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Li J, Bai J, Yang Y, Wu Z. Low-protein diet supplemented with 1% L-glutamine improves growth performance, serum biochemistry, redox status, plasma amino acids, and alters fecal microbiota in weaned piglets. ANIMAL NUTRITION (ZHONGGUO XU MU SHOU YI XUE HUI) 2024; 17:144-154. [PMID: 38766517 PMCID: PMC11101948 DOI: 10.1016/j.aninu.2023.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 05/22/2024]
Abstract
Glutamine, one of the most abundant amino acids in the body, has been shown to exert various beneficial effects in pigs. However, knowledge regarding the role of dietary glutamine in low-protein diet-fed piglets remains scarce. The present study aimed to investigate the effects of different levels of L-glutamine on growth performance, serum biochemistry parameters, redox status, amino acids, and fecal microbiota in low-protein diet-fed piglets. A total of 128 healthy crossbred piglets (Landrace × Yorkshire) were randomly allocated into 4 groups of 4 replicate pens, with 8 piglets per pen. Piglets in the 4 groups were fed with corn and soybean meal-based low-protein diets (crude protein level, 17%) that contained 0%, 1%, 2%, and 3% L-glutamine, respectively, for 28 d. Pigs administered 1% L-glutamine had greater body weight on d 28 and average daily gain (ADG, P < 0.01), whereas a lower feed to gain ratio (F:G) from d 1 to 28 (P < 0.01), compared to the other three groups. Besides, lower body weight on d 14 and 28, ADG, average daily feed intake, and higher F:G from d 15 to 28 and d 1 to 28 were observed in response to 2% and 3% L-glutamine treatments than 0% and 1% L-glutamine treatments (P < 0.01). Moreover, 1% L-glutamine reduced serum glucose, malondialdehyde, hydrogen peroxide concentrations and inhibited aspartate aminotransferase, alanine aminotransferase, myeloperoxidase activities in low-protein diet-fed piglets on d 14, with concomitantly upregulated catalase, total superoxide dismutase activities and glutathione level (P < 0.05). However, dietary 3% L-glutamine enhanced blood urea nitrogen content in pigs on d 14 (P < 0.05). Further investigation revealed that 1% L-glutamine upregulated the serum glutamine, lysine, methionine, tyrosine, and reduced plasma valine content (P < 0.05). Additionally, 1% L-glutamine upregulated the abundance of p_75_a5, Clostridium, Lactobacillus, Prevotellaceae_Prevotella, and Gemmiger in the stool of piglets on d 14, with the Streptococcus level being concomitantly reduced (P < 0.05). Collectively, dietary 1% L-glutamine enhances the growth performance and improves serum physiochemical parameters and antioxidative capacity in low-protein diet-fed piglets at an early age, which are associated with an increased synthesis of glutathione by modulating amino acid levels, and the optimization of gut microbiota.
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Affiliation(s)
- Jun Li
- State Key Laboratory of Animal Nutrition and Feeding, Department of Companion Animal Science, China Agricultural University, Beijing 100193, China
| | - Jun Bai
- State Key Laboratory of Animal Nutrition and Feeding, Department of Companion Animal Science, China Agricultural University, Beijing 100193, China
| | - Ying Yang
- State Key Laboratory of Animal Nutrition and Feeding, Department of Companion Animal Science, China Agricultural University, Beijing 100193, China
| | - Zhenlong Wu
- State Key Laboratory of Animal Nutrition and Feeding, Department of Companion Animal Science, China Agricultural University, Beijing 100193, China
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Hou L, Wang H, Yan M, Cai Y, Zheng R, Ma Y, Tang W, Jiang W. Obeticholic acid attenuates the intestinal barrier disruption in a rat model of short bowel syndrome. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167221. [PMID: 38718845 DOI: 10.1016/j.bbadis.2024.167221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Short bowel syndrome (SBS) features nutrients malabsorption and impaired intestinal barrier. Patients with SBS are prone to sepsis, intestinal flora dysbiosis and intestinal failure associated liver disease. Protecting intestinal barrier and preventing complications are potential strategies for SBS treatment. This study aims to investigate the effects of farnesoid X receptor (FXR) agonist, obeticholic acid (OCA), have on intestinal barrier and ecological environment in SBS. METHODS AND RESULTS Through testing the small intestine and serum samples of patients with SBS, impaired intestinal barrier was verified, as evidenced by reduced expressions of intestinal tight junction proteins (TJPs), increased levels of apoptosis and epithelial cell damage. The intestinal expressions of FXR and related downstream molecules were decreased in SBS patients. Then, global FXR activator OCA was used to further dissect the potential role of the FXR in a rat model of SBS. Low expressions of FXR-related molecules were observed on the small intestine of SBS rats, along with increased proinflammatory factors and damaged barrier function. Furthermore, SBS rats possessed significantly decreased body weight and elevated death rate. Supplementation with OCA mitigated the damaged intestinal barrier and increased proinflammatory factors in SBS rats, accompanied by activated FXR-related molecules. Using 16S rDNA sequencing, the regulatory role of OCA on gut microbiota in SBS rats was witnessed. LPS stimulation to Caco-2 cells induced apoptosis and overexpression of proinflammatory factors in vitro. OCA incubation of LPS-pretreated Caco-2 cells activated FXR-related molecules, increased the expressions of TJPs, ameliorated apoptosis and inhibited overexpression of proinflammatory factors. CONCLUSIONS OCA supplementation could effectively ameliorate the intestinal barrier disruption and inhibit overexpression of proinflammatory factors in a rat model of SBS and LPS-pretreated Caco-2 cells. As a selective activator of FXR, OCA might realize its protective function through FXR activation.
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Affiliation(s)
- Li Hou
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China; Department of Surgical Oncology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hanfei Wang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Yan
- Department of Pediatrics, Huai'an Maternal and Child Health Care Center, Huai'an, China
| | - Yaoyao Cai
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ruifei Zheng
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yujun Ma
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weibing Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Weiwei Jiang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
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Muranaka H, Akinsola R, Billet S, Pandol SJ, Hendifar AE, Bhowmick NA, Gong J. Glutamine Supplementation as an Anticancer Strategy: A Potential Therapeutic Alternative to the Convention. Cancers (Basel) 2024; 16:1057. [PMID: 38473414 PMCID: PMC10930819 DOI: 10.3390/cancers16051057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Glutamine, a multifaceted nonessential/conditionally essential amino acid integral to cellular metabolism and immune function, holds pivotal importance in the landscape of cancer therapy. This review delves into the intricate dynamics surrounding both glutamine antagonism strategies and glutamine supplementation within the context of cancer treatment, emphasizing the critical role of glutamine metabolism in cancer progression and therapy. Glutamine antagonism, aiming to disrupt tumor growth by targeting critical metabolic pathways, is challenged by the adaptive nature of cancer cells and the complex metabolic microenvironment, potentially compromising its therapeutic efficacy. In contrast, glutamine supplementation supports immune function, improves gut integrity, alleviates treatment-related toxicities, and improves patient well-being. Moreover, recent studies highlighted its contributions to epigenetic regulation within cancer cells and its potential to bolster anti-cancer immune functions. However, glutamine implementation necessitates careful consideration of potential interactions with ongoing treatment regimens and the delicate equilibrium between supporting normal cellular function and promoting tumorigenesis. By critically assessing the implications of both glutamine antagonism strategies and glutamine supplementation, this review aims to offer comprehensive insights into potential therapeutic strategies targeting glutamine metabolism for effective cancer management.
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Affiliation(s)
- Hayato Muranaka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rasaq Akinsola
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Stephen J. Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew E. Hendifar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil A. Bhowmick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Jun Gong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (H.M.); (R.A.); (S.B.); (S.J.P.); (A.E.H.); (N.A.B.)
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Chang HC, Huang WY, Chen PH, Huang TW, Gautama MSN. Effectiveness of glutamine for the treatment of radiodermatitis in cancer patients: a meta-analysis of randomized controlled trials. Support Care Cancer 2024; 32:201. [PMID: 38427125 DOI: 10.1007/s00520-024-08411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND After receiving radiation therapy, 60%-95% of patients with cancer develop radiodermatitis, which causes pain, wound infection, and poor quality of life. Glutamine is a popular nutritional supplement for patients with cancer. Several studies examined the usefulness of glutamine for reducing radiodermatitis. However, there is still no consolidated evidence for clinical use. METHODS We searched PubMed, Embase, Cochrane Library, CINAHL PLUS, and the China Knowledge Resource Integrated Database for the relevant literature published up to March 2023, without language restrictions. Two reviewers screened, filtered, and appraised these articles independently, and their data were pooled using a random-effects model. RESULTS Five randomized controlled trials (RCTs) with 218 participants were analyzed. The incidence of radiodermatitis in the glutamine group (89/110) was significantly lower than in the placebo group (99/108; risk ratio [RR], 0.90; 95% CI, 0.81-1.00; p = 0.05; I2 = 7%). The incidence of moderate to severe radiodermatitis was significantly lower in the glutamine group than in the placebo group (RR, 0.49; 95% CI, 0.32-0.76; p = 0.001; I2 = 52%). Moreover, subgroup analysis demonstrated heterogeneity (I2 = 52%) for moderate to severe radiodermatitis, the risk of which might be significantly reduced by a glutamine dose of 20-30 g/day (RR, 0.60; 95% CI, 0.41-0.87; I2 = 0%). CONCLUSION The meta-analysis indicate that glutamine might lead to a lower incidence of radiodermatitis, and that a glutamine dose of 20-30 g/day might decrease the incidence of moderate to severe dermatitis. Thus, the serious impact of radiodermatitis on treatment follow-up makes the clinical use of glutamine even more important. PROSPERO number: CRD42021254394.
