The metabolic pathway of (alanyl-)glutamine into citrulline and arginine in surgical patients
Year: 2008
Type: other
Abstract: Purpose of review The aim of this review is to describe the clinical relevance of supplementation of glutamine from the recent literature. First, new basic research and subsequently metaanalyses and recent clinical trials concerning the effect of glutamine on clinical outcome are discussed. Recent Findings Recent basic research on glutamine has further improved our understanding about the possible mechanisms behind the beneficial effects of glutamine on clinical outcome. We now know that the purpose of glutamine to serve as a substrate for protein synthesis and a respiratory fuel for cells of the immune system and the gastro-intestinal tract is incomplete. Recent discoveries on glutamine emphasize its role as a regulating molecule. Glutamine supports the immune system and blunts the inflammatory response. Glutamine protects organs from inflammation and concomitant oxidative stress by enhancing the availability of the antioxidants glutathione and taurine and by enhancing the expression of heat shock proteins. Furthermore, glutamine regulates the nitric oxide synthesis from arginine in endothelial cells and macrophages, and is an important precursor for the de novo synthesis of arginine in humans. Finally, glutamine helps to preserve insulin sensitivity. Summary of clinical evidence Based on an ongoing meta-analysis and up-to-date clinical trials, we may conclude that supporting the parenterally fed, critically ill patient with > 0.2 g glutamine · kg-1 · day-1 is beneficial because it improves survival. The benefits of enteral supplementation of glutamine seem established in trauma and burn patients. Currently, a large trial is ongoing involving 1200 critically ill patients receiving a combination of intravenous (0.35 g · kg-1 · day-1) and enteral glutamine (30 g/dag).
Source: Pure Amsterdam UMC
Author: Ligthart-Melis, G.C.
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2147779250