From laboratory to bedside: New strategies in the treatment of malnutrition in cancer patients

Nutrition

Volumn 12, Issue 2, 1996, Pages 112-122

  Laviano, Alessandro ^a   Renvyle, Tad ^a   Yang, Zhong Jin ^a  

^a University Hospital   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANABOLIC AGENT; ARGININE; BRANCHED CHAIN AMINO ACID; CANNABINOID; COLONY STIMULATING FACTOR 1; CORTICOSTEROID; CYPROHEPTADINE; CYTOKINE; DRONABINOL; GAMMA INTERFERON; GLUTAMINE; GROWTH HORMONE; HYDRAZINE SULFATE; INTERLEUKIN 1; INTERLEUKIN 6; LEUKEMIA INHIBITORY FACTOR; MEGESTROL ACETATE; MONOCLONAL ANTIBODY; NUCLEOTIDE; OMEGA 3 FATTY ACID; PENTOXIFYLLINE; SOMATOMEDIN C; TUMOR NECROSIS FACTOR;

ADVANCED CANCER; CACHEXIA; CANCER PATIENT; CARBOHYDRATE METABOLISM; DRUG MECHANISM; HUMAN; IMMUNOPATHOGENESIS; IMMUNOREACTIVITY; LIPID METABOLISM; NONHUMAN; NUTRITIONAL SUPPORT; PRIORITY JOURNAL; PROTEIN METABOLISM; REVIEW; TOTAL PARENTERAL NUTRITION;

EID: 0030013784     PISSN: 08999007     EISSN: None     Source Type: Journal    
DOI: 10.1016/0899-9007(96)90709-1     Document Type: Review

References (139)

1. Langstein HN, Norton JA. Mechanisms of cancer cachexia. Hematol Oncol Clin North Am 1991; 5:103
2. Peacock JL, Inculet RI, Corsey R, Ford DB, Rumble WF, Lawson D, et al. Resting energy expenditure and body cell mass alterations in non-cachectic patients with sarcomas. Surgery 1987; 102:465
3. DeWys WD, Begg D, Lavin PT, Bennet JM, Bertino JR, Cohen MH, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 1980; 69:491
4. Campos ACL, Waitzberg DL, Meguid MM. A comparison of the changes in carbohydrate, fat, and protein metabolism occurring with malignant and benign tumors and the impact of nutritional support. In: (Alfin-Slater RB and Kritchevsky D, eds.) Cancer and Nutrition. New York: Plenum, 1991:69
5. Daly JM, Redmond HP, Gallagher H. Perioperative nutrition in cancer patients. JPEN 1992;16(suppl. 6):100S
6. Meguid MM, Debonis D, Meguid V, Hill LR, Terz JJ. Complications of abdominal operations for malignant disease. Am J Surg 1988; 156:341
7. Donaldson S. Nutritional support as an adjunct to radiation therapy. JPEN 1984; 8:302
8. Grosvenor M, Bulcavage L, Chlebowski RT. Symptoms potentially influencing weight loss in a cancer population. Cancer 1989; 63:330
9. DeWys WD, Walters K. Abnormalities of taste sensation in cancer patients. Cancer 1975; 36:1888
10. Shivshanker K, Bennett RW, Haynie TP. Tumor associated gastroparesis: correction with metoclopramide. Am J Surg 1983; 145:221
11. Bernstein IL, Bernstein ID. Learned food aversion and cancer anorexia. Cancer Treat Rep 1981; 65(suppl. 5):43
12. Morrison SD. Limited capacity for motor activity as a cause for declining food intake in cancer. J Natl Cancer Inst 1973; 51:1535
13. Rossi Fanelli F, Cangiano C. Increased availability of tryptophan in brain as a common pathogenic mechanism for anorexia associated with different diseases. Nutrition 1991; 7:364
