Intravenous Glutamine Administration Reduces Lung and Distal Organ Injury in Malnourished Rats With Sepsis.

Malnutrition is a risk factor for infection, compromising immune response. Glutamine (Gln) protects the lungs and distal organs in well-nourished septic and non-septic conditions; however, no study to date has analyzed the effects of glutamine in the presence of sepsis and malnutrition. In the present work, we tested the hypothesis that early therapy with intravenous Gln prevents lung and distal organ damage in septic malnourished rats. Protein-energy malnutrition was induced in male Wistar rats for 4 weeks. At the end of 4 weeks, malnourished animals were assigned to a sepsis-inducing cecal ligation and puncture (CLP) group or a Sham surgery group. One hour after surgery, animals were given saline (Sal) or L-alanyl-L-glutamine (Gln) intravenously. In addition, a control group (C) was set up with rats fed ad libitum, not submitted to surgery or treatment. Forty-eight hours after surgery, in Malnutrition-Sham rats, Gln therapy lessened neutrophil lung infiltration and apoptosis in lung and liver. In Malnutrition-CLP rats, Gln therapy yielded: 1) reduced static lung elastance, alveolar collapse, inflammation (neutrophil infiltration, interleukin-6), and collagen deposition; 2) repair of types I and II epithelial cells; 3) no significant changes in heat shock protein (HSP) 70 expression or heat shock factor (HSF)-1 phosphorylation; 4) a greater number of M1 and M2 macrophages in lung tissue; and 5) less apoptosis in the lung, kidney, small intestine, and liver. In conclusion, early therapy with intravenous Gln reduced inflammation, fibrosis, and apoptosis, minimizing lung and distal organ injury, in septic malnourished rats. These beneficial effects may be associated with macrophage activation in the lung.