Total parenteral nutrition supplementation with glutamine improves survival after gut ischemia/reperfusion

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Abstract
BACKGROUND: Total parenteral nutrition (TPN) alters gut cytokines and mucosal immunity and increases intercellular adhesion molecule‐1 (ICAM‐1) expression, gut neutrophil levels, and mortality after gut ischemia. Supplementation of TPN with glutamine partially supports mucosal immunity by preserving respiratory and intestinal IgA levels, maintaining the proper IgA‐stimulating cytokine milieu within the intestine, and reducing intestinal ICAM‐1 expression and neutrophil accumulation. This work investigates whether glutamine supplementation of TPN affects mortality in mice after gut ischemic insult. METHODS: Thirty‐eight mice were randomized to receive chow, TPN, or 2% glutamine‐supplemented TPN (GLN‐TPN) for 5 days. After feeding their respective diets, gut ischemia/reperfusion (I/R) was induced with superior mesenteric artery occlusion for 30 minutes followed by resuscitation with 1 mL saline. Survival was recorded until 72 hours after reperfusion. RESULTS: Survival time was significantly reduced in the TPN‐fed mice compared with both chow‐fed and GLN‐TPN‐fed mice (p <.05). Survival at 72 hours after reperfusion was also significantly lower in the TPN‐fed mice than in the chow‐fed and GLN‐TPN‐fed mice (p <.05) CONCLUSIONS: Glutamine supplementation of TPN significantly improves survival after gut I/R, suggesting modulation of the inflammatory response or improved gut tolerance to low‐flow states.

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