Glutamater Semialdehyde

Ornithine Am Transferase

Ornithine Am Transferase

1-pyrroline-5-hydroxylate DH

NADH+H+

a-glutarate

FIGURE 4.2 The "triangle" relationship among proline, ornithine, and glutamate.

a-glutarate

1-pyrroline-5-hydroxylate DH

NADH+H+

Ornithine

Glutamate

FIGURE 4.2 The "triangle" relationship among proline, ornithine, and glutamate.

2. Tracer studies by Yu et al. revealed an accelerated ornithine disposal via TCA cycle combined with limited arginine formation in severely burned patients.48

3. Studies also revealed a reduced tissue glutamine availability after thermal injury.49 Therefore, the availability of proline is likely to be limited for protein synthesis including collagen. Further studies are warranted on exploring the provision of proline or its precursors ornithine and or glutamate/glutamine on whole body proline metabolism and its relation to protein metabolism in the wound healing process.

Protein nutrition is important in wound healing, but providing an excess of protein does not necessarily further help the wound healing process. Instead, this may cause serious metabolic complications. It is worth mentioning that the amount of protein intake for severely burned patients is at the level of 1.5g/kg/day. This level of protein intake has been suggested from clinical observations.50,51 Stable isotope studies using multiple labeled amino acids have indicated that in severely burned patients, the oxidation rates of individual essential amino acids are around 150% of their corresponding levels observed in healthy subjects.52 Increasing the feeding from 1.5g/kg/day to 2.5g/kg/day does not provide further benefit to whole body nitrogen economy.53 This finding is in agreement with the clinical observations that

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