be useful for the prevention, and treatment, of severe infection in critical illness and trauma.
Collapse
Affiliation(s)
- H Saito
- Surgical Center, Faculty of Medicine, University of Tokyo, Japan
| | | | | |
Collapse
|
26
|
Kew S, Wells SM, Yaqoob P, Wallace FA, Miles EA, Calder PC. Dietary glutamine enhances murine T-lymphocyte responsiveness. J Nutr 1999; 129:1524-31. [PMID: 10419985 DOI: 10.1093/jn/129.8.1524] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To examine the effects of dietary glutamine on lymphocyte function, male mice aged 6 wk were fed for 2 wk one of three isonitrogenous, isocaloric diets, which varied in glutamine concentration. The control diet included 200 g casein/kg, providing 19.6 g glutamine/kg; the glutamine-enriched diet provided 54.8 g glutamine/kg partly at the expense of casein; and the alanine + glycine-enriched diet provided 13.3 g glutamine/kg. The plasma concentrations of a number of amino acids varied because of the diet fed. The plasma glycine concentration was greater in mice fed the alanine + glycine-enriched diet (380 +/- 22 micromol/L) than in mice fed the control (177 +/- 17 micromol/L) or the glutamine-enriched (115 +/- 18 micromol/L) diets. The plasma glutamine concentration was greater in mice fed the glutamine-enriched diet (945 +/- 117 micromol/L) than in those fed the diet enriched with alanine + glycine (561 +/- 127 micromol/L), but was not different from that in mice fed the control diet (791 +/- 35 micromol/L). There was a significant linear relationship between the amount of glutamine in the diet and plasma glutamine concentration (r = 0.655, P = 0.015). Plasma alanine concentration was unaffected by diet. The reason for the lack of effect of increasing the amount of alanine in the diet upon its concentration in the circulation may relate to its use by the liver. Thymidine incorporation (56 +/- 18 kBq/well versus <10 kBq/well), expression of the alpha-subunit of the interleukin-2 receptor (62 versus 30% receptor positive cells) and interleukin-2 production [189 +/- 28 versus 106 +/- 5 (control) or 61 +/- 13 (alanine + glycine enriched) ng/L] were greater for concanavalin A-stimulated spleen lymphocytes from mice fed the glutamine-enriched diet compared to those from mice fed the other two diets. Thus, increasing the amount of glutamine in the murine diet enhances the ability of T lymphocytes to respond to mitogenic stimulation. Taken together, these observations suggest that increasing the oral availability of glutamine could promote the T-cell driven, cell-mediated immune response.
Collapse
Affiliation(s)
- S Kew
- Institute of Human Nutrition, University of Southampton, Bassett Crescent East, Southampton SO16 7PX, United Kingdom
| | | | | | | | | | | |
Collapse
|
27
|
Khan J, Iiboshi Y, Cui L, Wasa M, Sando K, Takagi Y, Okada A. Alanyl-glutamine-supplemented parenteral nutrition increases luminal mucus gel and decreases permeability in the rat small intestine. JPEN J Parenter Enteral Nutr 1999; 23:24-31. [PMID: 9888414 DOI: 10.1177/014860719902300124] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Effect of supplemental alanyl-glutamine in standard TPN (S-TPN) on luminal mucus gel and small intestinal permeability was investigated. METHODS Thirty Sprague-Dawley rats were divided into group I (n = 10), receiving standard rat diet; group II (n = 10), receiving S-TPN; and group III (n = 10), receiving alanyl-glutamine-supplemented TPN for 1 week. After 1 week, fluorescein isothiocyanate (FITC)-dextran was injected into the small intestine of the rats, and they were killed. A small intestinal sample and portal blood were obtained for morphologic and functional analysis of mucus gel and intestinal permeability. RESULTS In group II, thickness and optical density of mucus gel per millimeter serosal length of intestine were significantly lower than group I (p<.001) and were significantly higher in group III than in group II (p<.001). The number of goblet cells in the villi and in the crypt of the small intestine was significantly lower in group II than in group I (p<.001) and was significantly higher in group III than in group II (p<.001), with the exception of the villi of jejunum. Villous and crypt surface area per millimeter serosal length of intestine was significantly lower in group II than in group I (p<.001) and was significantly higher in group III than in group II (p<.001). Small intestinal permeability to FITC-dextran was significantly higher in group II than in group I (p<.001) and was significantly lower in group III than in group II (p<.001). Glucosamine synthetase level was significantly higher in group III than in group I and ileum of group II (p<.001). CONCLUSIONS Alanyl-glutamine-supplemented TPN prevents a decrease in mucus gel and an increase in small intestinal permeability associated with S-TPN.
