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Inhibition of tumor cell glutamine uptake by isolated neutrophils.

Antitumor activity of phorbol myristate acetate-(PMA) stimulated neutrophils was measured against CCRF-CEM cells. Neutrophils and tumor cells were incubated (a) as a suspension with continuous mixing to maximize the availability of oxygen or (b) after centrifugation as a pellet to maximize cell-cell contact. The cells were then incubated briefly as a suspension with [14C]glutamine under conditions that blocked further damage to the tumor cells. When cells were incubated as a suspension, inhibition of tumor-cell glutamine uptake was mediated by the myeloperoxidase/hydrogen peroxide/chloride system of stimulated neutrophils. Inhibition was blocked by adding catalase, an inhibitor of myeloperoxidase, or compounds that scavenge hypochlorous acid or chloramines. When cells were incubated as a pellet, a portion of the inhibition could not be blocked in this way, indicating that a nonoxidative mechanism contributed to inhibition. In both systems, inhibition of glutamine uptake was rapid and was obtained at effector-cell/target-cell ratios as low as 0.5:1. This inhibition was obtained under conditions that did not result in 51Cr release from cells labeled with [51Cr]-chromate, indicating that inhibition of glutamine uptake measured cytotoxicity rather than cytolysis. 51Cr release was observed only when cells were incubated together for an hour or more as a pellet at high E/T ratios. This cytolysis was mediated by the myeloperoxidase system, and a nonoxidative contribution to cytolysis was not observed. The results indicate that stimulated neutrophils are potent antitumor effectors cells when cytotoxicity rather than cytolysis is the measure of activity. Because glutamine is required for growth of many tumor cells, inhibition of glutamine uptake may represent a significant tumoristatic or tumoricidal effect.

Ammonium Chloride↗

A simple bacterial bioassay for the measurement of L-glutamine.

The amino acid L-glutamine has been shown to be important to numerous cells in the body. However, the routine measurement of glutamine in biological solutions is complicated by its relative instability, particularly at extremes of pH. We report a simple bacterial bioassay method for the estimation of glutamine, carried out at neutral pH, using an Escherichia coli that is specifically dependent on the presence of glutamine for replication. The assay is simple to perform and we have shown it to be highly reproducible. Furthermore, we observed significant correlation between the estimations of glutamine by the bioassay system and current methodologies. The levels of glutamine recorded were higher than by other methods. We also found that deproteinization and neutralization of samples allowed them to be stored at -70 degrees C for up to 24 weeks without deterioration.

Biological Assay↗

Effect of oral glutamine supplementation during bone marrow transplantation.

BACKGROUND: Because all patients receiving bone marrow transplant (BMT) and peripheral blood progenitor cell transplant (PBPCT) experience gastrointestinal (GI) toxicity from the preparative regimen of chemotherapy, with or without radiation, oral glutamine was administered during the preparatory regimen and after transplant to maintain GI structure and function. METHODS: To evaluate effects of oral glutamine on nutritional status and overall outcome, a prospective, randomized, double-blinded study was performed on 58 autologous and allogeneic BMT patients. Patients received 30 g of oral glutamine or placebo daily. RESULTS: The trends of decreased median length of stay and the median number of days of total parenteral nutrition (TPN) were seen in the group supplemented with the >0.285-g/kg (the recommended dosage) dose of glutamine; however, there was no statistically significant difference in the nutritional status and overall patient outcome as assessed by days receiving TPN, number of days required until oral intake resumed, length of hospitalization, number of days and highest grade of mucositis, and quantity and number of days of diarrhea. CONCLUSIONS: This study does not support the hypothesis that oral glutamine may offer benefit. Further investigation is required regarding clinical tools for determining effectiveness, administration for tolerance and compliance, dosage, and potential of oral glutamine usage.

Administration, Oral↗

Liver glutamine metabolism.

