Supplementing arginine and citrulline to parenteral nutrition to enhance intestinal recovery
Zack M. Clancy, Applied Physiology, Nutrition, and Metabolism 2020 Scientific Abstracts
Parenteral nutrition (PN) is a means by which nutrients are delivered
directly to the blood via intravenous infusion and is necessary when
infants cannot tolerate oral feedings. Although lifesaving, prolonged
PN leads to reduced blood flow to the gut, gut atrophy and reduced
protein synthesis.
The atrophied gut reduces the intestinal synthesis
of arginine, a key amino acid required for regulation of blood flow via
nitric oxide production, protein synthesis and creatine synthesis.
Supplemental arginine to PN can increase arginine availability, but is
rapidly broken down by the liver and not available to the rest of the
body.
Citrulline, the precursor to arginine, is a potential alternative
strategy to enhance arginine availability since citrulline bypasses liver
breakdown. We hypothesized that citrulline supplementation to PN
will enhance arginine availability, increase blood flow to the gut and
increase protein synthesis more effectively than arginine supplementation.
7-10 day old Yucatan piglets received one of three nutritional
interventions: control PN, arginine supplemented PN, or citrulline
supplemented PN for six days. Blood flow to the gut was assessed using
an ultrasonic probe surgically placed on the superior mesenteric artery and protein and creatine synthesis were measured using isotope
kinetics. Parenteral feeding resulted in reductions over time in arterial blood flow through the superior mesenteric artery in all piglets
(p=0.009 control diet, p=0.04 high arginine diet, p=0.039 citrulline
diet). Compared to the control PN treatment, supplemental arginine
or citrulline did not mitigate the reductions in blood flow to the gut,
suggesting that supplemental arginine or citrulline did not increase
nitric oxide synthesis via nitric oxide synthase. Moreover, daily
growth rate and gut morphological parameters were not different
among the three treatment groups, indicating that supplemental arginine and citrulline did not influence growth or gut morphology.
Although it appears supplemental arginine and citrulline did not enhance arginine availability for nitric oxide synthesis, it is possible
arginine was more available for its other functions, such as protein
or creatine synthesis, and these data are forthcoming.