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Affiliation(s)
- Hsu-Chieh Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Tri-Service General Hospital Beitou Branch, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yen Huang
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Wei Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Tafi E, Sagona S, Meucci V, Bortolotti L, Galloni M, Bogo G, Gatta D, Casini L, Barberis M, Nepi M, Felicioli A. Effect of amino acid enriched diets on hemolymph amino acid composition in honey bees. ARCHIVES OF INSECT BIOCHEMISTRY AND PHYSIOLOGY 2024; 115:e22085. [PMID: 38288497 DOI: 10.1002/arch.22085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Amino acids (AAs) are an abundant class of nectar solutes, and they are involved in the nectar attractiveness to flower visitors. Among the various AAs, proline is the most abundant proteogenic AA, and γ-amino butyric acid (GABA) and β-alanine are the two most abundant non-proteogenic AAs. These three AAs are known to affect insect physiology, being involved in flight metabolism and neurotransmission. The aim of this study was to investigate the effects of artificial diets enriched with either β-alanine, GABA, or proline on consumption, survival, and hemolymph composition in honey bees belonging to two different ages and with different metabolism (i.e., newly emerged and foragers). Differences in feed intake among diets were not observed, while a diet enriched with β-alanine improved the survival rate of newly emerged honey bees compared to the control group. Variations in the hemolymph AA concentrations occurred only in newly emerged honey bees, according to the diet and the time of hemolymph sampling. A greater susceptibility of young honey bees to enriched diets than older honey bees was observed. The variations in the concentrations of hemolymph AAs reflect either the accumulation of dietary AAs or the existence of metabolic pathways that may lead to the conversion of dietary AAs into different ones. This investigation could be an initial contribution to studying the complex dynamics that regulate hemolymph AA composition and its effect on honey bee physiology.
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Affiliation(s)
- Elena Tafi
- Department of Veterinary Science, University of Pisa, Pisa, Italy
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
| | - Simona Sagona
- Department of Veterinary Science, University of Pisa, Pisa, Italy
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | - Valentina Meucci
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - Laura Bortolotti
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
| | - Marta Galloni
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Gherardo Bogo
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Domenico Gatta
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - Lucia Casini
- Department of Veterinary Science, University of Pisa, Pisa, Italy
| | - Marta Barberis
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Massimo Nepi
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Antonio Felicioli
- Department of Veterinary Science, University of Pisa, Pisa, Italy
- Interdepartmental Research Centre "Nutraceuticals and Food for Health", University of Pisa, Pisa, Italy
- Center for Research in Agricultural and Environmental Sciences "E. Avanzi", University of Pisa, Pisa, Italy
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Zhou X, Zhang J, Sun Y, Shen J, Sun B, Ma Q. Glutamine Ameliorates Liver Steatosis via Regulation of Glycolipid Metabolism and Gut Microbiota in High-Fat Diet-Induced Obese Mice. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:15656-15667. [PMID: 37847053 DOI: 10.1021/acs.jafc.3c05566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Obesity and its associated conditions, such as nonalcoholic fatty liver disease (NAFLD), are risk factors for health. The aim of this study was to explore the effects of glutamine (Gln) on liver steatosis induced by a high-fat diet (HFD) and HEPG2 cells induced by oleic acid. Gln demonstrated a positive influence on hepatic homeostasis by suppressing acetyl CoA carboxylase (ACC) and fatty acid synthase (FAS) and promoting sirtuin 1 (SIRT1) expression while improving glucose metabolism by regulating serine/threonine protein kinase (AKT)/factor forkhead box O1 (FOXO1) signals in vivo and in vitro. Obese Gln-fed mice had higher colonic short-chain fatty acid (SCFA) contents and lower inflammation factor protein levels in the liver, HEPG2 cells, and jejunum. Gln-treated obese mice had an effective decrease in Firmicutes abundance. These findings indicate that Gln serves as a nutritional tool in managing obesity and related disorders.
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Affiliation(s)
- Xinbo Zhou
- College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China
| | - Junjie Zhang
- College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China
| | - Yutong Sun
- College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China
| | - Jian Shen
- College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China
| | - Bo Sun
- College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China
| | - Qingquan Ma
- College of Animal Science and Technology, Northeast Agricultural University, Harbin 150030, China
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Gong J, Osipov A, Lorber J, Tighiouart M, Kwan AK, Muranaka H, Akinsola R, Billet S, Levi A, Abbas A, Davelaar J, Bhowmick N, Hendifar AE. Combination L-Glutamine with Gemcitabine and Nab-Paclitaxel in Treatment-Naïve Advanced Pancreatic Cancer: The Phase I GlutaPanc Study Protocol. Biomedicines 2023; 11:1392. [PMID: 37239063 PMCID: PMC10216251 DOI: 10.3390/biomedicines11051392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Advanced pancreatic cancer is underscored by progressive therapeutic resistance and a dismal 5-year survival rate of 3%. Preclinical data demonstrated glutamine supplementation, not deprivation, elicited antitumor effects against pancreatic ductal adenocarcinoma (PDAC) alone and in combination with gemcitabine in a dose-dependent manner. The GlutaPanc phase I trial is a single-arm, open-label clinical trial investigating the safety of combination L-glutamine, gemcitabine, and nab-paclitaxel in subjects (n = 16) with untreated, locally advanced unresectable or metastatic pancreatic cancer. Following a 7-day lead-in phase with L-glutamine, the dose-finding phase via Bayesian design begins with treatment cycles lasting 28 days until disease progression, intolerance, or withdrawal. The primary objective is to establish the recommended phase II dose (RP2D) of combination L-glutamine, gemcitabine, and nab-paclitaxel. Secondary objectives include safety of the combination across all dose levels and preliminary evidence of antitumor activity. Exploratory objectives include evaluating changes in plasma metabolites across multiple time points and changes in the stool microbiome pre and post L-glutamine supplementation. If this phase I clinical trial demonstrates the feasibility of L-glutamine in combination with nab-paclitaxel and gemcitabine, we would advance the development of this combination as a first-line systemic option in subjects with metastatic pancreatic cancer, a high-risk subgroup desperately in need of additional therapies.
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Affiliation(s)
- Jun Gong
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Arsen Osipov
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jeremy Lorber
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Mourad Tighiouart
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Albert K. Kwan
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Hayato Muranaka
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Rasaq Akinsola
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandrine Billet
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Abrahm Levi
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Anser Abbas
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - John Davelaar
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Neil Bhowmick
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Andrew E. Hendifar
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Effect of L-Glutamine on Chylomicron Formation and Fat-Induced Activation of Intestinal Mucosal Mast Cells in Sprague-Dawley Rats. Nutrients 2022; 14:nu14091777. [PMID: 35565745 PMCID: PMC9104139 DOI: 10.3390/nu14091777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Glutamine (Gln) is required for intestinal mucosal homeostasis, and it can promote triglyceride absorption. The intestinal mucosal mast cells (MMCs) are activated during fat absorption. This study investigated the potential role of Gln on fat absorption-induced activation of MMCs in rats. Lymph fistula rats (n = 24) were studied after an overnight recovery with the infusion of saline only, saline plus 85 mM L-glutamine (L-Gln) or 85 mM D-glutamine (D-Gln), respectively. On the test day, rats (n = 8/group) were given an intraduodenal bolus of 20% Intralipid contained either saline only (vehicle group), 85 mM L-Gln (L-Gln group), or 85 mM D-Gln (D-Gln group). Lymph was collected hourly for up to 6 h for analyses. The results showed that intestinal lymph from rats given L-Gln had increased levels of apolipoprotein B (ApoB) and A-I (ApoA-I), concomitant with an increased spectrum of smaller chylomicron particles. Unexpectedly, L-Gln also increased levels of rat mucosal mast cell protease II (RMCPII), as well as histamine and prostaglandin D2 (PGD2) in response to dietary lipid. However, these effects were not observed in rats treated with 85 mM of the stereoisomer D-Gln. Our results showed that L-glutamine could specifically activate MMCs to degranulate and release MMC mediators to the lymph during fat absorption. This observation is potentially important clinically since L-glutamine is often used to promote gut health and repair leaky gut.
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Chantler S, Griffiths A, Matu J, Davison G, Holliday A, Jones B. A systematic review: Role of dietary supplements on markers of exercise-associated gut damage and permeability. PLoS One 2022; 17:e0266379. [PMID: 35417467 PMCID: PMC9007357 DOI: 10.1371/journal.pone.0266379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 03/19/2022] [Indexed: 12/12/2022] Open
Abstract
Nutrition strategies and supplements may have a role to play in diminishing exercise associated gastrointestinal cell damage and permeability. The aim of this systematic review was to determine the influence of dietary supplements on markers of exercise-induced gut endothelial cell damage and/or permeability. Five databases were searched through to February 2021. Studies were selected that evaluated indirect markers of gut endothelial cell damage and permeability in response to exercise with and without a specified supplement, including with and without water. Acute and chronic supplementation protocols were included. Twenty-seven studies were included. The studies investigated a wide range of supplements including bovine colostrum, glutamine, probiotics, supplemental carbohydrate and protein, nitrate or nitrate precursors and water across a variety of endurance exercise protocols. The majority of studies using bovine colostrum and glutamine demonstrated a reduction in selected markers of gut cell damage and permeability compared to placebo conditions. Carbohydrate intake before and during exercise and maintaining euhydration may partially mitigate gut damage and permeability but coincide with other performance nutrition strategies. Single strain probiotic strains showed some positive findings, but the results are likely strain, dosage and duration specific. Bovine colostrum, glutamine, carbohydrate supplementation and maintaining euhydration may reduce exercise-associated endothelial damage and improve gut permeability. In spite of a large heterogeneity across the selected studies, appropriate inclusion of different nutrition strategies could mitigate the initial phases of gastrointestinal cell disturbances in athletes associated with exercise. However, research is needed to clarify if this will contribute to improved athlete gastrointestinal and performance outcomes.
