Arginine Supplementation Enhances Mitogen-Induced Lymphocyte Proliferation in Elderly Nursing Home Residents With Pressure Ulcers

This presentation is part of : Gerontological Nursing

Joyce Stechmiller, ARNP, PhD, CS, Adult & Elderly Nursing, University of Florida College of Nursing, Gainesville, FL, USA and Bobbi Langkamp-Henken, PhD, RD, Food Science and Human Nutrition, University of Florida, Gainesville, FL, USA.

Objective: The purpose of this study was to determine the effect of arginine supplementation on in vivo and in vitro immune parameters in nursing home elders with pressure ulcers. Design: Experimental double blind controlled randomized study. Population, Sample, Setting, Years: Twenty six nursing home residents (> 65 years of age) with one or more pressure ulcers were randomized to one of two groups from 2001-2003. Methods: One group received 8.5 g of supplemental arginine and the other group received an isonitrogenous amount of a standard protein powder mixed in cherry syrup for 4 weeks. Immune function was measured by assessing mitogen-induced lymphocyte proliferation, delayed type hypersensitivity (DTH), neutrophil burst and incidence of infection prior to supplementation (baseline), 4 weeks post supplementation and after a washout period (10 weeks post-supplementation). Nutritional status was also assessed at baseline, week 4, and week 10. Interactions between general nutritional status and immune function were identified. Data was analyzed using multivariate methods. Findings: Supplemental arginine significantly increased plasma arginine and ornithine levels and was orally and metabolically tolerated with no clinically relevant changes in electrolyte levels among groups. Arginine supplementation significantly enhanced lymphocyte proliferation to mitogens by week ten. DTH and neutrophil burst were not different among supplementation groups. Conclusions: Pharmacologic doses of arginine was well tolerated and enhanced lymphocyte proliferation at ten weeks following a 4 week course in nursing home residents with pressure ulcers. Implications: This study demonstrates that 4 weeks of arginine supplementation enhances immune function and recommends its use. Further research needs to be completed investigating the effect of arginine supplementation on wound healing in this population.

Learning Objective #1: Review the effect of arginine supplementation on immune function and wound healing
Learning Objective #2: Review arginine metabolism and chronic wound healing