Glutamine supplementation in cancer patients.
OBJECTIVE
Three series of studies investigated whether 1) glutamine deficiency occurs in tumor-bearing rats, 2) glutamine supplementation improves protein metabolism during chemotherapy in tumor-bearing rats, and 3) oral glutamine supplement improves systemic immune and gut-barrier function in patients with esophageal cancer receiving radiochemotherapy.


METHODS
In the animal studies, AH109A hepatoma cells or Yoshida sarcoma cells were inoculated into male Donryu rats to induce tumors. Glutamine production was measured by U-14C-glutamine infusion and the conversion of arginine to glutamine was measured by infusion of U-14C-arginine. The effect of glutamine on protein metabolism was investigated by 1-14C-leucine infusion. In the clinical study, 13 patients with esophageal cancer were randomized into two groups, control and glutamine supplemented (30 g/d), for 4 wk.


RESULTS
Glutamine levels in plasma and skeletal muscle were decreased in tumor-bearing rats, although glutamine production and the conversion of arginine to glutamine were increased. Glutamine-supplemented total parenteral nutrition reduced whole-body protein breakdown rate during chemotherapy in tumor-bearing rats. Oral supplementation of glutamine to the patients with esophageal cancer enhanced lymphocyte mitogenic function and reduced permeability of the gut during radiochemotherapy.


CONCLUSIONS
Glutamine depletion in host tissues occurs in tumor-bearing rats. Glutamine supplementation can attenuate loss of protein in the muscle in tumor-bearing animals and protect immune and gut-barrier function during radiochemotherapy in patients with advanced cancer.
Yoshida
S
S
Department of Surgery, Kurume University, School of Medicine, Fukuoka, Japan. shogo@med.kurume-u.ac.jp
Kaibara
A
A
Ishibashi
N
N
Shirouzu
K
K
D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002100:Cachexia / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D002247:Carbon Isotopes; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D004195:Disease Models, Animal; D004938:Esophageal Neoplasms / Q000276:immunology / Q000503:physiopathology / Q000532:radiotherapy / Q000628:therapy*; D005973:Glutamine / Q000008:administration & dosage* / Q000378:metabolism* / Q000494:pharmacology; D006801:Humans; D008297:Male; D010289:Parenteral Nutrition, Total; D011506:Proteins / Q000378:metabolism*; D051381:Rats
D002247:Carbon Isotopes; D011506:Proteins; D005973:Glutamine