Plasma arginine and citrulline concentrations in critically ill children: strong relation with inflammation

Abstract

Background:The amino acid arginine plays a key role in many metabolic processes in health and disease. Low arginine concentrations are found in various illnesses in children. Objective: The objective was to investigate the relation between plasma concentrations of arginine (and precursor amino acids) and severity of inflammation in critically ill children. Design: This was an observational cohort study in children with viral respiratory disease (n ҃ 21; control group), accidental or surgical trauma (n ҃ 19), or sepsis (n ҃ 19) who were admitted to a pediatric intensive care unit. Results: Plasma arginine and citrulline concentrations were lower in subjects with sepsis and trauma than in those with viral disease (arginine: 33 Ȁ 4, 37 Ȁ 4, and 69 Ȁ 8 mol/L, respectively, P 0.01 for both; citrulline: 10 Ȁ 1, 14 Ȁ 1, and 23 Ȁ 2 mol/L, respectively, P 0.01 for both) and correlated strongly and inversely with severity of inflammation as indicated by plasma CRP concentration (r ҃ Ҁ0.645 and r ҃ Ҁ0.660, respectively; P 0.001 for both). During recovery, plasma arginine and citrulline concentrations increased and were strongly related to the reduction in inflammation as shown by the inverse correlation between arginine and citrulline concentrations and the CRP concentration on days 3 (r ҃ Ҁ0.832 and r ҃ Ҁ0.756, P 0.001 for both) and 7 (r ҃ Ҁ0.784 and r ҃ Ҁ0.694, P 0.001 for both). Conclusions: Plasma concentrations of arginine and citrulline are low during the acute phase of critical illness in children and normalize again during recovery. Plasma arginine and citrulline are strongly related to the severity of inflammation indicated by plasma CRP concentrations.

Acute intestinal failure in critically ill patients: is plasma citrulline the right marker?

“…Definition of acute intestinal failure based upon enterocyte mass reduction and/or enterocyte dysfunction Taking into account previous studies, a definition of acute intestinal failure based upon enterocyte mass reduction and/or enterocyte dysfunction, associated or not with loss of gut barrier function, may be proposed. Even if the gut hypothesis of multiple organ failure still requires confirmation, recent literature reinforces such a model: critically ill patients with shock have an epithelial lifting of villi [16,17], enterocyte necrosis explaining the increased I-FABP concentration observed in this context [21], acute reduction of enterocyte mass explaining the lower gut citrulline synthesis and therefore the rapid decrease of plasma citrulline concentration [46,48,49]; acute dysfunction of enterocytes associated with SIRS [45], possibly by mitochondrial dysfunction, might also be involved in the reduction of citrulline synthesis observed in septic patients [48,49]; loss of gut barrier function associated with denuded villi might account for the higher prevalence of sepsis [48,49,52], and mortality [46] observed in critically ill patients with low plasma citrulline concentration. Both acute reduction of enterocyte mass and enterocyte dysfunction could coexist, representing the organic and functional aspects of acute intestinal failure.…”

A complementary food formulation from local products and exclusive use of watermelon (Citrullus lanatus (Thunb.) juice for the cooking : Nutritional and health interest

“…Furthermore, it has been demonstrated that plasma concentration of L-arginine and L-citrulline are low during illness in children and normalize again after recovery. Plasma L-arginine and L-citrulline are strongly related to the severity of inflammation indicated by plasma CRP concentration (Van Waardenburg et al, 2007). Also, it is necessary to increase consumption level of these amino acids in illness situations.…”

Enhanced L-citrulline in parboiled paddy rice with watermelon (Citrullus lanatus) juice for preventing Sarcopenia: A preliminary study

“…Furthermore, it has been demonstrated that plasma concentration of Larginine and L-citrulline are low during illness in children and normalize again after recovery. Plasma L-arginine and L-citrulline are strongly related to the severity of inflammation indicated by plasma CRP concentration (Van Waardenburg et al, 2007). Also, it is necessary to increase consumption level of these amino acids in illness situations.…”