Search Article Keyword:  

PubMed Submission Abstract PDF Feed Back Count: 3252 Download Count: 1129 

ISSN 1007-9327 CN 14-1219/R  World J Gastroenterol  2008 April 21;14(15): 2434-2439
                                                                                                                                         
    RAPID COMMUNICATION
Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and
immunomodulations in colorectal cancer patients


Bin Liang, Shan Wang, Ying-Jiang Ye, Xiao-Dong Yang, You-Li Wang, Jun Qu, Qi-Wei Xie, Mu-Jun Yin


Bin Liang, Shan Wang, Ying-Jiang Ye, Xiao-Dong Yang, You-Li Wang, Jun Qu, Qi-Wei Xie, Mu-Jun Yin, Division of Surgical Oncology and Division of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China

Author contributions: Liang B and Wang S contributed equally to this work; Liang B and Wang S designed the research; Liang B, Ye YJ, Yang XD, Wang YL, Qu J, Xie QW, Yin MJ performed the research and collected the data; Wang S and Ye YJ supervised the research; Liang B and Ye YJ analyzed the data; Liang B wrote the paper and revised the manuscript.

Correspondence to: Shan Wang, Professor, Division of Gas-troenterological Surgery, Peking University People’s Hospital, Beijing 100044, China. dr.wangshan@yahoo.com.cn

Telephone: +86-10-88326806  Fax: +86-10-88326808

Received: November 10, 2007   Revised: January 30, 2008

 

Abstract

AIM: To investigate the effect of omega-3 fatty acid parenteral supplementation postoperatively on clinical outcomes and immunomodulation in colorectal cancer patients.

 

METHODS: Forty-two patients undergoing radical colorectal cancer resection with an indication for total parenteral nutrition postoperatively were enrolled in this prospective, double-blind, randomized, controlled study. Patients received total parenteral nutrition supplemented with either soybean oil (LCT; Intralipid®, Fresenius-Kabi, SO group, n = 21) or a combination of omega-3 fish oil and soybean oil (LCT:fish oil = 5:1, fish oil; Omegaven®, Fresenius-Kabi, FO group, n = 21), up to a total of 1.2 g lipid/kg per day for 7 d postoperatively. A same volume calorie and nitrogen was administrated. Routine blood test, biochemistry, systemic levels of IL-6 and TNF-a, percentage of CD3+, CD4+, and CD8+ lymphocytes were evaluated preoperatively and on postoperative d 1 and 8. Patient outcome was evaluated considering mortality during the hospital stay, length of postoperative hospital stay, and occurrence of infectious complications.

 

RESULTS: Both lipid regimens were well tolerated. No differences between the two groups were noticed in demographics, baseline blood test, biochemistry, serum levels of IL-6 and TNF-a, percentage of CD4+, CD8+ lymphocytes, and ratios of CD4+/CD8+. Compared with those on postoperative d 1, serum IL-6 levels on postoperative d 8 were significantly depressed in the FO group than in the reference group (-44.43 ± 30.53 vs -8.39 ± 69.08, P = 0.039). Simultaneously, the ratios of CD4+/CD8+ were significantly increased in the FO group (0.92 ± 0.62 vs 0.25 ± 1.22, P = 0.035). In addition, depression of serum TNF-a levels (-0.82 ± 2.71 vs 0.27 ± 1.67, P = 0.125) and elevation of CD3+ and CD4+ lymphocyte percentage (12.85 ± 11.61 vs 3.84 ± 19.62, P = 0.081, 17.80 ± 10.86 vs 9.66 ± 17.55, P = 0.084, respectively) were higher in the FO group than in the reference group. Patients in the FO group trended to need a shorter postoperative hospital stay (17.45 ± 4.80 d
vs 19.62 ± 5.59 d, P = 0.19). No statistically significant difference was found when stratified to mortality and occurrence of infectious complications.

 

CONCLUSION: Postoperative supplementation of omega-3 fatty acids may have a favorable effect on the outcomes in colorectal cancer patients undergoing radical resection by lowering the magnitude of inflammatory responses and modulating the immune response.