14. Laviano A, Meguid MM, Yang Z-J, Gleason JR, Cangiano C, Rossi Fanelli F. Cracking the riddle of cancer anorexia.
15. Larrea J, Vega S, Martinez T, Torrent JM, Vega V, Nunez V. The nutritional status and immunological situation of cancer patients. Nutricion Hospitalaria 1992; 7:178
16. Lipman TO. Clinical trials of nutritional support in cancer. Parenteral and enteral therapy. Hematol Oncol Clin North Am 1991; 5:91
17. Campos ACL, Meguid MM. A critical appraisal of the usefulness of perioperative nutritional support. Am J Clin Nutr 1992; 55:117
18. Espat NJ, Moldawer LL, Copeland EM. 3rd. Cytokine-mediated alterations in host metabolism prevent nutritional repletion in cachectic cancer patients. J Surg Oncol 1995; 58:77
19. Moldawer LL, Rogy MA, Lowry SF. The role of cytokines in cancer cachexia. JPEN 1992; 16(suppl. 6):43S
20. Evans R, Duffy TM, Blake SS, Lin HS. Regulation of systemic macrophage IL-1 gene transcription: the involvement of tumor-derived macrophage growth factor CSF-1. J Leukocyte Biol 1989; 46:428
21. Yang Z-J, Koseki M, Meguid MM, Gleason JR, Debonis D. Synergistic effect of rhTNF-alpha and rhIL-1alpha in inducing anorexia in rats. Am J Physiol 1994; 267:R1056
22. Sherry B, Cerami B. Cachectin/tumor necrosis factor exerts endocrine, paracrine, and autocrine control of inflammatory responses. J Cell Biol 1988; 7:1269
23. Tracey KJ, Wei H, Manogue KR, Fong Y, Hesse DG, Nguyen HT, et al. Cachectin/tumor necrosis factor induces cachexia, anemia and inflammation. J Exp Med 1988; 167:1211
24. Lee MD, Zentella A, Vine W, Pekala PH, Cerami A. Effect of endotoxin-induced monokines on glucose metabolism in the muscle cell line L6. Proc Natl Acad Sci USA 1987; 84:2590
25. Tracey KJ, Morgello S, Koplin B, Fahey TJ 3rd, Fox J, Aledo A, et al. Metabolic effects of Cachectin/tumor necrosis factor are modified by site of production. Cachectin/tumor necrosis factor-secreting tumor in skeletal muscle induces chronic cachexia, while implantation in brain induces predominantly acute anorexia. J Clin Invest 1990; 86:2014
26. Flores EA, Bistrian BR, Pomposelli JJ, Dinarello CA, Blackburn GL, Istfan NW. Infusion of tumor necrosis factor/cachectin promotes muscle catabolism in the rat. J Clin Invest 1989; 83:1614
27. Sherry BA, Gelin J, Fong Y, Marano M, Wei H, Cerami A, et al. Anticachectin/tumor necrosis factor in tumor models. FASEB J 1989; 3:1956
28. Michie HR, Sherman ML, Spriggs DL, Rounds J, Christie M, Wilmore DW. Chronic TNF infusion causes anorexia but not accelerated nitrogen loss. Ann Surg 1989; 209:19
29. Plata-Salaman CR. Immunoregulators in the nervous system. Neurosci Biobehav Rev 1991; 15:185
30. McCarthy DO, Daun JM. The role of prostaglandins in interleukin-1 induced gastroparesis. Physiol Behav 1992; 52:351
31. Opara EI, Laviano A, Meguid MM, Yang Z-J. Correlation be-tween food intake and cerebrospinal fluid interleukin-1alpha in anorectic tumor bearing rats. Neuroreport 1995; 6:750
32. Moldawer LL, Gelin J, Schersten T, Lundholm KG. Circulating interleukin-1 and tumor necrosis factor during inflammation. Am J Physiol 1987; 259:R922
33. Gelin J, Moldawer LL, Lonnroth C, Sherry B, Chizzonite R, Lundholm K. Role of endogenous tumor necrosis factor alpha and interleukin-1 for experimental tumor growth and the development of cancer cachexia. Cancer Res 1991; 51:415
34. Laviano A, Meguid MM, Renvyle T, Yang Z-J, Cangiano C, Rossi Fanelli F. Relationship between interleukin-1 and cancer anorexia. Nutrition 1995; 11:680
