Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis.
Infusion of fish oil-based (n-3) lipids may influence leukocyte function and plasma lipids in critical care patients. Twenty-one patients with sepsis requiring parenteral nutrition were randomized to receive an n-3 lipid emulsion rich in eicosapentaenoic acid and docosahexaenoic acid or a conventional (n-6) lipid emulsion (index fatty acid: arachidonic acid) for 5 days. The impact on plasma-free fatty acids, mononuclear leukocyte cytokine generation, and membrane fatty acid composition was examined. Cytokine synthesis by isolated mononuclear leukocyte was elicited by endotoxin. Before the onset of lipid infusion therapy, plasma-free fatty acid concentrations were greatly increased in septic patients, with arachidonic acid by far surpassing eicosapentaenoic acid and docosahexaenoic acid, a feature maintained during conventional lipid infusion. Within 2 days of fish oil infusion, free n-3 fatty acids increased, and the n-3/n-6 ratio was reversed, with rapid incorporation of n-3 fatty acids into mononuclear leukocyte membranes. Generation of proinflammatory cytokines by mononuclear leukocytes was markedly amplified during n-6 and was suppressed during n-3 lipid application. After termination of lipid administration, free n-3 fatty acid concentrations and mononuclear leukocyte cytokine synthesis returned to preinfusion values. Use of lipid infusions might allow us to combine intravenous alimentation with differential impact on inflammatory events and immunologic functions in patients with sepsis.
Mayer
Konstantin
K
Medizinische Klinik II, Justus-Liebig-University, Giessen, Germany. Konstantin.Mayer@innere.med.uni-giessen.de
Gokorsch
Stephanie
S
Fegbeutel
Christine
C
Hattar
Katja
K
Rosseau
Simone
S
Walmrath
Dieter
D
Seeger
Werner
W
Grimminger
Friedrich
F
D016638:Critical Illness; D016207:Cytokines / Q000032:analysis / Q000096:biosynthesis*; D004281:Docosahexaenoic Acids / Q000008:administration & dosage; D015118:Eicosapentaenoic Acid / Q000008:administration & dosage; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D005395:Fish Oils / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000378:metabolism; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D012772:Shock, Septic / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome
D016207:Cytokines; D005217:Fat Emulsions, Intravenous; D005395:Fish Oils; D004281:Docosahexaenoic Acids; D015118:Eicosapentaenoic Acid