Immune stimulation using lipid emulsions during total parenteral nutrition (TPN)

Immune stimulation using lipid emulsions during total parenteral nutrition (TPN)

0.1 IMWNE STIMULATION USINGLIPIDEMULSIONSCURINS'IWTAL PAEENI'EBAL WlWTION (TPN) JRTMonson, CWFmmden, J Macfie,TG EWennan,RJGuillou Depar6t~sUrgery, S...

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0.1

IMWNE STIMULATION USINGLIPIDEMULSIONSCURINS'IWTAL PAEENI'EBAL WlWTION (TPN) JRTMonson, CWFmmden, J Macfie,TG EWennan,RJGuillou Depar6t~sUrgery, St. James'sUniversity MOSpitaI, Leeds, U.K. To investigatethe suggestion that lipid glpllsionsrender patients susceptibleto sepsis by depressing tilogioal function, we have performed a prospeotive 14 day cross-over study axrparing the effect of lipid based TPN on lynphooyteand killer cell function (ACCYZ) with that of a oarbohydratebased regirman. 23 patientswererandanly allocated to receive one of tko alternative equioaloricTpN regimens for the first 7 days and then the other for the second 7 days. Only one of these regimans included continuous infusion of a fat mlsion (TPN-L)as 50% of the calorie requirmts. W&=Yte proliferation,ADCC function, peripheral blood 'P-oellsubsets and lynphokinineproduction (interleukin-2)were measured on days 0, 7 and 14. hman+m) AIXX aZtivity (lvtic units)

TPN-LWly 0) 57.6 + 12.3 659

+ 95.7

TPN-L(Day 7) TFW-c(Day 0) 101.9 -+ 21.7 82.7 + 20.5

TPWc(Day7) 78'2 12.1

1134 + 115.1 1178 + 206.2

932 2 124.5

Basal IL-2 prod 16.6 2 (units/ml)

3.6

46.6 + 11.6

40.6 -+ 11.2

26.2 +

Max IL-2 prod (units/ml)

9

90.6 -+ 15.7

74.6 2 11.2

66.9 -+ 20.9

40.6 +

7.7

There vzxsa statisticallysignificant ('t' test) inprOVefIM?nt in XICC activity (p < 0.051, total T-lyxphooyte numbers (p < 0.02) and basal (p < 0.02) ard nexirml (p < 0.01) lyaphokinineproduotion during the lipid-basedTPN-L. No inprovenrantwasdeteotedduring TPN-C. These results suggest that far fran bein imnunosuppressive,lipid esxrlsions are inmuxrstinnrlatory in contrast to glucose alone. We conclude that lipidemlsions should be employedas an energysourcein TPN regions since they may reduce septic cxxaplioations by stinnilation of the inrnunesystem.

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EFFECTS OF INTRALIPID AND HEPARIN ON NEUTROPHIL (PMN) FUNCTIONS DURING TOTAL PARENTERAL NUTRITION (TPN). B. Escudier*, E. Escudier**,E. Mina**, B. Leclercq*, J.F. Bernaudin**,G. Nitenbergs l Institut Gustave-Roussy,94805 Villejuif, FRANCE. ** LHPD, Faculte de MQdecine, 94000 Cr&eil, FRANCE. TPN is widely used in the management of cancer patients. Previous studies have suggested that Intralipid (IL), which constitutes an essential part of TPN, might compromise human host defences, mainly by impairment of PMN functions. Heparin could also modify PMN functions. The aim of this study was to separate the effects of IL and heparin on various leucocyte functions during TPN. 16 cancer patients (mean : 58 + 10 years) witholt metastasis or sepsis were studied. Patients were randomized in two b-patient groups receiving either heparin (150 UI/Kg/day), either no heparin. TPN was administered via a central venous catheter ; the non proteic calorie intake was given in 60 g by glucose and in 40 % by IL (infusion rate : 85 ml/h). Aminoacids were given in order to provide 1 g nitrogen per 150 calories. PMN functions were assessed before, 3, 6 and 24 hours after the start of IL infusion. Leucocytes were isolated from titrated blood by sedimentationin dextran radioselectangradient. Random migration and chemotaxis of PMN were measured under agarose. The cytotoxins used were Formyl Methionyl Leucyl Phenylalanine,autologous serum and pooled human AB serum. PMN phagocytosiswas investigated with chemiluminescenceproduced by Phorbol-Myristate-Acetate. Presence of fat particles was searched by light microscopy on smears stained with oil-red 0 (Soudan II). Prior to therapy PMN functions in the 16 patients were within the normal range. No significant change in the PMN functions tested was observed in each group during and after IL infusion when compared with the basal state. No accumulation of fat pigments was found in the PMN cytoplasms during IL infusion. The 2 groups were not statistically different. These results show that : 1) The PMN functions are unchanged during 20 % IL infusion with a 85 ml/h infusion rate ; 2) Additional administration of low-dose heparin during TPN does not alter the PMN functions. 41