title: Glutamine-enriched enteral nutrition increases HLA-DR expression on monocytes of trauma patients.
abstract: The aim of this study was to investigate the effect of glutamine-(Gln)-enriched enteral nutrition (EN) on human leukocyte antigen (HLA)-DR and FcgammaR1/CD64 expression on monocytes and plasma glutamine concentrations in multi-trauma patients. HLA-DR expression on monocytes is crucial in the presentation of foreign antigen to the immune system and is severely reduced in trauma patients. In vitro monocyte HLA-DR and FcgammaRI/CD64 expression is dependent on glutamine availability. To study the effect of glutamine supplemented enteral nutrition on HLA-DR and FcgammaRI/CD64 expression on CD14(+) monocytes, 55 multi-trauma patients were studied in a randomized, double-blinded, controlled trial. Trauma patients received either a Gln-enriched EN (glutamine group, n = 28) or an isocaloric, isonitrogenous control EN (control group, n = 27) and were compared with a group of age-matched healthy volunteers (healthy volunteers, n = 53). On d 1, 5, 9 and 14 after trauma, expressions of HLA-DR and FcgammaRI/CD64 were determined on CD14(+) monocytes using FACS analysis. Plasma glutamine levels were measured using HPLC. Plasma glutamine was lower in both trauma patient groups compared with healthy volunteers and from d 3 to d 5; glutamine was higher in the glutamine group than in the control group. On d 1, HLA-DR expression was much lower in both trauma patient groups than in healthy volunteers. HLA-DR expression was greater on d 5, 9 and 14 in the glutamine group than in the control group. FcgammaRI/CD64 expression on monocytes of trauma patients was not different than the expression of healthy volunteers. This study showed that glutamine-enriched enteral nutrition was associated with a higher HLA-DR expression on CD14(+) monocytes of trauma patients. No difference in monocyte FcgammaRI/CD64 expression was detected between patients that received the two enteral diets and between trauma patients and the healthy volunteers. Increased HLA-DR expression may improve cellular immune function and may be involved in the beneficial effect of glutamine on the occurrence of infections in trauma patients.
authors.affiliation: Department of Surgery, Vrije Universiteit Medical Center, Amsterdam 1081 HV, The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: Boelens
authors.forename: Alexander P J
authors.initials: AP
authors.lastname: Houdijk
authors.forename: Johanna C M
authors.initials: JC
authors.lastname: Fonk
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nijveldt
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Ferwerda
authors.forename: B Mary E
authors.initials: BM
authors.lastname: Von Blomberg-Van Der Flier
authors.forename: Lambertus G
authors.initials: LG
authors.lastname: Thijs
authors.forename: Henk J Th M
authors.initials: HJ
authors.lastname: Haarman
authors.forename: Juan C
authors.initials: JC
authors.lastname: Puyana
authors.forename: Paul A M
authors.initials: PA
authors.lastname: Van Leeuwen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000008:administration & dosage* / Q000097:blood; D006684:HLA-DR Antigens / Q000096:biosynthesis*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D009104:Multiple Trauma / Q000097:blood / Q000276:immunology / Q000628:therapy*; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control; D017452:Receptors, IgG / Q000096:biosynthesis; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D006684:HLA-DR Antigens; D017452:Receptors, IgG; D005973:Glutamine