Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-31T23:00:47.941Z Has data issue: false hasContentIssue false
  • English
  • Français

The feeding route (enteral or parenteral) affects the plasma response of the dipetide Ala-Gln and the amino acids glutamine, citrulline and arginine, with the administration of Ala-Gln in preoperative patients

Published online by Cambridge University Press:  08 March 2007

Gerdien C. Melis ,
Petra G. Boelens ,
Joost R. M. van der Sijp ,
Theodora Popovici ,
Jean-Pascal De Bandt ,
Luc Cynober  and
Paul A. M. van Leeuwen
Gerdien C. Melis
Affiliation:
Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
Petra G. Boelens
Affiliation:
Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
Joost R. M. van der Sijp
Affiliation:
Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
Theodora Popovici
Affiliation:
Department of Clinical Biochemistry, Hotel-Dieu Hospital AP-HP, Paris, France
Jean-Pascal De Bandt
Affiliation:
Department of Clinical Biochemistry, Hotel-Dieu Hospital AP-HP, Paris, France
Luc Cynober
Affiliation:
Department of Clinical Biochemistry, Hotel-Dieu Hospital AP-HP, Paris, France
Paul A. M. van Leeuwen*
Affiliation:
Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
*
*Corresponding author: Professor P. A. M. van Leeuwen, fax +31 20 4443620, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Enhancement of depressed plasma concentrations of glutamine and arginine is associated with better clinical outcome. Supplementation of glutamine might be a way to provide the patient with glutamine, and also arginine, because glutamine provides the kidney with citrulline, from which the kidney produces arginine when plasma levels of arginine are low. The aim of the present study was to investigate the parenteral and enteral response of the administered dipeptide Ala-Gln, glutamine, citrulline and arginine. Therefore, seven patients received 20 g Ala-Gln, administered over 4 h, parenterally or enterally, on two separate occasions. Arterial blood samples were taken before and during the administration of Ala-Gln. ANOVA and a paired t test were used to test differences (P<0·05). Ala-Gln was undetectable with enteral administration, whereas Ala-Gln remained stable at a plasma concentration of 268 μmol/l throughout parenteral infusion and rapidly decreased towards zero after infusion was stopped. The highest level of glutamine was observed with parenteral infusion of the dipeptide, although enteral infusion also significantly increased plasma levels of glutamine. The highest plasma response of citrulline was observed with the enteral administration of the dipeptide, although parenteral administration also increased plasma levels of citrulline. Plasma arginine increased significantly with parenteral infusion, but not with enteral administration of Ala-Gln. In conclusion, administrations of Ala-Gln, parenteral or enteral, resulted in an increased plasma glutamine response, as compared with baseline. Interestingly, in spite of the high availability of citrulline with enteral administration of the dipeptide, only parenteral infusion of Ala-Gln increased plasma arginine concentration.

Keywords

Ala-GlnGlutamineCitrullineArginineParenteral nutritionEnteral nutrition
Type
Research Article
Information
British Journal of Nutrition , Volume 94 , Issue 1 , July 2005 , pp. 19 - 26
Copyright
Copyright © The Nutrition Society 2005