 

© 2008 WJG. All rights reserved.

 

Key words: Colorectal cancer; Parenteral nutrition; Omega-3 fatty acids; Immunomodulation; Abdominal surgery

 

Peer reviewer: Reinhold W Stockbrugger, Professor, Department of Gastroenterology and Hepatology, University Hospital Maastricht, Debyelaan 25, Maastricht NL-6206 AZ, The Netherlands

 

Liang B, Wang S, Ye YJ, Yang XD, Wang YL, Qu J, Xie QW, Yin MJ. Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients. World J Gastroenterol 2008; 14(15): 2434-2439  Available from: URL: http://www.wjgnet.com/1007-9327/14/2434.asp  DOI: http://dx.doi.org/10.3748/wjg.14.2434

 

INTRODUCTION

Lipid emulsions are regularly used postoperatively to supply energy and essential fatty acids[1]. Recently, the pharmacological role of fatty acid and omega-3 polyunsaturated fatty acid (PUFA) deficiency in colorectal cancer patients has been appreciated[2]. Conventional lipid soybean oil emulsions contain a very large amount of linoleic acid (LA; 18: 2n-6) and a relatively low amount of -linolenic acid (LNA; 18: 3n-3). Arachidonic acid (AA, C20: 4n-6), derived from linoleic acid, is metabolized by cyclo-oxygenase and lipo-oxygenase pathway to pro-inflammatory mediators, such as prostaglandin, thromboxane, and leukotriene. Omega-3 long-chain polyunsaturated fatty acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which can compete with AA for the production of less inflammatory active eicosanoid, are absent in these vegetable oils[3,4]. Therefore, omega-3 fatty acids should be added directly into lipid emulsions to suppress the system inflammatory response and to decrease the risk of postoperative thrombosis. Recently, supplementation with fish oil is supposed to improve standard clinical therapy for chronic hyper-inflammatory diseases such as Crohn’ disease[1,5], rheumatoid arthritis[6], cancer cachexia[7,8], and as an adjunct therapeutic measure for trauma, injure, and sepsis[2,9-12]. Although several studies have demonstrated the beneficial effects of omega-3 fatty acid supplementation on patient outcome or immune competence, randomized controlled clinical trials focusing on the use of parenteral fish oil are scarce[13-17]. The aim of this study was to assess whether parenteral supplementation of omega-3 fatty acid postoperatively improves the inflammatory and immunological function of colorectal cancer patients and their clinical outcomes.

 

MATERIALS AND METHODS

Patients

Forty-two patients with colon or rectal cancer staging TNMⅠ-Ⅲ undergoing radical resection, who gave their written, informed consent to participate in the study, were prospectively enrolled consecutively from May 2002 to October 2003. After operation, 41 patients were randomly assigned to receive total parenteral nutrition (TPN) supplemented with either soybean oil (SO) or SO + fish oil (FO) emulsion, one patient withdrew because of the unresectable disease. The clinical characteristics of the two groups of patients are summarized in Table 1.

 

Exclusion criteria

Exclusion criteria were: (1) age < 18 or > 70 years; (2) body mass index (BMI) < 16 or > 30; (3) diabetes mellitus; (4) hypertriglyceridemia (> 200 mg/dL) or hypercholesteremia (> 240 mg/dL); (5) abnormal liver function (ALT>60 IU/L or total bilirubin > 1.2 mg/dL); (6) abnormal renal function (serum creatinine > 1.6 mg/dL or BUN > 30 mg/dL); (7) post-splenectomy; (8) endocrine diseases, such as hyperthyroidism, hyperadrenocorticism, or medication with thyroxine, corticoids or other immunomodulators; (9) pregnancy or breast-feeding; (10) early chemotherapy or radiotherapy before postoperative d 8.

