Metabolismo da glutamina e Exercício Físico: aspectos gerais e perspectivas / Glutamine metabolism and Physical Exercise: General aspects and perspectives

Apesar de não haver um consenso sobre os benefícios da suplementação de glutamina no desempenho físico de atletas, a utilização deste aminoácido como uma importante ferramenta no combate a imunossupressão ainda merece discussão. Indivíduos que realizam exercícios muito intensos e prolongados (extenuantes) podem desenvolver um quadro catabólico e pró-inflamatório que influencia diretamente as funções imunológicas e, consequentemente, pode alterar negativamente o desempenho físico. A suplementação de glutamina é altamente recomendada e utilizada em indivíduos "imunodeprimidos" e, por essa razão, seu uso como ferramenta imunomodulatória em atletas deve ser considerado. Neste contexto, discutiremos aqui, o possível papel desse aminoácido na resposta ao estresse celular de células imunológicas; sugerindo que a sua eficácia parece estar relacionada com os aumentos na formação de um importante antioxidante, a glutationa (GSH), e da indução das proteínas de choque térmico de 7kDa (HSP70), com ação anti-inflamatória. Para isso, pesquisamos, no período de outubro de 2015 e janeiro de 2016, artigos sobre glutamina nas seguintes bases de dados: PubMed e Scholar Google. Foram utilizadas como palavras-chave na busca das informações, isoladamente ou relacionadas entre si: "glutamina", "sistema imunológico", "macrófago", "sepse", "linfócito", "suplementação" e "exercício físico" e suas respectivas traduções para o inglês. A busca de dados foi limitada na língua inglesa e portuguesa e os artigos analisados foram selecionados por apresentarem grande pertinência ao tema....(AU)

While there is as yet no general agreement on the benefits of glutamine supplementation with regards to athletes physical performance, the use of this amino acid as an important tool against immunosuppression still deserves discussion. Individuals that undergo thru very intense and prolonged exercise (strenous) may develop a catabolic and proinflammatory state that directly influence the immune function and, therefore, can adversely alter physical performance. Glutamine supplementation is highly recommended and used in immunocompromised individuals and, for this reason, its use as immunomodulatory tool in athletes should be considered. In this context, herein we discuss the possible role of this amino acid on the stress response in immune cells; suggesting that its efficiency appears to be related to increases in the formation of an important antioxidant, glutathione (GSH), and the induction of heat shock proteins of 70kDa (HSP70), with anti-inflammatory proprieties....(AU)

Physiological regulation of the heat shock response by glutamine: implications for chronic low-grade inflammatory diseases in age-related conditions

Aging is an intricate process modulated by different molecular and cellular events, such as genome instability, epigenetic and transcriptional changes, molecular damage, cell death and senescence, inflammation, and metabolic dysfunction. Particularly, protein quality control (chaperone systems) tends to be negatively affected by aging, thus leading to cellular senescence in metabolic tissues and, as a consequence, to the increasing dissemination of inflammation throughout the body. The heat shock (HS) response and its associated expression of the 70 kDa family of heat shock proteins (HSP70),which are anti-inflammatory molecular chaperones, are found to be markedly decreased during muscle inactivity and aging, while evidence supports the loss of HSP70 as a key mechanism which may drive muscle atrophy, contractile dysfunction, and reduced regenerative capacity. In addition, abnormal stress response is linked with higher incidence of neurodegenerative diseases as well as low-grade inflammatory diseases that are associated with physical inactivity and obesity. Therefore, strategies to increase or, at least, to maintain the levels of HSP70, and its accompanying HS response to stress, are key to reduce biological cell dysfunctions that occur in aging. In this sense, physical exercise is of note as it is the most powerful inducer of the HS response, comparable only to heat stress and fever-like conditions. On the other hand, the amino acidL-glutamine, whose production within the skeletal muscle and liberation into the bloodstream is dependent on muscle activity, is a potentializer of HSP70 expression and HS response, particularly via its entering in hexosamine biosynthetic pathway (HBP). Herein, we discuss the collaborative role of glutamine (and its donors/precursors) and physical exercise (mostly responsible for glutamine release into the circulation) as potential tools to increase HSP70 expression and the HS response in the elderly.

