Effects of perioperative immunonutrition on cell-mediated immunity, T helper type 1 (Th1)/Th2 differentiation, and Th17 response after pancreaticoduodenectomy.
BACKGROUND
The mechanisms of immunonutrition on reducing infectious complications are still poorly understood. This prospective randomized study was designed to determine whether immunonutrition influences the following factors: cell-mediated immunity, differentiation of T helper type 1 (Th1) and Th2 cells, interleukin (IL)-17-producing CD4(+) helper T (Th17) cell response, and infectious complication rate after pancreaticoduodenectomy.


METHODS
Thirty patients who underwent pancreaticoduodenectomy were divided into 3 groups. Ten patients in the perioperative group received immune-enhancing diets enriched with arginine, omega-3 fatty acids, and RNA for 5 days before operative resection, which was prolonged after operative resection by enteral infusion. Ten patients in the postoperative group received early postoperative enteral infusion of the same enriched formula with no artificial nutrition before operative resection. Ten patients in the control group received total parenteral nutrition postoperatively. The primary endpoint was immune responses; the secondary endpoint was the rate of infectious complications.


RESULTS
Concanavalin A (Con A)- or phytohemagglutinin (PHA)-stimulated lymphocyte proliferation and natural killer cell activity were significantly higher in the perioperative group than in the other groups. Messenger RNA (mRNA) expression levels of T-bet, interferon-gamma (IFN-gamma), related orphan receptor gammat (RORgammat), and interleukin-17F (IL-17F) were significantly higher in the perioperative group than in the other groups. In the perioperative group, the rate of infectious complications was significantly reduced compared with that in the other groups.


CONCLUSIONS
Perioperative immunonutrition reduced stress-induced immunosuppression after a major stressful operative resection. The modulation of Th1/Th2 differentiation and Th17 response may play important roles in this immunologic effect.
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Daisuke
D
Suzuki
Katsunori
K
Furukawa
Fumio
F
Kimura
Hiroaki
H
Shimizu
Hiroyuki
H
Yoshidome
Masayuki
M
Ohtsuka
Atsushi
A
Kato
Hideyuki
H
Yoshitomi
Masaru
M
Miyazaki
D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D002454:Cell Differentiation; D003208:Concanavalin A / Q000494:pharmacology; D004032:Diet; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology*; D007165:Immunosuppression Therapy / Q000379:methods; D007371:Interferon-gamma / Q000235:genetics; D007430:Intraoperative Care; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010835:Phytohemagglutinins / Q000494:pharmacology; D011300:Preoperative Care; D012313:RNA / Q000627:therapeutic use; D012333:RNA, Messenger / Q000235:genetics; D018417:Th1 Cells / Q000166:cytology / Q000276:immunology*; D018418:Th2 Cells / Q000166:cytology / Q000276:immunology*
D015525:Fatty Acids, Omega-3; D010835:Phytohemagglutinins; D012333:RNA, Messenger; D003208:Concanavalin A; D012313:RNA; D007371:Interferon-gamma; D001120:Arginine