GLUTAMINE DIPEPTIDES-SUPPLEMENTED PARENTERAL-NUTRITION REVERSES GUT MUCOSAL STRUCTURE AND INTERLEUKIN-6 RELEASE OF RAT INTESTINAL MONONUCLEAR-CELLS AFTER HEMORRHAGIC-SHOCK
J. Schroder et al., GLUTAMINE DIPEPTIDES-SUPPLEMENTED PARENTERAL-NUTRITION REVERSES GUT MUCOSAL STRUCTURE AND INTERLEUKIN-6 RELEASE OF RAT INTESTINAL MONONUCLEAR-CELLS AFTER HEMORRHAGIC-SHOCK, Shock, 10(1), 1998, pp. 26-31
Citations number
38
Categorie Soggetti
Peripheal Vascular Diseas","Emergency Medicine & Critical Care",Hematology,Surgery
Glutamine is an essential substrate for gut mucosal structure, but the
role for gut immune function is not fully known. To determine the eff
ect on gut cytokine release in relation to bacterial translocation and
gut morphology, a nonlethal hemorrhagic shock (30 min, 30 mmHg) was p
erformed in male Wistar rats followed by 4 days of different way of fe
eding. A conventional total parenteral nutrition (TPN) solution was co
mpared with an isocaloric and isonitrogenous TPN solution supplemented
with alanin-L-glutamine and glycyl-L-glutamine. An enteral chow-fed c
ontrol group was included. Gut mononuclear cells and splenic macrophag
es were obtained and endotoxin-induced supernatant tumor necrosis fact
or-alpha (TNF) and interleukin-6 (IL-6) bioactivity was measured. Hist
ological specimen of the small bowel were taken and mesenteric lymph n
odes (MLN) were separated. Enteral feeding following hemorrhagic shock
was accompanied by a normal mucosal structure and no bacterial transl
ocation could be detected. TPN was characterized by suppression of cyt
okine release in gut mononuclear cells and splenic macrophages compare
d with the enteral-fed control (p < .05). Decreased TNF and IL-6 relea
se was associated with a significantly increased mucosal injury score
Go <.05) and a high incidence of bacterial translocation to MLN (66%,
p < .05 vs. control). Supplementation of glutamine-dipeptides did not
prevent TPN-induced bacterial translocation to MLN (p < .05 vs. contro
l) but significantly improved mucosal injury (p < .05 vs. TPN). Down-r
egulation of TNF release in TPN-fed rats could not be reversed by glut
amine dipeptides while IL-6 release was significantly increased compar
ed with TPN-fed animals (p < .05), and no difference to enteral-fed co
ntrols could be found. Enteral nutrition following hemorrhagic shock i
s superior to parenteral nutrition with regard to mucosal structure, c
ytokine release, and bacterial translocation. Supplemention of TPN wit
h glutamine dipeptides could reverse TPN-induced suppression of IL-6 r
elease and improved mucosal structure, which may be beneficial in vari
ous disease conditions in which TPN is an integrated part of patients
management.