Perfil farmacoterapêutico de pacientes obesos no pós-operatório de cirurgia bariátrica / Pharmacotherapeutic profile of obese patients during the postoperative period after bariatric surgery

Resumo Contexto A obesidade pode estar relacionada a doenças como diabetes, hipertensão arterial e dislipidemia. A cirurgia bariátrica é um dos tratamentos mais eficazes, levando à diminuição de peso e comorbidades. Objetivo Avaliar o perfil metabólico e farmacoterapêutico de pacientes obesos após cirurgia bariátrica. Métodos Trata-se de um estudo observacional transversal retrospectivo, realizado em um hospital localizado na cidade de Porto Alegre, RS, Brasil. Foram avaliados 70 prontuários de pacientes que realizaram cirurgia bariátrica, nos períodos de antes de 2 meses e mais de 6 meses após a cirurgia bariátrica. A análise estatística foi realizada no programa SPSS 17.0®. Resultados A pressão arterial inicial foi de 130/85 mmHg, passando para 120/80 mmHg (p < 0,01). Com relação ao perfil metabólico antes de dois meses, o HDL foi de 34 mg/dL, o colesterol total foi de 195,07 ± 40,17 mg/dL, o LDL foi de 118,22 ± 41,28 mg/dL, os triglicerídeos foram de 141,09 ± 43,39 mg/dL, e a glicemia de jejum foi de 90 mg/dL. Após 6 meses de cirurgia, os valores passaram para 43 mg/dL, 133,67 ± 28,14 mg/dL, 65,53 ± 24,3 mg/dL, 104,41 ± 29,6 mg/dL, e 77 mg/dL, respectivamente (p < 0,01). Com relação ao uso de medicamentos, 41% utilizaram anti-hipertensivos, 39% utilizaram hipolipemiantes, 10% utilizaram hipoglicemiantes orais e 97% utilizaram suplementos antes dos 2 meses de cirurgia. Após os 6 meses, os percentuais foram alterados para 21%, 19%, 9% e 99%, respectivamente. Conclusões O estudo mostra o sucesso da cirurgia bariátrica em pacientes obesos com comorbidades, revelando melhora no perfil metabólico e redução na utilização de medicamentos para tratamento de comorbidades.

Abstract Background Obesity can be associated with diseases such as diabetes, arterial hypertension and dyslipidemia. Bariatric surgery is one of the most effective treatments available, reducing both weight and comorbidities. Objective To evaluate the metabolic and pharmacotherapeutic profile of obese patients after bariatric surgery. Methods This is a retrospective, cross-sectional, observational study conducted at a hospital located in the city of Porto Alegre, RS, Brazil, based on analysis of the medical records for 70 patients who underwent bariatric surgery covering periods spanning from 2 months prior to more than 6 months after their bariatric surgery. Statistical analysis was conducted using SPSS 17.0®. Results Initial arterial blood pressure was 130/85 mmHg, 6 months after surgery it was 120/80 mmHg (p < 0.01). The metabolic profile 2 months before surgery was as follows: HDL was 34 mg/dL, total cholesterol was 195.07 ± 40.17 mg/dL, LDL was 118.22 ± 41.28 mg/dL, triglycerides were 141.09 ± 43.39 mg/dL, and fasting glycemia was 90 mg/dL. The same figures 6 months after surgery were 43 mg/dL, 133.67 ± 28.14 mg/dL, 65.53 ± 24.3 mg/dL, 104.41 ± 29.6 mg/dL, and 77 mg/dL, respectively (p < 0.01). Use of medications 2 months before surgery was as follows: 41% were on antihypertensives, 39% on hypolipidemics, 10% on oral hypoglycemics, and 97% were on nutritional supplements. These percentages 6 months after surgery had changed to 21%, 19%, 9% and 99%, respectively. Conclusions This study illustrates that bariatric surgery for obese patients with comorbidities was successful, demonstrating improvements in their metabolic profile and reductions in use of medications used to treat comorbidities.