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Affiliation(s)
- Sarah Chantler
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Yorkshire Carnegie Rugby Union Club, Leeds, United Kingdom
| | - Alex Griffiths
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Jamie Matu
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Glen Davison
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Canterbury, United Kingdom
| | - Adrian Holliday
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- School of Science and Technology, University of New England, Armidale, NSW, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, the University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
- Leeds Rhinos Rugby League Club, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Leeds, United Kingdom
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Abstract
The aim of the article is to examine side effects of increased dietary intake of amino acids, which are commonly used as a dietary supplement. In addition to toxicity, mutagenicity and carcinogenicity, attention is focused on renal and gastrointestinal tract functions, ammonia production, and consequences of a competition with other amino acids for a carrier at the cell membranes and enzymes responsible for their degradation. In alphabetic order are examined arginine, β-alanine, branched-chain amino acids, carnosine, citrulline, creatine, glutamine, histidine, β-hydroxy-β-methylbutyrate, leucine, and tryptophan. In the article is shown that enhanced intake of most amino acid supplements may not be risk-free and can cause a number of detrimental side effects. Further research is necessary to elucidate effects of high doses and long-term consumption of amino acid supplements on immune system, brain function, muscle protein balance, synthesis of toxic metabolites, and tumor growth and examine their suitability under certain circumstances. These include elderly, childhood, pregnancy, nursing a baby, and medical condition, such as diabetes and liver disease. Studies are also needed to examine adaptive response to a long-term intake of any substance and consequences of discontinuation of supplementation.
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Affiliation(s)
- M HOLEČEK
- Department of Physiology, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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11
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Pires RS, Braga PGS, Santos JMB, Amaral JB, Amirato GR, Trettel CS, Dos Santos CAF, Vaisberg M, Nali LHS, Vieira RP, Maranhão RC, Pithon-Curi TC, Barros MP, Bachi ALL. l-Glutamine supplementation enhances glutathione peroxidase and paraoxonase-1 activities in HDL of exercising older individuals. Exp Gerontol 2021; 156:111584. [PMID: 34653558 DOI: 10.1016/j.exger.2021.111584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oxidative stress is an important factor in the formation of atherosclerotic plaques. High-density lipoprotein (HDL) harbors paraoxonase-1 (PON-1) and glutathione peroxidase (GPx), key enzymes in the protection against the harmful effects of oxidative stress. Although exercise training can increase both HDL-c content and its antioxidant action, and glutamine (Gln) intake also promotes GPx-based defenses, the association between exercise training and Gln in the regulation of PON-1 activity was not explored. Therefore, the objective of this study was to investigate the effects of Gln supplementation on the redox balance and on the total HDL antioxidant capacity by evaluation of the activity of PON-1 and GPx enzymes in physically exercised elderly individuals compared to non-exercised ones. METHODS Fifty-one practitioners of a combined exercise training program (CET, age: 71.9 ± 5.7 years) and 32 non-practitioners (NP, age: 73 ± 6.3 years) participated in the study. CET and NP groups were separated into 2 subgroups according to the supplementation: Gln, 0.3 g/kg/day + 10 g maltodextrin (CET-Gln, n = 26; and NP-Gln, n = 16) or placebo, 10 g maltodextrin (CET-PL, n = 25; and NP-PL, n = 16). Blood samples were drawn at baseline and after 30 days after commencement of the supplementation for biochemical and enzyme activity analyses. RESULTS Increased HDL-c, total peroxidase (PRx), and GPx activities were found in both CET-Gln and NP-Gln after the supplementation period, compared to baseline, in opposition to CET-PL and NP-PL groups. PON-1 activity increased only in CET-Gln. In both CET-Gln and NP-Gln groups, there was a reduction of the total peroxides/PRx, iron/PRx, and total peroxides/GPX ratios after supplementation. In CET-Gln, thiobarbituric acid-reactive substances (TBARS)/PRx and TBARS/GPx ratios were also lower after supplementation. CET-Gln and CET-PL subgroups had lower glycemia than NP-Gln and NP-PL, either at baseline or after the supplementation periods. The other parameters were unchanged after supplementation [total cholesterol, LDL-c, triglycerides, non-HDL cholesterol, total peroxides, TBARS, iron serum, Trolox-equivalent antioxidant capacity (TEAC), and uric acid]. CONCLUSIONS Gln supplementation can increase glutathione peroxidase activity regardless the individuals were physically active or sedentary, but the PON-1 activity only increased in physically active individuals. These results show the potential of Gln supplementation in the maintenance of the vascular redox balance, with potential implications for atherogenesis protection.
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Affiliation(s)
- Renier S Pires
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, SP 04829-300, Brazil
| | - Pedro G S Braga
- Lipid Metabolism Laboratory, Heart Institute (InCor), Medical School Hospital, University of São Paulo, SP 05403-900, Brazil
| | - Juliana M B Santos
- Post-Graduation Program in Science of Human and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP 11015-020, Brazil
| | - Jônatas B Amaral
- ENT Lab, Department of Otorhinolaryngology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04025-002, Brazil
| | - Gislene R Amirato
- ENT Lab, Department of Otorhinolaryngology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04025-002, Brazil
| | - Caio S Trettel
- Interdisciplinary Program in Health Sciences, Institute of Physical Activity Sciences and Sports (ICAFE), Cruzeiro do Sul University, São Paulo, SP 01506-000, Brazil
| | - Carlos A F Dos Santos
- Department of Medicine (Geriatrics and Gerontology), Federal University of São Paulo (UNIFESP), São Paulo, SP 04020-050, Brazil
| | - Mauro Vaisberg
- ENT Lab, Department of Otorhinolaryngology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04025-002, Brazil
| | - Luis H S Nali
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, SP 04829-300, Brazil
| | - Rodolfo P Vieira
- Post-Graduation Program in Science of Human and Rehabilitation, Federal University of São Paulo (UNIFESP), Santos, SP 11015-020, Brazil; Post-graduation Program in Bioengineering and Biomedical Engineering, Universidade Brasil, São Paulo, SP 08230-030, Brazil; Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Jose dos Campos, SP 12245-520, Brazil
| | - Raul C Maranhão
- Lipid Metabolism Laboratory, Heart Institute (InCor), Medical School Hospital, University of São Paulo, SP 05403-900, Brazil
| | - Tania C Pithon-Curi
- Interdisciplinary Program in Health Sciences, Institute of Physical Activity Sciences and Sports (ICAFE), Cruzeiro do Sul University, São Paulo, SP 01506-000, Brazil
| | - Marcelo P Barros
- Interdisciplinary Program in Health Sciences, Institute of Physical Activity Sciences and Sports (ICAFE), Cruzeiro do Sul University, São Paulo, SP 01506-000, Brazil
| | - André L L Bachi
- Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo, SP 04829-300, Brazil; ENT Lab, Department of Otorhinolaryngology, Federal University of São Paulo (UNIFESP), São Paulo, SP 04025-002, Brazil; Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Jose dos Campos, SP 12245-520, Brazil.
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12
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Pancreatic cancer cachexia: three dimensions of a complex syndrome. Br J Cancer 2021; 124:1623-1636. [PMID: 33742145 PMCID: PMC8110983 DOI: 10.1038/s41416-021-01301-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 02/08/2023] Open
Abstract
Cancer cachexia is a multifactorial syndrome that is characterised by a loss of skeletal muscle mass, is commonly associated with adipose tissue wasting and malaise, and responds poorly to therapeutic interventions. Although cachexia can affect patients who are severely ill with various malignant or non-malignant conditions, it is particularly common among patients with pancreatic cancer. Pancreatic cancer often leads to the development of cachexia through a combination of distinct factors, which, together, explain its high prevalence and clinical importance in this disease: systemic factors, including metabolic changes and pathogenic signals related to the tumour biology of pancreatic adenocarcinoma; factors resulting from the disruption of the digestive and endocrine functions of the pancreas; and factors related to the close anatomical and functional connection of the pancreas with the gut. In this review, we conceptualise the various insights into the mechanisms underlying pancreatic cancer cachexia according to these three dimensions to expose its particular complexity and the challenges that face clinicians in trying to devise therapeutic interventions.