 

Interventions

Patients were assigned to respective groups by computer-derived block randomization. The pharmacist was the only person who was aware of the randomization list. Both the patients and the investigators were, thus, unaware of the infused drug. Postoperatively, all patients received TPN for consecutive 7 d, as shown in Table 2, through an indwelling central venous catheter or peripheral catheter. Glucose, amino acids, SO emulsion, fat- and water- soluble vitamins as well as trace elements were provided to both groups by infusion pumps for 16-20 h daily in an “All-In-One” manner. In the FO group, the omega-6 lipid content of TPN was partially replaced by omega-3 PUFA (Omegaven, Fresenius-Kabi) up to 0.2 g/kg body weight daily. Thus, in the FO group, the omega-3/omega-6 ratio was 1:3. Calculated on body mass, the nutrition in both groups was isonitrogenous and isocaloric.

 

Blood samples and analytical methods

For laboratory measurements, 12 mL of whole blood (8 mL serum, 4 mL EDTA) was withdrawn before breakfast in the morning before operation (POD-1) and on the first and eighth days after the operation (POD+1, POD+8). Routine blood test and biochemistry analysis were immediately performed at the Department of Clinical Chemistry, Peking University People’s Hospital according to standard procedures. Serum vials for analysis of cytokines such as IL-6 and TNF- were separated and kept at 2-8 and measured in 24 h. For quantitative detection of IL-6 and TNF-, enzyme immunoassays were performed according to the manufacturer’s instructions with IL-6 or TNF- enzyme-linked immunosorbent assay (ELISA) kit commercially available from R&D Systems (Minneapolis, MN, USA). Percentage of CD3+, CD4+, and CD8+ lymphocytes was analyzed by flow cytometry (COULTER EPICS ELITE ESP, USA). Fluorescence- labeled antibodies were purchased from BD (Franklin Lakes, NJ, USA) and flow-check fluorospheres were obtained from Beckman-Coulter (Fullerton, CA, USA). Cytokines and percentage of CD3+, CD4+, and CD8+ lymphocytes were analyzed at the Department of Clinical Chemistry, Peking Union Medical College Hospital.

Outcomes of the patients were evaluated considering mortality during the hospital stay, length of postoperative hospital stay, and occurrence of infectious complications.

 

Statistical analysis

Data were expressed as mean ± SD and tested for statistical significance using the software SPSS (version 10.0). Analysis of variance or Student’s t-test or chi-square test was used in statistical analyses. P < 0.05 was considered statistically significant.

 

RESULTS

Clinical characteristics of patients

Only one patient withdrew from the study because of the unresectable disease, whereas 41 patients completed the study, without changes in medication. There were no statistically significant differences between the two groups of patients at entry concerning the clinical characteristics (Table 1). Blood test, biochemistry, serum levels of IL-6 and TNF-, percentage of CD4+, CD8+ lymphocytes, and ratios of CD4+/CD8+ are shown in Tables 3 and 4. Both lipid regimens were well tolerated with no adverse events in terms of bleeding complication.

 

Clinical outcomes

No death occurred in both groups during the hospital stay, and only one case had incision infection in each group. Therefore, no statistical significant difference was found when stratified to death and occurrence of infectious complications. Although patients in the FO group trended to need a shorter postoperative hospital stay, no statistically significant difference was found (17.45 ± 4.80 d vs 19.62 ± 5.59 d, P = 0.19).

 

Laboratory parameters

Seven days after parenteral nutrition, no statistically significant difference was observed with respect to routine blood test and biochemical evaluation. White blood cell count and serum level of -GT in the FO group were lower than those in the SO group (Table 3). Compared with POD+1, serum IL-6 levels on POD+8 were significantly lower in group FO than in reference group (Table 4, -44.43 ± 30.53 vs -8.39 ± 69.08, P = 0.039). Simultaneously, the ratios of CD4+/CD8+ were significantly increased in the FO group (Table 5, 0.92 ± 0.62 vs 0.25 ± 1.22, P = 0.035) compared with the reference group. In addition, depression of serum TNF- levels (-0.82 ± 2.71 vs 0.27 ± 1.67, P = 0.125) and elevation of CD3+ and CD4+ lymphocyte percentage (12.85 ± 11.61 vs 3.84 ± 19.62, P = 0.081, 17.80 ± 10.86 vs 9.66 ± 17.55, P = 0.084, respectively) were higher in the FO group than in the reference group (Tables 4 and 6).