Collapse
Affiliation(s)
- J Khan
- Department of Pediatric Surgery, Osaka University Medical School, Suita, Japan
| | | | | | | | | | | | | |
Collapse
|
28
|
Quan J, Fitch MD, Fleming SE. Rate at which glutamine enters TCA cycle influences carbon atom fate in intestinal epithelial cells. THE AMERICAN JOURNAL OF PHYSIOLOGY 1998; 275:G1299-308. [PMID: 9843766 DOI: 10.1152/ajpgi.1998.275.6.g1299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Glutamine carbon entry into the tricarboxylic acid (TCA) cycle was assessed in small intestinal epithelial cells by measuring CO2 production from [1-14C]glutamine, and these data together with [U-14C]glutamine data were used to calculate fractional oxidation rates for glutamine. CO2 production from either [1-14C]glutamine or [U-14C]glutamine showed saturation kinetics, and the concentration needed to achieve the half-maximal rate of CO2 production was 0.7 and 0.4 mmol/l, respectively. Maximal rate for [1-14C]glutamine was twice that for [U-14C]glutamine. Increasing glutamine concentration did not cause proportional increases in glutamine entry into the TCA cycle and glutamine oxidation. Consequently, fractional oxidation of glutamine decreased with increasing glutamine concentration. Fractional oxidation could be predicted from the rate at which glutamine carbon entered the TCA cycle. (Aminooxy)acetic acid, an aminotransferase inhibitor, reduced entry of glutamine into the TCA cycle and increased fractional oxidation of glutamine. Glutamate carbon entered the TCA cycle at about one-half the rate of glutamine-derived glutamate carbon and had a higher fractional oxidation rate when provided at equivalent concentrations to glutamine. These differences in the rate of entry predictably account for the differences in the metabolic fate of glutamine vs. glutamate carbon.
Collapse
Affiliation(s)
- J Quan
- Department of Nutritional Sciences, University of California, Berkeley, California 94720-1304, USA
| | | | | |
Collapse
|
29
|
Abstract
Glutamine has traditionally been thought of as a nonessential amino acid, but laboratory and clinical data suggests that it may be essential during certain inflammatory conditions, such as infection and injury. Glutamine is a necessary nutrient for cell proliferation, serves as a specific fuel for inflammatory cells and enterocytes, and, when present in appropriate concentrations, enhances cell function. During inflammatory states, glutamine consumption may outstrip endogenous production and a relative glutamine deficiency state may exist. Animal and clinical studies suggest that improved outcome may be possible by providing the appropriate dose of this nutrient by the appropriate route to achieve adequate tissue concentrations. Such an approach prevents patients from being exposed to some of the inadequacies of present day conventional nutrition. The overall benefit of providing an appropriate glutamine-supplemented diet to all metabolically compromised patients arises from the multiple anabolic and host protective effects of this amino acid, of which immunomodulation is only one important facet of glutamine's essential nature.
Collapse
Affiliation(s)
- D W Wilmore
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | | |
Collapse
|
30
|
Easson AM, Bode BP, Fischer CP, Souba WW. Effects of endotoxin challenge on hepatic amino acid transport during cancer. J Surg Res 1998; 77:29-34. [PMID: 9698528 DOI: 10.1006/jsre.1998.5323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The hepatic uptake of amino acids is increased in both sepsis and cancer, and this response appears to be both global and essential in the catabolic host. Because immunocompromised cancer patients are susceptible to episodes of gram-negative sepsis, we examined the capacity of hepatocytes from normal and tumor-influenced livers to respond to the additional challenge of endotoxemia via increases in the Na+-dependent uptake of glutamine and zwitterionic amino acids by System N and System A, respectively. MATERIALS AND METHODS Fischer 344 rats were implanted with methylcholanthrene-induced fibrosarcomas. Control rats were sham-operated and pair-fed. Animal pairs (tumor burden = 8-32% carcass weight) were injected intraperitoneally with either Escherichia coli endotoxin (10 mg/kg) or PBS, and after 4 h, hepatocytes were isolated from the livers of the animals via collagenase perfusion and placed in primary culture. Three hours later, amino acid transport rates were measured using radiolabeled glutamine for System N and alpha-methylaminoisobutyric acid (MeAIB), a nonmetabolizable substrate specific for System A. RESULTS Cancer-independent of tumor size-and endotoxin each elicited similar 1.5- to 2-fold inductions of System N activity. When combined, their effects were additive rather than synergistic. In contrast, endotoxin induced an insignificant increase in System A activity, whereas cancer stimulated this carrier 2-fold in either the absence or the presence of endotoxin. CONCLUSIONS The primary glutamine and alanine carriers in hepatocytes are differentially influenced during catabolic states, and the tumor-influenced liver is competent to further increase glutamine uptake in response to additional catabolic insults.