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13
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Diet-related interventions for cancer-associated cachexia. J Cancer Res Clin Oncol 2021; 147:1443-1450. [PMID: 33718995 DOI: 10.1007/s00432-021-03592-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Cancer-associated cachexia is a common condition in patients with advanced cancer, and is associated with extreme and involuntary weight loss and irreversible muscle wasting. Despite its high morbidity and mortality, there is no known treatment to reverse its effects. Thus, there is increasing interest in whether diet and exercise can assist in the minimization of cancer-associated cachexia. METHODS We reviewed the literature on the impact of dietary patterns, dietary components, and exercise on the progress and severity of cancer cachexia. RESULTS Although most studies have produced inconclusive or controversial findings, some promising studies using animal models and early human clinical trials suggest that dietary and physical therapy interventions may alleviate cancer-associated cachexia. Moreover, many studies suggest that controlling diet and exercise nevertheless improved the quality of life (QoL) for cancer patients with cachexia. CONCLUSION Ongoing studies will continue to examine whether different forms of multimodal therapy-combinations of cancer treatment, dietary regimens, anti-inflammatory therapy, and physical therapy-are effective methods to improve outcomes in advanced cancer patients with cachexia. Moreover, future studies should examine the effects of such interventions on long-term QoL and establish nutritional guidelines for the management of cancer-associated cachexia.
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14
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Merlotti D, Cosso R, Eller-Vainicher C, Vescini F, Chiodini I, Gennari L, Falchetti A. Energy Metabolism and Ketogenic Diets: What about the Skeletal Health? A Narrative Review and a Prospective Vision for Planning Clinical Trials on this Issue. Int J Mol Sci 2021; 22:ijms22010435. [PMID: 33406758 PMCID: PMC7796307 DOI: 10.3390/ijms22010435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
The existence of a common mesenchymal cell progenitor shared by bone, skeletal muscle, and adipocytes cell progenitors, makes the role of the skeleton in energy metabolism no longer surprising. Thus, bone fragility could also be seen as a consequence of a “poor” quality in nutrition. Ketogenic diet was originally proven to be effective in epilepsy, and long-term follow-up studies on epileptic children undergoing a ketogenic diet reported an increased incidence of bone fractures and decreased bone mineral density. However, the causes of such negative impacts on bone health have to be better defined. In these subjects, the concomitant use of antiepileptic drugs and the reduced mobilization may partly explain the negative effects on bone health, but little is known about the effects of diet itself, and/or generic alterations in vitamin D and/or impaired growth factor production. Despite these remarks, clinical studies were adequately designed to investigate bone health are scarce and bone health related aspects are not included among the various metabolic pathologies positively influenced by ketogenic diets. Here, we provide not only a narrative review on this issue, but also practical advice to design and implement clinical studies on ketogenic nutritional regimens and bone health outcomes. Perspectives on ketogenic regimens, microbiota, microRNAs, and bone health are also included.
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Affiliation(s)
- Daniela Merlotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.M.); (L.G.)
| | - Roberta Cosso
- Istituto Auxologico Italiano “Scientific Institute for Hospitalisation and Care”, 20100 Milano, Italy; (R.C.); (I.C.)
| | - Cristina Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico Milano, 20122 Milano, Italy;
| | - Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia of Udine, 33100 Udine, Italy;
| | - Iacopo Chiodini
- Istituto Auxologico Italiano “Scientific Institute for Hospitalisation and Care”, 20100 Milano, Italy; (R.C.); (I.C.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milano, Italy
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (D.M.); (L.G.)
| | - Alberto Falchetti
- Istituto Auxologico Italiano “Scientific Institute for Hospitalisation and Care”, 20100 Milano, Italy; (R.C.); (I.C.)
- Correspondence:
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15
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The Possible Importance of Glutamine Supplementation to Mood and Cognition in Hypoxia from High Altitude. Nutrients 2020; 12:nu12123627. [PMID: 33255790 PMCID: PMC7760805 DOI: 10.3390/nu12123627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
Hypoxia induced by low O2 pressure is responsible for several physiological and behavioral alterations. Changes in physiological systems are frequent, including inflammation and psychobiological declines such as mood and cognition worsening, resulting in increased reaction time, difficulty solving problems, reduced memory and concentration. The paper discusses the possible relationship between glutamine supplementation and worsening cognition mediated by inflammation induced by high altitude hypoxia. The paper is a narrative literature review conducted to verify the effects of glutamine supplementation on psychobiological aspects. We searched MEDLINE/PubMed and Web of Science databases and gray literature by Google Scholar for English articles. Mechanistic pathways mediated by glutamine suggest potential positive effects of its supplementation on mood and cognition, mainly its potential effect on inflammation. However, clinical studies are scarce, making any conclusions impossible. Although glutamine plays an important role and seems to mitigate inflammation, clinical studies should test this hypothesis, which will contribute to a better mood and cognition state for several people who suffer from problems mediated by hypoxia.
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16
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Ogden HB, Child RB, Fallowfield JL, Delves SK, Westwood CS, Millyard A, Layden JD. Gastrointestinal Tolerance of Low, Medium and High Dose Acute Oral l-Glutamine Supplementation in Healthy Adults: A Pilot Study. Nutrients 2020; 12:nu12102953. [PMID: 32992440 PMCID: PMC7601811 DOI: 10.3390/nu12102953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022] Open
Abstract
l-Glutamine (GLN) is a conditionally essential amino acid which supports gastrointestinal (GI) and immune function prior to catabolic stress (e.g., strenuous exercise). Despite potential dose-dependent benefits, GI tolerance of acute high dose oral GLN supplementation is poorly characterised. Fourteen healthy males (25 ± 5 years; 1.79 ± 0.07 cm; 77.7 ± 9.8 kg; 14.8 ± 4.6% body fat) ingested 0.3 (LOW), 0.6 (MED) or 0.9 (HIGH) g·kg·FFM−1 GLN beverages, in a randomised, double-blind, counter-balanced, cross-over trial. Individual and accumulated GI symptoms were recorded using a visual analogue scale at regular intervals up to 24-h post ingestion. GLN beverages were characterised by tonicity measurement and microscopic observations. 24-h accumulated upper- and lower- and total-GI symptoms were all greater in the HIGH, compared to LOW and MED trials (p < 0.05). Specific GI symptoms (discomfort, nausea, belching, upper GI pain) were all more pronounced on the HIGH versus LOW GLN trial (p < 0.05). Nevertheless, most symptoms were still rated as mild. In comparison, the remaining GI symptoms were either comparable (flatulence, urge to regurgitate, bloating, lower GI pain) or absent (heart burn, vomiting, urge to defecate, abnormal stools, stitch, dizziness) between trials (p > 0.05). All beverages were isotonic and contained a dose-dependent number of GLN crystals. Acute oral GLN ingestion in dosages up to 0.9 g·kg·FFM−1 are generally well-tolerated. However, the severity of mild GI symptoms appeared dose-dependent during the first two hours post prandial and may be due to high-concentrations of GLN crystals.
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Affiliation(s)
- Henry B. Ogden
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth PL6 8BH, UK; (C.S.W.); (A.M.); (J.D.L.)
- Correspondence:
| | - Robert B. Child
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK;
| | | | - Simon K. Delves
- Institute of Naval Medicine, Alverstoke PO12 2DL, UK; (J.L.F.); (S.K.D.)
| | - Caroline S. Westwood
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth PL6 8BH, UK; (C.S.W.); (A.M.); (J.D.L.)
| | - Alison Millyard
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth PL6 8BH, UK; (C.S.W.); (A.M.); (J.D.L.)
| | - Joseph D. Layden
- Faculty of Sport, Health and Wellbeing, Plymouth MARJON University, Plymouth PL6 8BH, UK; (C.S.W.); (A.M.); (J.D.L.)
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17
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Abstract
Oxidative stress is an important contributor to the pathophysiology of sickle cell disease. The pathways involved are complex and interlinked. L-glutamine is an amino acid with myriad roles in the body, including the synthesis of antioxidants, such as reduced glutathione and the cofactors NAD(H) and NADP(H), as well as nitric oxide—so it has therapeutic potential as an antioxidant. However, the relative impact of L-glutamine on the redox environment in red blood cells in sickle cell disease is not fully understood, and there are few therapeutic trials in sickle cell disease. Following the FDA approval of L-glutamine for sickle cell disease, more research is still needed to understand its clinical effects and role in therapy.
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Affiliation(s)
- Alina Sadaf
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Charles T Quinn
- Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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18
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Yalcin S, Gumus M, Oksuzoglu B, Ozdemir F, Evrensel T, Sarioglu AA, Sahin B, Mandel NM, Goker E. Nutritional Aspect of Cancer Care in Medical Oncology Patients. Clin Ther 2019; 41:2382-2396. [PMID: 31699437 DOI: 10.1016/j.clinthera.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Awareness of advances in the nutritional aspects of cancer care and translation of this information into clinical practice are important for oncology practitioners to effectively couple oncologic and nutritional approaches throughout the cancer journey. The goal of this consensus statement by a panel of medical oncologists was to provide practical and implementable guidance addressing nutritional aspects of cancer care from the perspective of the medical oncologist. METHODS A panel of medical oncologists agreed on a series of statements supported by scientific evidence and expert clinical opinion. FINDINGS Participating experts emphasized that both poor nutritional intake and metabolic alterations underlie cancer-related malnutrition. The use of liquid and high energy-dense oral nutritional supplements may enable better patient compliance, whereas higher efficacy is more likely with the use of pharmaconutrient-enriched oral nutritional supplements in terms of improved weight, lean body mass, functional status, and quality of life, as well as better tolerance to antineoplastic treatment. A multimodal approach is currently believed to be the best option to counteract the catabolism leading to cancer-related malnutrition; this treatment is scheduled in parallel with anticancer therapies and includes nutritional interventions, multitarget drug therapies, and exercise and rehabilitation programs. Participating experts emphasized the role of the oncologist as a reference professional figure in the coordination of nutritional care for patients with cancer within the context of complex and different clinical scenarios, particularly for permissive-adjunctive nutritional support. IMPLICATIONS This review article provides practical guidance addressing major nutritional aspects of cancer care from the medical oncologist's perspective. Thus, this document is expected to assist oncology practitioners in terms of awareness of advances in the nutritional aspects of cancer care and translation of this information into their clinical practice to effectively couple oncologic and nutritional approaches as part of the continuum of care for patients with cancer.
