Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy

Abstract

Glutamine is a major dietary amino acid that is both a fuel and nitrogen donor for healing tissues damaged by chemotherapy and radiation. Evidence supports the benefit of oral (enteral) glutamine to reduce symptoms and improve and/or maintain quality of life of cancer patients. Benefits include not only better nutrition, but also decreased mucosal damage (mucositis, stomatitis, pharyngitis, esophagitis, and enteritis). Glutamine supplementation in a high protein diet (10 grams/day) + disaccharides, such as sucrose and/or trehalose, is a combination that increases glutamine uptake by mucosal cells. This increased topical effect can reduce painful mucosal symptoms and ulceration associated with chemotherapy and radiation in the head and neck region, esophagus, stomach and small intestine. Topical and oral glutamine seem to be the preferred routes for this amino acid to promote mucosal healing during and after cancer treatment.

Future Directions in the Treatment of Osteosarcoma

“…One of us (PMA) uses this information correlating immune variables with durable osteosarcoma responses to help patients and caregivers re-focus the more than two-thirds of systemic therapy that is given after limb salvage surgery. Such changes include reducing treatment related toxicity, such as nausea, and mucositis [ 29 ] and improving immune function via better nutrition [ 29 ]. There is also an increased focus on outpatient therapy using chemotherapy pumps with supportive medication regimens during this period [ 30 ].…”

Targeting Glutaminolysis: New Perspectives to Understand Cancer Development and Novel Strategies for Potential Target Therapies

“…Rapidly-dividing cells including those in kidney, gastrointestinal tract, immune compartments and cancer cells, possess a tremendous appetite for glutamine. For example, deprivation of glutamine induces necrosis of intestinal mucosa and apoptosis in human cell lines (12,18), while additional oral supplementation of glutamine among cancer patients undergoing radio-and chemotherapy improves mucosa healing and ameliorate life quality (19). Flux of glutamine is mediated by the transporter SLC1A5 (ASCT2) and antiporter SCL7A5/SCL3A2 on cell membrane, and the newly identified SLC1A5 variant on the inner mitochondrial membrane (20,21).…”

A Systematic Review and Meta-Analysis on the Efficacy of Curcumin/Turmeric for the Prevention and Amelioration of Radiotherapy/Radiochemotherapy Induced Oral Mucositis in Head and Neck Cancer Patients

“…Palifermin (keratinocyte growth factor-1) has been approved by the US Food and Drug Administration but due to its application only for patients on high dose chemotherapy, expensiveness, difficulty to administer, is not considered a better choice (Nooka et al, 2014). Oral zinc sulfate (Tian et al, 2018), Oral glutamine (Anderson and Lalla, 2020),laser therapy (de lima et al, 2020), photobiomodulation therapy (Campos et al, 2020) are recently been tried but definitive therapy has not been established.…”