Effects of Oral Citrulline on Protein Metabolism in Patients With Intestinal Failure (Citrugrêle 2)

Study Overview
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Brief Summary
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The specific aim of this study is to determine whether oral citrulline administration enhances whole body protein synthesis in patients with intestinal failure. Protein metabolism will be assessed using an intravenous infusion of stable isotope labeled leucine. The investigators hypothesize that citrulline supplementation will decrease leucine oxidation without altering proteolysis, and consequently stimulate protein synthesis.

Official Title
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Effects of Oral Citrulline on Protein Metabolism in Patients With Intestinal Failure : a Prospective, Randomized, Double-blind, Cross-over Study

Conditions
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Intestinal Failure

Intervention / Treatment
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* Drug: Citrulline and placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult between 18 and 75 years Patient with short bowel syndrome Patient with an incompetent small intestine after intestinal resection Patient fed orally and beyond more than 6 weeks after surgery Absence of any earlier supplementation with citrulline, glutamine, ornithine a-ketoglutarate, or stimol® No current artificial feeding (parenteral) No low-sodium diet- No renal, cardiac, respiratory or hepatic insufficiency No chronic inflammatory disease (intestinal or other) No current corticosteroid treatment Fasting blood glucose below 6mmol/L Patient able to understand benefits and risks of protocol Women who are of childbearing potential must have a negative serum pregnancy test and agree to use a medically acceptable method of contraception throughout the study and for 15 days following the end of the study Signed informed consent Exclusion Criteria: Subject not fulfilling inclusion criteria Subject mentioned in articles L1121-5 to L1121-8 of code de la santé publique Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Citrulline/Placebo<br> | Drug: Citrulline and placebo<br>* After receiving a 7-day oral supplementation with either citrulline or placebo, each subject will be admitted for a half day, after an overnight fast, and will receive a 5-h intravenous infusion of L-[1-13C]leucine. At regular intervals throughout the isotope infusion, blood will be obtained to measure 13C-enrichment in plasma a-keto-isocaproate, using gas chromatography-mass spectrometry. Simultaneously, 13C-enrichment will be measured in aliquots of expired air CO2 using isotope ratio mass spectrometry, and total CO2 production (VCO2) will be measured using direct calorimetry, respectively. Then the subject take no treatment for 13 days. The study will then be repeated a second time in an identical fashion, after a second 7-day period of oral supplementation with either citrulline or placebo.<br>|
| Experimental: Placebo/Citrulline<br> | Drug: Citrulline and placebo<br>* After receiving a 7-day oral supplementation with either citrulline or placebo, each subject will be admitted for a half day, after an overnight fast, and will receive a 5-h intravenous infusion of L-[1-13C]leucine. At regular intervals throughout the isotope infusion, blood will be obtained to measure 13C-enrichment in plasma a-keto-isocaproate, using gas chromatography-mass spectrometry. Simultaneously, 13C-enrichment will be measured in aliquots of expired air CO2 using isotope ratio mass spectrometry, and total CO2 production (VCO2) will be measured using direct calorimetry, respectively. Then the subject take no treatment for 13 days. The study will then be repeated a second time in an identical fashion, after a second 7-day period of oral supplementation with either citrulline or placebo.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| whole body protein synthesis | To determine whether oral citrulline administration enhances whole body protein synthesis in patients with intestinal insufficiency, as measured using an intravenous infusion of stable isotope labelled leucine. |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| nitrogen balance | Using a 6-h urine collection, to determine the effect of oral citrulline administration on nitrogen balance |  | 
| Measure of insulin | to determine whether the putative protein anabolic effect of citrulline is mediated by insulin or insulin-like-growth factor 1 (IGF-1), based on measurement of their plasma concentrations |  | 
| Measure of insulin-like-growth factor 1 (IGF-1) | To determine whether the putative protein anabolic effect of citrulline is mediated by insulin or insulin-like-growth factor 1 (IGF-1), based on measurement of their plasma concentrations. |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nutrition, protein metabolism, stable isotopes, mass spectrometry, intestinal failure