title: Parenteral glutamine supplementation in combination with enteral nutrition improves intestinal immunity in septic rats.
abstract: OBJECTIVE
  The gut-associated lymphoid tissue is continuously exposed to antigens in the gut lumen and becomes the first line of defense against enteric bacteria and associated toxin. The aim of this study was to investigate the effects of parenteral glutamine (GLN) supplementation in combination with enteral nutrition (EN) on intestinal mucosal immunity in septic rats by cecal ligation and puncture (CLP).
  
  
  METHODS
  Male Sprague-Dawley rats were randomly assigned into four groups: A sham CLP + EN + saline group (n = 10), a sham CLP + EN + GLN group (n = 10), a CLP + EN + saline group (n = 10), and a CLP + EN + GLN group (n = 10). At 2 h after CLP or sham CLP, all rats in each of the four groups received an identical enteral nutrition solution as their base formula. Then, the rats in the sham CLP + EN + GLN group and CLP + EN + GLN group were given 0.35 g GLN/kg body weight daily for 7 d, all at the same time, via a tail vein injection; whereas those in the sham CLP + EN + saline group and CLP + EN + saline group were daily administered isovolumic sterile 0.9% saline for comparison. All rats in each of the four groups were given 290 kcal/kg body wt/d for 7 d. At the end of the seventh day after the nutritional program was finished, all rats were euthanized and the entire intestine was collected. Total Peyer's patches (PP) cell yield was counted by a hemocytometer. The percentage of PP lymphocyte subsets was analyzed by flow cytometry. The number of intestinal lamina propria IgA plasma cells was determined by the immunohistochemistry technique. The intestinal immunoglobulin A (IgA) levels were assessed by ELISA. PP apoptosis was evaluated by terminal deoxyuridine nick-end labeling.
  
  
  RESULTS
  The results revealed total PP cell yield, the numbers of PP lymphocyte subsets, intestinal lamina propria IgA plasma cells, and intestinal IgA levels in the CLP + EN + GLN group were significantly increased when compared with the CLP + EN + saline group (P < 0.05). On the other hand, the number of TUNEL-stained cells within PPs in the CLP + EN + GLN group was markedly decreased as compared with the CLP + EN + saline group (P < 0.05).
  
  
  CONCLUSIONS
  The results of this study show that parenteral glutamine supplementation in combination with enteral nutrition may attenuate PP apoptosis, increase PP cell yield and intestinal lamina propria IgA plasma cells, and subsequently improve intestinal mucosal immunity. Clinically, these results suggest therapeutic efforts at improving intestinal immunity may contribute to the prevention and treatment of sepsis.
authors.affiliation: Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, P.R. China. Electronic address: fanjundoctor@sina.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, P.R. China.
authors.forename: Guoping
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, P.R. China.
authors.forename: Lidong
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, P.R. China.
authors.forename: Shaoyu
authors.initials: S
authors.lastname: Tao
authors.affiliation: Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, P.R. China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, P.R. China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Sheng
authors.affiliation: Department of Burns, The Northern Hospital, Liaoning, P.R. China.
authors.forename: Qingyan
authors.initials: Q
authors.lastname: Meng
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D019587:Dietary Supplements; D004195:Disease Models, Animal; D004750:Enteral Nutrition / Q000379:methods*; D005973:Glutamine / Q000008:administration & dosage / Q000494:pharmacology*; D018928:Immunity, Mucosal / Q000187:drug effects*; D007070:Immunoglobulin A / Q000378:metabolism; D007413:Intestinal Mucosa / Q000187:drug effects / Q000276:immunology*; D008214:Lymphocytes / Q000187:drug effects; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*; D010581:Peyer's Patches / Q000187:drug effects; D010950:Plasma Cells / Q000187:drug effects; D051381:Rats; D017207:Rats, Sprague-Dawley; D018805:Sepsis / Q000276:immunology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D007070:Immunoglobulin A; D005973:Glutamine
keywords: Enteral nutrition; Immunoglobulin A; Parenteral glutamine supplementation; Peyer's patches; Sepsis