Fatty acids and lymphocyte functions

Lipid emulsions - Guidelines on Parenteral Nutrition, Chapter 6

The infusion of lipid emulsions allows a high energy supply, facilitates the prevention of high glucose infusion rates and is indispensable for the supply with essential fatty acids. The administration of lipid emulsions is recommended within ≤7 days after starting PN (parenteral nutrition) to avoid deficiency of essential fatty acids. Low-fat PN with a high glucose intake increases the risk of hyperglycaemia. In parenterally fed patients with a tendency to hyperglycaemia, an increase in the lipid-glucose ratio should be considered. In critically ill patients the glucose infusion should not exceed 50% of energy intake. The use of lipid emulsions with a low phospholipid/triglyceride ratio is recommended and should be provided with the usual PN to prevent depletion of essential fatty acids, lower the risk of hyperglycaemia, and prevent hepatic steatosis. Biologically active vitamin E (α-tocopherol) should continuously be administered along with lipid emulsions to reduce lipid peroxidation. Parenteral lipids should provide about 25–40% of the parenteral non-protein energy supply. In certain situations (i.e. critically ill, respiratory insufficiency) a lipid intake of up to 50 or 60% of non-protein energy may be reasonable. The recommended daily dose for parenteral lipids in adults is 0.7–1.3 g triglycerides/kg body weight. Serum triglyceride concentrations should be monitored regularly with dosage reduction at levels >400 mg/dl (>4.6 mmol/l) and interruption of lipid infusion at levels >1000 mg/dl (>11.4 mmol/l). There is little evidence at this time that the choice of different available lipid emulsions affects clinical endpoints.

Therapeutic potential of n-3 polyunsaturated fatty acids in disease

PURPOSE

The potential therapeutic benefits of supplementation with n-3 polyunsaturated fatty acids (PUFAs) in various diseases are reviewed, and the antiinflammatory actions, activity, and potential drug interactions and adverse effects of n-3 PUFAs are discussed.

SUMMARY

Fish oils are an excellent source of long-chain n-3 PUFAs, such as eicosapentaenoic acid and docosahexaenoic acid. After consumption, n-3 PUFAs can be incorporated into cell membranes and reduce the amount of arachidonic acid available for the synthesis of proinflammatory eicosanoids (e.g., prostaglandins, leukotrienes). Likewise, n-3 PUFAs can also reduce the production of inflammatory cytokines, such as tumor necrosis factor alpha, interleukin-1, and interleukin-6. Considerable research has been conducted to evaluate the potential therapeutic effects of fish oils in numerous conditions, including arthritis, coronary artery disease, inflammatory bowel disease, asthma, and sepsis, all of which have inflammation as a key component of their pathology. Additional investigations into the use of supplementation with fish oils in patients with neural injury, cancer, ocular diseases, and critical illness have recently been conducted. The most commonly reported adverse effects of fish oil supplements are a fishy aftertaste and gastrointestinal upset. When recommending an n-3 PUFA, clinicians should be aware of any possible adverse effect or drug interaction that, although not necessarily clinically significant, may occur, especially for patients who may be susceptible to increased bleeding (e.g., patients taking warfarin).

CONCLUSION

The n-3 PUFAs have been shown to be efficacious in treating and preventing various diseases. The wide variation in dosages and formulations used in studies makes it difficult to recommend dosages for specific treatment goals.

Effects of cholesterol and docosahexaenoic acid on cell viability and (Ca(2+))(i) levels in acutely isolated mouse thymocytes

We investigated the effects of lipids on thymocyte function. The effects of application of cholesterol or docosahexaenoic acid (DHA), a C22, omega-3 (n-3) polyunsaturated fatty acid (PUFA), on viability and intracellular calcium concentrations of acutely isolated mouse thymocytes were investigated using flow cytometry. Cholesterol (100 microM) caused significant cell death after 30-60 min whether or not calcium was present in the medium. Cell death was associated with an elevation of intracellular calcium whether or not calcium was present in the extracellular medium. However, the elevation of calcium concentration was not responsible for the cell death since calcium levels in the presence of ionomycin rose higher without significant cell death. DHA had similar actions but was more potent, causing significant cell death and elevation of calcium concentration within 5 min at 1 microM. In the absence of extracellular calcium 1 microM DHA caused 100% cell death within 15 min. Linolenic acid, a C18 omega-3 fatty acid also caused cytotoxicity at low concentrations whether or not albumin was present, but omega-6 or saturated C22 fatty acids were much less effective. These observations demonstrate that thymocyte viability is very sensitive to acute exposure to low concentrations of omega-3 fatty acids.

