Clinical immunology
Anti-inflammatory response to early enteral immunonutrition in malnourished patients after pancreaticoduodenectomy

The aim of the study was to investigate whether the early enteral immunonutrition in comparison with standard enteral feeding affects the systemic production of pro- and anti-inflammatory cytokines in malnourished patients after pancreaticoduodenectomy. Prospective, randomized studies performed in 41 patients after pancreaticoduodenectomy receiving early enteral standard nutrition (group I, n=22) or enteral immunonutrition (group II, n=19). Cytokines and cytokine inhibitors (IL-1β, TNF-α, IL-6, IL-8, IL-10, IL-1ra, and sTNFRI) were determined before and on day 1, 3, 7, 10 and 14 after surgery using ELISA test. Patients treated with enteral immunonutrition showed elevated concentrations of IL-6 for longer periods (between day 1-14, p<0.05) and higher values than in patients receiving standard nutrition (on day 10-14: 150.5±85 and 142.3±77 pg/ml vs. 96.1±45 and 73.6±42 pg/ml, all p=0.01). The significantly higher concentrations of IL-1ra were also found in patients receiving immunonutrition (on day 7-14 respectively: 3909.2±1398.3; 4544.8±2215.2 pg/ml and 4238.2±2326.1 pg/ml in the immunonutrition-treated group vs. 2221.3±994.9; 2694.5±1223.6 and 2586.3±1105.7 pg/ml in patients receiving standard nutrition, all p= 0.01). The values for remaining cytokines did not significantly differ in the comparable groups of patients. The main factor increasing the level of cytokines on day 1 was the extensive operative trauma. The early enteral immunonutrition as compared with standard nutrition shows an immunomodulative effect on the changes in immune response after an extensive surgical trauma resulting in selective stimulation of IL-6 and IL-1ra production, but only the interleukin-1 receptor antagonist is the early sensitive marker of anti-inflammatory response to enteral immunonutrition in malnourished patients after pancreaticoduodenectomy.