GLUTAMINE-SUPPLEMENTED TOTAL PARENTERAL-NUTRITION ENHANCES T-LYMPHOCYTE RESPONSE IN SURGICAL PATIENTS UNDERGOING COLORECTAL RESECTION

Objective The authors determined the effect of glutamine-supplementati on of TPN on postoperative peripheral blood T-cell response and proinf lammatory cytokine production in patients undergoing colorectal resect ion. Summary Background Data Several vital tissues, including the immu ne system, are very dependent on glutamine; however, this amino acid, which may be essential in conditions of stress, only now is becoming f ormulated suitably for incorporation into TPN. The effects of such sup plementation on the immune function of stressed surgical patients is u nknown. Methods Patients (n = 20) were randomized to receive conventio nal TPN (0.2 g nitrogen/kg/d) or an isonitrogenous/isocaloric regimen with 0.18 g of glutamine/kg/d from days 1 to 6 postoperatively. T-cell DNA synthesis and interleukin (IL)-2 production and peripheral blood mononuclear cell IL-6 and tumor necrosis factor (TNF) production were measured in vitro preoperatively and on days 1 and 6 postoperatively. Results T-cell DNA synthesis alter 5 days of TPN was increased compare d with preoperative values in the glutamine-supplemented group (median preoperative tritiated thymidine uptake: 78.3 X 10(3) cpm, day 6: 95. 0 x 10(3) cpm, p < 0.05). There was no such increase in the control TP N group (preoperative: 89.0 x 10(3) cpm, day 6: 69.4 X 10(3) cpm, p > 0.05). Glutamine supplementation did not influence IL-2 production or the production of TNF or IL-6. Conclusions Glutamine supplementation m ay be a method oi enhancing T-cell function in the surgical patient re ceiving TPN.