Enrichment of RAW264.7 macrophages with essential 18-carbon fatty acids affects both respiratory burst and production of immune modulating cytokines

Macrophages play a vital role in the innate immune system. Thereby, production of both reactive oxygen intermediates and immune modulating cytokines is crucial for successful pathogen defense. Fatty acids may interfere with immune response in several ways. In this study, we investigated the influence of essential polyunsaturated fatty acids (PUFA) on key macrophage functions. RAW264.7 macrophages were cultured in a medium supplemented with 2 or 15 micromol/L of the n-6 PUFA linoleic acid (LA) or of the n-3 PUFA alpha-linolenic acid (LNA), respectively. Cells were tested for incorporation of fatty acids as well as NADPH oxidase activity. Furthermore, supernatants were collected for detection of NO and cytokine release (TNF-alpha, IL-6, IL-10). Exposure of RAW264.7 macrophages to LA or LNA resulted in incorporation of these fatty acids and their derivatives. Thereby, supplementation with both LA and LNA caused a significant increase in NADPH oxidase activity. In contrast, synthesis of NO was not affected by PUFA supplementation. Moreover, distinct effects could be seen in the release of immune modulating cytokines. Due to enhancement of NADPH oxidase activity, PUFA presumably promote the killing of pathogens crucial in host defense. In addition, the unsaturated fatty acids tested in our study were shown to modulate cytokine release by the macrophages, thus driving immune response into an anti-inflammatory direction. Of note, distinct differences between the n-6 PUFA LA and the n-3 PUFA LNA underline the impact of PUFA family on immune response.

Higher immunoglobulin production in conjugated linoleic acid-supplemented rats during gestation and suckling

Conjugated linoleic acid (CLA) has been reported to exert beneficial physiological effects on body composition and the immune system. However, little information is available on the influence of CLA on immune function during early life periods. The present study evaluates the effect of feeding an 80:20 mixture of cis-9, trans-11- and trans-10, cis-12-CLA isomers during gestation and suckling on the systemic immune response of weaned Wistar rats. Pups received dietary CLA from dams through the placental barrier and during suckling by breast milk (group A) or by oral administration (group B). Pups from group C only received CLA during suckling by oral administration. Group D constituted the reference group. Milk from dams fed the CLA diet had a high content of CLA and higher IgA and IgG concentrations than rats fed the standard diet. The plasma of pups from groups A, B and C showed six, twelve and nine times higher content of the cis-9, trans-11-CLA isomer than that of the group D pups. Rats from group A exhibited higher serum IgG concentrations than rats from the rest of the groups (22.14 (SEM 2.14) v. about 5 mg/ml; P < 0.05), whereas rats from groups A and B showed approximately 2-fold higher splenocyte IgM production than rats from groups C and D. However, CLA supplementation did not influence significantly the splenocyte proliferative response or cytokine secretion. Supplementation during gestation and suckling with an 80:20 cis-9, trans-11-trans-10, cis-12 CLA mix enhances the production of the main in vivo and in vitro Ig isotypes in Wistar rats.

Glycerol-3-phosphate acyltransferase 1 is essential for the immune response to infection with coxsackievirus B3 in mice

Livers and hearts from mice deficient in glycerol-3-phosphate acyltransferase 1 (GPAT1; Gpat1(-/-)) have a decreased content of glycerolipid intermediates and triacylglycerol, an altered composition of liver phospholipids, and elevated markers of oxidative stress. Compared with control C57BL/6 mice, infection of Gpat1(-/-) mice with coxsackievirus B3 (CVB3) resulted in higher mortality, an approximately 50% increase in heart pathology, a significant increase in liver viral titers, and a 100-fold increase in heart viral titers. Moreover, heart mRNA levels for proinflammatory cytokines tumor necrosis factor-alpha, interleukin (IL)-6, and IL-1B were increased in the Gpat1(-/-) mice. Loss of Gpat1 also resulted in dysregulation of specific immune cells. Splenic dendritic cells from Gpat1(-/-) mice were fully capable of stimulating T cells from control mice; however, splenic T cells from Gpat1(-/-) mice were defective in their response to CVB3 antigen. Our data indicate that a lack of GPAT1 activity affects both innate and adaptive immune mechanisms. Innate mechanisms may be affected by altered membrane composition or host redox status, whereas the adaptive response may require GPAT1 activity itself.