References

Albers, S, Wernerman, J, Stehle, P, Vinnars, E & Furst, P (1988) Availability of amino acids supplied intravenously in healthy man as synthetic dipeptides: kinetic evaluation of L-alanyl-L-glutamine and glycyl-L-tyrosine. Clin Sci 75, 463–468.CrossRefGoogle Scholar
Albers, S, Wernerman, J, Stehle, P, Vinnars, E & Furst, P (1989) Availability of amino acids supplied by constant intravenous infusion of synthetic dipeptides in healthy man. Clin Sci 76, 643–648.CrossRefGoogle ScholarPubMed
Bertolini, G, Iapichino, G, Radrizzani, D, Facchini, R, Simini, B, Bruzzone, P, Zanforlin, G & Tognoni, G (2003) Early enteral immunonutrition in patients with severe sepsis: results of an interim analysis of a randomized multicentre clinical trial. Intensive Care Med 29, 834–840.CrossRefGoogle ScholarPubMed
Boelens, PG, Houdijk, AP, de Thouars, HN, Teerlink, T, Van Engeland, MI, Haarman, HJ & Van Leeuwen, PA (2003) Plasma taurine concentrations increase after enteral glutamine supplementation in trauma patients and stressed rats. Am J Clin Nutr 77, 250–256.CrossRefGoogle ScholarPubMed
Cynober, L, Le Boucher, J & Vasson, MP (1995) Arginine metabolism in mammals. J Nutr Biochem 6, 402–413.CrossRefGoogle Scholar
Darmaun, D, Matthews, DE & Bier, DM (1986) Glutamine and glutamate kinetics in humans. Am J Physiol 251, E117–E126.Google ScholarPubMed
Dudrick, PS, Inoue, Y, Espat, NJ & Souba, WW (1993) Na(+)-dependent glutamine transport in the liver of tumour-bearing rats. Surg Oncol 2, 205–215.CrossRefGoogle ScholarPubMed
Elia, M & Lunn, PG (1997) Biological markers of protein-energy malnutrition. Clin Nutr 16, Suppl. 1, 11–17.CrossRefGoogle ScholarPubMed
Espat, NJ, Bode, BP, Lind, DS, Copeland, EM & Souba, WW (1995) Normalization of tumor-induced increases in hepatic amino acid transport after surgical resection. Ann Surg 221, 50–58.CrossRefGoogle ScholarPubMed
Furst, P (1998) Old and new substrates in clinical nutrition. J Nutr 128, 789–796.CrossRefGoogle ScholarPubMed
Giner, M, Laviano, A, Meguid, MM & Gleason, JR (1996) In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 12, 23–29.CrossRefGoogle ScholarPubMed
Heyland, DK, Novak, F, Drover, JW, Jain, M, Su, X & Suchner, U (2001) Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA 286, 944–953.CrossRefGoogle ScholarPubMed
Houdijk, AP, Rijnsburger, ER, Jansen, J, Wesdorp, RIC, Welss, JK, McCamish, MA, Teerling, T, Meuwissen, SGM, Haarman, JThM & Van Leeuwen, PAM (1998) Randomised trial of glutamine-enriched enteral nutrition on infectious morbidity in patients with multiple trauma. Lancet 352, 772–776.CrossRefGoogle ScholarPubMed
Houdijk, AP, Van Leeuwen, PA, Teerlink, T, Flinkerbusch, EL, Boermeester, MA & Sauerwein, HP (1994) Glutamine-enriched enteral diet increases renal arginine production. JPEN 18, 422–426.CrossRefGoogle ScholarPubMed
Hubl, W, Druml, W, Langer, K & Lochs, H (1989) Influence of molecular structure and plasma hydrolysis on the metabolism of glutamine-containing dipeptides in humans. Metabolism 38, Suppl. 1, 59–62.CrossRefGoogle Scholar
Le Bacquer, O, Laboisse, C & Darmaun, D (2003) Glutamine preserves protein synthesis and paracellular permeability in Caco-2 cells submitted to ‘luminal fasting'. Am J Physiol 285, G128–G136.Google ScholarPubMed
Lochs, H, Roth, E, Gasic, S, Hubl, W, Morse, EL & Adibi, SA (1990) Splanchnic, renal, and muscle clearance of alanylglutamine in man and organ fluxes of alanine and glutamine when infused in free and peptide forms. Metabolism 39, 833–836.CrossRefGoogle ScholarPubMed
