Parenteral glutamine protects hepatic function during bone marrow transplantation

Area of Science:

• Hepatology
• Transplantation Immunology
• Nutritional Biochemistry

Background:

• Hepatic veno-occlusive disease (VOD) is a frequent complication after bone marrow transplantation (BMT) due to high-dose chemotherapy.
• Reduced glutathione (GSH) levels post-chemotherapy are linked to liver injury, specifically in centrilobular hepatocytes and endothelium.
• Animal studies indicate glutamine can maintain GSH levels and offer protection against cellular damage.

Purpose of the Study:

• To prospectively evaluate the effect of glutamine supplementation on liver function markers in patients undergoing BMT.
• To determine if glutamine preserves key proteins like protein C and albumin, which are known to decrease post-BMT and predict VOD severity.
• To assess glutamine's impact on markers of coagulation and fibrinolysis activation.

Main Methods:

• A randomized controlled trial involving 34 patients undergoing BMT.
• Patients received either glycyl-L-glutamine or an isonitrogenous mixture of non-essential amino acids.
• Liver function markers, including protein C, albumin, and markers of thrombin and plasmin generation, were measured at specified time points.

Main Results:

• Glutamine supplementation significantly preserved protein C levels at days +4 and +7 (P < 0.05).
• Albumin levels were also significantly preserved in the glutamine group at days 0 and +4 (P < 0.02).
• No significant differences were observed between groups in markers of thrombin or plasmin generation.

Conclusions:

• Glutamine supplementation appears to preserve hepatic function during BMT, evidenced by maintained protein C and albumin levels.
• While glutamine supports hepatic function, it does not appear to significantly alter thrombin or plasmin generation.
• These findings suggest a potential role for glutamine in mitigating VOD risk by protecting liver function post-BMT.