Original

Intensive Care Medicine

, Volume 31, Issue 8, pp 1079-1086

First online:

Parenteral glutamine increases serum heat shock protein 70 in critically ill patients

  • Thomas R. ZieglerAffiliated withDepartment of Medicine/Center for Clinical and Molecular Nutrition, School of Medicine, Emory UniversityNutrition and Metabolic Support Service, Emory University Hospital
  • , Lorraine G. OgdenAffiliated withDepartment of Preventive Medicine and Biometrics, Health Sciences Center, University of Colorado
  • , Kristen D. SingletonAffiliated withDepartment of Anesthesiology, Health Sciences Center, University of Colorado
  • , Menghua LuoAffiliated withDepartment of Medicine/Center for Clinical and Molecular Nutrition, School of Medicine, Emory UniversityNutrition and Metabolic Support Service, Emory University Hospital
  • , Concepcion Fernandez-EstivarizAffiliated withDepartment of Medicine/Center for Clinical and Molecular Nutrition, School of Medicine, Emory UniversityNutrition and Metabolic Support Service, Emory University Hospital
  • , Daniel P. GriffithAffiliated withNutrition and Metabolic Support Service, Emory University Hospital
  • , John R. GallowayAffiliated withNutrition and Metabolic Support Service, Emory University HospitalDepartment of Surgery, School of Medicine, Emory University
  • , Paul E. WischmeyerAffiliated withDepartment of Anesthesiology, Health Sciences Center, University of Colorado Email author 

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Abstract

Objective

Heat shock protein 70 (HSP-70) is protective against cellular and tissue injury. Increased serum HSP-70 levels are associated with decreased mortality in trauma patients. Glutamine (Gln) administration increases serum and tissue HSP-70 expression in experimental models of sepsis. Gln has been safely administered to critically ill patients and can improve clinical outcomes, but the effect of Gln administration on HSP-70 expression in humans is unknown. We examined whether Gln-supplemented parenteral nutrition (PN) increases serum HSP-70 levels in critically ill patients.

Design and setting

Randomized, controlled, double-blind study in surgical intensive care units (SICU) in a university hospital.

Patients

29 patients admitted to the SICU and requiring PN for more than 7 days.

Interventions

Patients received either Gln-PN (containing alanyl-glutamine dipeptide; 0.5 g/kg per day; n=15) or standard Gln-free PN (control-PN) that was iso-nitrogenous to Gln-PN (n=14). Serum HSP-70 concentrations were measured at enrollment and at 7 days. Clinical outcome measures were also determined.

Results

HSP-70 concentrations were unchanged in control-PN subjects from baseline to day 7. In marked contrast, Gln-PN subjects demonstrated significantly higher (3.7-fold) serum HSP-70 concentrations than control subjects. In Gln-PN patients there was a significant correlation between increases in HSP-70 levels over baseline and decrease in ICU length of stay.

Conclusions

Gln-PN significantly increases serum HSP-70 in critically ill patients. The magnitude of HSP-70 enhancement in Gln-treated patients was correlated with improved clinical outcomes. These data indicate the need for larger, randomized trials of the Gln effect on serum and tissue HSP-70 expression in critical illness and relationship to clinical outcomes.

Keywords

Heat shock proteins Critical Illness Glutamine Parenteral nutrition Outcome