L-alanyl-glutamine preoperative infusion in patients with critical limb ischemia subjected to distal revascularization reduces tissue damage and protects from oxidative stress.
BACKGROUND
Critical limb ischemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb. Our aim was to examine the effects of preoperative infusion of l-alanyl-glutamine (l-Ala-Gln) during the ischemic period and during the first 30 minutes following blood reflow in patients with CLI who are undergoing distal femoral artery bypass surgery.


METHODS
Thirty-two patients with CLI were alternately allocated to group 1 (saline) or group 2 (l-Ala-Gln). Saline (1000 mL) or L-Ala-Gln 250 mL plus 750 mL of saline were infused intravenously over a 3-hour period prior to surgery. Samples (muscle and blood) were collected at the beginning of the surgical procedure, at the end of ischemia, and at 15 and 30 minutes after reperfusion.


RESULTS
l-Ala-Gln induced elevation in glutathione (GSH) muscle concentrations while promoting reduction in thiobarbituric acid reactive substance concentrations, demonstrating enhancement of antioxidant capacity and protection from lipid peroxidation. Decreases in LDH, lactate, and glucose blood concentrations in l-Ala-Gln-treated patients suggest increased glucose utilization by muscle and peripheral tissues. Reduction in creatine phosphokinase blood concentrations may reflect smaller muscle cell damage in l-Ala-Gln-treated patients.


CONCLUSIONS
l-Ala-Gln pretreatment reduces muscle cell damage and enhances antioxidant capacity in patients with CLI.
Alves
Wellington Forte
WF
General Hospital of Fortaleza, Fortaleza, Brazil.
Aguiar
Erika Elisa
EE
Guimarães
Sergio Botelho
SB
da Silva Filho
Antonio Ribeiro
AR
Pinheiro
Petrúcia Maria Antero
PM
Soares
Gabriel dos Santos Dias
Gdos S
de Vasconcelos
Paulo Roberto Leitão
PR
D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001938:Brazil; D003402:Creatine Kinase / Q000097:blood; D016638:Critical Illness; D004151:Dipeptides / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005978:Glutathione / Q000378:metabolism; D006801:Humans; D007262:Infusions, Intravenous; D007511:Ischemia / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007770:L-Lactate Dehydrogenase / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D015227:Lipid Peroxidation / Q000187:drug effects; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D018384:Oxidative Stress / Q000187:drug effects*; D011300:Preoperative Care; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000637:transplantation*; D017392:Thiobarbituric Acid Reactive Substances / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
D000975:Antioxidants; D015415:Biomarkers; D001786:Blood Glucose; D004151:Dipeptides; D017392:Thiobarbituric Acid Reactive Substances; D019344:Lactic Acid; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; D005978:Glutathione; C054122:alanylglutamine