Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer.
OBJECTIVE
The objective of this study was to determine whether oral glutamine supplements can protect lymphocyte and gut barrier function in patients with advanced esophageal cancer undergoing radiochemotherapy.


BACKGROUND
Glutamine supplements improved protein metabolism in tumor bearing rats who underwent chemotherapy and reduced the toxicity of chemotherapy through an enhancement of glutathione production in rats.


METHODS
Thirteen patients with esophageal cancer were randomly placed in either a control or a glutamine group. Glutamine was administered orally (30 g/day) at the start of radiochemotherapy and for the subsequent 28 days. All patients underwent mediastinal irradiation and chemotherapy consisting of 5-fluorouracil and cisplatin. The lymphocyte count was determined, and blast formation was assessed after stimulation with phytohemagglutinin and concanavalin A. Gut barrier function was assessed by measuring the total amount of phenolsulfonphthalein excreted in the urine after the oral administration of phenolsulfonphthalein.


RESULTS
Glutamine supplements prevented a reduction in the lymphocyte count (control: 567 +/- 96/mm3 vs. glutamine: 1007 +/- 151, p < 0.05), and blast formation of lymphocyte (phytohemagglutinin, control: 19478 +/- 2121 dpm vs. glutamine: 33860 +/- 1433, p < 0.01, concanavalin A, control: 19177 +/- 1897 dpm vs. glutamine: 29473 +/- 2302, p < 0.01), and amount of phenolsulfonphthalein excretion in the urine was greater with control than with glutamine group (control: 15.4 +/- 2.4% vs. glutamine: 7.4 +/- 1.2, p < 0.05) 7 days after the initiation of radiochemotherapy.


CONCLUSIONS
Oral glutamine supplementation protects lymphocytes and attenuates gut permeability in patients with esophageal cancer during radiochemotherapy.
Yoshida
S
S
First Department of Surgery, Kurume University, School of Medicine, Japan.
Matsui
M
M
Shirouzu
Y
Y
Fujita
H
H
Yamana
H
H
Shirouzu
K
K
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002463:Cell Membrane Permeability; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology / Q000532:radiotherapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005973:Glutamine / Q000494:pharmacology*; D006801:Humans; D007202:Indicators and Reagents / Q000493:pharmacokinetics; D007413:Intestinal Mucosa / Q000503:physiopathology; D007422:Intestines / Q000503:physiopathology*; D008213:Lymphocyte Activation; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010637:Phenolsulfonphthalein / Q000493:pharmacokinetics; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage
D007202:Indicators and Reagents; D011838:Radiation-Sensitizing Agents; D005973:Glutamine; D010637:Phenolsulfonphthalein; D002945:Cisplatin; D005472:Fluorouracil