Are the olive oil and other dietary lipids related to cancer? Experimental evidence

There is a wealth of evidence supporting the relationship between dietary lipids and cancer, particularly those of the breast, colon and rectum and prostate. The main support comes from the international correlational studies and, especially, from experimental ones. The evidence from human analytical studies is less consistent because of several conflicting findings, probably due to methodological issues. Experimentally, it has been clearly demonstrated that quantity and type of dietary lipids as well as the particular critical phases of the carcinogenesis in which they act, are the essential factors in this relationship. Thus, whereas high dietary intake of n-6 polyunsaturated fatty acids (PUFA), primarily LA, and saturated fat has tumor-enhancing effects, long chain n-3 PUFA, CLA and GLA have inhibitory effects. Monounsaturated fatty acids (MUFA), mainly OA, present in high quantities in olive oil, seem to be protective although some inconsistent results have been reported. Bioactive compounds of virgin olive oil may also account for the protective effect of this oil, which is the main source of fat in the Mediterranean diet. Experimental studies have also provided evidence of several putative mechanisms of action of dietary lipids on cancer. Lipids can influence the hormonal status, modify cell membranes structure and function, cell signalling transduction pathways and gene expression, and modulate the function of the immune system. Although further studies are needed to evaluate and verify these mechanisms in humans, based on the multiple ways dietary lipids can act, they may have an important influence on tumorigenesis.

Fish oil n-3 polyunsaturated fatty acids selectively affect plasma cytokines and decrease illness in Thai schoolchildren: a randomized, double-blind, placebo-controlled intervention trial

OBJECTIVE

To determine whether very long-chain n-3 polyunsaturated fatty acids (PUFAs) affect illness and selected plasma cytokines in schoolchildren.

STUDY DESIGN

Thai schoolchildren aged 9 to 12 years consumed milk containing placebo (soybean) oil (n = 86) or fish oil (n = 94) on 5 days per week for 6 months; the latter provided 200 mg eicosapentaenoic acid plus 1 g docosahexaenoic acid daily. Episodes and duration of illness were recorded, and plasma interleukin (IL)-2 receptor, IL-6, IL-10, and transforming growth factor (TGF)-beta1 concentrations and the fatty acid profile of plasma phosphatidylcholine determined.

RESULTS

After intervention, very long-chain n-3 PUFAs were higher in plasma phosphatidylcholine in the fish oil group than in the placebo group (P < .001). The fish oil group showed fewer episodes (P = .014) and shorter duration (P = .024) of illness (mainly upper respiratory tract) than the placebo group. Plasma IL-2 receptor, IL-10, and IL-6 were not affected by either treatment. Plasma TGF-beta1 increased in both groups, but the increase was smaller in the fish oil group, and at the end of supplementation TGF-beta1 concentration was lower in the fish oil group (P < .001).

CONCLUSIONS

Very long-chain n-3 PUFAs reduce illness, mainly infections, in healthy Thai schoolchildren.

Effect of dietary fatty acid composition on Th1/Th2 polarization in lymphocytes

BACKGROUND

It has become increasingly clear that polyunsaturated fatty acids (PUFAs) have immunomodulatory effects. However, the intake of these fatty acids used in animal studies often greatly exceeds dietary human intake. Whether differences in the composition of fatty acids that are consumed in amounts consistent with normal dietary intake can influence immune function remains uncertain.

METHODS

We manufactured 3 types of liquid diet, related to modified fatty acid composition (omega-6/omega-3 = 0.25, 2.27 and 42.9), but excluding eicosapentaenoic acid and docosahexaenoic acid, based upon a liquid diet used clinically in humans. We assessed CD3-stimulated cytokine production of splenocytes in female BALB/c mice (n = 4 per group) fed 1 of 3 liquid diets for 4 weeks. We also measured the cytokine production of peripheral blood mononuclear cells stimulated with phorbol myristate acetate and ionomycin in humans at the end of a 4-week period of consumption of 2 different liquid diets (omega-6/omega-3 = 3 and 44).

RESULTS

We found that the ratio of interfero omega-gamma (IFN-gamma) / interleukin-4 (IL-4) was significantly higher in mice fed the omega-3 rich diet than in others. In humans, IFN-gamma / IL-4 was significantly higher after the omega-3 versus the omega-6 enhanced diet.