McCauley, R, Kong, SE & Hall, J (1998) Glutamine and nucleotide metabolism within enterocytes. JPEN 22, 105–111.CrossRefGoogle ScholarPubMed
Matthews, DE, Marano, MA & Campbell, RG (1993) Splanchnic bed utilization of glutamine and glutamic acid in humans. Am J Physiol 264, E848–E854.Google ScholarPubMed
Minami, H, Morse, EL & Adibi, SA (1992) Characteristics and mechanism of glutamine-dipeptide absorption in human intestine. Gastroenterology 103, 3–11.CrossRefGoogle ScholarPubMed
Murphy, C & Newsholme, P (1998) Importance of glutamine metabolism in murine macrophages and human monocytes to L-arginine biosynthesis and rates of nitrite or urea production. Clin Sci 95, 397–407.CrossRefGoogle ScholarPubMed
Neveux, N, David, D & Cynober, L (2004) Measurement of amino acid concentrations in biological fluids and tissues using ion exchange chromatography. In Metabolic and Therapeutic Aspects of Amino Acids in Clinical Nutrition, 2nd ed., pp. 17–28[Cynober, L, editor]. Boca Raton, FL: CRC Press.Google Scholar
Newsholme, P (2001) Why is L-glutamine metabolism important to cells of the immune system in health, postinjury, surgery or infection?. J Nutr 131, 2515S–2522S.CrossRefGoogle ScholarPubMed
Prins, HA, Houdijk, AP, Wiezer, MJ, Teerlink, T, Van Lambalgen, AA, Thijs, LG, Van Leeuwen, PA (1999) Reduced arginine plasma levels are the drive for arginine production by the kidney in the rat. Shock 11, 199–204.CrossRefGoogle ScholarPubMed
Ridge, JA, Bading, JR, Gelbard, AS, Benua, RS & Daly, JM (1987) Perfusion of colorectal hepatic metastasis: relative distribution from the hepatic artery and portal vein. Cancer 59, 1547–1553.3.0.CO;2-6>CrossRefGoogle Scholar
Rodriguez, PC, Zea, AH, Culotta, KS, Zabaleta, J, Ochoa, JB & Ochoa, AC (2002) Regulation of T cell receptor CD3zeta chain expression by L-arginine. J Biol Chem 277, 21123–21129.CrossRefGoogle ScholarPubMed
Scheppach, W, Loges, C, Bartram, P, Christl, SU, Richter, F, Dusel, G, Stehele, P, Fuerst, P & Kasper, H (1994) Effect of free glutamine and alanyl-glutamine dipeptide on mucosal proliferation of the human ileum and colon. Gastroenterology 107, 429–434.CrossRefGoogle ScholarPubMed
Silk, DB (1974) Progress report. Peptide absorption in man. Gut 5, 494–501.CrossRefGoogle Scholar
Souba, WW (1992) Glutamine: Physiology, Biochemistry and Nutrition in Critical Illness. Austin, TX: RG Landes.Google Scholar
Teerlink, T, Van Leeuwen, PA & Houdijk, A (1994) Plasma amino acids determined by liquid chromatography within 17 minutes. Clin Chem 40, 245–249.CrossRefGoogle Scholar
van der Hulst, RR, Van Kreel, BK, von Meyenfeldt, MF, Brummer, RJ, Arends, JW, Deutz, NE & Soeters, PB (1993) Glutamine and the preservation of gut integrity. Lancet 341, 1363–1365.CrossRefGoogle ScholarPubMed
Windmueller, HG & Spaeth, AE (1981) Source and fate of circulating citrulline. Am J Physiol 241, E473–E480.Google ScholarPubMed
Wiren, M, Magnusson, KE & Larsson, J (1998) The role of glutamine, serum and energy factors in growth of enterocyte-like cell lines. Int J Biochem Cell Biol 30, 1331–1336.CrossRefGoogle ScholarPubMed
Wu, G & Morris, SM Jr (1998) Arginine metabolism: nitric oxide and beyond. Biochem J 336, 1–17.CrossRefGoogle ScholarPubMed
Ziegler, TR, Evans, ME, Fernandez-Estivariz, C & Jones, DP (2003) Trophic and cytoprotective nutrition for intestinal adaptation, mucosal repair, and barrier function. Annu Rev Nutr 23, 229–261.CrossRefGoogle ScholarPubMed