Morbid obesity in a young woman affected by advanced chronic kidney disease: an exceptional case report. Does a high dose of essential amino acids play a key role in therapeutic success?

A 38-year-old woman, obese (219\u2009kg), diabetic, hypertensive, chronic kidney disease (CKD) stage 4, with low plasma albumin level (2.9\u2009g\u2009dl(-1)) and marked proteinuria (22\u2009g per day) was studied. Given the advanced-stage CKD with nephrotic proteinuria, we supplemented low-protein diet with high doses of a tailored essential amino acid mixture (AAs: 44\u2009g per day) to improve weight reduction in the patient. After 20 months of conservative therapy, the patient lost 43\u2009kg; despite two episodes of infection, albumin plasma levels increased up to 3.7\u2009g per day. After a further 20 months of dialysis, the patient maintained a diet of 1800 kcal supplemented with 32\u2009g of AAs and lost 47\u2009kg, whereas both albumin (3.89\ub10.12\u2009g\u2009dl(-1)) and C reactive protein returned to normal. During the follow-up period, anemia improved, erythropoietin was thus discontinued and insulin requirement decreased to 105 IU. This therapeutic option may be beneficial in advanced CKD patients with obesity and diabetes resulting from malnutrition

Protein-Amino Acid Metabolism Disarrangements : The Hidden Enemy of Chronic Age-Related Conditions

Proteins are macro-molecules crucial for cell life, which are made up of amino acids (AAs). In healthy people, protein synthesis and degradation are well balanced. However, in the presence of hypercatabolic stimulation (i.e., inflammation), protein breakdown increases as the resulting AAs are consumed for metabolic proposes. Indeed, AAs are biochemical totipotent molecules which, when deaminated, can be transformed into energy, lipids, carbohydrates, and/or biochemical intermediates of fundamental cycles, such as the Krebs' cycle. The biochemical consequence of hyper-catabolism is protein disarrangement, clinically evident with signs such as sarcopenia, hypalbuminemia, anaemia, infection, and altered fluid compartmentation, etc. Hypercatabolic protein disarrangement (HPD) is often underestimated by clinicians, despite correlating with increased mortality, hospitalization, and morbidity quite independent of the primary disease. Simple, cheap, repeatable measurements can be used to identify HPD. Therefore, identification and treatment of proteins' metabolic impairment with appropriate measurements and therapy is a clinical strategy that could improve the prognosis of patients with acute/chronic hypercatabolic inflammatory disease. Here, we describe the metabolism of protein and AAs in hypercatabolic syndrome, illustrating the clinical impact of protein disarrangement. We also illustrate simple, cheap, repeatable, and worldwide available measurements to identify these conditions. Finally, we provide scientific evidence for HPD nutritional treatment

"The enemy within" : how to identify chronic diseases induced-protein metabolism impairment and its possible pharmacological treatment

Recent clinical and experimental data show that considerable impairment of protein metabolism occurs in patients with chronic diseases such as heart failure. However, too often the extent of impairment is under-estimated or ignored by most clinicians and no therapy is considered leading to progressive loss of body proteins, increase morbidity, hospital stay and mortality. This paper illustrates the possible biological markers to evaluate general protein metabolism, including quantification of related damage and possible improvement of the metabolism using specific therapeutical metabolic strategies recently studied in a clinical setting

Topical application of dressing with amino acids improves cutaneous wound healing in aged rats

The principal goal in treating surgical and non-surgical wounds, in particular for aged skin, is the need for rapid closure of the lesion. Cutaneous wound healing processes involve four phases including an inflammatory response with the induction of pro-inflammatory cytokines. If inflammation develops in response to bacterial infection, it can create a problem for wound closure. Reduced inflammation accelerates wound closure with subsequent increased fibroblast function and collagen synthesis. On the contrary, prolonged chronic inflammation results in very limited wound healing. Using histological and immunohistochemical techniques, we investigated the effects of a new wound dressing called Vulnamin that contains four essential amino acids for collagen and elastin synthesis plus sodium ialuronate (Na-Ial), compared with Na-Ial alone, in closure of experimental cutaneous wounds of aged rats. Our results showed that the application of Vulnamin dressings modulated the inflammatory response with a reduction in the number of inflammatory cells and inducible nitric oxide synthase (iNOS) immunolocalisation, while increasing endothelial nitric oxide synthase (eNOS) and transforming growth factor-beta1 (TGF-beta1) immunolocalisation. Furthermore, the dressing increased the distribution density of fibroblasts and aided the synthesis of thin collagen fibers resulting in a reduction in healing time. The nutritive approach using this new wound dressing can provide an efficacious and safe strategy to accelerate wound healing in elderly subjects, simplifying therapeutic procedures and leading to an improved quality of life