A fundamental conceptional change in the field of hepatic glutamine metabolism is derived from an understanding of the unique regulatory properties of hepatic glutaminase, the occurrence of glutamine cycling, and the discovery of marked hepatocyte heterogeneities in nitrogen metabolism, with metabolic interactions between differently localized subacinar hepatocyte populations. This change provided new insight into the role of the liver in maintaining ammonia and bicarbonate homeostasis under physiologic and pathologic conditions. Glutamine synthetase is present only in a specialized cell population at the hepatic venous outflow of the liver acinus; these cells act as scavengers for ammonia and probably also for various signal molecules ("perivenous scavenger cell hypothesis"). The function of mitochondrial glutaminase is that of a pH- and hormone-modulated ammonia amplification system that controls carbamoylphosphate synthesis and urea cycle flux in periportal hepatocytes. Not only is hepatic glutamine metabolism essential for maintenance of bicarbonate and ammonia homeostasis, but glutamine itself can act in the liver as a signal modulating hepatic metabolism. This article summarizes some major aspects of hepatic glutamine metabolism, based on previous reviews.

Animals↗

Role of glutamine and its analogs in posttraumatic muscle protein and amino acid metabolism.

Skeletal muscle protein catabolism following trauma has until recently not been possible to counteract by intravenous nutritional means. The obligatory loss of nitrogen with concomitant reduction of skeletal muscle protein synthesis is also accompanied by a decrease of muscle free glutamine, the extent of which is proportional to the muscle protein catabolism. Serving as a human model of surgical trauma, patients undergoing elective cholecystectomy were given total parenteral nutrition including additions of either glutamine or its analogs (ornithine-alpha-ketoglutarate, alpha-ketoglutarate, or alanylglutamine) during 3 postoperative days. The polyribosome concentration and the intracellular glutamine concentration in skeletal muscle, as well as nitrogen balance, showed a less pronounced skeletal muscle catabolism in these groups than when conventional total parenteral nutrition was given. It is concluded that a support of either glutamine or its carbon skeleton, alpha-ketoglutarate, counteracts the postoperative fall of muscle free glutamine and of muscle protein synthesis. Furthermore, statistical correlations could be shown between the changes of muscle glutamine and muscle protein synthesis and the postoperative nitrogen losses.

Amino Acids↗

Glutamine facilitates chemotherapy while reducing toxicity.

Dose intensification of chemotherapy is thought to increase survival. With recent advances in hemopoietic cell modulators such as granulocyte colony stimulating factor, the limiting toxicity of intensifying chemotherapeutic regimens has become the severity of the associated enterocolitis. In animal models, glutamine protects the host from methotrexate-induced enterocolitis. This study evaluates the effects of a glutamine-supplemented diet on the tumoricidal effectiveness of methotrexate. Sarcoma-bearing Fisher 344 rats (n = 30) were pair-fed an isocaloric elemental diet containing 1% glutamine or an isonitrogenous amount of glycine beginning on day 25 of the study. Rats from each group received two intraperitoneal injections of methotrexate (5 mg/kg) or saline on days 26 and 33 of the study. On day 40, rats were killed, tumor volume and weight were recorded, and tumor glutaminase activity and tumor morphometrics were measured. Blood was taken for arterial glutamine content, complete blood count, and blood culture. The gut was processed for glutaminase activity and synthesis phase of the deoxyribonucleic acid. In rats receiving methotrexate, the tumor volume loss was nearly doubled when glutamine was added to the diet. Significant differences in tumor glutaminase activity and morphometrics were not detected. The toxicity to the host was ameliorated. Significantly increased synthesis phase of deoxyribonucleic acid of the whole jejunum, decreased bacteremia, "sepsis," and mortality were demonstrated. Glutamine supplementation enhances the tumoricidal effectiveness of methotrexate while reducing its morbidity and mortality in this sarcoma rat model.

Animals↗

Glutamine prevents parenteral nutrition-induced increases in intestinal permeability.

In addition to its role in absorbing nutrients, the intestinal mucosa provides an important barrier against toxins and bacteria in the bowel lumen. This study evaluated changes in rat jejunal permeability and histology after total parenteral nutrition (TPN) or TPN supplemented with glutamine. Lactulose and mannitol were used to measure jejunal permeability, and fixed stained histologic specimens were used to measure mucosal dimensions. After the insertion of central venous catheters, 18 male rats were randomly divided into three groups: CHOW, saline infusion with a standard laboratory rat diet ad libitum; TPN; and GLN, 2% L-glutamine-supplemented TPN. The TPN and GLN groups received isocaloric, isovolumic, and isonitrogenous feedings. After 7 days of infusion, a laparotomy was performed, and lactulose and mannitol were instilled into the lumen of a 25-cm ligated segment of jejunum. Urine was collected for 5 hours and assayed for lactulose, mannitol, and creatinine. The jejunum was harvested, and wet weight, villus height, mucosal thickness, and villus width were measured. Intestinal permeability to lactulose and the lactulose to mannitol ratio significantly increased after TPN compared with CHOW, and these effects were prevented with the addition of glutamine to the TPN solution. Jejunal villus height and mucosal thickness significantly decreased following TPN but were not significantly different from CHOW when glutamine was added to the TPN solution. These data suggest that TPN was associated with increased jejunal permeability and that glutamine, when added to the TPN solution, prevented this effect. In addition, glutamine reduced TPN-associated atrophy of the jejunum.

