title: Preoperative oral immune-enhancing nutritional supplementation corrects TH1/TH2 imbalance in patients undergoing elective surgery for colorectal cancer.
abstract: OBJECTIVE
  Recent studies have shown that the type 1/2 CD4+ T cell (Th1/Th2) balance shifts toward Th2 dominance in cancer-bearing state or by surgical stress. Perioperative immunonutrition is reported to improve the outcome in patients with gastrointestinal cancer. This study was designed to investigate whether preoperative immunonutrition corrects the impaired Th1/Th2 balance in the perioperative period.
  
  
  METHODS
  Thirty-six patients with colorectal cancer were prospectively divided into two groups as follows: preoperative oral intake supplementation with a formula enriched with arginine, omega-3 fatty acids and ribonucleic acid for five days (supplemented group; n = 19); and (control group; n = 17). Blood sampling was performed before supplementation, on the morning of surgery, and 3, 7, and 14 days postoperatively. The proportions of CD4+ T cells producing intracellular cytokines (interferon-gamma and interleukin-4) were measured by flow cytometry.
  
  
  RESULTS
  In the preoperative period, the proportions of CD4+ T cells producing interleukin-4 significantly decreased and Th1/Th2 ratio significantly increased on the morning of surgery compared with those before supplementation. In the postoperative period, the proportions of CD4+ T cells producing interferon-gamma in both groups maintained the preoperative level. The proportions of CD4+ T cells producing interleukin-4 in the control group showed a gradual increase from the preoperative level, which implies Th2 dominant shift. In contrast, the supplemented group maintained the preoperative level of Th1/Th2 ratio.
  
  
  CONCLUSIONS
  Preoperative immunonutrition corrects impaired Th1/Th2 balance in both cancer-bearing state and the postoperative period. This correction may be one of the important determinants of the clinical benefits of immunonutrition.
authors.affiliation: Surgery for Organ Function and Biologic Regulation (Department of Surgery 1), Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan. a-matsu@nms.ac.jp
authors.forename: Akihisa
authors.initials: A
authors.lastname: Matsuda
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takasaki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Hayato
authors.initials: H
authors.lastname: Kan
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuruta
authors.forename: Seiichi
authors.initials: S
authors.lastname: Shinji
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015179:Colorectal Neoplasms / Q000097:blood / Q000276:immunology* / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D019587:Dietary Supplements; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007167:Immunotherapy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D018417:Th1 Cells; D018418:Th2 Cells; D016896:Treatment Outcome
chemical_list: D016207:Cytokines