Prevention of chronic radiation enteropathy by dietary glutamine

Joseph C. Jensen, Robert Schaefer, Emmanuel Nwokedi, David W. Bevans, Max L. Baker, Alex A. Pappas, Kent C. Westbrook, Vicki Klimberg

Research output: Contribution to journalArticle

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Abstract

Background: Nearly 50% of all cancer patients receive therapeutic radiation during the course of their disease. The risk of late complications is the main dose-limiting factor in the delivery of radiation therapy. The small intestine, the major site of chronic radiation enteropathy, is also the principal organ of glutamine consumption. We therefore hypothesized that the provision of supplemental glutamine may have a protective effect on the development of chronic radiation enteropathy. Methods: This study evaluated the effects of supplemental oral glutamine on the development of chronic radiation (XRT) enteropathy. After scrotalization of a loop of small intestine, rats were randomized to receive 1 g/kg/day glutamine (GLN) or glycine (GLY) by gavage. After 2 days of prefeeding, rats were randomized to 1 of 4 groups: GLN + XRT (n=10), GLY + XRT (n=10), GLN only (n=10), GLY only (n=10). Twenty Gy was delivered to the scrotalized bowel in the GLN + XRT and GLY + XRT groups via a collimated beam. Gavage was continued for 10 days. Animals were then pair-fed chow. Rats were killed at 2 months postirradiation. Chronic radiation injury was assessed microscopically. Results: Injury scores in GLN + XRT were similar to those of unirradiated bowel and significantly different from GLY + XRT (1.89 ± 0.48 in XRT + GLN vs. 6.42 ± 1.55 in the XRT + GLY, p<0.01). Elevated Injury Scores in the XRT + GLY group correlated with gross thickening and fibrosis, a 10-fold decrease in gut GLN extraction (1.40 ± 4.3% in GLY + XRT vs. 16.0 ± 5.1% in GLN + XRT, p<0.05), and a 30% decrease in glutathione content (2.46 ± 0.19 and GLY + XRT vs. 3.17 ± 0.17 GLN + XRT, p<0.05). Conclusions: Provision of GLN during abdominal/pelvic XRT may prevent XRT injury and decrease the long-term complications of radiation enteropathy.

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalAnnals of Surgical Oncology
Volume1
Issue number2
DOIs
StatePublished - Mar 1994
Externally publishedYes

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Glutamine
Radiation
Glycine
Small Intestine
Wounds and Injuries
Radiation Injuries
Glutathione
Fibrosis
Radiotherapy

Keywords

  • Chronic radiation enteropathy
  • Glutamine (GLN)

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Jensen, J. C., Schaefer, R., Nwokedi, E., Bevans, D. W., Baker, M. L., Pappas, A. A., ... Klimberg, V. (1994). Prevention of chronic radiation enteropathy by dietary glutamine. Annals of Surgical Oncology, 1(2), 157-163. https://doi.org/10.1007/BF02303560

Prevention of chronic radiation enteropathy by dietary glutamine. / Jensen, Joseph C.; Schaefer, Robert; Nwokedi, Emmanuel; Bevans, David W.; Baker, Max L.; Pappas, Alex A.; Westbrook, Kent C.; Klimberg, Vicki.

In: Annals of Surgical Oncology, Vol. 1, No. 2, 03.1994, p. 157-163.

Research output: Contribution to journalArticle

Jensen, JC, Schaefer, R, Nwokedi, E, Bevans, DW, Baker, ML, Pappas, AA, Westbrook, KC & Klimberg, V 1994, 'Prevention of chronic radiation enteropathy by dietary glutamine', Annals of Surgical Oncology, vol. 1, no. 2, pp. 157-163. https://doi.org/10.1007/BF02303560
Jensen JC, Schaefer R, Nwokedi E, Bevans DW, Baker ML, Pappas AA et al. Prevention of chronic radiation enteropathy by dietary glutamine. Annals of Surgical Oncology. 1994 Mar;1(2):157-163. https://doi.org/10.1007/BF02303560
Jensen, Joseph C. ; Schaefer, Robert ; Nwokedi, Emmanuel ; Bevans, David W. ; Baker, Max L. ; Pappas, Alex A. ; Westbrook, Kent C. ; Klimberg, Vicki. / Prevention of chronic radiation enteropathy by dietary glutamine. In: Annals of Surgical Oncology. 1994 ; Vol. 1, No. 2. pp. 157-163.
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abstract = "Background: Nearly 50{\%} of all cancer patients receive therapeutic radiation during the course of their disease. The risk of late complications is the main dose-limiting factor in the delivery of radiation therapy. The small intestine, the major site of chronic radiation enteropathy, is also the principal organ of glutamine consumption. We therefore hypothesized that the provision of supplemental glutamine may have a protective effect on the development of chronic radiation enteropathy. Methods: This study evaluated the effects of supplemental oral glutamine on the development of chronic radiation (XRT) enteropathy. After scrotalization of a loop of small intestine, rats were randomized to receive 1 g/kg/day glutamine (GLN) or glycine (GLY) by gavage. After 2 days of prefeeding, rats were randomized to 1 of 4 groups: GLN + XRT (n=10), GLY + XRT (n=10), GLN only (n=10), GLY only (n=10). Twenty Gy was delivered to the scrotalized bowel in the GLN + XRT and GLY + XRT groups via a collimated beam. Gavage was continued for 10 days. Animals were then pair-fed chow. Rats were killed at 2 months postirradiation. Chronic radiation injury was assessed microscopically. Results: Injury scores in GLN + XRT were similar to those of unirradiated bowel and significantly different from GLY + XRT (1.89 ± 0.48 in XRT + GLN vs. 6.42 ± 1.55 in the XRT + GLY, p<0.01). Elevated Injury Scores in the XRT + GLY group correlated with gross thickening and fibrosis, a 10-fold decrease in gut GLN extraction (1.40 ± 4.3{\%} in GLY + XRT vs. 16.0 ± 5.1{\%} in GLN + XRT, p<0.05), and a 30{\%} decrease in glutathione content (2.46 ± 0.19 and GLY + XRT vs. 3.17 ± 0.17 GLN + XRT, p<0.05). Conclusions: Provision of GLN during abdominal/pelvic XRT may prevent XRT injury and decrease the long-term complications of radiation enteropathy.",
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AU - Pappas, Alex A.

