title: Cytokine responses in very low birth weight infants receiving glutamine-enriched enteral nutrition.
abstract: OBJECTIVE
  Very low birth weight (VLBW) infants receiving glutamine-enriched enteral nutrition may present with a lower infection rate, which may result from enhanced antimicrobial innate or Th1 cytokine responses. We investigated whether glutamine-enriched enteral nutrition in VLBW infants increased these cytokine responses following in vitro stimulation of whole blood cells.
  
  
  METHODS
  In a double-blind, placebo-controlled, randomized controlled trial, VLBW infants (gestational age <32 weeks and/or birth weight <1500 g) received enteral glutamine supplementation (0.3 g x kg(-1) x day(-1)) or isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Cytokine responses following in vitro whole blood cell stimulation with anti-(alpha)CD3/alphaCD28 or lipopolysaccharide were analyzed by cytometric bead array at 3 time points: before the start of the study, at day 7 of life, and at day 14 of life.
  
  
  RESULTS
  Baseline patient and nutritional characteristics were not different between groups. At least 2 blood samples were analyzed in 25 of 52 (48%) and 38 of 50 (76%) infants in the glutamine-supplemented and control groups, respectively. Glutamine-enriched enteral nutrition was not associated with significant alterations in cytokine responses (interferon-gamma, tumor necrosis factor-alpha, interleukin [IL]-2, IL-4, IL-5, and IL-10) of peripheral blood cells upon stimulation with either anti-alphaCD3/alphaCD28 or lipopolysaccharide.
  
  
  CONCLUSIONS
  We hypothesize that glutamine-enriched enteral nutrition decreases the infection rate in VLBW infants by influencing the mucosal and not the systemic immune system.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Academic Medical Center, Amsterdam, the Netherlands. a.vandenberg@vumc.nl
authors.forename: Anemone
authors.initials: A
authors.lastname: van den Berg
authors.forename: Ruurd M
authors.initials: RM
authors.lastname: van Elburg
authors.forename: Linda
authors.initials: L
authors.lastname: Vermeij
authors.forename: Annelies
authors.initials: A
authors.lastname: van Zwol
authors.forename: Gijs R
authors.initials: GR
authors.lastname: van den Brink
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Edward E S
authors.initials: EE
authors.lastname: Nieuwenhuis
authors.forename: Willem P F
authors.initials: WP
authors.lastname: Fetter
mesh_terms: D001724:Birth Weight; D018106:CD28 Antigens / Q000276:immunology; D017252:CD3 Complex / Q000276:immunology; D016207:Cytokines / Q000097:blood* / Q000276:immunology; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D005865:Gestational Age; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood / Q000276:immunology*; D015931:Intensive Care, Neonatal; D007371:Interferon-gamma / Q000097:blood; D007378:Interleukins / Q000097:blood; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D018106:CD28 Antigens; D017252:CD3 Complex; D016207:Cytokines; D007378:Interleukins; D008070:Lipopolysaccharides; D010919:Placebos; D014409:Tumor Necrosis Factor-alpha; D005973:Glutamine; D007371:Interferon-gamma