Glutamine protects gut against chemotherapy toxicity.





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The presence of colon cancer that has spread to other parts of the body can be a challenge for the oncologist caring for the patient. The recommended therapy can result in numerous side effects that can limit the dose of chemotherapy given to the patient. Much research has been devoted to the use of 5-fluorouracil plus folinic acid. The side effects can affect the entire digestive tract. Common problems are diarrhea and mucositis or small sores and inflammation forming inside the mouth and throat. The presence of these problems can affect the lining of the digestive tract, which can ultimately decrease the absorption of nutrients from the diet which could cause further problems.1,2,3
This study evaluated patients with colon cancer and the use of glutamine, an amino acid, to help control the side effects that can occur in the digestive tract. One group of patients took 18 grams of oral glutamine daily for two weeks, while the other group received a placebo five days before starting treatment with 5-fluourouracil and folinic acid, the most common chemotherapy agents used against colorectal cancer. The patients receiving the placebo showed decreased absorption of nutrients in the intestines and increased chance of absorbing harmful substances such as bacteria. However, in the patients who took glutamine, this damage to intestines was reduced significantly, by nearly one-half. The glutamine patients had less severe and less frequent diarrhea. The researchers concluded that glutamine nourishes the intestinal tract and helps prevent the breakdown of the gut's protective lining, preventing potentially harmful toxins, allergens, and bacteria from entering the circulation.4


1. Kohne CH, Wilke H, Hiddemann W, Bokemeyer C, Lohrmann HP, Bodenstein H, et al. Phase II evaluation of 5-fluourouracil plus folinic acid and alpha 2b-interferon in metastatic colorectal cancer. Oncology. Mar-Apr 1997;54(2):96-101.
2. Brunetti I, Falcone A, Bertuccelli M, Cianci C, Ricci S, Conte PF. Double 5-fluorouracil modulation with folinic acid and recombinant alpha-2B-interferon. A phase I-II study in metastatic colorectal cancer patients. Am J Clin Oncol. Jun 1994;17(3):210-4.
3. Becouarn YH, Brunet RC, Rouhier ML, Bussieres EJ, Avril AR, Richaud PM, et al. High dose folinic acid and 5-fluorouracil bolus and continuous infusion for patients with advanced colorectal cancer. Cancer 1995 Oct 1;76(7):1126-31.
4. Daniele B, Perrone F, Gallo C, et al. Oral glutamine in the prevention of fluorouracil induced intestinal toxicity: a double blind, placebo controlled, randomised trial. Gut. Jan 2001;48:28-33.