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Affiliation(s)
- Suayib Yalcin
- Hacettepe University Institute of Cancer, Ankara, Turkey.
| | - Mahmut Gumus
- Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Berna Oksuzoglu
- Health Sciences University, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Feyyaz Ozdemir
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | | | - Berksoy Sahin
- Çukurova University Faculty of Medicine, Adana, Turkey
| | | | - Erdem Goker
- Ege University Faculty of Medicine, Izmir, Turkey
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19
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Gould RL, Pazdro R. Impact of Supplementary Amino Acids, Micronutrients, and Overall Diet on Glutathione Homeostasis. Nutrients 2019; 11:E1056. [PMID: 31083508 PMCID: PMC6566166 DOI: 10.3390/nu11051056] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/22/2022] Open
Abstract
Glutathione (GSH) is a critical endogenous antioxidant found in all eukaryotic cells. Higher GSH concentrations protect against cellular damage, tissue degeneration, and disease progression in various models, so there is considerable interest in developing interventions that augment GSH biosynthesis. Oral GSH supplementation is not the most efficient option due to the enzymatic degradation of ingested GSH within the intestine by γ-glutamyltransferase, but supplementation of its component amino acids-cysteine, glycine, and glutamate-enhances tissue GSH synthesis. Furthermore, supplementation with some non-precursor amino acids and micronutrients appears to influence the redox status of GSH and related antioxidants, such as vitamins C and E, lowering systemic oxidative stress and slowing the rate of tissue deterioration. In this review, the effects of oral supplementation of amino acids and micronutrients on GSH metabolism are evaluated. And since specific dietary patterns and diets are being prescribed as first-line therapeutics for conditions such as hypertension and diabetes, the impact of overall diets on GSH homeostasis is also assessed.
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Affiliation(s)
- Rebecca L Gould
- Department of Foods and Nutrition, University of Georgia, Athens, GA 30602, USA.
| | - Robert Pazdro
- Department of Foods and Nutrition, University of Georgia, Athens, GA 30602, USA.
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20
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Ma W, Heianza Y, Huang T, Wang T, Sun D, Zheng Y, Hu FB, Rexrode KM, Manson JE, Qi L. Dietary glutamine, glutamate and mortality: two large prospective studies in US men and women. Int J Epidemiol 2019; 47:311-320. [PMID: 29140419 DOI: 10.1093/ije/dyx234] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Emerging studies have related circulating glutamine metabolites to various chronic diseases such as cardiovascular disease and cancer; diet is the major source of nutrients involved in glutamine metabolism. However, it remains unknown whether dietary intakes of glutamine, glutamate,and their ratio are related to total and cause-specific mortality. Methods We followed 74 082 women from the Nurses' Health Study (1984-2012) and 42 303 men from the Health Professionals Follow-up Study (1986-2012), who were free of cardiovascular disease and cancer at baseline. Diet was updated every 2 to 4 years by using validated food frequency questionnaires. The content of glutamine and glutamate in foods was calculated based on protein fractions generated from gene sequencing methods and adjusted for total energy intake. Results We documented 30 424 deaths during 2 878 344 person-years of follow-up. After adjustment for potential confounders including lifestyle and dietary factors, higher intakes of glutamine and glutamine-to-glutamate ratio were associated with significantly lower risk of total and cause-specific mortality. Compared with people in the lowest quintile of dietary glutamine-to-glutamate ratio, the pooled hazard ratio (HR) in the highest quintile was 0.87 [95% confidence interval (CI): 0.84, 0.91; P for trend < 0.001) for total mortality, 0.81 (95% CI: 0.75, 0.88; P for trend < 0.001) for cardiovascular mortality, and 0.93 (95% CI: 0.87, 0.99; P for trend = 0.01) for cancer mortality. Conclusions We found dietary glutamine and glutamine-to-glutamate ratio were inversely related to risk of mortality, particularly cardiovascular mortality, independent of other dietary and lifestyle factors, in US men and women.
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Affiliation(s)
- Wenjie Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Tao Huang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Tiange Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Dianjianyi Sun
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Yan Zheng
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine
| | - Kathryn M Rexrode
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lu Qi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine
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21
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Exogenous glutamine impairs neutrophils migration into infections sites elicited by lipopolysaccharide by a multistep mechanism. Amino Acids 2018; 51:451-462. [PMID: 30449005 DOI: 10.1007/s00726-018-2679-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022]
Abstract
Glutamine (GLN) is the most abundant free amino acid in the body, and is considered as a conditionally essential amino acid under stress conditions, acting as an important modulator of the immune response. We here investigated the role of exogenous GLN treatment on leukocyte migration after the onset of endotoxemia and the intracellular mechanisms of GLN actions on neutrophils. Two in vivo models of endotoxemia caused by lipopolysaccharide of Escherichia coli (LPS) injection were carried out in male outbred Balb/C mice 2-3 months old, as follow: (1) LPS (50 μg/kg) was intravenously injected 1 h prior to intravenous injection of GLN (0.75 mg/kg) and samples were collected 2 h later to investigate the role of GLN on the acute lung inflammation; (2) LPS (1 mg/kg) was intraperitoneally injected 1 h prior to intravenous injection of GLN (0.75 mg/kg) and samples were collected 18 h later to measure the effects of GLN on local and later phases of inflammation in the peritoneum. Results showed that GLN administration reduced the number of neutrophils in the inflamed lungs, partially recovery of the reduced number of leukocytes in the blood; reduced adhesion molecules on lung endothelium and on circulating neutrophils. Moreover, GLN treatment diminished the number of neutrophils, levels of chemotactic cytokine CXCL2 in the inflamed peritoneum, and neutrophils collected from the peritoneum of GLN-treated mice presented lower levels of Rho, Rac, and JNK. Together, our data show novel mechanisms involved in the actions of GLN on neutrophils migration.
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22
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Is the Response of Tumours Dependent on the Dietary Input of Some Amino Acids or Ratios among Essential and Non-Essential Amino Acids? All That Glitters Is Not Gold. Int J Mol Sci 2018; 19:ijms19113631. [PMID: 30453654 PMCID: PMC6275049 DOI: 10.3390/ijms19113631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023] Open
Abstract
Energy production is the main task of the cancer cell metabolism because the costs of duplicating are enormous. Although energy is derived in cells by dismantling the carbon-to-carbon bonds of any macronutrient, cancer nutritional needs for energetic purposes have been studied primarily as being dependent on glycolysis. Since the end of the last century, the awareness of the dependence of cancer metabolism on amino acids not only for protein synthesis but also to match energy needs has grown. The roles of specific amino acids such as glutamine, glycine and serine have been explored in different experimental conditions and reviewed. Moreover, epidemiological evidence has revealed that some amino acids used as a supplement for therapeutic reasons, particularly the branched-chain ones, may reduce the incidence of liver cancer and a specific molecular mechanism has been proposed as functional to their protective action. By contrast and puzzling clinicians, the metabolomic signature of some pathologies connected to an increased risk of cancer, such as prolonged hyperinsulinemia in insulin-resistant patients, is identified by elevated plasma levels of the same branched-chain amino acids. Most recently, certain formulations of amino acids, deeply different from the amino acid compositions normally present in foods, have shown the power to master cancer cells epigenetically, slowing growth or driving cancer cells to apoptotic death, while being both beneficial for normal cell function and the animal’s health and lifespan. In this review, we will analyze and try to disentangle some of the many knots dealing with the complexities of amino acid biology and links to cancer metabolism.
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Cruzat V, Macedo Rogero M, Noel Keane K, Curi R, Newsholme P. Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation. Nutrients 2018; 10:nu10111564. [PMID: 30360490 PMCID: PMC6266414 DOI: 10.3390/nu10111564] [Citation(s) in RCA: 518] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Glutamine is the most abundant and versatile amino acid in the body. In health and disease, the rate of glutamine consumption by immune cells is similar or greater than glucose. For instance, in vitro and in vivo studies have determined that glutamine is an essential nutrient for lymphocyte proliferation and cytokine production, macrophage phagocytic plus secretory activities, and neutrophil bacterial killing. Glutamine release to the circulation and availability is mainly controlled by key metabolic organs, such as the gut, liver, and skeletal muscles. During catabolic/hypercatabolic situations glutamine can become essential for metabolic function, but its availability may be compromised due to the impairment of homeostasis in the inter-tissue metabolism of amino acids. For this reason, glutamine is currently part of clinical nutrition supplementation protocols and/or recommended for immune suppressed individuals. However, in a wide range of catabolic/hypercatabolic situations (e.g., ill/critically ill, post-trauma, sepsis, exhausted athletes), it is currently difficult to determine whether glutamine supplementation (oral/enteral or parenteral) should be recommended based on the amino acid plasma/bloodstream concentration (also known as glutaminemia). Although the beneficial immune-based effects of glutamine supplementation are already established, many questions and evidence for positive in vivo outcomes still remain to be presented. Therefore, this paper provides an integrated review of how glutamine metabolism in key organs is important to cells of the immune system. We also discuss glutamine metabolism and action, and important issues related to the effects of glutamine supplementation in catabolic situations.
