Glutamine Research: Treating Cancer-Related Oral Mucositis

[Review Paper] Anderson P and Lalla R, Nutrients 2020; 12(6),1675

• Evidence from glutamine research supports the benefit of oral (enteral) glutamine to reduce symptoms and improve and/or maintain quality of life of cancer patients. Benefits include not only better nutrition, but also decreased mucosal damage (mucositis, stomatitis, pharyngitis, esophagitis, and enteritis).

• Glutamine supplementation in a high protein diet (10 grams/day) + disaccharides, such as sucrose and/or trehalose, is a combination that increases glutamine uptake by mucosal cells. This increased topical effect can reduce painful mucosal symptoms and ulceration associated with chemotherapy and radiation in the head and neck region, esophagus, stomach and small intestine.

• Topical and oral glutamine seem to be the preferred routes for this amino acid to promote mucosal healing during and after cancer treatment. 
  
  

Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer: A Systematic Review.

Sayles et al, Nutrition in Clin Practice, 2016; 31[2]:171

• A systematic review of clinical trials found glutamine reduced the severity and duration of oral mucositis by (i) inhibiting the production of pro-inflammatory cytokines, and (ii) meeting the demands of mucosal tissue during wound healing. However, because glutamine is only moderately soluble in water, and undergoes non-enzymatic degradation in the stomach, its bioavailability is limited, when administered orally or parenterally. 
  
  

Role of Oral Glutamine in Alleviation and Prevention of Radiation‑Induced Oral Mucositis: A Prospective Randomized Study.

Chattopadhyay et al, South Asian J of Cancer, 2014; [3]1:8-12

• A randomized, prospective case-control study (adult head and neck cancer patients undergoing radiation therapy) demonstrated grades 3 and 4 mucositis were observed significantly less in patients receiving glutamine than in the control group.
  
  

A Double-blind Randomized Placebo-controlled Study of Oral Glutamine in the Prevention of Mucositis in Children Undergoing Hematopoietic Stem Cell Transplantation: A Pediatric Blood and Marrow Transplant Consortium Study.

Aquino et al, Bone Marrow Transplantation, 2005; [36]:611-16

• Severe mucositis is a common cause of morbidity in hematopoietic stem cell transplant (HSCT) recipients. A double-blind, randomized, placebo-controlled study (pediatric patients undergoing hematopoietic stem cell transplantation) showed oral supplementation with glutamine significantly decreased the severity of oral mucositis.