Metabolic effects of amino acid solutions infused for renal protection during therapy with radiolabelled somatostatin analogues.
BACKGROUND
Infusion of amino acids (AAs) can reduce renal uptake of radiolabelled somatostatin analogues resulting in a lower kidney exposure during peptide radiotherapy of patients with neuroendocrine tumours. In this study, we investigated the metabolic effects related to the infusion of large amounts of amino acids in patients undergoing positron emission tomography (PET) studies with [(86)Y]DOTA(0)-D-Phe(1)-Tyr(3)-octreotide.


METHODS
Twenty-four patients, in four consecutive groups of six, received a 4 h infusion of 120 g of mixed AAs and, in addition, either a 4 h infusion of 50 g of L-lysine (n = 6), a 10 h infusion of 240 g of mixed AAs (n = 6), a 4 h infusion of 50 g of L-lysine + L-arginine (Lys-Arg; n = 6) or no infusion (control; n = 6) in randomly ordered crossover studies. A number of clinical and biochemical parameters in blood and urine were measured over 24 h, including calculation of creatinine clearance, tubular reabsorption of inorganic phosphate (TRP) and fractional urate excretion.


RESULTS
No clinical side effects occurred during the infusions except for nausea and vomiting under mixed AAs. Patients in the latter group showed an increase in serum urea, whereas patients receiving L-lysine showed an increase in serum potassium and chloride. Inorganic phosphate levels dropped at 2.5 h in all groups except controls, and a significant decrease in TRP was observed with mixed AAs but not with L-lysine or Lys-Arg.


CONCLUSIONS
Although infusion of AA solutions can improve the effect of therapy by allowing the administration of higher doses of radiolabelled somatostatin analogues, each preparation has specific sides effects that should be taken into account with this type of therapy.
Barone
Raffaella
R
Center of Nuclear Medicine, University of Louvain Medical School, UCL 54.30, Avenue Hippocrate, 54, B-1200 Brussels, Belgium. raffaella.barone@clin.ucl.ac.be
Pauwels
Stanislas
S
De Camps
Joëlle
J
Krenning
Eric P
EP
Kvols
Larry K
LK
Smith
M Charles
MC
Bouterfa
Hakim
H
Devuyst
Olivier
O
Jamar
François
F
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage*; D005260:Female; D006571:Heterocyclic Compounds / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000532:radiotherapy*; D015282:Octreotide / Q000009:adverse effects*; D009942:Organometallic Compounds / Q000009:adverse effects*; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals / Q000009:adverse effects*; D012996:Solutions; D013004:Somatostatin / Q000031:analogs & derivatives
D000596:Amino Acids; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D012996:Solutions; C113625:yttrium(III)-1,4,7,10-tetraazacyclotetradecane-N,N',N'',N'''-tetraacetic acid; D013004:Somatostatin; D015282:Octreotide