Enteral immunonutrition during sepsis prevents pulmonary dysfunction in a rat model.
BACKGROUND
Sepsis often results in severe pulmonary dysfunction. Via the thoracic duct, the lung is the first organ exposed to gut-derived inflammatory mediators released into mesenteric lymph during sepsis.


OBJECTIVE
To investigate whether an enteral immunonutrition during sepsis improves pulmonary function.


METHODS
Mesenteric lymph was obtained from lymph fistula donor rats after intra peritoneal (i.p.) saline (control lymph) or lipopolysaccharide (sepsis lymph) injection. Sepsis lymph was also collected during enteral immunonutrition with omega-3 enriched, long-chain fatty acids (SMOF lipid). Control, sepsis, or sepsis-SMOF lymph was reinfused into the jugular vein of separate recipient rats. The lungs were then harvested, stained with hematoxylin-eosin, and analyzed for: (1) perpendicular parenchyma thickness of the alveolar wall; (2) myeloperoxidase-positive cells; and (3) terminal deoxynucleotidyl transferase Biotin-dUTP nick end labeling (TUNEL)-positive cells.


RESULTS
Enteral immunonutrition during sepsis reduced the release of TNFalpha into mesenteric lymph by about 4.5-fold within the first 2 h. Infusion of sepsis lymph into recipient rats induced thickening of alveolar walls, inflammatory reaction, and apoptosis. Infusion of sepsis lymph obtained during enteral immunonutrition did not cause anatomical changes, induced only a mild inflammatory reaction, and prevented apoptosis in the lungs of recipient rats.


CONCLUSIONS
Mediators in sepsis lymph induce pulmonary dysfunction such as an increased distance for oxygen transport, inflammatory reaction, and apoptosis. The lung may be protected by an enteral immunonutrition containing long-chain fatty acids.
Glatzle
Joerg
J
Department of General and Transplantation Surgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. joerg.glatzle@med.uni-tuebingen.de
Kasparek
Michael S
MS
Mueller
Mario H
MH
Binder
Fiedrich
F
Meile
Tobias
T
Kreis
Martin E
ME
Konigsrainer
Alfred
A
Steurer
Wolfgang
W
D000818:Animals; D004195:Disease Models, Animal; D004750:Enteral Nutrition / Q000379:methods*; D015525:Fatty Acids, Omega-3 / Q000032:analysis / Q000276:immunology*; D005395:Fish Oils / Q000627:therapeutic use; D008168:Lung / Q000473:pathology; D008196:Lymph / Q000737:chemistry / Q000276:immunology; D008297:Male; D008643:Mesentery; D000069463:Olive Oil; D010938:Plant Oils / Q000627:therapeutic use; D011665:Pulmonary Valve Insufficiency / Q000276:immunology* / Q000473:pathology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D018805:Sepsis / Q000150:complications / Q000276:immunology*; D013024:Soybean Oil / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D000069463:Olive Oil; D010938:Plant Oils; D014409:Tumor Necrosis Factor-alpha; D013024:Soybean Oil