Collapse
Affiliation(s)
- A M Easson
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114, USA
| | | | | | | |
Collapse
|
31
|
Abstract
The problem with any attempt to feed patients in multiple organ failure is that, because of an ongoing inflammatory process, the conventional techniques of supplying energy and protein do not maintain lean tissue mass. In addition, the conventional markers of nutritional status, both anthropometric (body mass and composition, arm circumference, etc.) and visceral protein (albumin, prealbumin) as well as immunological markers (delayed reactive skin hypersenstivity to common antigens and lymphocyte counts) are confounded by fluid retention (5-15 l) and the metabolic response to the illness. Recent research has focussed on the nature and origin of this inflammatory response, the problems of trying to feed an individual undergoing such a response, the details of the protein breakdown observed in sepsis and multiple organ failure and methods of modifying the response favourably.
Collapse
Affiliation(s)
- I T Campbell
- University of Department of Anaesthesia and Intensive Care Unit, Withington Hospital, Manchester, UK
| |
Collapse
|
32
|
Abstract
This review deals with recent developments in methodology and the effects of nutrition, hormonal modulation and muscular activity on changes in lean body mass and protein turnover in the whole body and in muscle. It also deals with organ-specific protein metabolism of the splanchnic region, particularly the gut, liver and kidney.
Collapse
Affiliation(s)
- M J Rennie
- Department of Anatomy and Physiology, University of Dundee, UK.
| |
Collapse
|
33
|
Furukawa S, Saito H, Inaba T, Lin MT, Inoue T, Naka S, Fukatsu K, Hashiguchi Y, Han I, Matsuda T, Ikeda S, Muto T. Glutamine-enriched enteral diet enhances bacterial clearance in protected bacterial peritonitis, regardless of glutamine form. JPEN J Parenter Enteral Nutr 1997; 21:208-14. [PMID: 9252946 DOI: 10.1177/0148607197021004208] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effects of glutamine (Gln)-enriched enteral diets on bacterial clearance were investigated in a rat protracted peritonitis model. The effects of the Gln form, peptide-based vs free amino acid-based, were also compared. METHODS Twenty-three rats underwent gastrostomy. An osmotic pump was implanted in the peritoneal cavity. The rats received a continuous intragastric infusion of one of three diets: Gln-depleted (Gln 0), Gln-enriched with the Gln in free amino acid form (Gln F), or Gln-enriched with the Gln in oligopeptide form (Gln P). The three formulas were isocaloric and isonitrogenous. The pumps delivered a continuous infusion of Escherichia coli, starting at 48 hours after implantation, for 24 hours. Then, the animals were killed. RESULTS Bacterial numbers in peritoneal lavaged fluid (PLF) and the liver were significantly lower in the Gln P and Gln F groups than in the Gln 0 group. The bacterial number in PLF correlated with that in the liver. Neither the number nor the population of peritoneal exudative cells differed among groups. Plasma levels of proline, alanine and citrulline were significantly higher in the Gln P and Gln F groups than in the Gln 0 group. Both Gln supplemented groups showed significantly greater villous height, crypt depth, and numbers of mitoses per crypt in the small intestine than the Gln 0 group. CONCLUSIONS Supplemental Gln enhances peritoneal and hepatic bacterial clearance, regardless of Gln form. Gln-enriched may be more beneficial than Gln-depleted enteral diets in peritonitis.
Collapse
Affiliation(s)
- S Furukawa
- Department of Surgery, Faculty of Medicine, University of Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Naka S, Saito H, Hashiguchi Y, Lin MT, Furukawa S, Inaba T, Fukushima R, Wada N, Muto T. Alanylglutamine-enriched total parenteral nutrition improves protein metabolism more than branched chain amino acid-enriched total parenteral nutrition in protracted peritonitis. THE JOURNAL OF TRAUMA 1997; 42:183-90. [PMID: 9042868 DOI: 10.1097/00005373-199702000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Branched chain amino acids (BCAAs) and glutamine are both recommended in catabolic states. The object of this study was to compare the efficacies of alanylglutamine (Ala-Gln)-enriched and BCAA-enriched total parenteral nutrition (TPN) on the protein kinetics in peritonitis. Rats were divided into Ala-Gln and BCAA groups after intraperitoneal implantation of an osmotic pump, delivering a continuous infusion of Escherichia coli. Glutamine composed 30.0% (w/v) of the total amino acids in the Ala-Gln group, and BCAA composed 30.5% (w/v) of the total amino acids in the BCAA group. The two solutions were isocaloric and isonitrogenous. Whole body protein turnover and organ fractional protein synthetic rates (FSR) were measured on days 3 and 5. Serum amino acid levels and mucosal morphology were determined. Ala-Gln group had higher rates of whole body protein turnover, and hepatic FSR on both days. Serum glutamine levels correlated with hepatic and muscle FSR. Ala-Gln TPN group had greater mucosal thickness, numbers of mitoses per crypt, and FSR in distal intestine. Ala-Gln-enriched TPN may be a useful nutritional treatment modality in sepsis.
Collapse
Affiliation(s)
- S Naka
- Department of Surgery, The University of Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|