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11 Glutamine
Pages 265-278

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From page 265...
... Almost all human cells contain the enzyme glutamine synthetase, which can, under appropriate conditions, produce glutamine. However, it recently has been postulated that during catabolism, the tissue demands for glutamine exceed the endogenous production of this amino acid, resulting in a state of glutamine deficiency (Lacey and Wilmore, 1990~.
From page 266...
... Excluding taurine, glutamine represents about 60 percent of the free amino acids in skeletal muscle and maintains an intracellular concentration of about 20 mmol/Liter intracellular water. With normal plasma concentrations ranging from 600 to 650 ~mol/Liter, this large concentration gradient (about 30:1)
From page 267...
... and thus initiate de novo glutamine synthesis and enhanced skeletal muscle glutamine production and release into the bloodstream. In normal humans in the postabsorptive state, approximately 40 percent of plasma glutamine is thought to be derived from other amino acids, and an additional 45 percent originates from its direct release from tissue protein (Perriello et al., 1995~.
From page 268...
... Glutamine enhanced bactericidal function in normal neutrophils and generally restored this function to normal levels in neutrophils taken from burn patients (Ogle et al., 1994~. Others have demonstrated that glutamine plays a supportive role in the generation of lymphokine-activated killer cells (LAK cells)
From page 269...
... After a week of intensive chemotherapy and total body radiation, parenteral nutrition was initiated the day after bone marrow transplantation. Patients were randomized to receive glutamine-supplemented (0.57 gig/d)
From page 270...
... Whether these effects can be universally translated to all critically ill individuals is not known; to date the populations studied are highly specific and results are dependent on the dose and duration of glutamine administered. GLUTAMINE AND THE GASTROINTESTINAL TRACT The gut is another important target organ for glutamine metabolism, and the maintenance of normal function of this organ may be invaluable to host defense against intestinal flora and/or their by-products.
From page 271...
... Finally, glutamine administered to patients in an intensive care unit enhanced absorption from the gastrointestinal tract when compared to that of patients receiving glutamine-free intravenous solutions (Tremel et al., 1994~. Taken together, these studies demonstrate that glutamine enhances normal structure and function of the gastrointestinal tract in humans.
From page 272...
... 1989. Addition of glutamine to total parenteral nutrition after elective abdominal surgery spares free glutamine in muscle, counteracts the fall in muscle protein synthesis, and improves nitrogen balance.
From page 273...
... 1994. A cost-evaluation of glutamine-supplemented parenteral nutrition in adult bone marrow transplant patients.
From page 274...
... 1994. Glutamine-enriched parenteral nutrition increases circulating lymphocytes after bone marrow transplantation.
From page 275...
... There are some randomized trials going on in AIDS patients following weight loss, for example, where there is an early increase in body weight, which in fact may be due to water because glutamine helps transport water across the gastrointestinal tract. Realize that with all the anabolic agents, protein synthesis is associated with water retention and cell swelling.
From page 276...
... ' s question. When I was at Washington University, we infused normal healthy males with either an amino acid solution without glutamine or an amino acid solution supplemented with glutamine and looked at the effects on muscle protein synthesis by carbon-13 level and leucine incorporation in skeletal muscle and found no difference in those young healthy males.
From page 277...
... In the hospital, we are moderately aggressive with glutamine administration, and it is not unusual to give one-third of the amino acid load as glutamine. That comes from the fact that that is what your skeletal muscle is producing.
From page 278...
... Rowell looked at in the 1960s or early 1970s. He ran students Tom the University of Washington so hard, he could make their liver enzymes go up and had simultaneous splanchnic blood flow measurements, which demonstrated splanativic ischemia.


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