35. Cangiano C, Testa U, Muscaritoli M, Meguid MM, Mulieri M, Laviano A, et al. Cytokines, tryptophan and anorexia in cancer patients before and after surgical tumor ablation. Anticancer Res 1994; 14:1451
36. Akira S, Hirano T, Taga T, Kishimoto T. Biology of multifunctional cytokines: IL-6 and related molecules. FASEB J 1990; 4:2860
37. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990; 265:621
38. Gelin J, Moldawer LL, Lonnroth C, de Man P, Svanborg-Eden L, Lowry SF, et al. Appearance of hybridoma growth factor/IL-6 in the serum of mice bearing a methylcholanthrene-induced sarcoma. Biochem Biophys Res Commun 1988; 157:575
39. Schobitz B, Holsboer F, de Kloet R. Cytokines in the healthy and diseased brain. NIPS 1994; 9:138
40. Strassmann G, Fong M, Kenney JS, Jacob CO. Evidence for the involvement of interleukin-6 in experimental cancer cachexia. J Clin Invest 1992; 148:1681
41. Billiau A. Gamma-interferon: the match that lights the fire? Immunol Today 1988; 9:37
42. Patton JS, Shepard HM, Wilking H. Interferons and tumor necrosis factor have similar catabolic effect on 3T3LI cells. Proc Natl Acad Sci USA 1986; 83:8313
43. Langstein HN, Doherty GM, Fraker DL, Buresh CM, Norton JA. The roles of interferon-gamma and tumor necrosis factor in an experimental rat model of cancer cachexia. Cancer Res 1991; 51:2302
44. Metcalf D, Gearing DP. Fatal syndrome in mice engrafted with cells producing high levels of the leukemia inhibitory factor. Proc Natl Acad Sci USA 1982; 86:5948
45. Metcalf D. The leukemia inhibitory factor (LIF). Int J Cell Cloning 1991; 9:95
46. Mori M, Yamaguchi K, Abe K. Purification of a lipoprotein lipase-inhibiting protein produced by a melanoma cell line associated with cancer cachexia. Biochem Biophys Res Commun 1989; 160:1085
47. Han J, Thompson P, Beutler B. Dexamethasone and pentoxifylline inhibit endotoxin-induced cachectin/tumor necrosis factor synthesis at separate points in the signaling pathway. J Exp Med 1990; 172:391
48. Hardin TC. Cytokine mediators of malnutrition: clinical implications. Nutr Clin Prac 1993; 8:55
49. Moertel CG, Schutt AJ, Reitemeier RJ, et al. Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer 1974; 33:1607
50. Willox J, Corr J, Shaw J, Richardson M, Calman KC, Drennan M. Prednisolone as an appetite stimulant in patients with cancer. Br Med J 1984; 288:27
51. Semmler J, Gebert U, Eisenhut T, et al. Xanthine derivatives: comparison between suppression of tumor necrosis factor-alpha production and inhibition of cAMP phosphodiesterase activity. Immunology 1993; 78:520
52. Fazely F, Dezube BJ, Allen-Ryan J, Pardee AB, Ruprecht RM. Pentoxifylline (Trental) decreases the replication of the human immunodeficiency virus type 1 in human peripheral blood mononuclear cells and in cultured T cells. Blood 1991; 77:1653
53. Doherty GM, Jensen JC, Alexander HR, Buresh CM, Norton CA. Pentoxifylline suppression of tumor necrosis factor gene transcription. Surgery 1991; 110:192
54. Thanhauser A, Reiling N, Bohle A, et al. Pentoxifylline: a potent inhibitor of IL-2 and IFN-gamma biosynthesis and BCG-induced cytotoxicity. Immunology 1993; 80:151
55. Levi M, ten Cate H, Bauer KA, et al. Inhibition of endotoxin-induced activation of coagulation and fibrinolysis by pentoxifylline or by a monoclonal anti-tissue factor antibody in chimpazees. J Clin Invest 1994; 93:114
