THE ROLE OF GLUTAMINE IN THE IMMUNE-SYSTEM AND IN INTESTINAL FUNCTION IN CATABOLIC STATES

Glutamine is designated a non-essential amino acid: however, evidence is accumulating that glutamine becomes essential when catabolic conditions prevail. It has been established that glutamine is an important fuel for lymphocytes and macrophages, even when resting. Plasma and muscle glutamine concentrations are decreased after trauma such as burns, major surgery, and in sepsis. The effectiveness of the immune system is decreased after trauma: this may be due, in part, to the decrease in plasma glutamine concentrations. Most studies on sepsis in humans have shown plasma glutamine concentrations to be decreased: this may be due to an increased rate of utilization of glutamine by lymphocytes and macrophages during proliferation or phagocytosis. In contrast, several studies on rats show increased plasma glutamine levels in sepsis. A species difference in the way in which glutamine is metabolised could be the main reason for the conflicting results. Other contributory factors could be diurnal variation and timing of sample collection. A substantial amount of dietary glutamine is taken up by intestinal cells. When the supply of glutamine via the diet is decreased, glutamine is taken up from the circulation by the intestine. In total parenteral nutrition (TPN) sepsis can sometimes occur because the gut is ''rested'', leading to villous atrophy and increased gut mucosal barrier permeability. There is now a move towards the use of enteral nutrition in preference to TPN. Provision of exogenous glutamine has had beneficial effects in humans and animals, particularly in improving intestinal function. The safety and efficacy of glutamine administration to humans is discussed in detail.