Animals↗

Oral glutamine decreases bacterial translocation and improves survival in experimental gut-origin sepsis.

BACKGROUND: Glutamine has been shown to be an important dietary component for the maintenance of gut metabolism. The purpose of this study was to assess the potential benefit of glutamine-enriched diets on experimental gut-derived sepsis. METHODS: BALB/c mice were fed either 2% glutamine-supplemented or 1% glycine-supplemented (near-isonitrogenous control) AIN-76A diets. Control mice received either nonsupplemented AIN-76A or regular Purina Rodent Laboratory Mouse Chow 5001 diets. After 10 days of feeding, the mice were transfused with allogeneic blood (from C3H/HeJ mice), and the feeding protocols were continued for an additional 5 days. The mice then underwent gavage with 10(10) Escherichia coli labeled with either indium-111 oxine or [14C]glucose followed immediately by a 20% burn injury. Some mice were observed 10 days postburn for survival rates. Others were killed 4 hours after burn, and the mesenteric lymph nodes, liver, and spleen were harvested to determine radionuclide and bacterial colony counts. The percentages of viable translocated E coli were also calculated. RESULTS: Mice fed glutamine-enriched diets had a lower degree of translocation (as measured by both radionuclide and bacterial counts) to the tissues than did the other groups and had an improvement in the ability to kill translocated E coli (as measured by the percentage of viable bacteria). Survival was significantly higher in the group fed 2% glutamine (81%) compared with the groups fed 1% glycine (36%), AIN-76A (35%), and Purina Rodent Laboratory Mouse Chow 5001 (36%) diets (p < .004). CONCLUSIONS: Glutamine-supplemented enteral diets may exert important benefits in preventing gut-origin sepsis after trauma.

Animals↗

The effects of glutamine-supplemented parenteral nutrition in premature infants.

BACKGROUND: Glutamine (GLN) is the primary fuel for rapidly dividing cells, yet it is not a constituent of parenteral nutritional formulas administered to newborns. The aims of this prospective, randomized, double-blind trial were (1) to confirm the safety of glutamine supplementation for premature infants and (2) to examine the effects of glutamine-supplemented parenteral nutrition on length of stay, days on total parenteral nutrition (TPN), days on the ventilator, and other clinical outcomes. METHODS: Premature infants received either standard or glutamine-supplemented TPN and were monitored throughout length of stay for various health and biochemical indices. The group was examined as a whole (n = 44; birth weight range: 530 to 1250 g) and in two weight subgroups, < 800 and > or = 800 g. RESULTS: Serum ammonia, blood urea nitrogen, and glutamate tended to be higher in the GLN groups, but the levels were well within normal limits. In the < 800-g cohort (n = 24), glutamine-supplemented infants required fewer days on TPN (13 vs 21 days, p = .02), had a shorter length of time to full feeds (8 vs 14 days, p = .03), and needed less time on the ventilator (38 vs 47 days, p = .04). There was a tendency toward a shorter length of stay in the NICU (73 vs 90 days, NS). These findings were not observed in the infants > or = 800 g (n = 20). CONCLUSIONS: Glutamine appears to be safe for use in premature infants and seems to be conditionally essential in premature infants with extremely low birth weights. Larger multicenter trials are needed to confirm these observations and further evaluate the efficacy of GLN in these high-risk premature infants.

Birth Weight↗

Parenteral glutamine infusion alters insulin-mediated glucose metabolism.

