Postoperative glycyl-glutamine infusion reduces immunosuppression: partial prevention of the surgery induced decrease in HLA-DR expression on monocytes

Clin Nutr. 2001 Feb;20(1):37-42. doi: 10.1054/clnu.2000.0153.

Abstract

Background and aims: Surgery, trauma and inflammation reduce HLA-DR expression on monocytes, which is associated with an increased susceptibility to infection and sepsis. Furthermore, surgery decreases plasma glutamine (GLN) levels. The expression of HLA-DR on human monocytes in vitro is dependent on the concentration of GLN in the culture medium. We therefore hypothesized that postoperative infusions of glutamine-dipeptides would prevent the decreased HLA-DR expression on monocytes.

Methods: Thirty patients undergoing major abdominal surgery were randomly allocated to receive either 1500 ml Vamin (control) or an isonitrogenic formulation containing Vamin and 500 ml glycyl-glutamine (35 g GLN; 0.5g/kg BW) (GLY-GLN), or Vamin and 500 ml alanyl-glutamine (35 g GLN; 0.5 g/kg BW) (ALA-GLN) as a continuous infusion over 48 h post-operatively. Immediately and 48 h after surgery blood samples were collected to determine HLA-DR expression on monocytes by flow cytometry.

Results: The groups were comparable with respect to age, gender distribution and operation time. In patients receiving GLY-GLN mean HLA-DR expression on monocytes at 48 h was significantly better preserved than in controls (65.0 %+/-7 % vs 42.5 %+/-4 %;P<0.05), whereas HLA-DR expression on monocytes in patients receiving ALA-GLN was not significantly different.

Conclusion: This is the first study comparing the dipeptides GLY-GLN and ALA-GLN in the postoperative setting. The GLY-GLN induced preservation of HLA-DR on monocytes following surgery may prevent infectious complications in these patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Abdomen / surgery*
  • Adult
  • Aged
  • Amino Acids / administration & dosage
  • Amino Acids / blood
  • Dipeptides / administration & dosage*
  • Electrolytes
  • Female
  • Flow Cytometry
  • Glucose
  • HLA-DR Antigens / biosynthesis*
  • Humans
  • Immunosuppression
  • Infusions, Parenteral
  • Leukocyte Count
  • Lipopolysaccharides / pharmacology
  • Male
  • Middle Aged
  • Monocytes / drug effects
  • Monocytes / immunology*
  • Parenteral Nutrition Solutions
  • Postoperative Complications / immunology*
  • Postoperative Complications / prevention & control
  • Sepsis / immunology*
  • Sepsis / prevention & control
  • Solutions
  • Time Factors
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • Amino Acids
  • Dipeptides
  • Electrolytes
  • HLA-DR Antigens
  • Lipopolysaccharides
  • Parenteral Nutrition Solutions
  • Solutions
  • Tumor Necrosis Factor-alpha
  • amino-acid, glucose, and electrolyte solution
  • glycylglutamine
  • Glucose
  • alanylglutamine