Combined infusion of glutamine and arginine: does it make sense?
OBJECTIVE
Glutamine and arginine are conditionally essential amino acids because depletion occurs in stressed conditions. Intravenous glutamine supplementation reduces morbidity and mortality in critically ill patients fed parenterally. In surgical patients, arginine-enriched diets have beneficial effects, but the use of supplemental arginine in critically ill patients should be avoided in most cases.


RESULTS
In addition to its role as a fuel, glutamine regulates gut barrier function, immuno-inflammatory response and antioxidant status. Arginine metabolism leads to nitric oxide and/or polyamines and thus modulates the immuno-inflammatory response and wound healing. Glutamine and arginine metabolism are closely related, and therefore may give additive or antagonist effects on several pathways. The effects of combined arginine and glutamine are still poorly documented. Combined administration of arginine and glutamine resulted in additive or synergistic effects on gut barrier function and inflammatory response but arginine reduced glutamine protection against oxidative stress. Preliminary data indicate that the combination may be beneficial during intestinal inflammation, whereas data in surgical or critically ill patients are still lacking.


CONCLUSIONS
Mostly speculative effects of combined infusion of arginine and glutamine are discussed. Future studies are needed in specific pathophysiological conditions to assess whether this combination is beneficial or detrimental.
Coëffier
Moïse
M
Department of Nutrition, Rouen University Hospital and ADEN EA4311, Institute for Biomedical Research, Institute for Peptides Research (IFRMP23), Medical School, Rouen University, Rouen, France.
Déchelotte
Pierre
P
D001120:Arginine / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D016638:Critical Illness / Q000628:therapy*; D019587:Dietary Supplements; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005973:Glutamine / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000503:physiopathology; D018384:Oxidative Stress / Q000187:drug effects; D010288:Parenteral Nutrition; D011183:Postoperative Complications
D005973:Glutamine; D001120:Arginine