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Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial

BACKGROUND: A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. METHODS: This was a monocentric, randomized,...

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Autores principales: Heming, Nicholas, Carlier, Robert, Prigent, Helene, Mekki, Ahmed, Jousset, Camille, Lofaso, Frederic, Ambrosi, Xavier, Bounab, Rania, Maxime, Virginie, Mansart, Arnaud, Crenn, Pascal, Moine, Pierre, Foltzer, Fabien, Cuenoud, Bernard, Konz, Tobias, Corthesy, John, Beaumont, Maurice, Hartweg, Mickaël, Roessle, Claudia, Preiser, Jean-Charles, Breuillé, Denis, Annane, Djillali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9670468/
https://www.ncbi.nlm.nih.gov/pubmed/36397118
http://dx.doi.org/10.1186/s13054-022-04232-5
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author Heming, Nicholas
Carlier, Robert
Prigent, Helene
Mekki, Ahmed
Jousset, Camille
Lofaso, Frederic
Ambrosi, Xavier
Bounab, Rania
Maxime, Virginie
Mansart, Arnaud
Crenn, Pascal
Moine, Pierre
Foltzer, Fabien
Cuenoud, Bernard
Konz, Tobias
Corthesy, John
Beaumont, Maurice
Hartweg, Mickaël
Roessle, Claudia
Preiser, Jean-Charles
Breuillé, Denis
Annane, Djillali
author_facet Heming, Nicholas
Carlier, Robert
Prigent, Helene
Mekki, Ahmed
Jousset, Camille
Lofaso, Frederic
Ambrosi, Xavier
Bounab, Rania
Maxime, Virginie
Mansart, Arnaud
Crenn, Pascal
Moine, Pierre
Foltzer, Fabien
Cuenoud, Bernard
Konz, Tobias
Corthesy, John
Beaumont, Maurice
Hartweg, Mickaël
Roessle, Claudia
Preiser, Jean-Charles
Breuillé, Denis
Annane, Djillali
author_sort Heming, Nicholas
collection PubMed
description BACKGROUND: A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. METHODS: This was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline. RESULTS: Thirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH(2)0 (P = 0.035) and 3.12 [0.5; 5.73] cm(3)/kg (P = 0.022), respectively). CONCLUSIONS: Amino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04232-5.
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spelling pubmed-96704682022-11-18 Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial Heming, Nicholas Carlier, Robert Prigent, Helene Mekki, Ahmed Jousset, Camille Lofaso, Frederic Ambrosi, Xavier Bounab, Rania Maxime, Virginie Mansart, Arnaud Crenn, Pascal Moine, Pierre Foltzer, Fabien Cuenoud, Bernard Konz, Tobias Corthesy, John Beaumont, Maurice Hartweg, Mickaël Roessle, Claudia Preiser, Jean-Charles Breuillé, Denis Annane, Djillali Crit Care Research BACKGROUND: A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. METHODS: This was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline. RESULTS: Thirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH(2)0 (P = 0.035) and 3.12 [0.5; 5.73] cm(3)/kg (P = 0.022), respectively). CONCLUSIONS: Amino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-022-04232-5. BioMed Central 2022-11-17 /pmc/articles/PMC9670468/ /pubmed/36397118 http://dx.doi.org/10.1186/s13054-022-04232-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Heming, Nicholas
Carlier, Robert
Prigent, Helene
Mekki, Ahmed
Jousset, Camille
Lofaso, Frederic
Ambrosi, Xavier
Bounab, Rania
Maxime, Virginie
Mansart, Arnaud
Crenn, Pascal
Moine, Pierre
Foltzer, Fabien
Cuenoud, Bernard
Konz, Tobias
Corthesy, John
Beaumont, Maurice
Hartweg, Mickaël
Roessle, Claudia
Preiser, Jean-Charles
Breuillé, Denis
Annane, Djillali
Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
title Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
title_full Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
title_fullStr Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
title_full_unstemmed Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
title_short Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
title_sort effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9670468/
https://www.ncbi.nlm.nih.gov/pubmed/36397118
http://dx.doi.org/10.1186/s13054-022-04232-5
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