 

DISCUSSION

To obtain a homogenous population, we selected patients with colorectal cancer staging TNM- to undergo radical resection. Patients were enrolled consecutively and randomly assigned to receive TPN supplemented with either SO or SO + FO emulsion. There were no statistically significant differences between the two groups at entry.

It was reported that reduction in platelet aggregation can be modified by increasing omega-3 long-chain fatty acid content of platelet phospholipids in humans[18]. In a randomized, controlled double-blind study, Heller AR and colleagues[19,20] demonstrated that no coagulation and platelet abnormalities are evoked by fish oil supplementation as high as 0.2 g/kg per day for five postoperative days. In the present study, the change in platelet counts showed no statistical difference between the two groups. Neither bleeding complication nor other adverse events were observed. This is in line with the notion that a short-term parenteral administration of omega-3 fish oil is safe[9,21]. In addition, our results demonstrate that the serum level of -GT on POD+8 in the FO group was lower than that in the SO group. Heller AR et al[20] found that after a major abdominal tumor surgery, fish oil supplementation could improve liver and pancreas function. Animal experiments have demonstrated improved perfusion and fewer translocations of viable bacteria from the gut into the mesenteric lymph nodes and liver after omega-3 fatty acid infusion in rats[22,23]. Therefore, our results suggest that parenteral nutrition supplemented with omega-3 fish oil might protect liver function after a major abdominal operation in colorectal cancer patients.

Omega-3 and -6 PUFAs are essential for humans and must be nutritionally provided. Recently, omega-3 PUFA deficiency has been recognized and appreciated[2]. After intravenous administration, EPA and docosahexaenoic acid (DHA) promptly incorporate into the cell membrane, compete with arachidonic acid (AA) in the cyclooxygenase and 5-lipoxygenase pathways, resulting in a reduced generation of diene prostanoids (e.g. PGE2, PGI2, TXA2) and tetraene leukotrienes (e.g. LTB4), derived from AA in favor of the corresponding triene prostanoids (e.g. PGE3, PGI3, TXA3) and pentaene leukotriene (LTB5) derived from EPA[13,24]. In a randomized controlled trial, Köller et al[17] demonstrated that release of 5-series leukotrienes from isolated leukocytes stimulated with Ca-ionophore is increased in patients receiving fish oil. Leukotrienes have numerous effects on inflammatory and immune functions, such as leucocyte-endothelial interaction, lymphocyte proliferation, and induction of cytokine gene expression (e.g. IL-1, IL-6, or TNF-)[25,26]. In a randomized controlled study, Wachtler et al[25] showed that the systemic levels of IL-10, IL-6 and TNF- are significantly decreased in surgical patients 5 d after administration of TPN enriched with omega-3 fatty acids. In another clinical trial, Weiss et al[27] also found that IL-6 levels are significantly decreased and TNF- release from monocytes is also decreased in patients receiving fish oil perioperatively. In addition, HLA-DR expression induced by monocytes, an indicator of compensatory potential required to balance immune response, is significantly decreased[28,29]. Mayer et al[13] displayed that neutrophil function is significantly improved in patients receiving omega-3 fatty acids, including leukotriene generation and respiratory burst. In our study, serum IL-6 levels were significantly lower in the FO group than t in the reference group. This is in agreement with the previous reports[25,27,30]. Simultaneously, the ratios of CD4+/CD8+ were significantly increased in the FO group. In addition, depression of serum TNF- levels and elevation of CD3+ and CD4+ lymphocyte percentage were noted in the FO group. In an experimental animal model, administration of parental fish oil during sepsis could prevent sepsis-induced suppression of lymphocyte proliferation and IL-2 release[31]. These findings suggest that supplementation of omega-3 PUFA may restrain inflammatory response, modulate lymphocyte proliferation, and maintain the function of immunocompetent cells under inflammatory conditions such as surgical trauma.

