title: Impaired leukotriene C4 generation in granulocytes from protein-energy malnourished chronically ill elderly.
abstract: OBJECTIVE
  The dysregulation of the immune and inflammatory systems observed in protein-energy malnutrition (PEM) may be partly due to perturbation of essential fatty acid metabolism. In this study, we assessed the calcium ionophore A23187-induced generation of the arachidonate metabolites leukotriene B4 (LTB4) and leukotriene C4 (LTC4) in isolated granulocyte suspensions.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A university-affiliated acute care hospital in urban Stockholm.
  
  
  METHODS
  Fourteen severely malnourished elderly subjects with stable non-malignant disorders (age 74 +/- 1 years, mean +/- SEM) and 12 healthy age-matched controls were examined.
  
  
  METHODS
  Leukotrienes were analysed by high-performance liquid chromatography. Body mass index (BMI, kg m-2) and delayed cutaneous hypersensitivity (DCH) reaction were determined.
  
  
  RESULTS
  BMI was 16. 5 +/- 0.5 and 26.2 +/- 0.9 kg m-2 (mean +/- SE) in the malnourished group and controls (P < 0.001), respectively. DCH was 8.5 mm (median) in patients and 29.5 mm in controls (P < 0.001). LTC4 generation in granulocytes from PEM patients was half of that of controls (9.1 +/- 2.0 vs. 17.8 +/- 5.2 pmol mL-1, P < 0.05) when cells were stimulated with 0.2 micromol L-1 of A23187, and 13.7 +/- 2.5 and 27.2 +/- 7.5 pmol mL-1, respectively (NS), upon stimulation with 1.0 micromol L-1 of A23187. LTB4 production in PEM patients and controls did not differ at any of the two calcium ionophore concentrations. LTC4 production correlated with BMI (r = 0.41, P < 0.05), but there was no significant correlation between DCH and LTB4 or LTC4 production.
  
  
  CONCLUSIONS
  Protein-energy malnutrition is accompanied by perturbation of leukotriene synthesis, which may be one factor underlying the dysregulation of inflammatory responses in the depleted patient.
authors.affiliation: Centre for Hematology and Inflammatory Research, Department of Geriatric Medicine, Huddinge University Hospital, Sweden. tommy.cederholm@ger.hs.sll.se
authors.forename: T
authors.initials: T
authors.lastname: Cederholm
authors.forename: J A
authors.initials: JA
authors.lastname: Lindgren
authors.forename: J
authors.initials: J
authors.lastname: Palmblad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016022:Case-Control Studies; D002851:Chromatography, High Pressure Liquid; D002908:Chronic Disease; D005260:Female; D006098:Granulocytes / Q000378:metabolism*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood; D007975:Leukotriene B4 / Q000096:biosynthesis*; D017997:Leukotriene C4 / Q000096:biosynthesis*; D008297:Male; D009961:Orosomucoid / Q000378:metabolism; D011502:Protein-Energy Malnutrition / Q000097:blood* / Q000276:immunology; D012867:Skin / Q000276:immunology; D013481:Superoxides / Q000097:blood
chemical_list: D015850:Interleukin-6; D020738:Leptin; D009961:Orosomucoid; D013481:Superoxides; D007975:Leukotriene B4; D017997:Leukotriene C4; D007334:Insulin-Like Growth Factor I