BACKGROUNDGlutamine, proposed to be conditionally essential for critically ill patients, is not added routinely to parenteral amino acid formulations for premature infants and is provided in only small quantities by the enteral route when enteral feeding is low. Parenteral feeding is the basic way of nutrition in the first days of life of premature infants. In this study, we evaluated the effects of glutamine supplemented parenteral nutrition for premature infants on growth and development, feeding toleration, and infective episodes.

METHODSFrom December 2002 to July 2006, 53 premature infants were given either standard or glutamine supplemented parenteral nutrition for more than 2 weeks. Twenty-eight infants were in glutamine supplemented group, whose gestational age (31.4 +/- 2.0) weeks, birth weight range (1386 +/- 251) g; twenty-five infants were in control group, gestational age (31.1 +/- 1.7) weeks, with birth weight range (1346 +/- 199) g. There were no differences between the two groups. Various growth and biochemical indices were monitored throughout the duration of hospital stay. Data between groups were analyzed with Student's t test. Nonparametric data were analyzed using a Chi-square test. A two-tailed P value < 0.05 was considered statistically significant.

RESULTSThe level of serum albumin was lower in the glutamine groups on the second week (3.0 vs 3.2 g/dl, P = 0.028), and blood urea nitrogen was higher in glutamine groups on the fourth week (8.1 vs 4.9 mg/dl, P = 0.014), but normal. Glutamine group infants took fewer days to regain birth weight (8.1 vs 10.4 days, P = 0.017), required fewer days on parenteral nutrition (24.8 vs 30.8 days, P = 0.035), with shorter stays in hospital (32.1 vs 38.6 days, P = 0.047). Episodes of hospital acquired infection in glutamine supplemented infants were lower than that in control group (0.96 vs 1.84 times, P = 0.000).

CONCLUSIONParenteral glutamine supplementation in premature infants can shorten days on parenteral nutrition and length of stay in hospital, and decrease hospital acquired infection episodes.

Blood Urea Nitrogen ; Child Development ; Cross Infection ; epidemiology ; Glutamine ; administration & dosage ; Growth ; Humans ; Infant, Newborn ; Infant, Premature ; Parenteral Nutrition

To evaluate the effects of glutamine-supplemented parenteral nutrition (PN) and probiotics in adult autoimmune enteropathy (AIE) patients. Four adult AIE patients were identified from April 2006 to January 2012. Clinical and nutritional data were obtained from the patients' medical records. Glutamine-supplemented PN started immediately when the AIE diagnosis was confirmed. The total PN duration was 351 days. According to the PN prescription, the average caloric intake ranged from 20 to 25 kcal/kg/day, and the protein intake ranged from 1.2 to 1.5 g/kg/day. Alanyl-glutamine (20 g/day) was administered to AIE patients for 4 weeks followed by a 2-week break, and this treatment schedule was repeated when PN lasted for more than 6 weeks. Body weight gain and an increased serum albumin level were achieved after PN, and defecation frequency and quality also improved. Each patient received oral supplements, 250 mL of Ensure and two probiotics capsules (each capsule containing 0.5x10(8) colonies) three times a day when enteral nutrition started. Three AIE patients were successfully weaned off PN, and one patient died of pneumonia. Glutamine-supplemented PN and probiotics show promise in managing patients with AIE and related malnutrition.
Adult ; Bifidobacterium ; Enterococcus faecalis ; Female ; Glutamine/*administration & dosage ; Humans ; Lactobacillus acidophilus ; Length of Stay ; Male ; Malnutrition/therapy ; Parenteral Nutrition/*methods ; Polyendocrinopathies, Autoimmune/*therapy ; Probiotics/*administration & dosage ; Young Adult

OBJECTIVETo study the effect of glutamine on intestinal barrier function by examining the changes of plasma D-lactic levels and diamine oxidase (DAO) levels in plasma and intestinal tissue after glutamine intervention in young rats with endotoxemia.

METHODSEighty 18-day-old rats were randomly divided into endotoxemia and glutamine intervention groups (n=40 each). Endotoxemia was induced by lipopolysaccharide (LPS) injection. Plasma and small intestine homogenate were collected 1.5, 6, 24 and 72 hrs and 7 days after LPS injection. The glutamine intervention group was immediately administered with oral glutamine (2 g/kg) after LPS injection. Afterwards, glutamine was administered once daily. Plasma D-lactic and DAO levels and intestinal DAO levels were measured.

