L-Glutamine Use in the Treatment and Prevention of Mucositis and Cachexia: A Naturopathic Perspective

Abstract

Abstractl-Glutamine (l-GLN) is considered a nonessential amino acid that has a variety of applications in naturopathic medicine. It has been postulated that in the critically ill patient, GLN becomes an essential amino acid for recovery, restoration, and repair at a cellular level. Mucositis is an intestinal mucosal damage of the gastrointestinal tract-mouth, throat, stomach, intestines, rectum, and anus-that is caused directly by chemotherapies and radiotherapies. Cancer cachexia is a significant biochemical event, which is characterized by weight loss, fatigue, and indicative of depletion of skeletal muscle GLN-a hypercatabolic state. There has been some question as to the use of GLN in this patient population because of its role as a preferred energy source not only for enterocytes and lymphocytes but for malignant cells as well. This article will address the questions of safety, efficacy, dosing, and toxicity of GLN used as an integrative therapeutic in ongoing integrative cancer treatment.

Cancer treatment-induced oral mucositis: a critical review

“…Current evidence for the pathobiology of mucosal injury indicates that reactive oxygen species, generated from both chemotherapy and radiation therapy, play a critical role in the initiation of oral mucositis. Glutamine, a precursor for glutathione, plays a pivotal role in regulating the intracellular redox potential 96,147 and clinical investigations indicate that glutamine inhibits other mediators of mucosal barrier injury by reducing the production of proinflammatory cytokines and cytokinerelated apoptosis 30,88 . Administering glutamine should have beneficial effects on patients undergoing radiotherapy and chemotherapy, as both therapies damage the mucosa, causing stomatitis, mucositis, or coloenteritis 29,45 .…”

The effect of immunonutrition (glutamine, alanine) on fracture healing

“…Particularly in critical cases such as multiple injuries, sepsis, or burns, glutamine is used as an essential amino acid as it undertakes the precursor task for nucleic acids, nucleotides, amino sugars, and proteins (3). Under catabolic conditions, glutamine takes on the aspects of an amino acid (3, 15). When muscle tissue is exposed to excessive stress, the most important of the amino acids which provide a repository of some amino acids, is glutamine (16).…”

Glutamine as an Immunonutrient

“…Enteral feeding of glutamine reduced mucositis in chemotherapy patients28 and in head and neck cancer patients with radiotheraphy 29. Total parenteral nutrition with glutamine reduced the severity and duration of mucositis, and the duration of hospitalization for bone marrow transplant patients 26,53.…”

“…Glutamine dipeptide-supplemented total parenteral nutrition had no effect on neutropenic period, fever, extra antibiotics, or toxicity scores, but body weight gain per treatment cycle in catabolic hematologic patients with intensive chemotherapy 27. Even though glutamine showed positive effects on mucositis of the gastrointestinal tract caused by chemotherapy, radiotherapy and cancer cachexia with depletion of skeletal muscle glutamine,28 the use of glutamine in this patient population is still up for debate. This is because glutamine can be an energy source for enterocytes and lymphocytes as well as malignant cells.…”