BACKGROUND: Glutamine is a conditionally essential amino acid that is critical for many basic cellular processes. Its supplementation has been found to be beneficial during several critical illnesses. This study examines the effects of increased glutamine availability on insulin-mediated glucose homeostasis in vivo in multicatheterized conscious canines (n = 5). METHODS: Two weeks before the study, catheters were placed in the femoral artery and the portal, hepatic, femoral, and renal veins for blood sampling and in the splenic vein for intraportal infusion of insulin and glucagon. Doppler probes were placed to measure blood flow. The metabolic study consisted of equilibration, basal, and experimental periods during which [3-3H]glucose was infused to measure glucose kinetics. During the 5-hour experimental period, a hyperinsulinemic-euglycemic clamp was performed by infusing somatostatin, basal glucagon, fivefold basal insulin, and glucose to maintain euglycemia. The experimental period was divided evenly into two subperiods performed in random order: (1) i.v. glutamine infusion (0.72 mmol kg(-1) h(-1)) and (2) i.v. saline infusion. RESULTS: With glutamine, the glucose required to maintain euglycemia was increased 46% over saline (6.8 +/- 1.0 to 9.9 +/- 1.7 mg kg(-1) min(-1). In addition, whole-body glucose production and utilization were increased by 1.4 and 4.6 mg kg(-1) min(-1), respectively. Finally, the increase in whole-body glucose utilization was manifested by increased hepatic and hindlimb glucose utilization. CONCLUSIONS: Increased glutamine availability blunted insulin's action on glucose production and enhanced insulin-mediated glucose utilization with the changes in utilization being threefold greater than the changes in production. Thus parenteral glutamine has potential benefit as a nutrient adjuvant during clinical situations associated with insulin resistance.

Animals↗

Type I diabetes affects skeletal muscle glutamine uptake in a fiber-specific manner.

Skeletal muscle serves as the body's major glutamine repository, and releases glutamine at enhanced rates during diabetes, but whether all muscles are equally affected is unknown. System N(m) activity mediates most trans-sarcolemmal glutamine movement, and although two System N (SN) isoforms have been identified (SN1/sodium-coupled neutral amino acid transporter or System N and A transporters [SNAT]-3; and SN2/SNAT5), their expression in skeletal muscle remains controversial. Here, the impact of Type I diabetes on glutamine uptake and System N transporter expression were examined in fast- and slow-twitch skeletal muscle from spontaneously diabetic (BB/Wor-DP) rats. Net glutamine uptake in fast-twitch fibers was decreased 75%-95%, but enhanced more than 2-fold in slow-twitch muscle from diabetic animals relative to nondiabetic controls. Both SNAT3 and SNAT5 mRNA were expressed in both muscle fiber types and their abundance was unaffected by diabetes. This represents the first report of differential fiber-specific effects of diabetes on skeletal muscle glutamine transport and the co-expression of distinct System N transporters in skeletal muscle.

Amino Acid Transport Systems, Neutral↗

The role of glutamine and other alternate substrates as energy sources in the fetal rat lung type II cell.

Glucose has been thought to be the primary substrate for energy metabolism in the developing lung; however, alternate substrates are used for energy metabolism in other organs. To examine the role of alternate substrates in the lung, we measured rates of oxidation of glutamine, glucose, lactate, and 3-hydroxybutyrate in type II pneumocytes isolated from d 19 fetal rat lungs by measuring the production of 14CO2 from labeled substrates. Glutamine had a rate of 24.36 +/- 4.51 nmol 14CO2 produced/ h/mg of protein (mean +/- SEM), whereas lactate had a significantly higher rate, 40.29 +/- 4.42. 3-Hydroxybutyrate had a rate of 14.91 +/- 1.93. The rate of glucose oxidation was 2.13 +/- 0.36, significantly lower than that of glutamine. To examine the interactions of substrates normally found in the intracellular milieu, we measured the effect of unlabeled substrates as competitors on labeled substrate. This identifies multiple metabolic compartments of energy metabolism. Glucose, but not lactate, inhibited the oxidation of glutamine, suggesting a compartmentation of tricarboxylic acid cycle activity, rather than simple dilution by glucose. Glucose and lactate had reciprocal inhibition. Our data suggest at least two separate compartments in the type II cells for substrate oxidation, one for glutamine metabolism and a second for glucose metabolism. In summary, we have documented that glutamine and other alternate substrates are oxidized preferentially over glucose for energy metabolism in the d 19 fetal rat lung type II pneumocyte. In addition, we have delineated some of the compartmentation that occurs within the developing type II cell, which may determine how these substrates are used.