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Affiliation(s)
- Vinicius Cruzat
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Biosciences, Curtin University, Perth 6102, Australia.
- Faculty of Health, Torrens University, Melbourne 3065, Australia.
| | - Marcelo Macedo Rogero
- Department of Nutrition, Faculty of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo 01246-904, Brazil.
| | - Kevin Noel Keane
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Biosciences, Curtin University, Perth 6102, Australia.
| | - Rui Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, São Paulo 01506-000, Brazil.
| | - Philip Newsholme
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Biosciences, Curtin University, Perth 6102, Australia.
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Cruzat V, Macedo Rogero M, Noel Keane K, Curi R, Newsholme P. Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation. Nutrients 2018. [PMID: 30360490 DOI: 10.20944/preprints201809.0459.v1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Glutamine is the most abundant and versatile amino acid in the body. In health and disease, the rate of glutamine consumption by immune cells is similar or greater than glucose. For instance, in vitro and in vivo studies have determined that glutamine is an essential nutrient for lymphocyte proliferation and cytokine production, macrophage phagocytic plus secretory activities, and neutrophil bacterial killing. Glutamine release to the circulation and availability is mainly controlled by key metabolic organs, such as the gut, liver, and skeletal muscles. During catabolic/hypercatabolic situations glutamine can become essential for metabolic function, but its availability may be compromised due to the impairment of homeostasis in the inter-tissue metabolism of amino acids. For this reason, glutamine is currently part of clinical nutrition supplementation protocols and/or recommended for immune suppressed individuals. However, in a wide range of catabolic/hypercatabolic situations (e.g., ill/critically ill, post-trauma, sepsis, exhausted athletes), it is currently difficult to determine whether glutamine supplementation (oral/enteral or parenteral) should be recommended based on the amino acid plasma/bloodstream concentration (also known as glutaminemia). Although the beneficial immune-based effects of glutamine supplementation are already established, many questions and evidence for positive in vivo outcomes still remain to be presented. Therefore, this paper provides an integrated review of how glutamine metabolism in key organs is important to cells of the immune system. We also discuss glutamine metabolism and action, and important issues related to the effects of glutamine supplementation in catabolic situations.
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Affiliation(s)
- Vinicius Cruzat
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Biosciences, Curtin University, Perth 6102, Australia. .,Faculty of Health, Torrens University, Melbourne 3065, Australia.
| | - Marcelo Macedo Rogero
- Department of Nutrition, Faculty of Public Health, University of São Paulo, Avenida Doutor Arnaldo 715, São Paulo 01246-904, Brazil.
| | - Kevin Noel Keane
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Biosciences, Curtin University, Perth 6102, Australia.
| | - Rui Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, São Paulo 01506-000, Brazil.
| | - Philip Newsholme
- School of Pharmacy and Biomedical Sciences, Curtin Health Innovation Research Institute, Biosciences, Curtin University, Perth 6102, Australia.
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Davani-Davari D, Karimzadeh I, Sagheb MM, Khalili H. The Renal Safety of L-Carnitine, L-Arginine, and Glutamine in Athletes and Bodybuilders. J Ren Nutr 2018; 29:221-234. [PMID: 30341034 DOI: 10.1053/j.jrn.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/07/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023] Open
Abstract
One of the major concerns about taking amino acid supplements is their potential adverse effects on the kidney as a major organ involved in the metabolism and excretion of exogenous substances. The aim of this study is to review available data about renal safety of the most prominent amino acid supplements including L-arginine, glutamine and also L-carnitine as well as creatine (as amino acid derivatives) in athletes and bodybuilders. The literature was searched by keywords such as "L-carnitine", "L-arginine", "glutamine", and "kidney injury" in databases such as Scopus, Medline, Embase, and ISI Web of Knowledge. Articles published from 1950 to December 2017 were included. Among 3171, 5740, and 1608 records after primary search in the relevant databases, 8, 7, and 5 studies have been finally included, respectively, for L-carnitine, L-arginine, and glutamine in this review. Arginine appears to have both beneficial and detrimental effects on kidney function. However, adverse effects are unlikely to occur with the routine doses (from 3 to >100 g/day). The risks and benefits of L-carnitine on the athletes' and bodybuilders' kidney have not been evaluated yet. However, L-carnitine up to 6000 mg/day is generally considered to be a safe supplement at least in healthy adults. Both short-term (20-30 g within a few hours) and long-term (0.1 g/kg four times daily for 2 weeks) glutamine supplementation in healthy athletes were associated with no significant adverse effects, but it can cause glomerulosclerosis and serum creatinine level elevation in the setting of diabetic nephropathy. Creatine supplementation (ranged from 5 to 30 g/day) also appears to have no detrimental effects on kidney function of individuals without underlying renal diseases. More clinical data are warranted to determine the optimal daily dose and intake duration of common supplemental amino acids associated with the lowest renal adverse effects in sportsmen and sports women.
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Affiliation(s)
- Dorna Davani-Davari
- Pharmaceutical Biotechnology Incubator, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Mahdi Sagheb
- Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Niihara Y, Miller ST, Kanter J, Lanzkron S, Smith WR, Hsu LL, Gordeuk VR, Viswanathan K, Sarnaik S, Osunkwo I, Guillaume E, Sadanandan S, Sieger L, Lasky JL, Panosyan EH, Blake OA, New TN, Bellevue R, Tran LT, Razon RL, Stark CW, Neumayr LD, Vichinsky EP. A Phase 3 Trial of l-Glutamine in Sickle Cell Disease. N Engl J Med 2018; 379:226-235. [PMID: 30021096 DOI: 10.1056/nejmoa1715971] [Citation(s) in RCA: 333] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Oxidative stress contributes to the complex pathophysiology of sickle cell disease. Oral therapy with pharmaceutical-grade l-glutamine (USAN, glutamine) has been shown to increase the proportion of the reduced form of nicotinamide adenine dinucleotides in sickle cell erythrocytes, which probably reduces oxidative stress and could result in fewer episodes of sickle cell-related pain. METHODS In a multicenter, randomized, placebo-controlled, double-blind, phase 3 trial, we tested the efficacy of pharmaceutical-grade l-glutamine (0.3 g per kilogram of body weight per dose) administered twice daily by mouth, as compared with placebo, in reducing the incidence of pain crises among patients with sickle cell anemia or sickle β0-thalassemia and a history of two or more pain crises during the previous year. Patients who were receiving hydroxyurea at a dose that had been stable for at least 3 months before screening continued that therapy through the 48-week treatment period. RESULTS A total of 230 patients (age range, 5 to 58 years; 53.9% female) were randomly assigned, in a 2:1 ratio, to receive l-glutamine (152 patients) or placebo (78 patients). The patients in the l-glutamine group had significantly fewer pain crises than those in the placebo group (P=0.005), with a median of 3.0 in the l-glutamine group and 4.0 in the placebo group. Fewer hospitalizations occurred in the l-glutamine group than in the placebo group (P=0.005), with a median of 2.0 in the l-glutamine group and 3.0 in the placebo group. Two thirds of the patients in both trial groups received concomitant hydroxyurea. Low-grade nausea, noncardiac chest pain, fatigue, and musculoskeletal pain occurred more frequently in the l-glutamine group than in the placebo group. CONCLUSIONS Among children and adults with sickle cell anemia, the median number of pain crises over 48 weeks was lower among those who received oral therapy with l-glutamine, administered alone or with hydroxyurea, than among those who received placebo, with or without hydroxyurea. (Funded by Emmaus Medical; ClinicalTrials.gov number, NCT01179217 .).
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Affiliation(s)
- Yutaka Niihara
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Scott T Miller
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Julie Kanter
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Sophie Lanzkron
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Wally R Smith
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Lewis L Hsu
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Victor R Gordeuk
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Kusum Viswanathan
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Sharada Sarnaik
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Ifeyinwa Osunkwo
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Edouard Guillaume
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Swayam Sadanandan
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Lance Sieger
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Joseph L Lasky
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Eduard H Panosyan
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Osbourne A Blake
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Tamara N New
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Rita Bellevue
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Lan T Tran
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Rafael L Razon
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Charles W Stark
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Lynne D Neumayr
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
| | - Elliott P Vichinsky
- From Emmaus Medical, Torrance (Y.N., L.T.T., R.L.R., C.W.S.), University of California at Los Angeles (Y.N.), Harbor-UCLA and Los Angeles BioMedical Research Institute (J.L.L., E.H.P.), and University of Southern California (C.W.S.), Los Angeles, Kaiser Permanente Medical Center, Inglewood (L.S., O.A.B.), and UCSF Benioff Children's Hospital and Research Center, Oakland (L.D.N., E.P.V.) - all in California; State University of New York-Downstate Medical Center (S.T.M.), Brookdale University Hospital and Medical Center (K.V.), Interfaith Medical Center (E.G.), Brooklyn Hospital Center (S. Sadanandan), and New York Presbyterian Brooklyn Methodist Hospital (R.B.) - all in Brooklyn, NY; Medical University of South Carolina, Charleston (J.K.); Johns Hopkins Hospital, Baltimore (S.L.); Virginia Commonwealth University Healthcare Systems, Richmond (W.R.S.); University of Illinois at Chicago, Chicago (L.L.H., V.R.G.); Children's Hospital of Michigan, Detroit (S. Sarnaik); Carolinas HealthCare System, Charlotte, NC (I.O.); and Children's Healthcare of Atlanta, Emory University, Atlanta (T.N.N.)