RESULTSPlasma DAO activity in the glutamine intervention group was significantly lower than that in the endotoxemia group 6 and 72 hrs after LPS injection (P<0.05). In contrast, the intestinal DAO activity in the glutamine intervention group was significantly higher than that in the endotoxemia group 6, 24 and 72 hrs and 7 days after LPS injection (P<0.05 or 0.01). Plasma D-lactic levels in the glutamine intervention group were significantly lower than those in the endotoxemia group 6, 24 and 72 hrs and 7 days after LPS injection (P<0.01).

CONCLUSIONSGlutamine may reduce the permeability of intestinal mucosa, and thus provides protective effects on intestinal barrier function in rats with endotoxemia.

Administration, Oral ; Amine Oxidase (Copper-Containing) ; metabolism ; Animals ; Behavior, Animal ; Endotoxemia ; metabolism ; Female ; Glutamine ; administration & dosage ; pharmacology ; Intestines ; drug effects ; metabolism ; Lactic Acid ; blood ; Male ; Rats ; Rats, Wistar

OBJECTIVETo evaluate the efficacy, safty and economical values of immunonutrition for clinical nutritional support.

METHODSThe following electronic databases were searched: Chinese Biomedicine database (CBM), MEDLINE, EMBASE, Cochrane Library and SCI. Data were extracted by two reviewers. RevMan 4.1 was applied for statistical analysis.

RESULTSSeventeen randomised trials comparing the use of immunonutrition which comprises nucleotides, omega-3 fatty acids and arginine with standard enteral nutrition in surgical, trauma/burn and critical illness patients. Combined analysis indicated that the use of immunonutrition decreased infectious events (pooled OR was 0.51, 95%CI [0.38, 0.67], P = 0.00001), length of hospitalization, and the cost. In sensitivity analysis for mortality, we found an increased tendency in immunonutrition (pooled OR was 1.94, 95%CI [1.05, 3.57], P = 0.03). Further sub-group analysis indicated that the effects of immunonutrition were various in different patient types.

CONCLUSIONSImmunonutrition is associated with decreasing of infectious rates, length of hospitalization and cost in selective operation patients. But current evidence can't affirm the role of immunonutrition on critical illness patients. Further studies are urgently needed to clarify the reliability of immunonutrition in this group.

Arginine ; administration & dosage ; Critical Illness ; Enteral Nutrition ; methods ; Fatty Acids, Omega-3 ; administration & dosage ; Food, Formulated ; Glutamine ; administration & dosage ; Humans ; Immune System ; drug effects ; Nucleotides ; administration & dosage ; Nutritional Support ; Outcome Assessment (Health Care)

OBJECTIVETo study the protective effect of glutamine (Gln) on intestinal permeability in patients receiving chemotherapy.

METHODSThirty-nine patients with gastrointestinal cancer after operation were randomly divided into Gln and control groups, and received oral administration of glutamine (30 g/d) for 7 days (n=22) or not (n=17). All patients received CF+ 5-FU chemotherapy for 5 days. Serum concentration of glutamine and urinary lactulose/mannitol (L/M) ratio were measured before and 1 day after chemotherapy.

RESULTSAfter chemotherapy, the serum Gln concentration was significantly decreased to (535.42+/- 53.75) micromol/L in the control group and increased to (54.44+/- 81.26) micromol/L in the Gln group, and there was significant difference between the two groups (P< 0.01). Urine L/M ratio was significantly increased to (0.0453+/- 0.0078) in the control group and decreased to (0.0331+/- 0.0061) in the Gln group, and there was significant difference between the two groups after chemotherapy (P< 0.01).

CONCLUSIONOral administration of glutamine granules can increase serum concentration of glutamine in chemotherapy patients with gastrointestinal cancer and can decrease intestinal permeability, maintain intestinal barrier.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; Female ; Gastrointestinal Neoplasms ; drug therapy ; therapy ; Glutamine ; administration & dosage ; therapeutic use ; Humans ; Intestinal Mucosa ; drug effects ; Male ; Middle Aged ; Postoperative Period

OBJECTIVETo investigate the effect of early enteral nutrition (EEN) supplemented with glutamine on postoperative intestinal mucosal barrier function of patients with gastric carcinoma.