The lower magnitude of postoperative inflammatory response to administration of omega-3 fatty acids may have a favorable impact on clinical outcomes of patients with CRC. A shorter postoperative hospital stay was noted in our study. No statistically significant difference was found when stratified to death and occurrence of infectious complications. In a cohort of elective postoperative patients, mortality is such a rare event that changes in mortality is underpowered to be detected. Various factors may influence the outcomes of surgical patients. A short single nutritional intervention is unlikely to produce extensive effects on the outcomes of postoperative patients. Recently, in a randomized controlled trial, Weiss et al[27] have demonstrated a shorter postoperative ICU and hospital stay, and a lower rate of severe infections in patients administrating omega-3 fish oil perioperatively beginning on POD-1. These results suggest that supplementation with with omega-3 fatty acids may have a more favorable effect on the outcomes of CRC patients after a major surgery.

In conclusion, postoperative supplementation of omega-3 fatty acids may have a favorable effect on the outcome of colorectal cancer patients by lowering the magnitude of inflammatory responses and modulating the immune response. Perioperative administration of omega-3 fish oil may have a more favorable effect on the outcome of CRC patients after a major surgery. Further prospective, randomized controlled trials are required to delineate this effect in a larger number of patients.

 

 COMMENTS

Background

Omega-3 and -6 polyunsaturated fatty acids (PUFAs) are essential for humans and must be nutritionally provided. After incorporated into cell membrane, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) promptly compete with arachidonic acid (AA) on the cyclooxygenase and 5-lipoxygenase pathways, resulting in a reduced generation of diene prostanoids (e.g. PGE2, PGI2, TXA2) and tetraene leukotrienes (e.g. LTB4), derived from AA and are in favor of triene prostanoids (e.g. PGE3, PGI3, TXA3) and pentaene leukotriene (LTB5) derived from EPA. Therefore, the benefit of omega-3 fatty acids is to suppress the system inflammatory response and decrease the risk of postoperative thrombosis, which has been appreciated recently.

 

Research frontiers

Recently, clinical nutrition has attempted to combine caloric support with modulation of the immune response. Several new generations of lipid emulsion containing n-3 lipids have been introduced, and immunonutrition has become the hot spot or an important area in this research field.

 

Innovations and breakthroughs

Although several studies have demonstrated the beneficial effects of omega-3 fatty acid supplementation on the outcome or immune competence of patients, randomized controlled clinical trials focusing on the use of parenteral fish oil are scarce, especially in colorectal cancer patients. To obtain a homogenous population, patients with colorectal cancer staging TNM- were selected to undergo radical resection, and concomitant disorders were restricted according to the exclusion criteria. Depression of inflammatory parameters, such as serum level of IL-6 and TNF- was observed. Elevation of CD4+/CD8+ ratio, CD3+ and CD4+ lymphocyte percentage, was noted after administration of omega-3 fatty acids supplementation. Meanwhile, a near-significant improvement in clinical outcome was demonstrated. Patients accepted omega-3 fatty acid supplementation trended to need a shorter postoperative hospital stay. In view of the authors, postoperative supplementation of omega-3 fatty acids may have a favorable effect on the outcome of colorectal cancer patients undergoing radical resection by lowering the magnitude of inflammatory responses and modulating the immune response.

 

Applications

By summing up the available data from surgical patients, we conclude that fish oil should be included in parenteral nutrition yielding positive impact on the outcome of patients.

 

Terminology

Immunonutrition, which combines caloric support and modulation of the immune response, has become the hot spot in this research field.

 

Peer review

This article on the effect of omega-3 fatty acid supplementation on colorectal cancer is interesting.

