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Abstract: Background: Anesthesia and surgery starts a series of stress responses in the body. Subsequently, loss of normal anabolic actions of insulin and development of insulin resistance occur. Resulting hyperglycemia has been considered by an evidence based study as a risk factor for perioperative morbidity and mortality. We tested whether a single preoperative dose of alanyl-glutamine would prevent such responses in addition to maintaining glutathione level; an important factor for maintaining cellular redox potential. Methods: A total of 40 cancer patients were enrolled in this study who received an infusions of 500ml of Normal Saline started an hour before surgery and continued throughout the surgery. The Dipeptiven® group (20 patients): 2ml Dipeptiven®/kg were added to saline, while the control group (20 patients): nothing was added to saline. Blood samples were taken a preoperative sample and two postoperative samples (immediately after immergence from anesthesia and 24h after surgery). These samples were analyzed for plasma glucose, plasma insulin to calculate insulin resistance by HOMA test. Plasma reduced glutathione level was also analyzed in the same time points. Results: We found that insulin resistance and glucose level were less in the tested time points in the Dipeptiven® group of patients when compared with the control group. Furthermore, plasma glutathione level was higher in the Dipeptiven® group than the control group. Conclusion: Preoperative alanyl-glutamine is helpful in amelioration of insulin resistance and improvement of plasma glutathione levels in the early postoperative period. [Copyright &y& Elsevier]

Summary: Background & aims: Increased intestinal permeability of Irritable bowel syndrome (IBS) patients has been recently associated with a decreased level of glutamine synthetase. Neonatal maternal deprivation (NMD) is considered as an IBS-like model. The aim of our study was to investigate whether early nutritional intervention with glutamine may attenuate the deleterious impact of early life stress on gut barrier function in NMD. Methods: 124 rat pups were separated from their dam 3 h daily during postnatal days 2–14, or left undisturbed (NS). Separated rats received by gavage either with alanyl-glutamine (GLN), an isonitrogenous amino acid mix (AA, control) or an equal amount of drinking water (H2O). Production of cytokines was measured by multiplex, expression of COX-2, PPARγ, tight junction proteins and TLR4 by western blot. Intestinal permeability was studied by Lactulose/Mannitol test. Results: Treatment of pups with GLN or AA abolished the decrease in body weight observed in NMD. Treatment with GLN decreased in the colon (i) TLR4 expression at D20, (ii) IL-2 and -10 productions at D60 (iii) protein expression of occludin at D20 compared to AA. GLN also decreased colon expression of COX2 and PPARγ at D60 compared to NS. Colon production of IFNγ is significantly reduced by GLN compared to H2O. No significant change in intestinal permeability was observed. Conclusions: These results showed that an early nutritional intervention with alanyl-glutamine specifically abolished the up-regulation of TLR4 expression in NMD. Glutamine may be evaluated as a potential treatment for IBS patients. [Copyright &y& Elsevier]