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Dos Santos GG, Hastreiter AA, Sartori T, Borelli P, Fock RA. L-Glutamine in vitro Modulates some Immunomodulatory Properties of Bone Marrow Mesenchymal Stem Cells. Stem Cell Rev Rep 2018; 13:482-490. [PMID: 28593472 DOI: 10.1007/s12015-017-9746-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Glutamine (GLUT) is a nonessential amino acid that can become conditionally essential under stress conditions, being able to act in the modulation of the immune responses. Mesenchymal stem cells (MSCs) are known to their capability in the modulation of immune responses through cell-cell contact and by the secretion of soluble factors. Considering that GLUT is an immunonutrient and little is known about the influence of GLUT on the capability of MSCs to modulate immune cells, this work aims to investigate how variations in GLUT concentrations in vitro could affect some immunomodulatory properties of MSCs. In order to evaluate the effects of GLUT on MSCs immunomodulatory properties, cell proliferation rates, the expression of NFκB and STAT-3, and the production of IL-1β, IL-6, IL-10, TGF-β and TNF-α by MSCs were assessed. Based on our findings, GLUT at high doses (10 mM) augmented the proliferation of MSCs and modulated immune responses by decreasing levels of pro-inflammatory cytokines, such as IL-1β and IL-6, and by increasing levels of anti-inflammatory cytokines IL-10 and TGF-β. In addition, MSCs cultured in higher GLUT concentrations (10 mM) expressed lower levels of NF-κB and higher levels of STAT-3. Furthermore, conditioned media from MSCs cultured at higher GLUT concentrations (10 mM) reduced lymphocyte and macrophage proliferation, increased IL-10 production by both cells types, and decreased IFN-γ production by lymphocytes. Overall, this study showed that 10 mM of GLUT is able to modify immunomodulatory properties of MSCs.
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Affiliation(s)
- Guilherme Galvão Dos Santos
- Laboratory of Experimental Hematology, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Avenida Lineu Prestes, 580 - Bloco 17., São Paulo, SP, 05508-900, Brazil
| | - Araceli Aparecida Hastreiter
- Laboratory of Experimental Hematology, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Avenida Lineu Prestes, 580 - Bloco 17., São Paulo, SP, 05508-900, Brazil
| | - Talita Sartori
- Laboratory of Experimental Hematology, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Avenida Lineu Prestes, 580 - Bloco 17., São Paulo, SP, 05508-900, Brazil
| | - Primavera Borelli
- Laboratory of Experimental Hematology, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Avenida Lineu Prestes, 580 - Bloco 17., São Paulo, SP, 05508-900, Brazil
| | - Ricardo Ambrósio Fock
- Laboratory of Experimental Hematology, Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Avenida Lineu Prestes, 580 - Bloco 17., São Paulo, SP, 05508-900, Brazil.
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Zheng C, Chen XK, Zhou Y. Acute glutamine ingestion modulates lymphocytic responses to exhaustive exercise in the heat. Appl Physiol Nutr Metab 2018; 43:213-220. [DOI: 10.1139/apnm-2017-0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to determine if acute intake of glutamine modulates homeostatic, hematologic, immune, and inflammatory responses to exhaustive exercise in the heat. Thirteen healthy, untrained young men participated in this randomized, double-blind, placebo-controlled, crossover study. They served as their own control and completed 2 trials of treadmill exercise at 40% maximal oxygen uptake to exhaustion in a hot environment (temperature, 38.0 ± 1.0 °C; relative humidity, 60.0% ± 5.0%; oxygen, 20.8%) following placebo (PLA) and glutamine (GLN) consumption. Heart rate, gastrointestinal temperature, forehead temperature, the rating of perceived exertion, and body weight were measured. Blood samples were collected before and after exercise. After exhaustive exercise in the heat (PLA vs. GLN: 42.0 ± 9.5 vs. 39.6 ± 7.8 min, p > 0.05), significant changes in homeostatic, hematologic, and immune parameters (elevated natural killer (NK) cells and neutrophils, and reduced CD4+/CD8+ ratio and CD19+ lymphocytes) were found in the control group owing to the time effect (p < 0.05). Moreover, a condition × time interaction effect was observed for the absolute count of CD3+ (F = 4.26, p < 0.05) and CD3+CD8+ T lymphocytes (F = 4.27, p < 0.05), which were elevated following acute glutamine intervention. While a potential interaction effect was also observed for the absolute count of CD3+CD4+ T lymphocytes (F = 3.21, p = 0.08), no condition or interaction effects were found for any other outcome measures. The results of this study suggest that acute glutamine ingestion evokes CD3+ and CD3+CD8+ T lymphocytosis but does not modulate neutrophil and NK cell leukocytosis and immune disturbances after exhaustive exercise in the heat.
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Affiliation(s)
- Chen Zheng
- Department of Exercise Physiology, Beijing Sport University, Xinxi Road, Haidian District, Beijing 100084, China
- Department of Sport Science and Physical Education, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Xiang-Ke Chen
- Department of Exercise Physiology, Beijing Sport University, Xinxi Road, Haidian District, Beijing 100084, China
- Department of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Yue Zhou
- Department of Exercise Physiology, Beijing Sport University, Xinxi Road, Haidian District, Beijing 100084, China
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Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017. [DOI: 10.1016/j.clnu.2016.07.015 10.1016/j.clnu.2016.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Neonatal l-glutamine modulates anxiety-like behavior, cortical spreading depression, and microglial immunoreactivity: analysis in developing rats suckled on normal size- and large size litters. Amino Acids 2016; 49:337-346. [DOI: 10.1007/s00726-016-2365-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/11/2016] [Indexed: 12/19/2022]
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Abstract
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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Ikeda T, Aizawa J, Nagasawa H, Gomi I, Kugota H, Nanjo K, Jinno T, Masuda T, Morita S. Effects and feasibility of exercise therapy combined with branched-chain amino acid supplementation on muscle strengthening in frail and pre-frail elderly people requiring long-term care: a crossover trial. Appl Physiol Nutr Metab 2016; 41:438-45. [DOI: 10.1139/apnm-2015-0436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the effects and feasibility of a twice-weekly combined therapy of branched-chain amino acids (BCAAs) and exercise on physical function improvement in frail and pre-frail elderly people requiring long-term care. We used a crossover design in which the combination of exercise and nutritional interventions was carried out twice a week during cycles A (3 months) and B (3 months) and the exercise intervention alone was performed during the washout period. The exercise intervention entailed the following 5 training sets: 3 sets of muscle training at 30% of maximum voluntary contraction, 1 set of aerobic exercise, and 1 set of balance training. For the nutritional intervention, 6 g of BCAAs or 6 g of maltodextrin was consumed 10 min before starting the exercise. We determined upper and lower limb isometric strength, performance on the Functional Reach Test (FRT) and the Timed Up and Go test, and activity level. In the comparison between the BCAA group and the control group after crossover, the improvement rates in gross lower limb muscle strength (leg press, knee extension) and FRT performance were significantly greater (by approximately 10%) in the BCAA group. In the comparison between different orders of BCAA administration, significant effects were shown for the leg press in both groups only when BCAAs were given. The combination of BCAA intake and exercise therapy yielded significant improvements in gross lower limb muscle strength and dynamic balance ability.
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Affiliation(s)
- Takashi Ikeda
- Tokyo Medical and Dental University Graduate School, Department of Rehabilitation Medicine, Tokyo 113-8510, Japan
- Rehab-care Shonan Kamakura, Japan
| | - Junya Aizawa
- Tokyo Medical and Dental University, Clinical Center for Sports Medicine & Sports Dentistry, Japan
| | - Hiroshi Nagasawa
- Kanagawa University of Human Services, Department of Rehabilitation, Japan
| | - Ikuko Gomi
- Kanagawa University of Human Services, Department of Nutrition, Japan
| | | | | | - Tetsuya Jinno
- Tokyo Medical and Dental University Graduate School, Department of Joint Surgery and Sports Medicine, Japan
| | - Tadashi Masuda
- Fukushima University, Faculty of Symbiotic Systems Science, Japan
| | - Sadao Morita
- Tokyo Medical and Dental University Graduate School, Department of Rehabilitation Medicine, Tokyo 113-8510, Japan
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Asparagine attenuates intestinal injury, improves energy status and inhibits AMP-activated protein kinase signalling pathways in weaned piglets challenged with Escherichia coli lipopolysaccharide. Br J Nutr 2015; 114:553-65. [PMID: 26277838 DOI: 10.1017/s0007114515001877] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The intestine requires a high amount of energy to maintain its health and function; thus, energy deficits in intestinal mucosa may lead to intestinal damage. Asparagine (Asn) is a precursor for many other amino acids such as aspartate, glutamine and glutamate, which can be used to supply energy to enterocytes. In the present study, we hypothesise that dietary supplementation of Asn could alleviate bacterial lipopolysaccharide (LPS)-induced intestinal injury via improvement of intestinal energy status. A total of twenty-four weaned piglets were assigned to one of four treatments: (1) non-challenged control; (2) LPS+0 % Asn; (3) LPS+0·5 % Asn; (4) LPS+1·0 % Asn. On day 19, piglets were injected with LPS or saline. At 24 h post-injection, piglets were slaughtered and intestinal samples were collected. Asn supplementation improved intestinal morphology, indicated by higher villus height and villus height:crypt depth ratio, and lower crypt depth. Asn supplementation also increased the ratios of RNA:DNA and protein:DNA as well as disaccharidase activities in intestinal mucosa. In addition, Asn supplementation attenuated bacterial LPS-induced intestinal energy deficits, indicated by increased ATP and adenylate energy charge levels, and decreased AMP:ATP ratio. Moreover, Asn administration increased the activities of key enzymes involved in the tricarboxylic acid cycle, including citrate synthase, isocitrate dehydrogenase and α-ketoglutarate dehydrogenase complex. Finally, Asn administration decreased the mRNA abundance of intestinal AMP-activated protein kinase-α1 (AMPKα1), AMPKα2, silent information regulator 1 (SIRT1) and PPARγ coactivator-1α (PGC1α), and reduced intestinal AMPKα phosphorylation. Collectively, these results indicate that Asn supplementation alleviates bacterial LPS-induced intestinal injury by modulating the AMPK signalling pathway and improving energy status.