 

REFERENCES

1      Yao GX, Wang XR, Jiang ZM, Zhang SY, Ni AP. Role of perioperative parenteral nutrition in severely malnourished

        patients with Crohn's disease. World J Gastroenterol 2005; 11: 5732-5734 PubMed

2      Fürst P, Kuhn KS. Fish oil emulsions: what benefits can they bring? Clin Nutr 2000; 19: 7-14 PubMed

3      Heller A, Koch T, Schmeck J, van Ackern K. Lipid mediators in inflammatory disorders. Drugs 1998; 55: 487-496

        PubMed

4      Mayer K, Grimm H, Grimminger F, Seeger W. Parenteral nutrition with n-3 lipids in sepsis. Br J Nutr 2002; 87 Suppl 1:

        S69-S75 PubMed

5      Ikehata A, Hiwatashi N, Kinouchi Y, Yamazaki H, Kumagai Y, Ito K, Kayaba Y, Toyota T. Effect of intravenously infused

        eicosapentaenoic acid on the leukotriene generation in patients with active Crohn's disease. Am J Clin Nutr 1992; 56:

        938-942 PubMed

6     Berbert AA, Kondo CR, Almendra CL, Matsuo T, Dichi I. Supplementation of fish oil and olive oil in patients with        

        rheumatoid arthritis. Nutrition 2005; 21: 131-136 PubMed

7      Jho D, Babcock TA, Helton WS, Espat NJ. Omega-3 fatty acids: implications for the treatment of tumor-associated

        inflammation. Am Surg 2003; 69: 32-36 PubMed

8      Larsson SC, Kumlin M, Ingelman-Sundberg M, Wolk A. Dietary long-chain n-3 fatty acids for the prevention of cancer: a

        review of potential mechanisms. Am J Clin Nutr 2004; 79: 935-945 PubMed

9      Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: from experimental to clinical data. Curr Opin Clin Nutr

        Metab Care 2006; 9: 140-148 PubMed

10    Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in

        mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003; 27: 355-373 PubMed

11    Tappy L, Chioléro R. Substrate utilization in sepsis and multiple organ failure. Crit Care Med 2007; 35: S531-S534

        PubMed

12    Berger MM, Chioléro RL. Antioxidant supplementation in sepsis and systemic inflammatory response syndrome. Crit

        Care Med 2007; 35: S584-S590 PubMed

13    Mayer K, Fegbeutel C, Hattar K, Sibelius U, Krämer HJ, Heuer KU, Temmesfeld-Wollbrück B, Gokorsch S, Grimminger F,

        Seeger W. Omega-3 vs. omega-6 lipid emulsions exert differential influence on neutrophils in septic shock patients:

        impact on plasma fatty acids and lipid mediator generation. Intensive Care Med 2003; 29: 1472-1481 PubMed

14    Tsekos E, Reuter C, Stehle P, Boeden G. Perioperative administration of parenteral fish oil supplements in a routine

        clinical setting improves patient outcome after major abdominal surgery. Clin Nutr 2004; 23: 325-330 PubMed

15    Heller AR, Fischer S, Rössel T, Geiger S, Siegert G, Ragaller M, Zimmermann T, Koch T. Impact of n-3 fatty acid

        supplemented parenteral nutrition on haemostasis patterns after major abdominal surgery. Br J Nutr 2002; 87 Suppl 1:

        S95-S101 PubMed

16    Antebi H, Mansoor O, Ferrier C, Tetegan M, Morvan C, Rangaraj J, Alcindor LG. Liver function and plasma antioxidant

        status in intensive care unit patients requiring total parenteral nutrition: comparison of 2 fat emulsions. JPEN J Parenter

        Enteral Nutr 2004; 28: 142-148 PubMed

17    Köller M, Senkal M, Kemen M, König W, Zumtobel V, Muhr G. Impact of omega-3 fatty acid enriched TPN on leukotriene

        synthesis by leukocytes after major surgery. Clin Nutr 2003; 22: 59-64 PubMed

18    Roulet M, Frascarolo P, Pilet M, Chapuis G. Effects of intravenously infused fish oil on platelet fatty acid phos-pholipid

        composition and on platelet function in posto-perative trauma. JPEN J Parenter Enteral Nutr 1997; 21: 296-301 PubMed

