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

Pierre Moine, Djillali Annane, Denis Breuillé, Jean-Charles Preiser, Claudia Roessle, Mickaël Hartweg, Maurice Beaumont, John Corthesy, Tobias Konz, Bernard Cuenoud, Fabien Foltzer, Nicholas Heming, Pascal Crenn, Arnaud Mansart, Virginie Maxime, Rania Bounab, Xavier Ambrosi, Frederic Lofaso, Camille Jousset, Ahmed Mekki, Helene Prigent, Robert Carlier

Journal: Critical care (London, England) 2022;26(1):358

PMID: 36397118

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Abstract

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] cmH0 (P = 0.035) and 3.12 [0.5; 5.73] cm/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.

Address: General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay, 104, Boulevard Raymond Poincaré, 92380, Garches, France.; Laboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris Saclay, Garches, France.; FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), 92380, Garches, France.; RHU RECORDS (Rapid rEcognition of CORticosteroiD Resistant or Sensitive Sepsis), 92380, Garches, France.; Department of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond Poincaré, Garches, France.; UFR des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.; Department of Physiology-AP-HP, Hôpital Raymond-Poincaré, Garches, France.; Department of Anesthesiology and Intensive Care Medicine, University Hospital of Nantes, Nantes, France.; Clinical Nutrition Unit and FHU Hepatinov, Hôpital Raymond Poincaré, APHP Université Paris Saclay, Garches, France.; Nestlé Research, Société de Produits de Nestlé, Lausanne, Switzerland.; Translation Research, Nestlé Health Science, Lausanne, Switzerland.; Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles, 1070, Brussels, Belgium.; General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay, 104, Boulevard Raymond Poincaré, 92380, Garches, France. [email protected].; Laboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris Saclay, Garches, France. [email protected].; FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), 92380, Garches, France. [email protected].; RHU RECORDS (Rapid rEcognition of CORticosteroiD Resistant or Sensitive Sepsis), 92380, Garches, France. [email protected].

DOI: 10.1186/s13054-022-04232-5

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MeSH Terms: Humans, Critical Illness, Citrulline, Creatinine, Alkaline Phosphatase, Alanine Transaminase, Muscles