56. Chao CC, Hu S, Close K, et al. Cytokine release from microglia: differential inhibition by pentoxifylline and dexamethasone. J Infect Dis 1992; 166:847
57. Dezube BJ, Fridovich-Keil JL, Bouvard I, Lange RF, Pardee AB. Pentoxifylline and wellbeing in patients with cancer (letter). Lancet 1990; 335:662
58. Lissoni P, Ardizzoia A, Perego MS, et al. Inhibition of tumor necrosis factor-alpha secretion by pentoxifylline in advanced cancer patients with abnormally high blood levels of tumor necrosis factor-alpha. J Biol Regul Homeostatic Agents 1993; 7:73
59. Dezube BJ, Sherman ML, Fridovich-Keil JL, Allen-Ryan J, Pardee AB. Down-regulation of tumor necrosis factor expression by pentoxifylline in cancer patients: a pilot study. Cancer Immunol Immunother 1993; 36:57
60. Edwards MJ, Heniford BT, Klar EA, Doak KW, Miller FN. Pentoxifylline inhibits interleukin-2-induced toxicity in C57BL/6 mice but preserves antitumor efficacy. J Clin Invest 1992; 90:637
61. Singer JW, Bianco JA, Takahashi G, Simrell C, Petersen J, Anfrews DF 3rd. Effect of methylxanthine derivatives on T cell activation. Bone Marrow Transplant 1992; 10:19
62. Shulman HM, Hinterberger W. Hepatic veno-occlusive disease-liver toxicity syndrome after bone marrow transplantation. Bone Marrow Transplant 1992; 10:197
63. Bianco JA, Appelbaum FR, Nemunaitis J, et al. Phase I-II trial of pentoxifylline for the prevention of transplant-related toxicities following bone marrow transplantation. Blood 1991; 78:1205
64. Attal M, Huguet F, Rubie H, et al. Prevention of regimen-related toxicities after bone marrow transplantation by pentoxifylline: a prospective, randomized trial. Blood 1993; 82:732
65. Tuckey JA, Parry BR, McCall JL. Pentoxifylline and wellbeing in cancer (letter). Lancet 1993; 342:617
66. Sallan SE, Cronin C, Zelen M, Zinberg NE. Antiemetics in patients receiving chemotherapy for cancer: a randomized comparison of delta-9-tetrahydrocannabinoid and prochlorperazine. N Engl J Med 1980; 302:135
67. Mitchelson F. Pharmacological agents affecting emesis. A review (part I). Drugs 1992; 43:295
68. Watzl B, Scuderi P, Watson RR. Marijuana components stimulate human peripheral blood mononuclear cell secretion of interferon-gamma and suppress interleukin-1 alpha in vitro. Int J Immunopharmacol 1991; 13:1091
69. Plasse TF, Gorter RW, Krasnow SH, Lane M, Shepard KV, Waldleigh RG. Recent clinical experience with dronabinol. Pharmacol Biochem Behav 1991; 40:695
70. Gorter R, Seefried M, Volberding P. Dronabinol effects on weight in patients with HIV infection. AIDS 1992; 6:127
71. Endres S, Ghorbani R, Kelley VE, et al. The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med 1989; 320:265
72. Maki PA, Newberne PM. Dietary lipids and immune function. J Nutr 1992; 122(suppl. 3):610
73. Sierra P, Ling PR, Istfan N, Bistrian BR. Fish-oil feeding improves insulin sensitivity in TNF-treated rats (abstract). JPEN 1994; 18(suppl. 1):23S
74. Anti M, Marra G, Armelao F, et al. Effect of omega-3 fatty acids on rectal mucosal cell proliferation in subjects at risk for colon cancer. Gastroenterology 1992; 103:883
75. Rose DP, Connolly JM. Effects of dietary omega-3 fatty acids on human breast cancer growth and metastases in nude mice. J Natl Cancer Inst 1993; 85:1743
76. Dinarello CA, Endres S, Meydani SN, Meydani N, Hellerstein MK. Interleukin-1, anorexia, and dietary fatty acids. Ann NY Acad Sci 1990; 587:332
