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Perioperative glutamine supplementation restores disturbed renal arginine synthesis after open aortic surgery: a randomized controlled clinical trial.
Am J Physiol Renal Physiol. 2016 09 01; 311(3):F567-75.AJ

Abstract

Postoperative renal failure is a common complication after open repair of an abdominal aortic aneurysm. The amino acid arginine is formed in the kidneys from its precursor citrulline, and citrulline is formed from glutamine in the intestines. Arginine enhances the function of the immune and cardiovascular systems, which is important for recovery after surgery. We hypothesized that renal arginine production is diminished after ischemia-reperfusion injury caused by clamping of the aorta during open abdominal aortic surgery and that parenteral glutamine supplementation might compensate for this impaired arginine synthesis. This open-label clinical trial randomized patients who underwent clamping of the aorta during open abdominal aortic surgery to receive a perioperative supplement of intravenous alanyl-glutamine (0.5 g·kg(-1)·day(-1); group A, n = 5) or no supplement (group B, n = 5). One day after surgery, stable isotopes and tracer methods were used to analyze the metabolism and conversion of glutamine, citrulline, and arginine. Whole body plasma flux of glutamine, citrulline, and arginine was significantly higher in group A than in group B (glutamine: 391 ± 34 vs. 258 ± 19 μmol·kg(-1)·h(-1), citrulline: 5.7 ± 0.4 vs. 2.8 ± 0.4 μmol·kg(-1)·h(-1), and arginine: 50 ± 4 vs. 26 ± 2 μmol·kg(-1)·h(-1), P < 0.01), as was the synthesis of citrulline from glutamine (4.8 ± 0.7 vs. 1.6 ± 0.3 μmol·kg(-1)·h(-1)), citrulline from arginine (2.3 ± 0.3 vs. 0.96 ± 0.1 μmol·kg(-1)·h(-1)), and arginine from glutamine (7.7 ± 0.4 vs. 2.8 ± 0.2 μmol·kg(-1)·h(-1)), respectively (P < 0.001 for all). In conclusion, the production of citrulline and arginine is severely reduced after clamping during aortic surgery. This study shows that an intravenous supplement of glutamine increases the production of citrulline and arginine and compensates for the inhibitory effect of ischemia-reperfusion injury.

Authors+Show Affiliations

Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands; sj.brinkmann@vumc.nl.Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands;Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands;Department of Pediatrics, Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands; and.Department of Pediatrics, Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands; and.Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands; Department of Surgery, Medical Centre Alkmaar, Trial Center Holland Health, Alkmaar, The Netherlands; Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands.Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands;Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands;Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands;

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27194717

Citation

Brinkmann, Saskia J H., et al. "Perioperative Glutamine Supplementation Restores Disturbed Renal Arginine Synthesis After Open Aortic Surgery: a Randomized Controlled Clinical Trial." American Journal of Physiology. Renal Physiology, vol. 311, no. 3, 2016, pp. F567-75.
Brinkmann SJ, Buijs N, Vermeulen MA, et al. Perioperative glutamine supplementation restores disturbed renal arginine synthesis after open aortic surgery: a randomized controlled clinical trial. Am J Physiol Renal Physiol. 2016;311(3):F567-75.
Brinkmann, S. J., Buijs, N., Vermeulen, M. A., Oosterink, E., Schierbeek, H., Beishuizen, A., de Vries, J. P., Wisselink, W., & van Leeuwen, P. A. (2016). Perioperative glutamine supplementation restores disturbed renal arginine synthesis after open aortic surgery: a randomized controlled clinical trial. American Journal of Physiology. Renal Physiology, 311(3), F567-75. https://doi.org/10.1152/ajprenal.00340.2015
Brinkmann SJ, et al. Perioperative Glutamine Supplementation Restores Disturbed Renal Arginine Synthesis After Open Aortic Surgery: a Randomized Controlled Clinical Trial. Am J Physiol Renal Physiol. 2016 09 1;311(3):F567-75. PubMed PMID: 27194717.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative glutamine supplementation restores disturbed renal arginine synthesis after open aortic surgery: a randomized controlled clinical trial. AU - Brinkmann,Saskia J H, AU - Buijs,Nikki, AU - Vermeulen,Mechteld A R, AU - Oosterink,Efraim, AU - Schierbeek,Henk, AU - Beishuizen,Albertus, AU - de Vries,Jean-Paul P M, AU - Wisselink,Willem, AU - van Leeuwen,Paul A M, Y1 - 2016/05/18/ PY - 2015/07/29/received PY - 2016/05/11/accepted PY - 2016/5/20/entrez PY - 2016/5/20/pubmed PY - 2017/7/14/medline KW - acute kidney injury KW - arginine KW - citrulline KW - glutamine KW - ischemia-reperfusion injury SP - F567 EP - 75 JF - American journal of physiology. Renal physiology JO - Am. J. Physiol. Renal Physiol. VL - 311 IS - 3 N2 - Postoperative renal failure is a common complication after open repair of an abdominal aortic aneurysm. The amino acid arginine is formed in the kidneys from its precursor citrulline, and citrulline is formed from glutamine in the intestines. Arginine enhances the function of the immune and cardiovascular systems, which is important for recovery after surgery. We hypothesized that renal arginine production is diminished after ischemia-reperfusion injury caused by clamping of the aorta during open abdominal aortic surgery and that parenteral glutamine supplementation might compensate for this impaired arginine synthesis. This open-label clinical trial randomized patients who underwent clamping of the aorta during open abdominal aortic surgery to receive a perioperative supplement of intravenous alanyl-glutamine (0.5 g·kg(-1)·day(-1); group A, n = 5) or no supplement (group B, n = 5). One day after surgery, stable isotopes and tracer methods were used to analyze the metabolism and conversion of glutamine, citrulline, and arginine. Whole body plasma flux of glutamine, citrulline, and arginine was significantly higher in group A than in group B (glutamine: 391 ± 34 vs. 258 ± 19 μmol·kg(-1)·h(-1), citrulline: 5.7 ± 0.4 vs. 2.8 ± 0.4 μmol·kg(-1)·h(-1), and arginine: 50 ± 4 vs. 26 ± 2 μmol·kg(-1)·h(-1), P < 0.01), as was the synthesis of citrulline from glutamine (4.8 ± 0.7 vs. 1.6 ± 0.3 μmol·kg(-1)·h(-1)), citrulline from arginine (2.3 ± 0.3 vs. 0.96 ± 0.1 μmol·kg(-1)·h(-1)), and arginine from glutamine (7.7 ± 0.4 vs. 2.8 ± 0.2 μmol·kg(-1)·h(-1)), respectively (P < 0.001 for all). In conclusion, the production of citrulline and arginine is severely reduced after clamping during aortic surgery. This study shows that an intravenous supplement of glutamine increases the production of citrulline and arginine and compensates for the inhibitory effect of ischemia-reperfusion injury. SN - 1522-1466 UR - https://www.unboundmedicine.com/medline/citation/27194717/Perioperative_glutamine_supplementation_restores_disturbed_renal_arginine_synthesis_after_open_aortic_surgery:_a_randomized_controlled_clinical_trial_ L2 - http://www.physiology.org/doi/full/10.1152/ajprenal.00340.2015?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -