Alanyl-glutamine enriched TPN improves protein metabolism greater than branched chain amino acid enriched TPN in protracted peritonitis

NORM FIUX

MUSCIE

FIUX

Muscle

PF2 124&21 491-11 oi1t 2i1t 232*83

Gln8 Amm’ Tyrb Phea z-ANC 3.MehIs GlllC

3930&73

3638+87

Gill’ AmmC T$ Phe’ a-ANC

MS02 102+9 87?13 5*2 7f2 455+82

r Eehis

1721 +I39

MS04 266+50 156i19 12+6 16k5 996+213 3.9+1.2 1673275

‘:$:z 2+1t 3+1 348f97

P.93 Alanyl-glutamine enriched TPN improves protein metabolism greater than branched chain amino acid enriched TPN in protracted peritonitis

PF4 129+12 21*4 2*1 411 31047:04; 35771253

S. Naka, H. Saito, Y. Hashiguchi, T. Inaba. K. Kuroiwa and T. Muto Department of Surgery, University of Tokyo, Japan Recent studies have shown that either an ALA-GLN or a BCAA enriched solution improves protein metabolism in surgical stress. However, it remains unclear which regimen produces more beneficial effects in severe surgical sepsis. The purpose of this study was to compare the metabolic efficacy of ALA-GLN enriched TPN and BCAA enriched TPN in protracted peritonitis. Seventeen rats underwent laparotomy and osmotic pumps were implanted into the peritoneal cavity to allow for continuous release of E. coli (10’ cfu/day) during the experimental period. The BCAA group received TPN containing a 30% BCAA solution at 194 kcal/kg/day and 1.7 gN/kg/day for 5 postoperative days. The ALA-GLN group received an isocaloric, isonitrogenous TPN containing ALA-GLN (4.55 g/kg/day). Whole-body protein turnover (WBPT) and fractional protein synthetic rate (FSR) of tissues were measured on POD 5 by 15N/glycine constant infusion. The results (mean + SE) are shown below:

Values are mean i SEM. Statistical analysis: ANOVA, MS0 group ~.?rs”s pairfedgroup, ‘p < 0.05, bp < 0.01, ‘p < 0.001, t: not significant from zero (p r 0.05). (-) = consumption, (+) = production.

These results suggest that MSO-induced chronic intramuscular glutamine depletion in vivo is associated with increased non-myofibrillar protein breakdown.

P.92 Glutamine supplementation does not prevent bacterial translocation after hemorrhagic stress in the rat, as determined by a biochemical fingerprint method

WEPT FIUX 343&6 380+12 coo5

BCAA ALA-GLN p value

T. Bark, P. Engervall’, M. Katoul?. 0. Ljungqvist, R. Mobby and T. Svenberg Departments of Surgery and Internal MedicineI, Karolinska Hospital, Department of Microbiology, Karolinska Institute2. Stockholm, Sweden

(mgN/100

g/d)

Synthesis 266111 287+27

FSR (96/d)

~;ez~kpwn141;yy 205&14

45*1 co.05

--- u---r Muscle’lleum 2.2+0.1 348+25 2.5+0.2 459k31 <0.05

These results suggest that ALA-GLN enriched TPN produces greater effects on whole body protein turnover and fractional rates of protein synthesis in the small intestine than BCAA enriched TPN in protracted bacterial peritonitis.

Bacterial translocation has been suggested to be an important cause of multiple organ failure after major trauma. The present aims were to evaluate an automated biochemical fingerprinting method, to verify bacterial translocation and to investigate whether glutamine supplementation prevents translocation in a rat model of hemorrhagic stress. Methods: In protocol I, 18 male SD rats were fed a complete enteral diet for 7 days. Thereafter, 6 rats were subjected to a hemorrhagic stress (50 mm Hg mean arterial pressure). Another 6 rats were sham operated and the last 6 rats were not instrumented at all. The following day bacterial samples were taken. Bacterial growth in mesenteric lymph nodes and cecal contents were compared using a biochemical fingerprinting method. In protocol II, 35 rats were fed using two isocaloric and isonitrogenous diets, one without and one with glutamine (3 g/kg BW a day). Nine rats fed the glutamine-free diet and 9 fed the glutamine-diet were subjected to hemorrhagic stress (50 mm Hg). Two corresponding groups were sham operated. Results: In protocol I lymph nodes in bled rats showed massive growth (> 150 colony forming units, c.f.u.) in 4/6 animals, while the sham and the unoperated groups only revealed low growth (<50 cfu.), (p < 0.05). Identical strains were found in cecal contents. In protocol II lymph nodes in bled rats showed massive growth in 4/9 (without glutamine) and 6/9 (with glutamine) rats (n.s.). No positive blood culture was found. All tests for endotoxin showed normal values. Conclusions: Bacterial translocation to mesenteric lymph nodes after hemorrhagic stress was verified using the biochemical fingerprinting method. Identical bacterial strains were found in lymph nodes and in feces. Glutamine supplementation did not prevent translocation in this model.

P.94 Improved protein metabolism supplemented with alanyl-glutamine tracted bacterial peritonitis

by TPN in pro-

S. Naka, H. Saito. Y. Hashiguchi, T. lnaba. K. Kuroiwa and T. Muto Department of Surgery, University of Tokyo, Japan Recent studies demonstrate that ALA-GLN enriched solutions improve protein metabolism after surgical operation. However, it has not been well known whether ALA-GLN enriched regimen produces beneficial effects in severe and sustained sepsis. The purpose of this study was to investigate the metabolic efficacy of ALA-GLN enriched TPN in protracted peritonitis. Thirteen rats underwent laparotomy and osmotic pumps were implanted into the peritoneal cavity to allow for continuous release of E. coli (1 O8 cfu/day) during the experimental period. The control group received conventional TPN with a standard commercial amino acid solution for 5 postoperative days. The ALA-GLN group received an isocaloric (194 kcal/kg/day), isonitrogenous (1.7 gN/kg/ day) TPN containing ALA-GLN (4.55 g/kg/day). Protein kinetics were measured on POD 5 by 15N-glycine constant infusion. The results (mean k SE) are shown below:

Control ALA-GLN p value

Whole body turnover (mgN/lW g/d) Synthesis Breakdown 157+9 175+11 176*6 196+10

’ Gashocnemius

80

Fractional rate (%/d) Liver 29.0+1.1 37.5 i 27 co.06

synthetic Mucosa MUSGle’ 1.6+0.1 2.0*0.1 <005

!zl :zi;: < 0.05

Ht