Glutamine study in hepatic schistosomiasis and effect of conventional medical therapy.

The liver plays a major role in urea and glutamine metabolism where it maintains ammonia and bicarbonate homeostasis under physiological and pathological conditions. Glutamine assessment in different liver diseases showed deviations from normal serum values. In the present study, glutamine level in serum [serum glutamate values] (SGV) and liver tissue homogenates (liver homogenate glutamine values] (LHGV) in patients with schistosomal hepatic fibrosis with and without conventional supportive medical therapy and anti-schistosomal therapy were correlated. LHGV in liver tissue homogenates from cases were higher than those of matched controls. SGV of patients with late hepatic schistosomiasis were greater than those with early stages of the disease. All patients, whether in early or late schistosomal hepatic fibrosis, showed reduction of SGV after treatment. We came to the conclusion that in patients with schistosomal hepatic fibrosis, whether early or late, there is a derangement of glutamine metabolism which could be corrected partially by the conventional supportive medical therapy. Again, estimation of glutamine in serum could be considered an early and reliable parameter for the assessment of liver function in patients with schistosomal hepatic fibrosis.

Gastro-vascular and micro-vascular changes in chronic murine schistosomiasis mansoni-response to propranolol.

Histopathologic study of the gastric wall of mice infected with Schistosoma mansoni was carried out at 8, 12, 16 and 20 weeks post-infection (p.i.). The gastric vascular structures were more sensitive to injury with the progression of liver disease than the glandular cells, with marked submucosal edema and thickening of submucosal and subserosal vessels. By transmission electron microscopy, the mucosal microvessels had thickened basement membrane and conspicuous endothelial cells with granular cytoplasm thrown into numerous intraluminal microprojections and with increased number and size of pinocytotic vesicles. When propranolol was administered orally as 20 mg/kg daily doses for two weeks at 6, 10, 14 and 18 weeks p.i., a striking regression of gastro vascular and micro-vascular changes has been observed, particularly with early drug therapy. Based on the present study, it can be concluded that "structural autoregulation" of gastric vasculature to the emerging portal hypertension in chronic murine schistosomiasis mansoni, is a dynamic process that could be reversed by propranolol therapy. This response could, possibly, improve gastric mucosal perfusion and functional abnormalities which may predispose the gastric mucosa to severe damage or hemorrhage.