77. Tisdale MJ, Dhesi JK. Inhibition of weight loss by omega-3 fatty acids in an experimental cachexia model. Cancer Res 1990; 50:5022
78. Gardner TE, Lappin J, Daly JM. Immunologic enhancement with enterai fish oil supplementation in a cachectic tumor model (abstract). JPEN 1994; 18(suppl. 1):18S
79. Arend WP. Interleukin-1 receptor antagonist. Adv Immunol 1993; 54:167
80. Chlebowski RT, Heber D. Hypogonadism in male patients with metastatic cancer prior to chemotherapy. Cancer Res 1982; 42:2495
81. Freed DLJ, Banks AJ, Longson D, Burley DM. Anabolic steroids in athletics: crossover double-blind trial on weightlifters. Br Med J 1975; 5:471
82. Chlebowski RT, Herrold J, Ali I, Oktay E, Chlebowski JS, Ponce AT, et al. Influence of nandrolone decanoate on weight loss in advanced non-small cell lung cancer. Cancer 1986; 58:183
83. Ng B, Wolf RF, Weksler B, Brennan MF, Burt M. Growth hormone administration preserves lean body mass in sarcoma-bearing rats treated with doxorubicin. Cancer Res 1993; 53:5483
84. Bartlett DL, Charland S, Torosian MH. Growth hormone, insulin, and somatostatin therapy of cancer cachexia. Cancer 1994; 73:1499
85. Mulligan K, Grunfeld C, Hellerstein MK, Neese RA, Schambelan M. Anabolic effects of recombinant human growth hormone in patients with wasting associated with human immunodeficiency virus infection. J Clin Endocrinol Metab 1993; 77:956
86. Wolf RF, Pearlstone DB, Newman E, et al. Growth hormone and insulin reverse net whole body and skeletal muscle protein catabolism in cancer patients. Ann Surg 1992; 216:280
87. Froesch ER, Schmid C, Schwander J, Zapf J. Actions of insulin-like growth factor. Annu Rev Physiol 1985; 47:433
88. Phillips LS. Nutrition, somatomedins and the brain. Metabolism 1986; 35:78
89. Eng-Hen NG, Rock CS, Lazarus DD, Stiaino-Coico L, Moldawer LL, Lowry SF. Insulin-like growth factor I preserves host lean tissue mass in cancer cachexia. Am J Physiol 1992; 262:R426
90. Tchekmedyian NS, Tait N, Moody M, Aisner J. High-dose megestrol acetate: a possible treatment for cachexia. JAMA 1987; 257:1195
91. Loprinzi CL, Jensen MD, Jiang NS, Schaid DJ. The effect of megestrol acetate on the human pituitary-adrenal axis. Mayo Clinic Proc 1992; 67:1160
92. Laviano A, Meguid MM, Gleason JR, Yang Z-J, Renvyle T. Comparison of long term observation of feeding pattern in male and female Fischer-344 rat: the influence of estrous cycle. Am J Physiol 1996; 270:R413
93. Loprinzi CL, Ellison NM, Schaid DJ, et al. Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia. J Natl Cancer Inst 1990; 82:1127
94. Bruera E, Macmillan K, Kuhn N, Hanson J, MacDonald RN. A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer. Cancer 1990; 66;1279
95. Loprinzi CL, Schaid DJ, Dose AM, Burnham NL, Jensen MD. Body-composition changes in patients who gain weight while receiving megestrol acetate. J Clin Oncol 1993; 11:152
96. Rowland KM, Jett JR, Jung SH, Loprinzi CL, Washburn JH, Shaw EG. Phase III randomized double blind placebo controlled trial of cisplatin (P) and etoposide (E) plus megestrol acetate (M)/ placebo in extensive stage small cell lung (SCLA): a North Central Cancer Treatment Group Study (abstract). Proc Am Soc Clin Oncol 1994; 13:330
97. McMillan DC, Simpson JM, Preston T, et al. Effect of megestrol acetate on weight loss, body composition and blood screen of gastrointestinal cancer patients. Clin Nutr 1994; 13:85
