title: Improvement of intestinal permeability with alanyl-glutamine in HIV patients: a randomized, double blinded, placebo-controlled clinical trial.
abstract: BACKGROUND
  Glutamine is the main source of energy of the enterocyte and diarrhea and weight loss are frequent in HIV infected patients.
  
  
  OBJECTIVE
  To determine the effect of alanyl-glutamine supplementation on intestinal permeability and absorption in these patients.
  
  
  METHODS
  Randomized double-blinded, placebo-controlled study using isonitrogenous doses of alanyl-glutamine (24 g/day) and placebo (glycine, 25 g/day) during 10 days. Before and after this nutritional supplementation lactulose and mannitol urinary excretion were determined by high performance liquid chromatography.
  
  
  RESULTS
  Forty six patients with HIV/AIDS, 36 of whom were male, with 37.28 ± 3 (mean ± standard error) years were enrolled. Twenty two and 24 subjects were treated with alanyl-glutamine and with glycine respectively. In nine patients among all in the study protocol that reported diarrhea in the 14 days preceding the beginning of the study, mannitol urinary excretion was significantly lower than patients who did not report this symptom [median (range): 10.51 (3.01-19.75) vs. 15.37 (3.93-46.73); P = 0.0281] and lactulose/mannitol ratio was significantly higher [median (range): 0.04 (0.00-2.89) vs. 0.02 (0.00-0.19); P = 0.0317]. There was also a significant increase in mannitol urinary excretion in the group treated with alanyl-glutamine [median (range): 14.38 (8.25-23.98) before vs 21.24 (6.27-32.99) after treatment; n = 14, P = 0.0382].
  
  
  CONCLUSIONS
  Our results suggest that the integrity and intestinal absorption are more intensely affected in patients with HIV/AIDS who recently have had diarrhea. Additionally, nutritional supplementation with alanyl-glutamine was associated with an improvement in intestinal absorption.
authors: Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brazil. roberiodias.leite@gmail.com
authors: Robério Dias
authors: RD
authors: Leite
authors: Noélia Leal
authors: NL
authors: Lima
authors: Christiane Araujo Chaves
authors: CA
authors: Leite
authors: Calil Kairalla
authors: CK
authors: Farhat
authors: Richard Littleton
authors: RL
authors: Guerrant
authors: Aldo Angelo Moreira
authors: AA
authors: Lima
mesh_terms: D000328:Adult; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D004151:Dipeptides / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000378:metabolism*; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects*; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D010539:Permeability; D011446:Prospective Studies
chemical_list: D004151:Dipeptides; C054122:alanylglutamine