AU - Westbrook, Kent C.

AU - Klimberg, Vicki

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N2 - Background: Nearly 50% of all cancer patients receive therapeutic radiation during the course of their disease. The risk of late complications is the main dose-limiting factor in the delivery of radiation therapy. The small intestine, the major site of chronic radiation enteropathy, is also the principal organ of glutamine consumption. We therefore hypothesized that the provision of supplemental glutamine may have a protective effect on the development of chronic radiation enteropathy. Methods: This study evaluated the effects of supplemental oral glutamine on the development of chronic radiation (XRT) enteropathy. After scrotalization of a loop of small intestine, rats were randomized to receive 1 g/kg/day glutamine (GLN) or glycine (GLY) by gavage. After 2 days of prefeeding, rats were randomized to 1 of 4 groups: GLN + XRT (n=10), GLY + XRT (n=10), GLN only (n=10), GLY only (n=10). Twenty Gy was delivered to the scrotalized bowel in the GLN + XRT and GLY + XRT groups via a collimated beam. Gavage was continued for 10 days. Animals were then pair-fed chow. Rats were killed at 2 months postirradiation. Chronic radiation injury was assessed microscopically. Results: Injury scores in GLN + XRT were similar to those of unirradiated bowel and significantly different from GLY + XRT (1.89 ± 0.48 in XRT + GLN vs. 6.42 ± 1.55 in the XRT + GLY, p<0.01). Elevated Injury Scores in the XRT + GLY group correlated with gross thickening and fibrosis, a 10-fold decrease in gut GLN extraction (1.40 ± 4.3% in GLY + XRT vs. 16.0 ± 5.1% in GLN + XRT, p<0.05), and a 30% decrease in glutathione content (2.46 ± 0.19 and GLY + XRT vs. 3.17 ± 0.17 GLN + XRT, p<0.05). Conclusions: Provision of GLN during abdominal/pelvic XRT may prevent XRT injury and decrease the long-term complications of radiation enteropathy.

AB - Background: Nearly 50% of all cancer patients receive therapeutic radiation during the course of their disease. The risk of late complications is the main dose-limiting factor in the delivery of radiation therapy. The small intestine, the major site of chronic radiation enteropathy, is also the principal organ of glutamine consumption. We therefore hypothesized that the provision of supplemental glutamine may have a protective effect on the development of chronic radiation enteropathy. Methods: This study evaluated the effects of supplemental oral glutamine on the development of chronic radiation (XRT) enteropathy. After scrotalization of a loop of small intestine, rats were randomized to receive 1 g/kg/day glutamine (GLN) or glycine (GLY) by gavage. After 2 days of prefeeding, rats were randomized to 1 of 4 groups: GLN + XRT (n=10), GLY + XRT (n=10), GLN only (n=10), GLY only (n=10). Twenty Gy was delivered to the scrotalized bowel in the GLN + XRT and GLY + XRT groups via a collimated beam. Gavage was continued for 10 days. Animals were then pair-fed chow. Rats were killed at 2 months postirradiation. Chronic radiation injury was assessed microscopically. Results: Injury scores in GLN + XRT were similar to those of unirradiated bowel and significantly different from GLY + XRT (1.89 ± 0.48 in XRT + GLN vs. 6.42 ± 1.55 in the XRT + GLY, p<0.01). Elevated Injury Scores in the XRT + GLY group correlated with gross thickening and fibrosis, a 10-fold decrease in gut GLN extraction (1.40 ± 4.3% in GLY + XRT vs. 16.0 ± 5.1% in GLN + XRT, p<0.05), and a 30% decrease in glutathione content (2.46 ± 0.19 and GLY + XRT vs. 3.17 ± 0.17 GLN + XRT, p<0.05). Conclusions: Provision of GLN during abdominal/pelvic XRT may prevent XRT injury and decrease the long-term complications of radiation enteropathy.

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