Oral eicosapentaenoic acid for complications of bone marrow transplantation

Abstract

Summary:The 'systemic inflammatory response syndrome' (SIRS) may represent the underlying cause of complications after bone marrow transplantation (BMT). This study was conducted to determine whether blocking the etiologic factors of SIRS could improve the complications of BMT. Sixteen consecutive patients with unrelated donors were allocated alternately to two groups. Seven patients received 1.8 g/day of eicosapentaenoic acid (EPA) orally from 3 weeks before to about 180 days after transplantation, while nine patients did not. These two groups were compared with respect to complications, survival, and various cytokines and factors causing vascular endothelial damage. All seven patients receiving EPA survived and only two had grade III graft-versus-host disease (GVHD). Among the nine patients not receiving EPA, three had grade III or IV GVHD. In addition, thrombotic microangiopathy developed in four patients and cytomegalovirus disease occurred in four. Five patients died in this group. The levels of leukotriene B 4 , thromboxane A 2 , and prostaglandin I 2 were significantly lower in patients receiving EPA than in those not receiving it (all P Ͻ 0.01). Cytokines such as tumor necrosis factor-␣, interferon-␥, and interleukin-10 were also significantly decreased by EPA (P Ͻ 0.05), as were factors causing vascular endothelial damage such as thrombomodulin and plasminogen activator inhibitor-1 (P Ͻ 0.05). The survival rate was significantly higher in the group given EPA (P Ͻ 0.01). EPA significantly reduced the complications of BMT, indicating that these complications may be manifestations of the systemic inflammatory response syndrome. Bone Marrow Transplantation (2001) 28, 769-774.

Effects of Fish Oil Supplementation on Kidney Transplantation

“…Among the five nonrenal transplant studies that were found (three on heart transplantation, one on liver transplantation, and one on bone marrow transplantation), the only potentially important clinical benefit reported was a reduction in acute colonic graft versus host disease and improved survival in a small RCT in bone marrow transplantation (30,31). However, there have been no additional studies to confirm these observations, raising concern as to whether the authors or other groups may not have been able to reproduce these results.…”

Nutritional support in patients with GVHD of the digestive tract: state of the art

“…64 Meta-analyses showed favourable effects of an enteral nutrition containing a high concentration of n-3 fatty acids on mortality, secondary infections and length of hospital stay in ICU patients with sepsis, acute respiratory distress syndrome and systemic inflammation response syndrome. 64 Systemic inflammation response syndrome has also been linked to the aetiology of GVHD, 65,66 and grade C evidence suggests beneficial effects of eicosapentaenoic acid: in a small prospective study, supplementation of eicosapentaenoic acid around BMT was associated with a reduction of inflammatory cytokines (IL-10, TNF-a and IFN-g), reduced vascular endothelial dysfunction, higher survival rate 67 and a lower grade of acute colonic GVHD. 68 Glutamine, arginine and nucleotides.…”

“…64 Systemic inflammation response syndrome has also been linked to the aetiology of GVHD, 65,66 and grade C evidence suggests beneficial effects of eicosapentaenoic acid: in a small prospective study, supplementation of eicosapentaenoic acid around BMT was associated with a reduction of inflammatory cytokines (IL-10, TNF-a and IFN-g), reduced vascular endothelial dysfunction, higher survival rate 67 and a lower grade of acute colonic GVHD. 68 Glutamine, arginine and nucleotides. The nonessential amino acid glutamine is a precursor for nucleotide synthesis; rapidly dividing cells, such as enterocytes, are most likely to suffer from a shortage of glutamine.…”

Role of PPARα in the attenuation of bile acid-induced apoptosis by omega-3 long-chain polyunsaturated fatty acids in cultured hepatocytes

“…Omega-3 PUFA have been shown to be antiinflammatory and immunomodulatory in the attenuation of cellular injury (8)(9)(10)(11)(12)(13). Recently, there has been much interest in the use of fish oil contacting ω3PUFA to treat parenteral nutrition-associated liver disease (PNALD) in children (14).…”