Does Modified Amino Acid Total Parenteral Nutrition Alter Immune‐Response in High Level Surgical Stress

Abstract

A randomized prospective double-blinded study was conducted in patients in moderate to high level surgical stress to ascertain the effect of high dose branched-chain (BcAA) hyperalimentation on skin test reactivity and lymphocyte count. Isocaloric, isonitrogenous balanced total parenteral nutrition solutions were administered to two treatment groups. The study group received the high dose (45% BcAA) solution while the control group received a standard amino acid solution (24.2% BcAA). All patients received 1 to 1.5 g/kg/day of amino acids and 30 nonprotein cal/kg/day, with 30% of them as fat. Immune function was assessed by absolute lymphocyte count and delayed cutaneous hypersensitivity on days 0 and 7 of therapy. Absolute lymphocyte count showed a marked improvement in patients receiving high dose aBcAA (p less than 0.03). All patients were anergic at baseline; a much greater percentage of skin test reactivity was observed in the BcAA group on day 7 (p less than 0.03). They were also in positive nitrogen balance. The data suggest that improved nitrogen retention and immune-competence is possible with branched-chain-enriched hyperalimentation in high level surgical stress.

Effects of Total Parenteral Nutrition Using a Solution Enriched with Branched-Chain Amino Acids on Experimental Pancreatitis in Rats

“…BCAA such as leucine helps to reduce proteolysis and stimulates protein synthesis in muscle [7,8.20,24], On the other hand. BCAA enriched TPN increases the im mune response [22,25], These findings are supported by the low mortality rate in the grup treated with BCAA-enriched TPN in our study.…”

The pretransplant systemic metabolic profile reflects a risk of acute graft versus host disease after allogeneic stem cell transplantation

“…Finally, both leucine, isoleucine or valine seem to enhance the proliferation of activated T cells (Calder 2006), and animal studies suggest that oral intake of isoleucine has an immunoregulatory function in the gut (Zhao et al 2014). Finally, several studies suggest that BCAA have immunostimulatory effects not only in animal models but also in humans (Alam et al 2011; Bassit et al 2002; Cerra et al 1984; Freund et al 1978; Nuwer et al 1983). Thus, our study suggests that the pretransplant status of the immunoregulatory system is important for the risk of posttransplant acute GVHD.…”

Branched-chain amino acids in liver diseases

“…In patients with cirrhosis, BCAA administration increases the numbers of hepatic lymphocytes and restores the phagocytic activity of neutrophils and the NK activity of lymphocytes [37] . In addition, BCAAs increased the number of blood lymphocytes in postsurgical patients [38,39] , and significant correlations were observed between the serum concentration of BCAAs and the survival rates of the patients with sepsis [40] . These data indicate that BCAAs are closely associated with the maturation and function of various immune cells.…”