METHODSEighty patients with gastric carcinoma who underwent intraoperative peritoneal hyperthermic chemotherapy(IPHC) were randomized into two groups: EEN+glutamine (EEN+Gln) group(n=40) and EEN group(n=40). Intestinal mucosal barrier function was evaluated by serum diamine oxidase (DAO), ratio of lactulose to mannitol(L/M), endotoxin lipopolysaccharides(LPS), and tumor necrosis factor-α(TNF-α) at 1 day before operation, 1 day, 7 days, 12 days after operation. Time to first flatus and tolerance to EEN were recorded as well.

RESULTSThere were no significant differences in the two groups in demographics(all P>0.05). Two cases(5%) in the EEN+Gln group and 1 case (2.5%) in the EEN group could not tolerate well(P>0.05). On postoperative day 1, there were no differences in serum DAO, L/M ratio, LPS, TNF-α between the two groups (P>0.05). On postoperative day 7, all the parameters for mucosal barrier function were significantly lower in the EEN+Gln group. On postoperative day 12, the urinary L/M and DAO, LPS, and TNF-α were still significantly lower in the EEN+Gln group, however, urinary L/M was comparable between the two groups. There were no differences between the two groups in the time to first flatus (P>0.05).

CONCLUSIONThe immunologic tolerance of enteral nutrition supplemented with glutamine is favorable, which provides protective effect on intestinal mucosal barrier in patients with gastric carcinoma undergoing IPHC.

Aged ; Enteral Nutrition ; methods ; Female ; Glutamine ; administration & dosage ; therapeutic use ; Humans ; Intestinal Mucosa ; drug effects ; physiopathology ; Male ; Middle Aged ; Postoperative Care ; Prospective Studies ; Stomach Neoplasms ; physiopathology ; therapy

OBJECTIVETo evaluate the effect of glutamine granules on immunofunction in severe burns and trauma patients.

METHODSOne hundred and twenty patients with severe burns, multiple trauma and post operation who met the requirements of the protocol joined this double-blind randomized controlled, multi-center clinical trail. Patients were randomly divided into two groups: placebo control group (P group, 60 patients) and glutamine granules treatment group (GLN group, 60 patients). There was isonitrogenous and isocaloric intake in both groups. GLN and P group patients had been given glutamine granules or placebo (glycine) at 0.5 g.kg(-1).d(-1) for 7 days, respectively. The level of plasma glutamine and some index of immunofunction were determined, and the complication and side effect were also observed.

RESULTSAfter 7 days of taking glutamine granules orally, plasma GLN concentration was significantly higher than that in P group [(593 +/- 185) micromol/L vs (407 +/- 190) micromol/L)] (P < 0.01). IL-2 level, CD(4)/CD(8) ratio, PMN swallow ratio in GLN group were significantly higher than those in P group (P < 0.05-0.01), but the concentration of IgG, IgM, C(3)/C(4) were not significantly different when compared with P group (P > 0.05). In addition, the occurrence of side effect in both groups was seldom.

CONCLUSIONTaking glutamine granules could increase plasma GLN concentration, enhance body immunofunction, and using glutamine granules is safe.

Administration, Oral ; Adolescent ; Adult ; Double-Blind Method ; Female ; Glutamine ; adverse effects ; blood ; therapeutic use ; Humans ; Male ; Middle Aged ; Wounds and Injuries ; blood ; drug therapy ; immunology

OBJECTIVETo explore the role of glutamine in LPS and D-Gal induced acute hepatic injury.

METHODSA total of 61 Wistar rats were randomly divided into three groups: control group, model group and GLN pretreated group. The animal model was established by LPS and D-Gal intraperitoneal injection. GLN at dose of 1 g/kg was intragastrically administrated for 7 d before intraperitoneal injection. To evaluate the hepatic injury, the serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBiL) were detected by automatic biochemistry analysator. The liver and bowel tissue was observed by lightmicroscope and transmission electron microscope (TEM). The apoptosis of hepatocyte was detected by TUNEL. HPLC-PED was used in the study of intestinal permeability.

RESULTSNo significant differences were noted between ALT, AST, TBIL level, death rate and intestinal permeability (L/M) between model group and GLN pretreated group; In microscope, the confused structure of hepatic injury and inflammatory infiltration were similar between model group and GLN pretreated group. The injury of bowel was not obviously. Compared with the model group, there was better trend in liver and bowel in GLN pretreated group by transmission electron microscope (TEM). The apoptosis index in GLN pretreated group were lower than those in model group.

