Glutamine supplementation in bone marrow transplantation

Abstract

An increasing number of clinical investigations have focused on supplementation of specialized enteral and parenteral nutrition with the amino acid glutamine. This interest derives from strong evidence in animal models and emerging clinical data on the efficacy of glutamine administration following chemotherapy, trauma, sepsis and other catabolic conditions. Glutamine has proteinanabolic effects in stressed patients and, among many key metabolic functions, is used as a major fuel/substrate by cells of the gastrointestinal epithelium and the immune system. These effects may be particularly advantageous in patients undergoing bone marrow transplantation (BMT), who exhibit post-transplant body protein wasting, gut mucosal injury and immunodeficiency. Studies to date indicate that enteral and parenteral glutamine supplementation is well tolerated and potentially efficacious after high-dose chemotherapy or BMT for cancer treatment.Although not all studies demonstrate benefits, sufficient positive data have been published to suggest that this nutrient should be considered as adjunctive metabolic support of some individuals undergoing marrow transplant. However, BMT is a rapidly evolving clinical procedure with regard to the conditioning and supportive protocols utilized. Thus, additional randomized, double-blind, controlled clinical trials are indicated to define the efficacy of glutamine with current BMT regimens.

New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition

“…The administration of enteral or parenteral glutamine at doses of up to 40 g/day appears safe according to studies of patients receiving BMT and high-dose chemotherapy published to date (60). It is possible that glutamine is utilized as a growth factor in interactions between malignant tumors and chemotherapeutic drugs (61).…”

“…Glutamine deserves further study to elucidate its interactions with methotrexate and to investigate its effects on autologous HSCT patients. Supplementation of glutamine should be considered in the design of future randomized, controlled clinical trials and in the metabolic support of individuals undergoing marrow transplantation and cancer (60,62).…”

Glutamine inhibits cytokine-induced apoptosis in human colonic epithelial cells via the pyrimidine pathway

“…This concentration is within the range of Gln concentrations found in normal, healthy human plasma (41) and likely considerably less than normal dietary consumption, which averages Ͻ 10 g/day in healthy, nonvegans (21). However, Gln concentrations in both the blood and tissues decrease dramatically during critical illness or inflammation when its utilization exceeds its supply (22,42,45). Furthermore, many enteral diets and total parenteral nutrition solutions used in critically ill/inflamed patients lack sufficient amounts of Gln, which further reduces Gln availability in the intestine.…”

L-Glutamine Use in the Treatment and Prevention of Mucositis and Cachexia: A Naturopathic Perspective

“…15 GLN has an anabolic effect and is used as a major fuel source by epithelial cells lining the GI tract. 6,15 The gut can be considered as a nitrogen-processing organ in the metabolic response to illness, with the GI tract using GLN as a respiratory fuel.…”

“…15 GLN has an anabolic effect and is used as a major fuel source by epithelial cells lining the GI tract. 6,15 The gut can be considered as a nitrogen-processing organ in the metabolic response to illness, with the GI tract using GLN as a respiratory fuel. 7 GLN is the dominant amino acid in the plasma and whole blood of the body and an essential nutrient for rapidly dividing cells as well as a major source for intestinal epithelium.…”