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Thompson JS, Weseman RA, Mercer DF, Rochling FA, Vargas LM, Grant WJ, Langnas AN. Risk of Intestinal Malignancy in Patients With Short Bowel Syndrome. JPEN J Parenter Enteral Nutr 2015; 41:562-565. [DOI: 10.1177/0148607115609587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Jon S. Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rebecca A. Weseman
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - David F. Mercer
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Fedja A. Rochling
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Luciano M. Vargas
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Wendy J. Grant
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Alan N. Langnas
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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Davis J, Samuels E, Mullins L. Nutrition Considerations in Duchenne Muscular Dystrophy. Nutr Clin Pract 2015; 30:511-21. [PMID: 25977513 DOI: 10.1177/0884533615586202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a serious degenerative muscular disease affecting males. Diagnosis usually occurs in childhood and is confirmed through genetic testing and/or muscle biopsy. Accompanying the disease are several nutrition-related concerns: growth, body composition, energy and protein requirements, constipation, swallowing difficulties, bone health, and complementary medicine. This review article addresses the nutrition aspects of DMD.
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Enteral L-Arginine and Glutamine Supplementation for Prevention of NEC in Preterm Neonates. Int J Pediatr 2015; 2015:856091. [PMID: 25861285 PMCID: PMC4377475 DOI: 10.1155/2015/856091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/02/2015] [Indexed: 02/03/2023] Open
Abstract
Objective. Evaluating the efficacy and safety of arginine and glutamine supplementation in decreasing the incidence of NEC among preterm neonates. Methods. Prospective case-control study done on 75 preterm neonates ≤34 weeks, divided equally into L-arginine group receiving enteral L-arginine, glutamine group receiving enteral glutamine, and control group. Serum L-arginine and glutamine levels were measured at time of enrollment (sample 1), after 14 days of enrollment (sample 2), and at time of diagnosis of NEC (sample 3). Results. The incidence of NEC was 9.3%. There was no difference in the frequency of NEC between L-arginine and control groups (P > 0.05). NEC was not detected in glutamine group; L-arginine concentrations were significantly lower in arginine group than control group in both samples while glutamine concentrations were comparable in glutamine and control groups in both samples. No significant difference was found between groups as regards number of septic episodes, duration to reach full oral intake, or duration of hospital stay. Conclusion. Enteral L-arginine supplementation did not seem to reduce the incidence of NEC. Enteral glutamine may have a preventive role against NEC if supplied early to preterm neonates. However, larger studies are needed to confirm these findings. This work is registered in ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT01263041).
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Weijs PJM, Cynober L, DeLegge M, Kreymann G, Wernerman J, Wolfe RR. Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:591. [PMID: 25565377 PMCID: PMC4520087 DOI: 10.1186/s13054-014-0591-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Proteins and amino acids are widely considered to be subcomponents in nutritional support. However, proteins and amino acids are fundamental to recovery and survival, not only for their ability to preserve active tissue (protein) mass but also for a variety of other functions. Understanding the optimal amount of protein intake during nutritional support is therefore fundamental to appropriate clinical care. Although the body adapts in some ways to starvation, metabolic stress in patients causes increased protein turnover and loss of lean body mass. In this review, we present the growing scientific evidence showing the importance of protein and amino acid provision in nutritional support and their impact on preservation of muscle mass and patient outcomes. Studies identifying optimal dosing for proteins and amino acids are not currently available. We discuss the challenges physicians face in administering the optimal amount of protein and amino acids. We present protein-related nutrition concepts, including adaptation to starvation and stress, anabolic resistance, and potential adverse effects of amino acid provision. We describe the methods for assessment of protein status, and outcomes related to protein nutritional support for critically ill patients. The identification of a protein target for individual critically ill patients is crucial for outcomes, particularly for specific subpopulations, such as obese and older patients. Additional research is urgently needed to address these issues.
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Affiliation(s)
- Peter J M Weijs
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. .,Department of Intensive Care Medicine, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. .,Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Wibautstraat 2-4 1091 GM, Amsterdam, the Netherlands. .,EMGO+ Institute of Health and Care Research, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Luc Cynober
- Clinical Chemistry Department, Cochin and Hôtel-Dieu Hospitals, APHP, 1 place du Parvis Notre-Dame 75004, Paris, France. .,Nutrition Lab, EA 4466, Department of Experimental, Metabolic and Clinical Biology, Faculty of Pharmacy, Paris Descartes University, 12 rue de l'Ecole de Médicine 75270, Paris, France.
| | - Mark DeLegge
- Baxter Healthcare, Deerfield, IL, 60015-4625, USA.
| | - Georg Kreymann
- Baxter Healthcare SA Europe, CH-8010, Zürich, Switzerland.
| | - Jan Wernerman
- Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Karolinska Institutet, 141 86, Stockholm, Sweden.
| | - Robert R Wolfe
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, 4243 Ireland St #336, College Station, TX, 77843, USA.
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Pochini L, Scalise M, Galluccio M, Indiveri C. Membrane transporters for the special amino acid glutamine: structure/function relationships and relevance to human health. Front Chem 2014; 2:61. [PMID: 25157349 PMCID: PMC4127817 DOI: 10.3389/fchem.2014.00061] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/16/2014] [Indexed: 12/26/2022] Open
Abstract
Glutamine together with glucose is essential for body's homeostasis. It is the most abundant amino acid and is involved in many biosynthetic, regulatory and energy production processes. Several membrane transporters which differ in transport modes, ensure glutamine homeostasis by coordinating its absorption, reabsorption and delivery to tissues. These transporters belong to different protein families, are redundant and ubiquitous. Their classification, originally based on functional properties, has recently been associated with the SLC nomenclature. Function of glutamine transporters is studied in cells over-expressing the transporters or, more recently in proteoliposomes harboring the proteins extracted from animal tissues or over-expressed in microorganisms. The role of the glutamine transporters is linked to their transport modes and coupling with Na+ and H+. Most transporters share specificity for other neutral or cationic amino acids. Na+-dependent co-transporters efficiently accumulate glutamine while antiporters regulate the pools of glutamine and other amino acids. The most acknowledged glutamine transporters belong to the SLC1, 6, 7, and 38 families. The members involved in the homeostasis are the co-transporters B0AT1 and the SNAT members 1, 2, 3, 5, and 7; the antiporters ASCT2, LAT1 and 2. The last two are associated to the ancillary CD98 protein. Some information on regulation of the glutamine transporters exist, which, however, need to be deepened. No information at all is available on structures, besides some homology models obtained using similar bacterial transporters as templates. Some models of rat and human glutamine transporters highlight very similar structures between the orthologs. Moreover the presence of glycosylation and/or phosphorylation sites located at the extracellular or intracellular faces has been predicted. ASCT2 and LAT1 are over-expressed in several cancers, thus representing potential targets for pharmacological intervention.
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Affiliation(s)
- Lorena Pochini
- Department DiBEST (Biologia, Ecologia, Scienze della Terra) Unit of Biochemistry and Molecular Biotechnology, University of Calabria Arcavacata di Rende, Italy
| | - Mariafrancesca Scalise
- Department DiBEST (Biologia, Ecologia, Scienze della Terra) Unit of Biochemistry and Molecular Biotechnology, University of Calabria Arcavacata di Rende, Italy
| | - Michele Galluccio
- Department DiBEST (Biologia, Ecologia, Scienze della Terra) Unit of Biochemistry and Molecular Biotechnology, University of Calabria Arcavacata di Rende, Italy
| | - Cesare Indiveri
- Department DiBEST (Biologia, Ecologia, Scienze della Terra) Unit of Biochemistry and Molecular Biotechnology, University of Calabria Arcavacata di Rende, Italy
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Holecek M, Sispera L, Skalska H. Enhanced Glutamine Availability Exerts Different Effects on Protein and Amino Acid Metabolism in Skeletal Muscle From Healthy and Septic Rats. JPEN J Parenter Enteral Nutr 2014; 39:847-54. [DOI: 10.1177/0148607114537832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/07/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Milan Holecek
- Department of Physiology, Charles University Prague, Faculty of Medicine Hradec Kralove, Czech Republic
| | - Ludek Sispera
- Department of Physiology, Charles University Prague, Faculty of Medicine Hradec Kralove, Czech Republic
| | - Hana Skalska
- Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University Hradec Kralove, Czech Republic
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40
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Protein and amino acid supplementation in older humans. Amino Acids 2013; 44:1493-509. [DOI: 10.1007/s00726-013-1480-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 02/21/2013] [Indexed: 01/09/2023]
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