19    Heller AR, Rössler S, Litz RJ, Stehr SN, Heller SC, Koch R, Koch T. Omega-3 fatty acids improve the diagnosis-related

        clinical outcome. Crit Care Med 2006; 34: 972-979 PubMed

20    Heller AR, Rössel T, Gottschlich B, Tiebel O, Menschikowski M, Litz RJ, Zimmermann T, Koch T. Omega-3 fatty acids

        improve liver and pancreas function in postoperative cancer patients. Int J Cancer 2004; 111: 611-616 PubMed

21    Harris WS. Expert opinion: omega-3 fatty acids and bleeding-cause for concern? Am J Cardiol 2007; 99: 44C-46C

        PubMed

22    Pscheidl E, Schywalsky M, Tschaikowsky K, Böke-Pröls T. Fish oil-supplemented parenteral diets normalize splanchnic

        blood flow and improve killing of translocated bacteria in a low-dose endotoxin rat model. Crit Care Med 2000; 28:        

        1489-1496 PubMed

23    Pscheidl EM, Wan JM, Blackburn GL, Bistrian BR, Istfan NW. Influence of omega-3 fatty acids on splanchnic blood flow

        and lactate metabolism in an endotoxemic rat model. Metabolism 1992; 41: 698-705 PubMed

24    Morlion BJ, Torwesten E, Lessire H, Sturm G, Peskar BM, Fürst P, Puchstein C. The effect of parenteral fish oil on

        leukocyte membrane fatty acid composition and leukotriene-synthesizing capacity in patients with postoperative trauma.

        Metabolism 1996; 45: 1208-1213 PubMed

25    Wachtler P, König W, Senkal M, Kemen M, Köller M. Influence of a total parenteral nutrition enriched with omega-3

        fatty acids on leukotriene synthesis of peripheral leukocytes and systemic cytokine levels in patients with major surgery.

        J Trauma 1997; 42: 191-198 PubMed

26    Rola-Pleszczynski M, Stanková J. Leukotriene B4 enhances interleukin-6 (IL-6) production and IL-6 messenger RNA

        accumulation in human monocytes in vitro: transcriptional and posttranscriptional mechanisms. Blood 1992; 80: 1004-

        1011 PubMed

27    Weiss G, Meyer F, Matthies B, Pross M, Koenig W, Lippert H. Immunomodulation by perioperative administration of n-3

        fatty acids. Br J Nutr 2002; 87 Suppl 1: S89-S94 PubMed

28    Bone RC. Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response

        syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS). Ann Intern Med 1996; 125: 680-687 PubMed

29    Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 1997; 112:

        235-243 PubMed

30    Mayer K, Meyer S, Reinholz-Muhly M, Maus U, Merfels M, Lohmeyer J, Grimminger F, Seeger W. Short-time infusion of

        fish oil-based lipid emulsions, approved for parenteral nutrition, reduces monocyte proinflammatory cytokine generation

        and adhesive interaction with endothelium in humans. J Immunol 2003; 171: 4837-4843 PubMed

31    Lanza-Jacoby S, Flynn JT, Miller S. Parenteral supplementation with a fish-oil emulsion prolongs survival and improves

        rat lymphocyte function during sepsis. Nutrition 2001; 17: 112-116 PubMed

 

S- Editor  Li DL    L- Editor  Wang XL    E- Editor  Yin DH

 

                                                                                            

 

Reviews Add
more>>


Related Articles:
Specific CEA-producing colorectal carcinoma cell killing with recombinant adenoviral vector containing cytosine deaminase gene
Colonoscopic screening and follow-up for colorectal cancer in the elderly
Transfection of colorectal cancer cells with chemokine MCP-3 (monocyte chemotactic protein-3) gene retards tumor growth and inhibits tumor metastasis
Analysis for phenotype of HNPCC in China
Transforming growth factor-beta1 in invasion and metastasis in colorectal cancer
more>>