The Use of Specialized Amino Acid Mixture in Pressure Ulcer Wound Healing Rates - A Placebo Controlled Trial

In April of 2010, researchers initiated a study to test the effectiveness of a commercial mixture of ingredients on bedsores. It was an interventional clinical trial with 26 participants. Participants were at least 21 years old and of both sexes. The inclusion criteria were:

• Patients with pressure ulcers stage II, III or IV, non-healing and admitted to Changi General Hospital for less than two weeks.
• Patients who are able to attend outpatient follow-up appointments for dietary and wound review.

The study's description gives the following information:

• Bedsores are areas of local damage to the skin or underlying tissue. Traction, friction or sustained pressure causes them, and they often form on bony protuberances. Bedsores occur frequently with many health conditions that leave a patient inactive or immobile or with poor sensation. These wounds can increase mortality, especially in the elderly.
• International rates of bedsore formation vary wildly, from 4.6% to 83.6%. This is due to variations in rates of care as well as differences in how bedsores are classified. In Singapore, a study on pressure sore prevalence in three different hospitals showed that bedsores occurred in 9% to 14% of the population of patients.
• Bedsores often do not heal quickly or easily, which results in a chronic, non-healing wound. The healing processes of haemostasis, inflammation, proliferation, angiogenesis and remodeling are required to heal wounds, and there are many factors about bedsores that can easily disrupt these processes. Nutrition and hydration have a large impact on healing, and investigators have been giving both aspects more attention as of late.
• Many studies have focused on the use of arginine to improve the wound healing process and to prevent bedsores. Arginine is a semi-essential amino acid. The body generally produces enough of it but at times caregivers must supplement, especially after critical illness or severe trauma. Arginine is essential for nitrogen balance, cell proliferation, T lymphocyte function and collagen production. It can also convert into nitric oxide, which is a vasodilator and aids angiogenesis.
• Glutamine plays an important part in the body's immune system. Lack of glutamine compromises the healing process so much so that it can even fail to function. Glutamine is an amino acid that the body can make, but when the body is under stress it needs more than it can produce. Glutamine is therefore conditionally essential. Normally, through body production and a healthy diet, the body gets all the glutamine it requires.
• Leucine is an essential amino acid. One of its metabolites is beta-hydroxy beta-methylbutyrate (HMB). HMB supplementation appears to aid in building muscle mass by apparently inhibiting muscle proteolysis and modulating protein turnover.
• Patients who take arginine orally saw an increase in levels of arginine and ornithine which improved the synthesis of collagen. Researchers recently discovered that arginine, when taken with glutamine and HMB, causes wounds to heal more rapidly. In a recent study over twelve months, elderly patients who had taken a mixture of the three substances experienced increase protein turnover. As of yet, there has been no randomized controlled trial on patients in acute care situations with chronic wounds that will not heal.

This study was a randomized, controlled, comparative trial study. Its goal was to compare the healing rates of ulcer patients. Some took only standard, high protein, high energy iso-nitrogenous medical nutritional supplements, while others, in addition to taking the former, also took a commercial mixture of HMB, arginine and lysine.

Alvin Wong was the principal investigator and conducted the study at Changi General Hospital in Singapore. Alvin Wong is a Senior Dietitian at Changi General Hospital.