Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients

Sun, Jianfang; Zhang, Wenhao; Chen, Wenxiu; Wang, Xiang; Mu, Xinwei

doi:10.3748/wjg.v25.i22.2799

Cited by 28 publications

(45 citation statements)

References 20 publications

(46 reference statements)

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“…As an essential treatment for sepsis, enteral nutrition (EN), especially early enteral nutrition (EEN), could improve immunologic imbalance and alleviate the intestinal barrier injury of patients in intensive care units (ICUs)[ 6 - 9 ]. Our previous clinical studies also confirmed that EEN could regulate the excessive immune response and improve the clinical severity of critically ill patients[ 10 , 11 ]. However, recent trials suggested that aggressive nutrition delivery may offer no benefit in the early stages of critical illness[ 12 - 17 ].…”

Section: Introductionsupporting

confidence: 63%

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

Sun¹,

Nie²,

Chen³

et al. 2021

WJG

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BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis. METHODS Patients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded. RESULTS A total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) ( P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A ( P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B ( P < 0.05) on the 7 th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups. CONCLUSION Early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.

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Section: Introductionsupporting

confidence: 63%

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

Sun¹,

Nie²,

Chen³

et al. 2021

WJG

Self Cite

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“…Acute intestinal barrier damage and systemic infection are a vicious cycle in critical diseases, especially in sepsis [ 1 , 19 , 20 ]. Our previous studies showed that T helper lymphocytes were associated with gastrointestinal injury and immune dysregulation in sepsis [ 20 , 21 ]. In addition to the conventional Th1/Th2 and Th17/Treg lymphocytes, Th9 cells also contribute to chronic intestinal and airway inflammation [ 7 – 10 , 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Interleukin-9 promotes intestinal barrier injury of sepsis: a translational research

et al. 2021

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Background Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Intestinal mucosal barrier injury is one of the important manifestations of sepsis. Interleukin-9 (IL-9) and IL-9-producing CD4(+) T cells were emerging pro-inflammatory mediators with development of intestinal injury. However, it is unclear whether IL-9 is related to the intestinal barrier injury of sepsis. Methods To investigate the roles of IL-9-producing CD4(+) T cells and IL-9 in the process of barrier injury in sepsis, serum IL-9-producing CD4(+) T cell percentages, IL-9, and D-lactate levels were measured in septic patients and controls. The markers of barrier function in serum and intestinal tissue were also collected in septic rats. Moreover, the barrier injury degree and survival rate of septic rats were also investigated after increasing or interfering with IL-9 expression. Results The serum IL-9-producing CD4(+) T cell percentages, IL-9, and D-lactate levels were significantly higher in septic patients or rats than those in controls. IL-9-producing CD4(+) T cells and IL-9 levels were positively correlated with D-lactate levels and had a high predictive value of 28-day mortality in septic patients. The non-survivors had significantly higher serum T cell percentages, IL-9, and D-lactate levels compared with survivors. In septic rats, IL-9 increased the expression levels of D-lactate, whereas that decreased the expression levels of zonula occludens 1. Moreover, the barrier injury was aggravated or alleviated by increasing or interfering with IL-9 expression, respectively. Survival rate analysis also showed that IL-9 decreased the 14-day survival rate of septic rats. Conclusion IL-9 is closely related to intestinal mucosal barrier injury and mortality in sepsis. IL-9 blockade has the potential to improve the barrier injury in sepsis. Trial registration The study was registered at ClinicalTrials.gov (ID: NCT03791866, Date: December 2018).

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“…The other previous studies have shown that T lymphocytes participate in lung injury by releasing a variety of inflammatory mediators in sepsis and Th17 cells participate in the initiation/amplification of lung inflammation, which plays an important role in ALI induced by LPS [24]. A clinical study on sepsis has demonstrated that regulating the proportion of Th17/ Treg cells can reduce the release of IL-23 and IL-17 and reduce the clinical severity of sepsis [25]. It is well known that IL-6 is a very important inflammatory factor in sepsis and an independent risk factor for prognosis [26].…”

Section: Discussionmentioning

confidence: 99%

Influences of Regulation of miR-126 on Inflammation,Th17/Treg Subpopulation Differentiation, and Lymphocyte Apoptosis through Caspase Signaling Pathway in Sepsis

Zou

Yang

et al. 2020

Inflammation

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To observe the inflammatory response, differentiation of Th17/Treg subsets and apoptosis of lymphocytes, by regulating miR-126 in lymphocytes of septic rats. After using cecal ligation and puncture to establish sepsis model, miR-126 mimic and miR-126 inhibitor were used to transfect lymphocytes of septic rats in vitro and in vivo. ELISA was used to detect TNF-α, IL-6, IL-17, and IL-10, the differentiation of Th17 and Treg was measured by flow cytometry, and apoptosis of lymphocytes was observed by fluorescence microscope; the changes of caspase signaling pathway were detected by immunofluorescence, PCR, and Western blotting. The result show that the expression of miR-126 increased in sepsis. After overexpression of miR-126, the release of TNF-α, IL-6, and IL-17 decreased; the release of IL-10 increased; T lymphocyte subsets differentiated toward Treg; caspase signaling pathway weakened; and lymphocyte of apoptosis decreased compared with sepsis group. While, after inhibition of miR-126, the release of TNF-α, IL-6, and IL-17 increased; the release of IL-10 decreased; T lymphocyte subsets differentiated toward TH17; caspase signaling pathway enhanced; and lymphocyte of apoptosis increased compared with sepsis group. Taken together, regulation of miR-126 can alter the inflammatory response, differentiation of T lymphocyte subsets, and apoptosis of lymphocytes in septic rats.

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Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients

Cited by 28 publications

References 20 publications

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

Interleukin-9 promotes intestinal barrier injury of sepsis: a translational research

Influences of Regulation of miR-126 on Inflammation,Th17/Treg Subpopulation Differentiation, and Lymphocyte Apoptosis through Caspase Signaling Pathway in Sepsis

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