A Randomized Controlled Trial of the Influence of the Mode of Enteral Ornithine α-Ketoglutarate Administration in Burn Patients

Abstract

To investigate appropriate mode and daily dose of enteral ornithine alpha-ketoglutarate (OKG) administration, 54 burn patients (total burn surface area: 20-50%) were included in a randomized controlled trial and assigned to receive either a supplement of OKG (10, 20 or 30 g/d) as bolus or continuous infusion, or a continuous infusion of an isonitrogenous amount of a soy protein mixture (Protil-1: 10, 20 or 30 g/d) in addition to their enteral diet. The influence of these treatments on clinical outcome and biological indices was evaluated. OKG administration significantly improved nitrogen balance and reduced 3-methylhistidine and hydroxyproline urinary elimination. This was associated with a gradual rise in plasma glutamine over time. Given as a bolus, OKG significantly improved wound healing, assessed both clinically [day of last graft: (mean +/- SEM) OKG bolus 23.7 +/- 2.1 d versus Protil-1, 39.9 +/- 9.9 d; P < 0.05] and by hydroxyproline excretion, and biological markers of nitrogen metabolism, and tended to reduce duration of enteral nutrition (P = 0.12). The higher catabolic status in the patients administered 20 g OKG/d at the onset of the study, despite randomization, precludes any definite conclusion (concerning the dose-effect relationship). However, based on 3-methylhistidine elimination, our data indicate a benefit of 30 g OKG/d administration over 10 g/d. This study further supports OKG supplementation in burn patients. In addition, this is the first trial based on objective data that favors bolus over continuous infusion of OKG in critically ill patients.

Infrared and Raman spectral studies of L‐ornithine nitrate

“…12 The ornithine cation, C 5 H 13 N 2 O 2 C , has several functional groups. Vibrations of the various groups, COO , NH 3 C , CH 2 , CH and CN, and skeletal vibrations are discussed in detail.…”

“…This may be due to the different hydrogen bond pattern associated with the NH 3 C group. In the compound under study, each of the three hydrogen atoms in the NH 3 C moiety participates in hydrogen bonding, which weakens the N-H bond. The effect of this is reflected in the spectra in which the asymmetric mode of the NH 3 C group is downshifted by about 60 cm 1 from the corresponding free ion value.…”

“…Brocker et al 2 reported that the supplements of ornithine˛-ketoglutarate helped to improve the appetite, weight gain and quality of life of people with acute illnesses. De Bandt et al 3 showed that ornithine˛-ketoglutarate supplementation improved wound healing and decreased hospitalization in people with severe burns.…”

Alpha-ketoglutarate inhibits glutamine degradation and enhances protein synthesis in intestinal porcine epithelial cells

“…Emerging evidence shows beneficial effects of AKG in clinical and experimental nutrition, particularly with respect to intestinal growth and integrity (Hou et al 2011;Pierzynowski and Sjodin 1998). For example, enteral administration of AKG reduces infectious complications after trauma and surgery in humans in the early postoperative phase (Junghans et al 2006), whereas AKG improves nitrogen balance in burn patients (De Bandt et al 1998) and the healing of the small intestine after radiation (Kalfarentzos et al 1996). Additionally, dietary supplementation with 1% AKG can alleviate mucosal damage and increase the absorptive function of the small intestine in the endotoxin-challenged piglet (Hou et al 2010), which is an excellent animal model for studying human nutrition and metabolism (Flynn et al 2009;Suryawan et al 2009;Wang et al 2009a;Wilson et al 2011).…”

Vibrational spectra of bis(L-ornithinium) chloride nitrate sulfate

“…1,2 In burn, trauma and surgical patients, muscle wasting is reduced, new muscle growth is increased and wound healing is promoted by ornithine˛-ketoglutarate therapy. 3,4 The inhibition of human ornithine decarboxylase activity by enantiomers of difluoromethylornithine has already been studied. 5 The use of L-ornithine, several spectroscopic studies of the inorganic acid complexes of various amino acids and their derivatives.…”