Glutamine-Supplemented Total Parenteral Nutrition Enhances T-Lymphocyte Response in Surgical Patients Undergoing Colorectal Resection

Abstract

ObjectiveThe authors determined the effect of glutamine-supplementation of TPN on postoperative peripheral blood T-cell response and proinflammatory cytokine production in patients undergoing colorectal resection. Summary Background DataSeveral vital tissues, including the immune system, are very dependent on glutamine; however, this amino acid, which may be essential in conditions of stress, only now is becoming formulated suitably for incorporation into TPN. The effects of such supplementation on the immune function of stressed surgical patients is unknoWn. MethodsPatients (n = 20) were randomized to receive conventional TPN (0.2 g nitrogen/kg/d) or an isonitrogenous/isocaloric regimen with 0.18 g of glutamine/kg/d from days 1 to 6 postoperatively. T-cell DNA synthesis and interleukin (IL)-2 production and peripheral blood mononuclear cell IL-6 and tumor necrosis factor (TNF) production were measured in vitro preoperatively and on days 1 and 6 postoperatively. ResultsT-cell DNA synthesis after 5 days of TPN was increased compared with preoperative values in the glutamine-supplemented group (median preoperative tritiated thymidine uptake: 78.3 X 103 cpm, day 6: 95.0 X 103 cpm, p < 0.05). There was no such increase in the control TPN group (preoperative: 89.0 X 103 cpm, day 6: 69.4 X 103 cpm, p > 0.05). Glutamine supplementation did not influence IL-2 production or the production of TNF or IL-6. ConclusionsGlutamine supplementation may be a method of enhancing T-cell function in the surgical patient receiving TPN. 212

Efficacy of Parenteral Nutrition Supplemented With Glutamine Dipeptide to Decrease Hospital Infections in Critically Ill Surgical Patients

“…The underlying mechanisms by which GLN may have decreased nosocomial infections in our study are unclear but potentially could include effects on the number and function of immune cells, 24,33,[36][37][38] improvement in gut barrier function and maintenance of the gut mucosa, 11,15,34,35,63 protein-anabolic effects, 25,27,31 and/or up-regulation of cytoprotective molecules, including the antioxidant glutathione 64 and specific heat shock proteins. 65 In the current study, we did not detect a significant effect of GLN-PN to up-regulate the total number of circulating T-lymphocytes or CD-4 or CD-8 T-cells, as has been observed in other patient groups.…”

“…65 In the current study, we did not detect a significant effect of GLN-PN to up-regulate the total number of circulating T-lymphocytes or CD-4 or CD-8 T-cells, as has been observed in other patient groups. 36,37 However, the sampling period of 7 days may have been too short to detect an effect of GLN on these key components of the adaptive immune system. Cells of the intestinal mucosa use GLN as a major fuel.…”

Glutamine-enriched total parenteral nutrition in patients with inflammatory bowel disease

“…The ability of glutamine to enhance T-cell function could promote inflammatory activity in Crohn's disease (O'Riordain et al, 1994). A further negative effect of increased glutamine supplementation may relate to the fact that glutamine is a precursor of nitric oxide.…”

Symposium 4: Hot topics in parenteral nutrition Current evidence and ongoing trials on the use of glutamine in critically-ill patients and patients undergoing surgery

“…Total events: 158 (treatment), 171 (control) Test for heterogeneity: χ 2 7·98, df 5 (P=0·16), I 2 37·3 % Test for overall effect: Z 0·98 (P=0·33) Surgical PN Jacobi et al (24) Klek et al (26) Neri et al (31) O'Riordain et al (35) Oguz et al (34) Spittler et al (40) Subtotal ( 3·00 0·69 0·87 0·31 0·56 1·08 0·80 0·85 0·11 0·83 0·78 0·14, 63·2 0·47, 1·03 0·56, 1·33 0·13, 0·77 0·32, 0·99 0·78, 1·48 0·27, 2·37 0·59, 1·22 0·01, 1·94 0·42, 1·66 0·63, 0·97 7 58 32 17 22 42 14 15 20 0·38 0·55 0·27 0·50 0·33 0·50 0·43 0·12, 1·23 0·25, 1·22 0·03, 2·13 0·05, 4·75 0·13, 0·84 0·12, 2·05 0·27, 0·69 18 34 16 11 57 20 156 2 1 8 8 2·29 2·29 7 7 898 878 0·21 7·17 6·43 2·12 4·50 8·74 1·53 7·71 0·24 3·30 41·95 3·87 2·79 7·27 7·29 10·55 9·81 41·58 8·32 8·32 1·33 2·67 0·45 0·39 1·95 0·95 7·73 0·41 0·41 100·00 0·81 0·70, 0·93 0·26, include trials from China, because of continuing concerns over the authenticity of randomised trial designs from China …”