title: Correlation of deglutition in subacute ischemic stroke patients with peripheral blood adaptive immunity: Essential amino acid improvement.
abstract: We aimed to document in stroke patients peripheral blood immune cell profiles, their relations with neuro-functional tests, and any possible influence of supplemented essential amino acids (EAAs) may have on both the immune system and the relationship of the latter with neuro-function.Forty-two dysphagic stroke patients (27 men; 71±9 years) underwent bio-humoral measurements, neuro-functional tests, including Functional Independence Measure (FIM) and Dysphagia Outcome and Severity Scale (DOSS), and were randomized to receive EAAs 8 g/d (EAA group) or isocaloric maltodextrin (placebo group).At discharge all measurements were repeated 38±1 days after randomization.At admission, total white cell (TWC), neutrophil (N), and lymphocyte (Lymph) counts were normal and the N/Lymph ratio was higher than normal values (<3.0). At discharge, both TWC and N decreased while Lymph increased significantly. As a result, the N/Lymph ratio significantly decreased (P <0.001) returning to normal levels. Absolute Lymph counts and Lymph % TWC correlated positively with DOSS (r = +0.235, P = 0.04 and r = +0.224, P = 0.05, respectively), negatively with C-reactive protein natural logarithm (ln CRP) (P = 0.02 and P = 0.0001, respectively), which is an inflammation marker. N correlated positively with ln CRP (P = 0.001) and had a slight negative association with FIM (P = 0.07). The N/Lymph ratio was inversely related to FIM (r = -0.262, P = 0.02) and DOSS (r = -0.279, P = 0.01). Finally, FIM correlated with DOSS (r = +0.35, P = 0.05).For the regression analysis, the overtime changes of Lymph % TWC correlated significantly with DOSS (P = 0.01). There was a positive correlation between Lymph % TWC and DOSS for the entire stroke population (P = 0.015). While this correlation was not important for the placebo group (P = 0.27), it was significant in the EAA subgroup (P = 0.018).In the sub-acute stroke stage, there may be slight alterations of peripheral blood immune cells. Lymph cells are associated with improved neuro-function tests with evidence that this association is enhanced by supplementing EAAs.
authors.affiliation: Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani", Università degli Studi di Pavia, Pavia (PV), Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Aquilani
authors.affiliation: Centro Medico di Nervi, Fondazione S. Maugeri, IRCCS, Nervi (GE), Italy.
authors.forename: Benevolo
authors.initials: B
authors.lastname: Emilio
authors.affiliation: Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani", Università degli Studi di Pavia, Pavia (PV), Italy.
authors.forename: Maurizia
authors.initials: M
authors.lastname: Dossena
authors.affiliation: Direzione Scientifica Centrale, Fondazione S. Maugeri, IRCCS, Pavia (PV), Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Baiardi
authors.affiliation: Centro Riabilitativo "E. Spalenza, Fondazione Don Gnocchi", Rovato (BS), Italy.
authors.forename: Amidio
authors.initials: A
authors.lastname: Testa
authors.affiliation: Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia (PV), Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Boschi
authors.affiliation: Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia (PV), Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Viglio
authors.affiliation: Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani", Università degli Studi di Pavia, Pavia (PV), Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Iadarola
authors.affiliation: Istituto Scientifico di Lumezzane (Brescia) Fondazione S. Maugeri, IRCCS, Lumezzane, Brescia, Italy.
authors.forename: Evasio
authors.initials: E
authors.lastname: Pasini
authors.affiliation: Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani", Università degli Studi di Pavia, Pavia (PV), Italy manuela.verri@unipv.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Verri
mesh_terms: D056704:Adaptive Immunity; D000368:Aged; D000601:Amino Acids, Essential / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000276:immunology* / Q000503:physiopathology; D002097:C-Reactive Protein / Q000032:analysis; D003679:Deglutition / Q000502:physiology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000276:immunology* / Q000503:physiopathology
chemical_list: D000601:Amino Acids, Essential; D002097:C-Reactive Protein
keywords: dysphagia; essential amino acids; immune system; sub-acute stroke