Gaurav Kumar, Goel R K, Shukla Mridula, Pandey Manoj
Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Indian J Med Paediatr Oncol. 2012 Jan;33(1):13-20. doi: 10.4103/0971-5851.96962.
Treatment of cancer is associated with short- and long-term side-effects. Cancer produces a state of glutamine deficiency, which is further aggravated by toxic effects of chemotherapeutic agents leading to increased tolerance of tumor to chemotherapy as well as reduced tolerance of normal tissues to the side-effects of chemotherapy. This article reviews the possible role of glutamine supplementation in reducing the serious adverse events in patients treated with anticancer drugs. The literature related to the possible role of glutamine in humans with cancer and the supportive evidence from animal studies was reviewed. Searches were made and the literature was retrieved using PUBMED, MEDLINE, COCHRANE LIBRARY, CENAHL and EMBASE, with a greater emphasis on the recent advances and clinical trials. Glutamine supplementation was found to protect against radiation-induced mucositis, anthracycline-induced cardiotoxicity and paclitaxel-related myalgias/arthralgias. Glutamine may prevent neurotoxicity of paclitaxel, cisplatin, oxaplatin bortezomib and lenolidamide, and is beneficial in the reduction of the dose-limiting gastrointestinal toxic effects of irinotecan and 5-FU-induced mucositis and stomatitis. Dietary glutamine reduces the severity of the immunosuppressive effect induced by methotrexate and improves the immune status of rats recovering from chemotherapy. In patients with acute myeloid leukemia requiring parenteral nutrition, glycyl-glutamine supplementation could hasten neutrophil recovery after intensive myelosuppressive chemotherapy. Current data supports the usefulness of glutamine supplementation in reducing complications of chemotherapy; however, paucity of clinical trials weakens the clear interpretation of these findings.
癌症治疗会带来短期和长期的副作用。癌症会导致谷氨酰胺缺乏状态，而化疗药物的毒性作用会进一步加剧这种缺乏，从而导致肿瘤对化疗的耐受性增加，同时正常组织对化疗副作用的耐受性降低。本文综述了补充谷氨酰胺在减少接受抗癌药物治疗患者严重不良事件方面的可能作用。对与谷氨酰胺在癌症患者中可能作用相关的文献以及动物研究的支持性证据进行了综述。通过使用PUBMED、MEDLINE、COCHRANE LIBRARY、CENAHL和EMBASE进行检索并获取文献，更侧重于近期进展和临床试验。发现补充谷氨酰胺可预防辐射引起的粘膜炎、蒽环类药物引起的心脏毒性以及紫杉醇相关的肌痛/关节痛。谷氨酰胺可能预防紫杉醇、顺铂、奥沙利铂、硼替佐米和来那度胺的神经毒性，并且有利于减少伊立替康的剂量限制性胃肠道毒性作用以及5-氟尿嘧啶引起的粘膜炎和口腔炎。饮食中的谷氨酰胺可降低甲氨蝶呤诱导免疫抑制作用的严重程度，并改善化疗后恢复的大鼠的免疫状态。在需要肠外营养的急性髓系白血病患者中，补充甘氨酰谷氨酰胺可加速强化骨髓抑制化疗后中性粒细胞的恢复。目前的数据支持补充谷氨酰胺在减少化疗并发症方面的有效性；然而，临床试验的匮乏削弱了对这些发现的清晰解读。