3-Hydroxybutyric Acid↗

Mischarging mutants of Su+2 glutamine tRNA in E. coli. II. Amino acid specificities of the mutant tRNAs.

Among the mischarging mutants isolated from strains with Su+2 glutamine tRNA, two double-mutants, A37A29 and A37C38, have been suggested to insert tryptophan at the UAG amber mutation site as determined by the suppression patterns of a set of tester mutants of bacteria and phages (Yamao et al., 1988). In this paper, we screened temperature sensitive mutants of E. coli in which the mischarging suppression was abolished even at the permissive temperature. Four such mutants were obtained and they were identified as the mutants of a structural gene for tryptophanyl-tRNA synthetase (trpS). Authentic trpS mutations, such as trpS5 or trpS18, also restricted the mischarging suppression. These results strongly support the previous prediction that the mutant tRNAs of Su+2, A37A29 and A37C38, are capable of interacting with tryptophanyl-tRNA synthetase and being misaminoacylated with tryptophan in vivo. However, in an assay to determine the specificity of the mutant glutamin tRNAs, we detected predominantly glutamine, but not any other amino acid, being inserted at an amber codon in vivo to any significant degree. We conclude that the mutant tRNAs still accept mostly glutamine, but can accept tryptophan in an extent for mischarging suppression. Since the amber suppressors of Su+7 tryptophan tRNA and the mischarging mutants of Su+3 tyrosine tRNA are charged with glutamine, structural similarity among the tRNAs for glutamine, tryptophan and tyrosine is discussed.

Base Sequence↗

L-glutamine supplementation improves nelfinavir-associated diarrhea in HIV-infected individuals.

PURPOSE: To determine whether L-glutamine decreases the severity of nelfinavir-associated diarrhea in HIV-infected individuals. Other endpoints include the effect on quality of life, muscle-wasting syndrome, CD4 counts, and viral load. METHOD: HIV-infected patients with nelfinavir-associated diarrhea for >1 month were randomized to receive L-glutamine 30 g/day or placebo for 10 days in a prospective, double-blind, crossover study. Diarrhea was measured on a scale ranging from grade 0 (no diarrhea) to grade 4 (severe diarrhea, > 7 stools/day). Quality of life was assessed by the Medical Outcome Study (MOS) HIV questionnaire. RESULTS: Twenty-five participants completed the study. There was a significant difference between the L-glutamine and placebo arms on the mean grade of diarrhea (0.762 vs. 1.850, p <.01) when placebo was administered first. When L-glutamine was administered first, there was a significant crossover effect (p <.02), with similar mean grades of diarrhea in the two groups. There was also a significant difference between L-glutamine and placebo in the mean change in MOS scores from baseline (1.48 vs. -2.19, p <.017). There were no significant differences between treatment groups for the other endpoints. CONCLUSIONS: In this population of HIV-positive participants, L-glutamine 30 g/day significantly (p <.01) reduced the severity of nelfinavir-associated diarrhea and produced improved quality of life compared with placebo.

Administration, Oral↗

The role of pH and the lack of a requirement for hydorgencarbonate in the regulation of hepatic glutamine metabolism.

The rate of net glutamine degradation in non-recirculating perfused rat liver was estimated by the release of urea, ammonia and alanine in steady states of operation of glutaminase. Corrected for a slight intracellular accumulation of glutamate, accounting for 7% of the flux at 5mM glutamine, the estimated glutaminase activity agrees well with measurements of glutamine removal described in the literature for recirculating perfusion experiments. Glutaminase activity was decreased when the perfusate pH was lowered (i) by infusion of hydrochloric acid, (ii) by increasing the CO2 concentration, or (iii) by decreasing the hydrogencarbonate concentration. Conversely, it was increased when the perfusate pH was increased by infusion of sodium hydroxide or by increasing the hydrogencarbonate concentration. However, glutaminase activity did not depend on medium hydrogencarbonate. When the hydrogencarbonate buffer system was replaced by DMO or by Hepes equilibrated with O2 (no CO2 present), there was practically no change in the observed rates. These results, obtained in an iso-pH system, are in contrast to recent suggestions of a role of hydrogencarbonate in the regulation of glutamine metabolism based on results from incubations of isolated mitochondria or hepatocytes. It is concluded that the conservation of glutamine by the inhibition of hepatic glutaminase, which provides glutamine for the pH regulation by renal glutaminase, can be increased not only in metabolic acidosis but also in respiratory acidosis associated with high hydrogencarbonate concentration.

