Alanyl‐Glutamine‐Supplemented Total Parenteral Nutrition Improves Survival and Protein Metabolism in Rat Protracted Bacterial Peritonitis Model

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Abstract
Background: The effects of glutamine‐enriched total parenteral nutrition (TPN) solution on survival, and protein turnover in the whole body and in individual organs were investigated in a rat protracted peritonitis model. Methods: Twenty‐three rats underwent venous catheter insertion. Osmotic pumps were implanted in the peritoneal cavity to allow continuous delivery of Escherichia coli (4 × 108 CFU/d). The conventional TPN group received a conventional amino acid solution. The Ala‐Gln TPN group received an alanyl‐glutamine‐enriched TPN solution. The two TPN solutions were isocaloric and isonitrogenous. Results: Over the 5 days of TPN treatment, the survival rate of the Ala‐Gln group was significantly higher than that of the conventional group. The Ala‐Gln group tended to have increased whole‐body protein turnover compared with the conventional group. Fractional protein synthetic rates (FSR) in the liver and gastrocnemius muscle of the Ala‐Gln group were significantly higher than those of the conventional group. The serum glutamine concentration correlated positively with the FSR of both liver and muscle. The Ala‐Gln group showed significantly greater mucosal height and mitoses per crypt, in the small intestine, than did the conventional group. Conclusions: Our results suggested that, in comparison with standard glutamine‐free TPN, Ala‐Gln‐supplemented TPN increases protein synthesis in the liver and skeletal muscle, protects the morphology of the intestinal mucosa, and improves survival in protracted bacterial peritonitis. Ala‐Gln supplementation may be useful in septic patients. (Journal of Parenteral and Enteral Nutrition 20:417–423, 1996)