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Human Nutrition and Metabolism

Glutamine-Enriched Enteral Nutrition Increases HLA-DR Expression on Monocytes of Trauma Patients^{1 ,2}

Petra G. Boelens^*, Alexander P. J. Houdijk^*, Johanna C. M. Fonk, Robert J. Nijveldt^*, Charlotte C. Ferwerda^*, B. Mary E. Von Blomberg-Van der Flier, Lambertus G. Thijs^**, Henk J.Th.M. Haarman^*, Juan C. Puyana and Paul A. M. Van Leeuwen^*3

From the Departments of ^* Surgery, Pathology and ^** Internal Medicine, Vrije Universiteit Medical Center, Amsterdam 1081 HV, The Netherlands; and the Department of Surgical Intensive Care Unit, University of Pittsburgh Medical Center, Pittsburgh, PA 15213

³To whom correspondence should be addressed. E-mail: pam.vleeuwen{at}vumc.nl.

The aim of this study was to investigate the effect of glutamine-(Gln)-enriched enteral nutrition (EN) on human leukocyte antigen (HLA)-DR and FcR1/CD64 expression on monocytes and plasma glutamine concentrations in multi-trauma patients. HLA-DR expression on monocytes is crucial in the presentation of foreign antigen to the immune system and is severely reduced in trauma patients. In vitro monocyte HLA-DR and FcRI/CD64 expression is dependent on glutamine availability. To study the effect of glutamine supplemented enteral nutrition on HLA-DR and FcRI/CD64 expression on CD14⁺ monocytes, 55 multi-trauma patients were studied in a randomized, double-blinded, controlled trial. Trauma patients received either a Gln-enriched EN (glutamine group, n = 28) or an isocaloric, isonitrogenous control EN (control group, n = 27) and were compared with a group of age-matched healthy volunteers (healthy volunteers, n = 53). On d 1, 5, 9 and 14 after trauma, expressions of HLA-DR and FcRI/CD64 were determined on CD14⁺ monocytes using FACS analysis. Plasma glutamine levels were measured using HPLC. Plasma glutamine was lower in both trauma patient groups compared with healthy volunteers and from d 3 to d 5; glutamine was higher in the glutamine group than in the control group. On d 1, HLA-DR expression was much lower in both trauma patient groups than in healthy volunteers. HLA-DR expression was greater on d 5, 9 and 14 in the glutamine group than in the control group. FcRI/CD64 expression on monocytes of trauma patients was not different than the expression of healthy volunteers. This study showed that glutamine-enriched enteral nutrition was associated with a higher HLA-DR expression on CD14⁺ monocytes of trauma patients. No difference in monocyte FcRI/CD64 expression was detected between patients that received the two enteral diets and between trauma patients and the healthy volunteers. Increased HLA-DR expression may improve cellular immune function and may be involved in the beneficial effect of glutamine on the occurrence of infections in trauma patients.

KEY WORDS: • glutamine • human leukocyte antigen DR • Fc receptor • trauma • surgery