CONCLUSIONLPS can induce acute liver injury in D-Gal-sensitized rats.Glutamine has't the trend of protecting liver function and intestinal barrier function,decreasing death rates.

Animals ; Apoptosis ; drug effects ; Female ; Glutamine ; administration & dosage ; Injections, Intraperitoneal ; Intestinal Mucosa ; drug effects ; enzymology ; physiology ; Liver ; drug effects ; injuries ; Random Allocation ; Rats ; Rats, Wistar

OBJECTIVETo elucidate the inhibitory effects of recombinant Chinese scorpion neurotoxin BmK IM on seizures induced by pentylenetetrazol (PTZ) and the possible mechanism.

METHODSAfter purifying recombinant BmK IM from an E. coli cell line, its toxicity (both LD50 and minimum lethal dose) on rats was determined. BmK IM was then microinjected into the CA3 region of the right hippocampus and its ability to inhibit the effects of an intraperitoneal injection of PTZ was assessed. The effects of BmK IM on the electrophysiological properties of isolated CA3 pyramidal neurons were then studied using whole-cell patch clamp techniques.

RESULTSBmK IM can significantly prolong the latent period of epileptic seizures, decrease the degree of seizures, and decrease the frequency of epileptiform discharges induced by PTZ. At the same time, 24h after injection of BmK IM into the hippocampal tissue, BmK IM significantly reduces the concentration of the neurotransmitter glutamate and alleviates PTZ-induced lesions in the hippocampus. Whole-cell patch clamp recordings indicate that BmK IM inhibits INa of rat hippocampal neurons in a dose-dependent manner. BmK IM significantly shifts the activation curve of INa in a positive direction, indicating that BmK IM enhances the threshold potential of INa.

CONCLUSIONSBmK IM has significant anti-epileptic properties, and may prove useful as a drug in the therapy of epilepsy. The inhibitory effects of BmK IM on seizures caused by pentylenetetrazol might depend on reductions in the release of presynaptic glutamate via the blocking of Na+ channels.

Animals ; Glutamine ; secretion ; Hippocampus ; drug effects ; Male ; Microinjections ; Pentylenetetrazole ; Peptides ; administration & dosage ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Scorpion Venoms ; administration & dosage ; therapeutic use ; Seizures ; chemically induced ; prevention & control ; Sodium Channels ; drug effects

OBJECTIVETo investigate the influence of combined supplementation of glutamine (Gln) and recombinant human growth hormone (rhGH) on the protein metabolism in severely burned patients.

METHODSSixty severely burned patients were enrolled in the study and were randomly divided into control (C, n = 20) and Gln with rhGH (Gln + rhGH, n = 20) groups. The patients in C group received glycine as the placebo, while those in Gln group took Gln orally in dose of 0.5 g kg(-1) d(-1) during 1-14 postburn days (PBDs). For the patients in Gln + rhGH group rhGH was administered subcutaneously in dose of 0.2 U kg(-1) d(-1) in addition to glutamine in same dosage beginning on the 7 PBD for 7 days. The plasma Gln concentration in the 3 groups of patients was determined on the 1st, 7th and 14th PBD and the plasma albumin level was determined on 14th and 21st PBD. The wound healing rate of the patients within 30 PBSs and the total hospital stay days were recorded.

RESULTSThe plasma Gln concentration in Gln + rhGH group of patients was evidently higher than that in C group after 7 PBD[(452.28 +/- 21.72) micromol/L vs(325.12 +/- 25.34) micromol/L, P < 0.05]. The plasma albumin level in Gln + rhGH group was obviously higher than that in C and Gln groups on the 21st PBD (P < 0.05). The wound healing rate in Gln + rhGH group was evidently higher than that in Gln and C groups on the 30th PBD (P < 0.05). The total hospital stay days in Gln + rhGH group were obviously less than that in C and Gln groups (P < 0.05 or 0.01).

CONCLUSIONCombined administration of Gln and rhGH could be beneficial to the elevation of plasma Gln level in severely burned patients and the systemic protein synthesis was therefore enhanced and the wound healing rate was improved.

Adult ; Aged ; Burns ; metabolism ; therapy ; Female ; Glutamine ; administration & dosage ; blood ; therapeutic use ; Human Growth Hormone ; administration & dosage ; therapeutic use ; Humans ; Male ; Middle Aged ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Treatment Outcome ; Wound Healing ; drug effects ; Young Adult