Abstract
Circulating citrulline is more than an intermediary metabolic product. This amino acid synthesized by enterocytes of intestinal mucosa is not included in proteins and is a precursor for renal production of arginine by kidney. Anabolic role of citrulline — that escape to hepatic metabolism — on nitrogen balance and muscular proteins was shown in experimental animal models. This is the basis for clinical experimentation of citrulline in malnutrition with increase of splanchnic sequestration as in elderly subjects. Moreover, citrulline is, in clinical situation, an established biomarker of enterocyte metabolic mass in children and in adult patients due to its high relation to functional small bowel remnant length. Plasma citrulline concentration less than 10–20 μmol/L can give an objective threshold for nutrition parenteral use in case of intestinal failure due to enterocyte abnormalities or lack.
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