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Prevention of chronic radiation enteropathy by dietary glutamine

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Background: Nearly 50% of all cancer patients receive therapeutic radiation during the course of their disease. The risk of late complications is the main dose-limiting factor in the delivery of radiation therapy. The small intestine, the major site of chronic radiation enteropathy, is also the principal organ of glutamine consumption. We therefore hypothesized that the provision of supplemental glutamine may have a protective effect on the development of chronic radiation enteropathy.

Methods: This study evaluated the effects of supplemental oral glutamine on the development of chronic radiation (XRT) enteropathy. After scrotalization of a loop of small intestine, rats were randomized to receive 1 g/kg/day glutamine (GLN) or glycine (GLY) by gavage. After 2 days of prefeeding, rats were randomized to 1 of 4 groups: GLN + XRT (n=10), GLY + XRT (n=10), GLN only (n=10), GLY only (n=10). Twenty Gy was delivered to the scrotalized bowel in the GLN + XRT and GLY + XRT groups via a collimated beam. Gavage was continued for 10 days. Animals were then pair-fed chow. Rats were killed at 2 months postirradiation. Chronic radiation injury was assessed microscopically.

Results: Injury scores in GLN + XRT were similar to those of unirradiated bowel and significantly different from GLY + XRT (1.89 ± 0.48 in XRT + GLN vs. 6.42 ± 1.55 in the XRT + GLY,p<0.01). Elevated Injury Scores in the XRT + GLY group correlated with gross thickening and fibrosis, a 10-fold decrease in gut GLN extraction (1.40 ± 4.3% in GLY + XRT vs. 16.0 ± 5.1% in GLN + XRT,p<0.05), and a 30% decrease in glutathione content (2.46 ± 0.19 and GLY + XRT vs. 3.17 ± 0.17 GLN + XRT,p<0.05).

Conclusions: Provision of GLN during abdominal/pelvic XRT may prevent XRT injury and decrease the long-term complications of radiation enteropathy.

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Dr. Jensen is a recipient of the Armand Hammer Travel Award from the Society of Surgical Oncology.

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Jensen, J.C., Schaefer, R., Nwokedi, E. et al. Prevention of chronic radiation enteropathy by dietary glutamine. Annals of Surgical Oncology 1, 157–163 (1994).

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