Parenteral glutamine increases serum heat shock protein 70 in critically ill patients.
OBJECTIVE
Heat shock protein 70 (HSP-70) is protective against cellular and tissue injury. Increased serum HSP-70 levels are associated with decreased mortality in trauma patients. Glutamine (Gln) administration increases serum and tissue HSP-70 expression in experimental models of sepsis. Gln has been safely administered to critically ill patients and can improve clinical outcomes, but the effect of Gln administration on HSP-70 expression in humans is unknown. We examined whether Gln-supplemented parenteral nutrition (PN) increases serum HSP-70 levels in critically ill patients.


METHODS
Randomized, controlled, double-blind study in surgical intensive care units (SICU) in a university hospital.


METHODS
29 patients admitted to the SICU and requiring PN for more than 7 days.


METHODS
Patients received either Gln-PN (containing alanyl-glutamine dipeptide; 0.5 g/kg per day; n=15) or standard Gln-free PN (control-PN) that was iso-nitrogenous to Gln-PN (n=14). Serum HSP-70 concentrations were measured at enrollment and at 7 days. Clinical outcome measures were also determined.


RESULTS
HSP-70 concentrations were unchanged in control-PN subjects from baseline to day 7. In marked contrast, Gln-PN subjects demonstrated significantly higher (3.7-fold) serum HSP-70 concentrations than control subjects. In Gln-PN patients there was a significant correlation between increases in HSP-70 levels over baseline and decrease in ICU length of stay.


CONCLUSIONS
Gln-PN significantly increases serum HSP-70 in critically ill patients. The magnitude of HSP-70 enhancement in Gln-treated patients was correlated with improved clinical outcomes. These data indicate the need for larger, randomized trials of the Gln effect on serum and tissue HSP-70 expression in critical illness and relationship to clinical outcomes.
Department of Medicine/Center for Clinical and Molecular Nutrition, School of Medicine, Emory University, Atlanta, GA 30322, USA.
Thomas R
TR
Ziegler
Lorraine G
LG
Ogden
Kristen D
KD
Singleton
Menghua
M
Luo
Concepcion
C
Fernandez-Estivariz
Daniel P
DP
Griffith
John R
JR
Galloway
Paul E
PE
Wischmeyer
D016638:Critical Illness; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D018840:HSP70 Heat-Shock Proteins / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011379:Prognosis; D016896:Treatment Outcome
D018840:HSP70 Heat-Shock Proteins; D005973:Glutamine