Effects of Arginine and Citrulline supplementation on inflammatory markers in critically ill patients
-
Bahareh Barkhidarian
,
Shirin seyedhamzeh
,
Seyed Issac Hashemi
,
Mohsen Nematy
,
Ashraf Rahbar
,
Roya Ranjbar
,
Mohammad Safarian
Abstract
Background: Citrulline is a nonessential amino acid that is a main precursor of Arginine and therefore could be a best alternative for arginine supplementation. The current study aimed to assess the effects of Arginine and Citrulline administration on inflammatory factors (C-reactive protein (CRP), interlukine-6 (IL-6)) in critically ill trauma patients.
Method: A total of 102 patients in 5 traumas intensive care units (ICU) were divided into three groups: Arginine, Citrulline and Control. Patients received 10 g/d Arginine powder (Arginine Group) or 10 g/d Citrulline powder (Citrulline Group) for 10 days. Serum level of CRP, IL-6 were determined in all patients before (day 0) and after intervention (day 11) and their correlation with APACHE II as an indicator of severity of disease were assessed.
Results: There were significant reduction in IL6 levels only in Citrulline group (P=0.009). Moreover, serum levels of CRP decreased in both experimental group but it was elevated during study period in Control group (mean changes in control group were 0.28 ±19.66, in Citrulline group -11.16 ± 22.72 and in arginine group it was -1.12 ± 28.30) which was only significant in Citrulline group (P= 0.025). Results showed that APACHE II score were decreased in all three groups but there were no significant differences between groups after 10 days intervention (P=0.44). Changes in APACHE II score had significant correlation with IL6 level (r=0.29, P=0.02).
Conclusion: Citrulline supplementation could have modulatory effects on inflammatory biomarkers.
- Yvette C Luiking, Martijn Poeze, Graham Ramsay and Nicolaas EP Deutz, Reduced Citrullineproduction in sepsis is related to diminished de novo arginine and nitric oxide production, Am J Clin Nutr 2009, 89: 142-152.
- Yvette C. Luiking, Martijn Poeze, Graham Ramsay, and Nicolaas E. P. Deutz, The Role of Arginine in Infection and Sepsis, Journal of Parenteral and Enteral Nutrition,2005 , S70-S74
- Barbul A, Rettura G, Levenson SM, Seifter E. Wound healing and thymotrophic effects of arginine: a pituitary mechanism of action. Am J Clin Nutr. 1983;37:786-794.
- Barbul A. Arginine: biochemistry, physiology, and therapeutic implications. JPEN J Parenter Enteral Nutr. 1986;10:227-238.
- van Waardenburg DA, de Betue CT, Luiking YC, Engel M, Deutz NE (2007) Plasma arginine and Citrullineconcentrations in critically ill children: strong relation with inflammation. Am J
- Oberholzer A, Oberholzer C, Moldawer LL, Mitchell P. Cytokine signaling-regulation of the immune response in normal and critically ill states. Crit Care Med 2000;28(Suppl. 4):N3–N12.
- Calandra T, Gerain J, Heumann D, Baumgartner JD, Glauser MP. High circulating levels of interleukin-6 in patients with septic shock: evolution during sepsis, prognostic value, and interplay with other cytokines. The Swiss–Dutch J5 immunoglobulin study group. Am J Med 1991;91:23–9.
- Bozza FA, Salluh JI, Japiassu AM, Soares M, Assis EF, Gomes RN, et al. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care 2007;11:R49.
- Roumen RH, Hendriks T, van der Ven-Jongekrijg J, Nieuwenhuijzen GA, Sauerwein RW, van der Meer JWM, et al. Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Ann Surg 1993;218:769–76.
- Neidhardt R, Keel M, Steckholzer U, Safret A, Ungethuem U, Trentz O, et al. Relationship of interleukin-10 plasma levels to severity of injury and clinical outcome in injured patients. J Trauma 1997;42:863–71.
- Dimopoulou I, Armaganidis A, Douka E, Mavrou I, Augustatou C, Kopterides P, et al. Tumour necrosis factor-alpha (TNF-a) and interleukin-10 are crucial mediators in post-operative systemic inflammatory response and determine the occurrence of complication after major abdominal surgery. Cytokine 2007;37:55–61.
- Berney T, Gasche Y, Robert J, Jenny A, Mensi N, Grau G, et al. Serum profiles of interleukin-6, interleukin-8, and interleukin-10 in patients with severe and mild pancreatitis. Pancreas 1999;18:371–7.
- Yamada Y, Endo S, Inada K. Plasma cytokine levels in patients with severe burn injury-with reference to the relationship between infection and prognosis. Burns 1996;22:587–93
- Geppert A, Steiner A, Zorn G, Delle-Karth G, Koreny M, Haumer M, et al. Multiple organ failure in patients with cardiogenic shock is associated with high plasma levels of interleukin-6. Crit Care Med 2002;30:1987–94.
- Van Bokhorst-de van der Schueren MAE, von Blomberg-van-der Flier BME & Riezebos RK (1998): Differences in immune status between well nourished and malnourished head and neck cancer patients. Clin. Nutr. 17, 107 – 111
- Daly JM, Reynolds J & Thom A (1988): Immune and metabolic effects of arginine in the surgical patient. Ann. Surg. 208, 521– 523.
- Biffl WL, Moore EE, Moore FA, Peterson VM. Interleukin-6 in the injured patient: marker of injury or mediator of inflammation? Ann Surg. 1996;224:647-664
- Ueo H, Inoue H, Honda M, et al. Production of interleukin-6 at operative wound sites in surgical patients. J Am Coll Surg. 1994;179:326-332.
- Gebhard F, Pfetsch H, Steinbach G, Strecker W, Kinzl L, ckner U, Is Interleukin 6 an Early Marker of Injury Severity Following Major Trauma in Humans? ARCH SURG/VOL 135, MAR 2000
- van Os JP, Roumen RM, Schoots FJ, et al. Is early osteosynthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion? J Trauma. 1994;36:495-498.
- Issihiki H, Akira S, Sugita T, et al. Reciprocal expression of NFIL6 and C/EBP in hepatocytes: possible involvement of NF-IL6 in acute phase protein gene expression. New Biol 1991;3:63–70.
- Fleck A, Colley CM, Myers MA. Liver export proteins and trauma. Brit Med Bull 1985;41:265–73.
- Khorana J, Rerkasem K, Apichartpiyakul C, Sakonwasun C , Watcharasakslip W, Waniyapong T and et al, Immunonutrition and Cytokine Response in Patients with Head Injury, J Med Assoc Thai 2009; 92 (2): 188-94
- Asgeirsson T, Zhang S, Nunoo b, Mascarenas C, Dujovny N, Luchtefeld M, S. Cavey G, and Senagore A, Citrulline: A potential immunomodulator in sepsis, Surgery 2011;150:744-51
| Files | ||
| Issue | Vol 2, No 2 (Spring 2016) | |
| Section | Original Article(s) | |
| Keywords | ||
| L-arginine L-citrulline Inflammatory factors Critically ill patients | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
