title: Glutamine effects on heat shock protein 70 and interleukines 6 and 10: Randomized trial of glutamine supplementation versus standard parenteral nutrition in critically ill children.
abstract: OBJECTIVE
  To determine whether glutamine (Gln) supplementation would have a role modifying both the oxidative stress and the inflammatory response of critically ill children.
  
  
  METHODS
  Prospective, randomized, double-blind, interventional clinical trial. Selection criteria were children requiring parenteral nutrition for at least 5 days diagnosed with severe sepsis or post major surgery. Patients were randomly assigned to standard parenteral nutrition (SPN, 49 subjects) or standard parenteral nutrition with glutamine supplementation (SPN + Gln, 49 subjects).
  
  
  RESULTS
  Glutamine levels failed to show statistical differences between groups. At day 5, patients in the SPN + Gln group had significantly higher levels of HSP-70 (heat shock protein 70) as compared with the SPN group (68.6 vs 5.4, p = 0.014). In both groups, IL-6 (interleukine 6) levels showed a remarkable descent from baseline and day 2 (SPN: 42.24 vs 9.39, p < 0.001; SPN + Gln: 35.20 vs 13.80, p < 0.001) but only the treatment group showed a statistically significant decrease between day 2 and day 5 (13.80 vs 10.55, p = 0.013). Levels of IL-10 (interleukine 10) did not vary among visits except in the SPN between baseline and day 2 (9.55 vs 5.356, p < 0.001). At the end of the study, no significant differences between groups for PICU and hospital stay were observed. No adverse events were detected in any group.
  
  
  CONCLUSIONS
  Glutamine supplementation in critically-ill children contributed to maintain high HSP-70 levels for longer. Glutamine supplementation had no influence on IL-10 and failed to show a significant reduction of IL-6 levels.
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: ijordan@hsjdbcn.org.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Jordan
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: mbalaguer@hsjdbcn.org.
authors.forename: Mònica
authors.initials: M
authors.lastname: Balaguer
authors.affiliation: Department of Animal Biology-Anthropology, Faculty of Biology, University of Barcelona, Barcelona, Spain; Institut de Recerca de la Biodiversitat (IRBIO), University of Barcelona, Barcelona, Spain. Electronic address: mesteban@ub.edu.
authors.forename: M Esther
authors.initials: ME
authors.lastname: Esteban
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: fjcambra@hsjdbcn.org.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Cambra
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: afelipe@hsjdbcn.org.
authors.forename: Aida
authors.initials: A
authors.lastname: Felipe
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: lhernandez@hsjdbcn.org.
authors.forename: Lluïsa
authors.initials: L
authors.lastname: Hernández
authors.affiliation: Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain. Electronic address: lalsina@hsjdbcn.org.
authors.forename: Laia
authors.initials: L
authors.lastname: Alsina
authors.affiliation: Clinical Pharmacological Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: mmolero@hsjdbcn.org.
authors.forename: Marta
authors.initials: M
authors.lastname: Molero
authors.affiliation: Clinical Laboratory Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: mvillaronga@hsjdbc.org.
authors.forename: Miquel
authors.initials: M
authors.lastname: Villaronga
authors.affiliation: Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain. Electronic address: eesteban@hsjdbc.org.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Esteban
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D004311:Double-Blind Method; D002149:Energy Intake; D005973:Glutamine / Q000008:administration & dosage* / Q000097:blood; D018840:HSP70 Heat-Shock Proteins / Q000097:blood*; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007902:Length of Stay; D010288:Parenteral Nutrition; D011184:Postoperative Period; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018840:HSP70 Heat-Shock Proteins; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D005973:Glutamine; D016753:Interleukin-10
keywords: Glutamine; HSP-70; Inflammatory mediators; Parenteral nutrition; Pediatric intensive care unit