Immune and metabolic effects of arginine in the surgical patient

Arginine enhances immune function and promotes nitrogen retention in animal models, but its immunomodulatory effects in surgical patients are unknown. This randomized, prospective trial evaluated the immune and metabolic effects of supplemental L-arginine (25 g/day, n = 16) or isonitrogenous L-glycine (43 g/day, n = 14) in 30 cancer patients undergoing major operation. Two groups of patients received either arginine or glycine for 7 days after surgery as a supplement to a graduated enteral diet. Nitrogen balance was measured daily, and immune parameters were determined both before and after surgery, on Days 1, 4, and 7. The T-lymphocyte response to concanavalin A (con A) and PHA and dual marker phenotype analysis of lymphocyte (CD2, CD4, CD4/DR, CD8, CD8/DR) and macrophage (M3/DR) subsets were determined. Mean age, degree of preoperative weight loss, disease stage, number of perioperative transfusions, and calorie and nitrogen intake were similar for the groups studied. Mean daily nitrogen balance (-2.3 g/day in the arginine group vs. -3.9 g/day in the glycine group) was not significantly different between the two groups, but positive mean nitrogen balance was achieved only in the arginine group between Days 5 and 7 after surgery. Supplemental arginine significantly enhanced the mean T-lymphocyte response (stimulation index) to con A from 45 +/- 26 on postoperative Day 1 to 72 +/- 47 and 87 +/- 49 on postoperative Days 4 and 7, compared with the values of 29 +/- 15, 27 +/- 20, and 33 +/- 34 in the glycine group at the same time points, respectively. Supplemental arginine increased mean CD4 phenotype (% T-cells) on postoperative Days 1 and 7 from 25 +/- 9 to 43 +/- 14, compared with the values of 30 +/- 14 and 29 +/- 13 in the glycine group (p less than 0.05). The beneficial effect of arginine on the immune system appeared distinct from its more moderate effect on nitrogen metabolism. As a nutrient substrate, arginine was nontoxic, and may benefit surgical patients who are at increased risk of infection.