Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial
Nicholas Heming,
Robert Carlier,
Helene Prigent,
Ahmed Mekki,
Camille Jousset,
Frederic Lofaso,
Xavier Ambrosi,
Rania Bounab,
Virginie Maxime,
Arnaud Mansart,
Pascal Crenn,
Pierre Moine,
Fabien Foltzer,
Bernard Cuenoud,
Tobias Konz,
John Corthesy,
Maurice Beaumont,
Mickaël Hartweg,
Claudia Roessle,
Jean-Charles Preiser,
Denis Breuillé,
Djillali Annane
Affiliations
Nicholas Heming
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay
Robert Carlier
Department of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond Poincaré
Helene Prigent
Department of Physiology-AP-HP, Hôpital Raymond-Poincaré
Ahmed Mekki
Department of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond Poincaré
Camille Jousset
Department of Radiology, APHP, DMU Smart Imaging, GH Université Paris-Saclay, Hôpital Raymond Poincaré
Frederic Lofaso
Department of Physiology-AP-HP, Hôpital Raymond-Poincaré
Xavier Ambrosi
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay
Rania Bounab
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay
Virginie Maxime
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay
Arnaud Mansart
Laboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris Saclay
Pascal Crenn
UFR des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines
Pierre Moine
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay
Fabien Foltzer
Nestlé Research, Société de Produits de Nestlé
Bernard Cuenoud
Translation Research, Nestlé Health Science
Tobias Konz
Nestlé Research, Société de Produits de Nestlé
John Corthesy
Nestlé Research, Société de Produits de Nestlé
Maurice Beaumont
Nestlé Research, Société de Produits de Nestlé
Mickaël Hartweg
Nestlé Research, Société de Produits de Nestlé
Claudia Roessle
Translation Research, Nestlé Health Science
Jean-Charles Preiser
Nutrition Team, Erasme University Hospital, Université Libre de Bruxelles
Denis Breuillé
Nestlé Research, Société de Produits de Nestlé
Djillali Annane
General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines, University Paris Saclay
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] cmH20 (P = 0.035) and 3.12 [0.5; 5.73] cm3/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.
