Oleh Admin Kalbe Medical pada May 08, 2017 07:30

Efek Glutamin pada Acute Limb Ischemic

Acute limb ischemia (ALI) adalah gejala klinis yang sering disebabkan oleh kondisi medis seperti emboli arterial, acute atherosclerotic thrombosis, trauma, atau trauma vaskular yang iatrogenik. Dibutuhkan pembentukan kembali aliran darah ke jaringan iskemik untuk memelihara kebutuhan metabolik jaringan, meskipun reperfusi darah segar ke jaringan iskemik juga dapat menginduksi kerusakan jaringan lokal. Selain itu, reperfusi juga mengembalikan metabolit beracun dari lingkungan sekitar ke dalam sirkulasi sistemik dan menginduksi trauma jaringan yang letaknya jauh.

Trauma iskemia/reperfusi merupakan penyebab morbiditas pada trauma, transplantasi organ, dan replanation tungkai berat. Mekanisme terjadinya trauma iskemia/reperfusi bersifat multifaktorial dan dibutuhkan strategi terapi secara simultan dari beberapa senyawa yang mempunyai aktivitas berbeda-beda. Terapi eksperimental didesain dengan berbagai komponen untuk trauma iskemia/reperfusi yang meliputi aktivasi komplemen, infiltrasi neutrofil, reactive oxygen species (ROS), kegagalan metabolik, dan inflamasi.

Glutamin merupakan asam amino non-esensial pada orang sehat tetapi sangat diperlukan pada kondisi kritis. Penelitian Hey Iand, dkk. menemukan bahwa pemberian glutamin dosis tinggi berhubungan dengan meningkatnya mortalitas pada pasien kritis yang disertai dengan multi-organ failure (MOF), tetapi kebanyakan penelitian lain menunjukkan bahwa suplementasi glutamin dapat memperbaiki outcome pada kondisi katabolik. Diduga mekanismenya dengan melindungi jaringan, anti-inflamasi, mengatur sistem imun, dan meningkatkan kapasitas antioksidan. Dengan mekanisme tersebut, diharapkan pemberian glutamin eksogen dapat membantu melindungi tungkai yang mengalami iskemia pada fase awal maupun akhir.    

Tujuan penelitian ini adalah untuk menilai efek pemberian glutamin terhadap adhesi molekul dan mediator inflamasi pada hewan coba yang mengalami trauma iskemia/reperfusi. Pada penelitian ini dibagi menjadi 2 kelompok, yaitu kelompok perlakuan diberi glutamin dengan dosis 0,75 g/kgBB 90 menit sebelum tindakan dan kelompok kontrol hanya diberikan plasebo. Parameter yang dinilai adalah adhesi molekul dan jumlah mediator inflamasi. Penilaian ini dilakukan sebelum tindakan, 4 jam, dan 24 jam setelah tindakan. Hasilnya menunjukkan bahwa pada kelompok perlakuan mengalami penurunan adhesi molekul dan jumlah mediator inflamasi dibandingkan kelompok kontrol, sehingga pada kelompok perlakuan reaksi inflamasi lokal ataupun sistemiknya lebih rendah dan perlindungan terhadap organ yang letaknya jauh dari iskemia dapat dipertahankan.

Simpulan:
Penelitian pre-klinis menunjukkan pemberian glutamin eksogen dengan dosis 0,75 g/kgBB 90 menit sebelum tindakan pada ALI dapat menurunkan reaksi inflamasi lokal ataupun sistemik dan juga dapat melindungi jaringan. (LAI)

Image : Ilustrasi
Referensi:
1.Shih YM, Shih JM, Pai MH, Hou YC, Yeh CL, Yeh SL. Glutamine administration after sublethal lower limb ischemia reduces inflammatory reaction and offers organ protection in ischemia/reperfusion injury. JPEN J Parenter Enteral Nutr. 2016;40:1122-30.
2.Wischmeyer PE. Glutamine: Mode of action in critical illness. Crit Care Med. 2007;35(9)(suppl):541-4.

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