Protein and amino acid metabolismGlutamine: recent developments in research on the clinical significance of glutamineMelis, Gerdien C; ter Wengel, Nathalie; Boelens, Petra G; van Leeuwen, Paul AM Author Information Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands Correspondence to Prof. P.A.M. van Leeuwen MD PhD, Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands Tel: +31 20 4444444; fax: +31 20 4443620; e-mail: [email protected] Abbreviations CPB: cardiopulmonary bypass GALT: gut-associated lymphoid tissue HLA: human leukocyte antigen HSP: heat shock protein ICU: intensive care unit IGF-I: insulin-like growth factor-I iNOS: inducible nitric oxide synthetase IQR: interquartile range NOS: nitric oxide synthase PMN: polymorphonuclear neutrophil TNF: tumour necrosis factor TPN: total parenteral nutrition Current Opinion in Clinical Nutrition and Metabolic Care: January 2004 - Volume 7 - Issue 1 - p 59-70 Buy Abstract Purpose of review The aim of this review is to describe the clinical relevance of supplementation of glutamine from the recent literature. First, new basic research is examined and subsequently recent clinical trials and a metaanalysis are illustrated. Recent findings Glutamine has a major impact on the functionality of the immune system. It has recently been established that glutamine not only has a protective effect on cells of the immune system, but also on other cells of the body, for instance cardiomyocytes. Evidence is accumulating for an effect of glutamine via glutathione, heat shock proteins as well as taurine. Another area of interest is the way glutamine enhances gut barrier function. More and more research is concentrating on the positive effect of glutamine on the gut-associated lymphoid tissue. Summary Based on a recent meta-analysis and up-to-date clinical trials, we may conclude that glutamine has a beneficial effect on infectious complications and reduces hospital stay. In critically ill patients glutamine supplementation may reduce morbidity and mortality. The greatest effect was observed in patients receiving high dose parenteral glutamine. A recent study with high dose enteral glutamine demonstrated a reduced mortality in the glutamine supplemented group. In the future more trials with larger numbers of participants are needed, especially with high dose enteral glutamine in the perioperatively and the intensive care unit setting. © 2004 Lippincott Williams & Wilkins, Inc.