Immunosupression and infection after major surgery: a nutritional deficiency.
T cell dysfunction significantly increases susceptibility to infections and organ failure after trauma or surgery (physical injury). This coincides with a persistent drop in arginine availability, a necessary amino acid for normal T cell function. Recent data led to the identification of a novel mechanism of T cell suppression caused by the depletion of arginine through the induction of arginase 1 (ARG1) in a specialized group of immature myeloid cells, now named myeloid-derived suppressor cells (MDSC). In addition to T cell dysfunction, arginine depletion leads to the decrease in nitric oxide (NO) production. Dietary therapy containing arginine at supraphysiologic concentrations along with other components such as omega-3 fat acids, antioxidants, nucleotides, and vitamin A is associated with improvement in T cell function, NO production, and a significant decrease in infection rates. The authors propose that a pathologic decrease in arginine availability is an identifiable nutrition deficiency syndrome that worsens outcomes if left untreated.
Zhu
Xinmei
X
F1264 PUH-UPMC, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Herrera
Gabriel
G
Ochoa
Juan B
JB
D001424:Bacterial Infections / Q000209:etiology / Q000276:immunology*; D004198:Disease Susceptibility; D006801:Humans; D007108:Immune Tolerance; D009102:Multiple Organ Failure / Q000276:immunology; D044623:Nutrition Therapy / Q000379:methods*; D011183:Postoperative Complications / Q000276:immunology* / Q000517:prevention & control; D013601:T-Lymphocytes / Q000276:immunology*