98. Foitl DR, Hyman G, Lefkowitch JH. Jaundice and intrahepatic cholestasis following high-dose megestrol acetate for breast cancer. Cancer 1989; 63:438
99. Henry K, Rathgaber S, Sullivan C, McCabe K. Diabetes mellitus induced by megestrol acetate in a patient with AIDS and cachexia. Ann Intern Med 1992; 116:53
100. Nathwani D, Green ST, Heslop JM, Goldberg DJ, Kennedy DH. Beneficial response to megoestrol acetate in AIDS-related cachexia and a possible megoestrol withdrawal-associated syndrome? Acta Derm Venereol (Stockholm) 1990; 70:520
101. Kardinal CG, Loprinzi CL, Schaid DJ, et al. A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer 1990; 65:2657
102. Glennon RA. Serotonin receptors: clinical implications. Neurosci Biobehav Rev 1990; 14:35
103. Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfate in cancer patients with weight loss. A placebo controlled clinical experience. Cancer 1987; 59:406
104. 14C-lysine metabolism in cancer patients. Lancet 1987;2(8553):241
105. Kosty MP, Fleishman SB, Herndon JEII, et al. Cisplatin, vinblastine and hydrazine sulfate in advanced, non-small-cell lung cancer: a randomized, placebo-controlled, double-blind phase III study of the Cancer and Leukemia Group B. J Clin Oncol 1994; 12:1113
106. Loprinzi CL, Goldberg RM, Su JQ, et al. Placebo-controlled trial of hydrazine sulfate in patients with newly diagnosed non-small-cell lung cancer. J Clin Oncol 1994; 12:1126
107. Loprinzi CL, Kuross SA, O'Fallon JR, et al. Randomized placebo-controlled evaluation of hydrazine sulfate in patients with advanced colorectal cancer. J Clin Oncol 1994; 12:1121
108. Daly JM, Mihranian MH, Kehoe JE, Brennan MF. Effects of post-operative infusion of branched chain amino acids on nitrogen balance and forearm muscle substrate flux. Surgery 1983; 94:151
109. Echenique MM, Bistrian BR, Moldawer LL, Palombo JD, Miller MM, Blackburn GL. Improvement in amino acid use in the critically ill patient with parenteral formulas enriched with branched chain amino acids. Surg Gynecol Obstet 1984; 159:233
110. Hunter DC, Weintraub M, Blackburn GL, Bistrian BR. Branched chain amino acids as the protein component of parenteral nutrition in cancer cachexia. Br J Surg 1989; 76:149
111. Crosby LE, Bistrian BR, Ling P-R, Istfan NW, Blackburn GL, Hoffman SB. Effects of branched chain amino acids-enriched total parenteral nutrition on amino acid utilization in rats bearing Yoshida sarcoma. Cancer Res 1988; 48:2698
112. Smith QR. The blood-brain barrier and the regulation of amino acid uptake and availability to brain. Adv Exp Med Biol 1991; 291:55
113. Cangiano C, Laviano A, Preziosa I, et al. Effects of oral branched-chain amino acids (BCAA) administration in the treatment of cancer anorexia (abstract). Clin Res 1994; 2:129A
114. Souba WW. Glutamine and cancer. Ann Surg 1993; 218:715
115. Chen MK, Salloum RM, Austgen TR, et al. Tumor regulation of hepatic glutamine metabolism. JPEN 1991; 15:159
116. Austgen TR, Chen MK, Dudrick PS, Copeland EM 3rd, Souba WW. Cytokine regulation of intestinal glutamine utilization. Am J Surg 1992; 163:174
117. van Laschot JJ, Mealy K, Wilmore DW. The effects of tumor necrosis factor on intestinal structure and metabolism. Ann Surg 1990; 212:663
118. Fahr MJ, Blossom S, Kornbluth J, Klimberg VS. Glutamine enhances immunoregulation of tumor growth (abstract). JPEN 1994; 18(suppl. 1):19S
119. Ziegler TR, Young LS, Benfell K, et al. Clinical and metabolic efficacy of glutamine-supplemented parenteral nutrition after bone marrow transplantation. A randomized, double-blind, controlled study. Ann Intern Med 1992; 116:821
