Can the interleukin-1 receptor antagonist (IL-1ra) be a marker of anti-inflammatory response to enteral immunonutrition in malnourished patients after pancreaticoduodenectomy?
OBJECTIVE
To investigate whether early enteral immunonutrition in comparison with standard enteral feeding affects the systemic production of pro- and anti-inflammatory cytokines in malnourished patients after pancreaticoduodenectomy with an uneventful postoperative course.


METHODS
Prospective, randomized study.


METHODS
Forty-one patients who had undergone pancreaticoduodenectomy.


METHODS
Patients received early enteral standard nutrition (No. 22) or enteral immunonutrition (No. 19).


METHODS
Cytokines and cytokine inhibitors (IL-1 beta, TNF-alpha, IL-6, IL-8, IL-10, IL-1ra, and sTNFRI) were determined before and on days 1, 3, 7, 10 and 14 after surgery using the ELISA test.


RESULTS
Serum concentrations of IL-1ra in the early post-operative period were significantly higher in patients treated with enteral immunonutrition than in those treated with the standard diet (day 7: P<0.001; day 10: P=0.002; day 14: P=0.005). Similar results were observed for IL-6 (day 10: P=0.017; day 14: P=0.001), IL-8 (day 1: P=0.011; days 3, 7, 10, and 14: P<0.001) and IL-10 (days 3 and 10: P<0.001) whereas the post-operative levels of IL-1 beta (day 7: P<0.001; day 14: P=0.022) and TNF-alpha (day 3: P=0.006; day 7: P<0.001) were significantly higher in patients with standard enteral nutrition.


CONCLUSIONS
Early enteral immunonutrition as compared to standard nutrition has an immunomodulative effect on the changes in the immune response after extensive surgical trauma resulting in the selective stimulation of cytokines and cytokine inhibitors. The interleukin-1 receptor antagonist is the earliest sensitive marker of anti-inflammatory response to enteral immunonutrition in malnourished patients after pancreaticoduodenectomy.
Slotwinski
Robert
R
Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland. slotwinski@cmdik.pan.pl
Olszewski
Waldemar L
WL
Slotkowski
Maciej
M
Lech
Gustaw
G
Zaleska
Marzena
M
Slotwinska
Sylwia M
SM
Krasnodebski
Wojciech I
WI
D000368:Aged; D015415:Biomarkers / Q000097:blood; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology* / Q000276:immunology; D053590:Interleukin 1 Receptor Antagonist Protein / Q000097:blood*; D016753:Interleukin-10 / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000178:diet therapy* / Q000209:etiology*; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015415:Biomarkers; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10