Alanine↗

Glutamine transport by mouse inner cell masses.

Mouse blastocysts take up glutamine by specific transport systems. Glutamine is an important precursor for macromolecular synthesis and a potential alternative fuel to glucose. This study compared glutamine uptake in blastocysts and isolated inner cell masses and characterized the major participating systems in the latter. Inner cell masses take up glutamine by facilitated transport systems. The identity of these was investigated using substrate competition and kinetic studies. Na(+)-dependent uptake of 13 mumol glutamine l-1 was inhibited by 60% by 1 mmol tryptophan l-1, 25% by 1 mmol 2-amino-2-norbornanecarboxylic acid l-1 and 50% by 1 mmol lysine l-1. Furthermore, 1 mmol 2-methyl(amino)isobutyric acid (MeAIB) l-1 inhibited uptake by 29%. Kinetic analysis of MeAIB-resistant uptake revealed a predominant Na(+)-dependent facilitated uptake system with Km and Vmax values of 434 +/- 72 mumol l-1 and 237 +/- 38 fmol per inner cell mass per 10 min, respectively. The inhibition of Na(+)-dependent uptake by tryptophan, lysine and the analogue 2-amino-2-norbornanecarboxylic acid suggests that most uptake of glutamine by inner cell masses occurs via the same system that predominates in whole blastocysts, Bo,+. The period of assay was so brief that significant participation of the inner cell mass in whole blastocyst uptake was precluded showing that system Bo,+ is expressed by both the trophectoderm and inner cell mass components of the blastocyst. However, MeAIB inhibited uptake by inner cell masses but not by blastocysts. This MeAIB-sensitive uptake had a Km value of 4.3 +/- 1.7 mmol l-1 and a Vmax value of 451 +/- 119 fmol per inner cell mass per 10 min. These characteristics suggest the first embryonic appearance of system A, which is a common Na(+)-dependent transporter in many somatic cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗

Pilot study with a glutamine-supplemented enteral formula in critically ill infants.

Seriously ill infants often display protein-calorie malnutrition due to the metabolic demands of sepsis and respiratory failure. Glutamine has been classified as a conditionally essential amino acid, with special usefulness in critical patients. Immunomodulation, gut protection, and prevention of protein depletion are mentioned among its positive effects in such circumstances. With the intent of evaluating the tolerance and clinical impact of a glutamine supplement in seriously ill infants, a prospective randomized study was done with nine patients. Anthropometric and biochemical determinations were made, and length of stay in the intensive care unit (ICU), in the hospital, and under artificial ventilation, and septic morbidity and mortality were tabulated. Infants in the treatment group (n = 5) were enterally administered 0.3 g/kg of glutamine, whereas controls received 0.3 g/kg of casein during a standard period of five days. Septic complications occurred in 75% of the controls (3/4) versus 20% of the glutamine-treated group (1/5, p < or = 0.10), and two patients in the control group died of bacterial infections (50% vs. 0%, p < or = 0.10). Days in the ICU, in the hospital, and with ventilation numerically favored glutamine therapy, although without statistical significance. The supplements were usually well tolerated, and no patient required discontinuation of the program. The conclusion was that glutamine supplementation was safe and tended to be associated with less infectious morbidity and mortality in this high-risk population.

Child, Preschool↗

Metabolic fate of glutamine in lymphocytes, macrophages and neutrophils.

Eric Newsholme's laboratory was the first to show glutamine utilization by lymphocytes and macrophages. Recently, we have found that neutrophils also utilize glutamine. This amino acid has been shown to play a role in lymphocyte proliferation, cytokine production by lymphocytes and macrophages and phagocytosis and superoxide production by macrophages and neutrophils. Knowledge of the metabolic fate of glutamine in these cells is important for the understanding of the role and function of this amino acid in the maintenance of the proliferative, phagocytic and secretory capacities of these cells. Glutamine and glucose are poorly oxidized by these cells and might produce important precursors for DNA, RNA, protein and lipid synthesis. The high rate of glutamine utilization and its importance in such cells have raised the question as to the source of this glutamine, which, according to current evidence, appears to be muscle.

Cell Division↗