Glutamine Enriched Total Parenteral Feeding and Proline Metabolism in Severely Burned Patients
| Status: | Withdrawn |
|---|---|
| Conditions: | Other Indications |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/14/2017 |
| Start Date: | August 1997 |
| End Date: | January 2010 |
Glutamine Enriched Total Parenteral Feeding and Proline Metabolism in Severely Burned Patients.
Proline is a non-essential amino acid that helps with collagen formation. Collagen is one of
the main ingredients of skin, bone, tendons, and connective tissue. It is thought that
proline becomes depleted in burn patients because it is being used in greater than normal
quantities to help the injured skin and connective tissue heal. If this is true, then the
body must look for alternate energy sources as proline becomes depleted.
This study aims to evaluate 1)the metabolic kinetics of the amino acids proline, glutamate,
and ornithine and 2) the effects of glutamine supplemented total parenteral nutrition (TPN)
on the metabolism of these amino acids.
the main ingredients of skin, bone, tendons, and connective tissue. It is thought that
proline becomes depleted in burn patients because it is being used in greater than normal
quantities to help the injured skin and connective tissue heal. If this is true, then the
body must look for alternate energy sources as proline becomes depleted.
This study aims to evaluate 1)the metabolic kinetics of the amino acids proline, glutamate,
and ornithine and 2) the effects of glutamine supplemented total parenteral nutrition (TPN)
on the metabolism of these amino acids.
Proline is a nutritionally dispensable (non-essential) amino acid. Its synthesis and
catabolism is via the pathway of ornithine and glutamate. The latter two amino acids serve
as immediate precursors for proline, as well as metabolites. Ornithine is one of the
intermediates for urea cycle. Glutamate is metabolically connected to tricarboxylic acid
(TCA) cycle, the major cycle for energy production.
It is hypothesized that the significantly increased rates of net nitrogen loss and energy
"production", as the consequence of the accelerated activities of both the urea and TCA
cycles in burn injury "drain" both ornithine and glutamate, thus depleting tissues of the
availability of proline. Hence, the de novo synthesis of proline is likely to be affected by
the reduced availability of its major precursors: glutamate and ornithine. We further
propose that increased supply of glutamine would increase the de novo synthesis of proline
and / or spare the loss of proline via its metabolite glutamate. Hence, glutamine will be
beneficial to the overall nutritional status of the burn patients.
catabolism is via the pathway of ornithine and glutamate. The latter two amino acids serve
as immediate precursors for proline, as well as metabolites. Ornithine is one of the
intermediates for urea cycle. Glutamate is metabolically connected to tricarboxylic acid
(TCA) cycle, the major cycle for energy production.
It is hypothesized that the significantly increased rates of net nitrogen loss and energy
"production", as the consequence of the accelerated activities of both the urea and TCA
cycles in burn injury "drain" both ornithine and glutamate, thus depleting tissues of the
availability of proline. Hence, the de novo synthesis of proline is likely to be affected by
the reduced availability of its major precursors: glutamate and ornithine. We further
propose that increased supply of glutamine would increase the de novo synthesis of proline
and / or spare the loss of proline via its metabolite glutamate. Hence, glutamine will be
beneficial to the overall nutritional status of the burn patients.
Inclusion Criteria:
Burn patients being treated at MGH Burn Unit with one or more of the following criteria:
1) >=5% TBSA; 2) inhalation injury; or 3) resting energy expenditure (REE) of >15% of the
predicted Basal Metabolic Rate using the Harris-Benedict equation.
Must be receiving total parenteral nutrition in the course of their treatment.
Exclusion Criteria:
Patients with thyroid disease. Patients who are not hemodynamically stable or show
unstable vital signs Patients at the stage of major organ failure, e.g. renal and/or liver
failure.
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