GLUTAMINE-SUPPLEMENTED TOTAL PARENTERAL-NUTRITION REDUCES BLOOD MONONUCLEAR CELL INTERLEUKIN-8 RELEASE IN SEVERE ACUTE-PANCREATITIS

Glutamine, a conditionally essential amino acid, is important for immu ne function. It is now being formulated for incorporation into total p arenteral nutrition (TPN). The aims of this study were to examine the effect of glutamine administration on lymphocyte proliferation and pro inflammatory cytokine release in patients with severe acute pancreatit is. Fourteen patients were randomized (in a double-blind fashion) to r eceive either conventional or isocaloric, isonitrogenous glutamine-sup plemented (0.22 g glutamine.kg(-1).d(-1) as glycyl-glutamine) TPN for 7 d. DNA synthesis (index of lymphocyte proliferation) and the 24-h re lease of tumor necrosis factor (TNF), interleukin (IL)-6, and IL-8 fro m peripheral blood mononuclear cells were measured in vitro on days 0, 4, and 7. Thirteen patients completed the study protocol (6 glutamine TPN, 7 conventional TPN). Glutamine supplementation increased median DNA synthesis by 3099 cpm over the study period against 219 cpm in the conventional group (increase not significantly different between the two groups). Glutamine supplementation did not significantly influence TNF or IL-6 release, but, in contrast, median IL-8 release was reduce d by day 7 in the glutamine group while it was increased in the conven tional group (-17.7 ng/mL (median change over study period) versus +43 .3 ng/mL, respectively; P = 0.045). Small patient numbers and substant ial interindividual variation limit the conclusions, but there is a tr end for the glutamine group to have improved lymphocyte proliferation, and in the case of IL-8, reduced proinflammatory cytokine release. (C ) Elsevier Science Inc. 1998.