Topical application of dressing with amino acids improves cutaneous wound healing in aged rats

The principal goal in treating surgical and non-surgical wounds, in particular for aged skin, is the need for rapid closure of the lesion. Cutaneous wound healing processes involve four phases including an inflammatory response with the induction of pro-inflammatory cytokines. If inflammation develops in response to bacterial infection, it can create a problem for wound closure. Reduced inflammation accelerates wound closure with subsequent increased fibroblast function and collagen synthesis. On the contrary, prolonged chronic inflammation results in very limited wound healing. Using histological and immunohistochemical techniques, we investigated the effects of a new wound dressing called Vulnamin® that contains four essential amino acids for collagen and elastin synthesis plus sodium ialuronate (Na-Ial), compared with Na-Ial alone, in closure of experimental cutaneous wounds of aged rats. Our results showed that the application of Vulnamin® dressings modulated the inflammatory response with a reduction in the number of inflammatory cells and iNOS expression, while increasing eNOS and TGF-β1 expression. Furthermore, the dressing increased the distribution density of fibroblasts and aided the synthesis of thin collagen fibers resulting in a reduction in healing time. The nutritive approach using this new wound dressing can provide an efficacious and safe strategy to accelerate wound healing in elderly subjects, simplifying therapeutic procedures and leading to an improved quality of life

Microcrystalline cellulose suspensions : Effects on the surface tension at the air-water boundary

In the light of the recent clinical employment of microcrystalline cellulose (MCC) as a pharmaceutical device, in the present work the changes in surface tension caused by the addition of MCC powders to aqueous solutions have been studied. Further, analyses to give a preliminary characterization the soluble solute, considered the responsible of the surface tension changes, have also been performed. The Wilhelmy plate technique has been employed for the surface tension determinations, while for the characterization of the solute polymerization degree, elemental analysis, X-ray photoelectron spectroscopy and conductivity measurements have been performed. The obtained results are preliminary discussed in the light of the clinical evidence. (C) 2001 Elsevier Science B.V. In the light of the recent clinical employment of microcrystalline cellulose (MCC) as a pharmaceutical device, in the present work the changes in surface tension caused by the addition of MCC powders to aqueous solutions have been studied. Further, analyses to give a preliminary characterization the soluble solute, considered the responsible of the surface tension changes, have also been performed. The Wilhelmy plate technique has been employed for the surface tension determinations, while for the characterization of the solute polymerization degree, elemental analysis, X-ray photoelectron spectroscopy and conductivity measurements have been performed. The obtained results are preliminary discussed in the light of the clinical evidence

Oral amino acid supplements improve exercise capacities in elderly patients with chronic heart failure

We investigated whether 30 days of oral supplementation with a special mixture of amino acids (AAs), together with conventional therapy, could improve exercise capacity in elderly outpatients with chronic heart failure (CHF). A group of 95 outpatients (12 women and 83 men; New York Heart Association class II-III) aged 65-74 years were studied. This was a randomized, double-blind, placebo-controlled study. The patients performed a basal exercise test and were then randomly assigned to a special oral nutritional mixture of AAs 4 g twice daily (n = 43) or placebo (n = 42). After 30 days we repeated the exercise test. In both tests we measured the following: oxygen consumption (VO2), CO2 production (VCO2), minute ventilation (VE), oxygen cost of ventilation (VO2/VE), CO2 elimination per liter of ventilation (VCO2/VE), respiratory exchange ratio (RER; calculated as VCO2/VO2), oxygen pulse (VO2/heart rate [HR]) and anaerobic metabolism during exercise (ANA-VO2). At day 30, exercise capacity in the AA group had improved (+11 +/- 8 W, p 50% in patients on AAs (from 20.2 +/- 10 mL/kg at day 0 to 10.9 +/- 5 mL/kg at day 30; p <0.02). These variables did not significantly change for patients who received placebo. In conclusion, the study showed that oral AA supplementation, in conjunction with standard pharmacologic therapy, appears to increase exercise capacity by improving circulatory function, muscle oxygen consumption, and aerobic production of energy in elderly outpatients with CHF