IMPROVEMENT OF INTESTINAL PERMEABILITY WITH ALANYL-GLUTAMINE IN HIV PATIENTS: a randomized, double blinded, placebo-controlled clinical trial

• Main Authors: Robério Dias LEITE, Noélia Leal LIMA, Christiane Araujo Chaves LEITE, Calil Kairalla FARHAT, Richard Littleton GUERRANT, Aldo Angelo Moreira LIMA
• Format: Article
• Language: English
• Published: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia (IBEPEGE) 2013-03-01
• Series: Arquivos de Gastroenterologia
• Subjects: Absorção intestinal; Glutamina; HIV; Placebo; Intestinal absorption; Glutamine; Placebos
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032013000100056

Context Glutamine is the main source of energy of the enterocyte and diarrhea and weight loss are frequent in HIV infected patients. Objective To determine the effect of alanyl-glutamine supplementation on intestinal permeability and absorption in these patients. Methods Randomized double-blinded, placebo-controlled study using isonitrogenous doses of alanyl-glutamine (24&#8197;g/day) and placebo (glycine, 25&#8197;g/day) during 10 days. Before and after this nutritional supplementation lactulose and mannitol urinary excretion were determined by high performance liquid chromatography. Results Forty six patients with HIV/AIDS, 36 of whom were male, with 37.28 &#177; 3 (mean &#177; standard error) years were enrolled. Twenty two and 24 subjects were treated with alanyl-glutamine and with glycine respectively. In nine patients among all in the study protocol that reported diarrhea in the 14 days preceding the beginning of the study, mannitol urinary excretion was significantly lower than patients who did not report this symptom [median (range): 10.51 (3.01&#8211;19.75) vs. 15.37 (3.93&#8211;46.73); P = 0.0281] and lactulose/mannitol ratio was significantly higher [median (range): 0.04 (0.00&#8211;2.89) vs. 0.02 (0.00&#8211;0.19); P = 0.0317]. There was also a significant increase in mannitol urinary excretion in the group treated with alanyl-glutamine [median (range): 14.38 (8.25&#8211;23.98) before vs 21.24 (6.27&#8211;32.99) after treatment; n = 14, P = 0.0382]. Conclusion Our results suggest that the integrity and intestinal absorption are more intensely affected in patients with HIV/AIDS who recently have had diarrhea. Additionally, nutritional supplementation with alanyl-glutamine was associated with an improvement in intestinal absorption.<br> Contexto A glutamina &#233; a principal fonte de energia do enter&#243;cito e diarreia e perda de peso s&#227;o frequentes em pacientes infectados pelo HIV. Objetivo Determinar o efeito da alanil-glutamina sobre a permeabilidade e a absor&#231;&#227;o intestinais nesses pacientes. M&#233;todos Estudo duplo-cego, randomizado, controlado por placebo, utilizando doses isonitrog&#234;nicas de alanil-glutamina (24&#8197;g/dia) e de placebo (glicina, 25&#8197;g/dia) durante 10 dias. Antes e depois dessa suplementa&#231;&#227;o nutricional a excre&#231;&#227;o urin&#225;ria de lactulose e manitol foi determinada por cromatografia l&#237;quida de alta performance. Resultados Quarenta e seis pacientes com HIV/AIDS, sendo 36 do sexo masculino, com 37,28 &#177; 3 anos (m&#233;dia &#177; erro padr&#227;o) foram inclu&#237;dos. Vinte e dois e 24 indiv&#237;duos foram tratados com alanil-glutamina e com glicina, respectivamente. Nos nove pacientes que relataram ter apresentado diarreia nos 14 dias anteriores ao in&#237;cio do estudo, a excre&#231;&#227;o urin&#225;ria de manitol foi significativamente menor do que nos pacientes que n&#227;o referiram essa queixa [mediana (intervalo): 10,51 (3,01-19,75) vs 15,37 (3,93-46,73), P = 0,0281] e a raz&#227;o lactulose/manitol foi significativamente mais elevada [mediana (intervalo): 0,04 (0,00-2,89) vs 0,02 (0,00-0,19), P = 0,0317]. Constatou-se tamb&#233;m aumento significativo na excre&#231;&#227;o urin&#225;ria de manitol no grupo tratado com alanil-glutamina [mediana (intervalo): 14,38 (8,25-23,98), antes vs 21,24 (6,27-32,99) ap&#243;s o tratamento, n = 14, P = 0,0382]. Conclus&#227;o Os resultados do presente estudo sugerem que a integridade e a absor&#231;&#227;o intestinais s&#227;o mais intensamente afetadas em pacientes com HIV/AIDS que tiveram diarreia recentemente. Adicionalmente, a suplementa&#231;&#227;o nutricional com alanil-glutamina associou-se &#224; melhoria na absor&#231;&#227;o intestinal.