120. Schloerb PR, Amare M. Total parenteral nutrition with glutamine in bone marrow transplantation and other clinical applications (a randomized, double-blind study). JPEN 1993; 17:407
121. Fischer JE, Chance WT. Total parenteral nutrition, glutamine, and tumor growth. JPEN 1990; 14(suppl. 4):86S
122. Austgen TR, Dudrick PS, Sitren H, Bland KI, Copeland E, Souba WW. The effects of glutamine-enriched total parenteral nutrition on tumor growth and host tissues. Ann Surg 1992; 215:107
123. Souba WW, Limberg VS, Copeland EM 3rd. Glutamine nutrition in the management of radiation enteritis. JPEN 1990; 14(suppl. 4):106S
124. Klimberg VS, Nwokedi E, Hutchins LF, Pappas AA, Lang NP, Broadwater JR, et al. Glutamine facilitates chemotherapy while reducing toxicity. JPEN 1992; 16(suppl. 6):83S
125. Salloum RM, Copeland EM 3rd, Bland KI. Selective stimulation of brush border glutamine transport in the tumor-bearing rat. J Surg Res 1991; 50:391
126. Klimberg VS, Souba WW, Salloum RM, Plumley DA, Cohen FS, Dolson DJ, et al. Glutamine-enriched diets support muscle glutamine metabolism without stimulating tumor growth. J Surg Res 1990; 48:319
127. Barbul A. Arginine: biochemistry, physiology, and therapeutic implications. JPEN 1986; 10:227
128. Kirk SJ, Barbul A. Role of arginine in trauma, sepsis and immunity. JPEN 1990; 14(suppl.):226S
129. Niijima A, Renvyle T, Meguid MM. Mechanisms of arginine and lysine immune enhancing activity. Surg Forum 1995; 46:27
130. Reynolds JV, Daly JM, Shou J, Sigal R, Ziegler MM, Naji A. Immunologic effects of arginine supplementation in tumor-bearing and non-tumor-bearing hosts. Ann Surg 1990; 211:202
131. Ye SL, Istfan NW, Driscoll DF, Bistrian BR. Tumor and host response to arginine and branched chain amino acid-enriched total parenteral nutrition. A study involving Walker 256 carcinosarcoma-bearing rats. Cancer 1992; 69:261
132. Grossie VB Jr, Nishioka K, Ajani JA, Ota DM. Substituting ornithine for arginine in total parenteral nutrition eliminates enhanced tumor growth. J Surg Oncol 1992; 50:161
133. Carlson SE. Human milk non protein nitrogen: occurrence and possible function. Adv Pediatr 1985; 32:43
134. He Y, Chu SH, Walker WA. Nucleotide supplements alter proliferation and differentiation of cultured human (Caco-2) and rat (IEC-6) intestinal epithelial cells. J Nutr 1993; 123:1017
135. Van Buren CT, Rudolph FB, Kulkarni A, Pizzini R, Fanslow WC, Kumar S. Reversal of immunosuppression induced by a protein-free diet: comparison of nucleotides, fish oil, and arginine. Crit Care Med 1990; 18:S114
136. Iijima S, Tsujinaka T, Kido Y, et al. Intravenous administration of nucleosides and a nucleotide mixture diminishes intestinal mucosal atrophy induced by total parenteral nutrition. JPEN 1993; 17:265
137. Daly JM, Lieberman MD, Goldfine J, et al. Enterai nutrition with supplemental arginine, RNA, and omega-3 fatty acids in patients after operation: immunologic, metabolic, and clinical outcome. Surgery 1992; 112:56
138. Van Buren CT, Kulkarni AD, Rudolph FB. The role of nucleotides in adult nutrition. J Nutr 1994; 124(suppl. 1):160S
139. Kuhr T, Dougherty GJ, Klingemann HG. Transfer of the tumor necrosis factor-alpha gene into hematopoietic progenitor cells as a model for site-specific cytokine delivery after marrow transplantation. Blood 1994; 84:2966