Enteral Immunonutrition with Long Chain Triglycerides Significantly Reduces the Recruitment of Immune Cells Into the Liver During Experimental Sepsis
Maximilian Feilitzsch*, Theo Maier, Judith Junginger, Tobias Meile, Markus a. Kueper, Alfred Koenigsrainer, Jorg Glatzle
General and Transplant Surgery, University of Tuebingen, Tuebingen, Germany
Background: There is strong evidence that hepatocellular injury during sepsis is initiated by inflammatory processes originated by both activated Kupffer cells and circulating blood cells which become adherent within the endotoxemic liverRecently, we have shown, that an enteral immunonutrition with long chain triglycerides significantly reduced lung injury during sepsis (Glatzle et al J. Gastrointest. Surg. 2007). Aim: To investigate, whether an enteral immunonutrition with long chain triglycerides reduces inflammatory response in the liver during sepsis.
Methods: Mesenteric lymph was obtained from lymph fistula donor rats under control conditions (n=6, control lymph, CL) or during sepsis (n=6, LPS, 5mg/kg i.p., sepsis lymph, SL). Sepsis lymph was also collected during enteral immunonutrition with 1% olive oil (n=6, SL-OO) or 1% of fish oil (n=6, SL-FO). CL, SL, SL-OO, SL-FO were re-infused into the jugular vein of separate healthy recipient rats (n=4 each group). Thereafter, liver tissue was collected and the number of Kupffer cells (ED2) or recruited macrophages (ED1) were analyzed at t=90 and t=180min (n=30 optical sections per rat).
Results: The release of TNFa from the gastrointestinal tract into mesenteric lymph was up to 200fold increased during sepsis. Infusion of sepsis lymph into separate recipient rats increased the number of ED1 positive cells by more than twice at t=180min, whereas no changes were observed after 90 min. Infusion of sepsis lymph did not change the number of ED2 positive cells in the liver of recipient rats. Interestingly, infusion of sepsis lymph collected during an enteral immunonutrition with either olive oil or fish oil, significantly reduced the number of recruited ED1 positive macrophages into the liver by more than 30% and 40% respectively (ED1 positive cells/optical field, t=180min: CL: 0.89±0.09, SL: 1.8±0.1*, SL-OO: 1.2±0.1#, SL-FO: 1.0±0.07#, *p<0.001vs. CL, #p<0.001 vs. SL).
Conclusion: An enteral immunonutrition with long chain triglycerides during sepsis reduces inflammatory mediator release from the gastrointestinal tract and has a protective effect regarding inflammatory response of the liver during sepsis.