CONCLUSIONS

Differences in the composition of omega-3 and omega-6 PUFAs induces a shift in the Th1/Th2 balance in both mouse and human lymphocytes, even when ingested in normal dietary amounts. An omega-3 rich diet containing alpha-linolenic acid modulates immune function.

Glucose metabolism by lymphocytes, macrophages, and tumor cells from Walker 256 tumor-bearing rats supplemented with fish oil for one generation

Here we investigated the effect of lifelong supplementation of the diet with coconut fat (CO, rich in saturated fatty acids) or fish oil (FO, rich in n-3 polyunsaturated fatty acids) on tumor growth and lactate production from glucose in Walker 256 tumor cells, peritoneal macrophages, spleen, and gut-associated lymphocytes. Female Wistar rats were supplemented with CO or FO prior to mating and then throughout pregnancy and gestation and then the male offspring were supplemented from weaning until 90 days of age. Then they were inoculated subcutaneously with Walker 256 tumor cells. Tumor weight at 14 days in control rats (those fed standard chow) and CO supplemented was approximately 30 g. Supplementation of the diet with FO significantly reduced tumor growth by 76%. Lactate production (nmol h(-1) mg(-1) protein) from glucose by Walker 256 cells in the group fed regular chow (W) was 381.8 +/- 14.9. Supplementation with coconut fat (WCO) caused a significant reduction in lactate production by 1.6-fold and with fish oil (WFO) by 3.8-fold. Spleen lymphocytes obtained from W and WCO groups had markedly increased lactate production (553 +/- 70 and 635 +/- 150) when compared to non-tumor-bearing rats ( approximately 260 +/- 30). FO supplementation reduced significantly the lactate production (297 +/- 50). Gut-associated lymphocytes obtained from W and WCO groups increased lactate production markedly (280 +/- 31 and 276 +/- 25) when compared to non-tumor-bearing rats ( approximately 90 +/- 18). FO supplementation reduced significantly the lactate production (168 +/- 14). Lactate production by peritoneal macrophages was increased by tumor burden but there was no difference between the groups fed the various diets. Lifelong consumption of FO protects against tumor growth and modifies glucose metabolism in Walker tumor cells and lymphocytes but not in macrophages.

Supplemental fish oil does not alter immune competence or the pathophysiological response to an intramammary infusion of endotoxin in peri-partum multiparous Holstein cows

The objective was to determine the effects of supplementing the diet with fish oil during the peri-partum period on the immune competence and the pathophysiological response to a lipopolysaccharide-induced mastitis challenge. Multiparous Holstein cows (n=30) were completely randomized to one of two treatments at 3 weeks pre-partum. Treatments differed only in the source of supplemental lipid and included either Energy Booster or fish oil. Treatment diets were fed from -21 d relative to expected date of parturition until 10 d post partum. Treatments were fed as a bolus prior to the a.m. feeding. The dose of lipid during the pre-partum period was 250 g/d, whereas the amount of lipid supplemented post partum was adjusted to the level of intake, approximately 0.92% of the previous day's dry matter intake. Ex-vivo analyses of immune competence were measured including the antimicrobial activity of whole blood against Escherichia coli, Salmonella typhimurium and Candida albicans as well as the production of interferon-gamma by peripheral blood mononuclear cultures. At 7 days in milk cows were infused with 100 microg of Esch. coli lipopolysaccharide into one rear quarter. Supplementing fish oil increased plasma concentrations of eicosapentaenoic and docosahexaenoic acids, but had no affect on the proportions of arachidonic acid at calving. Fish oil did not influence the production of interferon-gamma or the antimicrobial activity of whole blood against any of the microorganisms. Furthermore, fish oil had no ameliorative effect on either the local or the systemic acute phase response following an intramammary lipopolysaccharide challenge in early lactating Holstein cows. Supplementing fish oil in the diet of peri-partum cows will not protect them from deleterious effects of an excessive acute phase response.

Dietary (n-3) polyunsaturated fatty acids affect the kinetics of pro- and antiinflammatory responses in mice with Pseudomonas aeruginosa lung infection

The underlying mechanisms by which eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) affect host resistance to Pseudomonas aeruginosa are unclear. The aim of this study was to determine their role on the kinetic of pro- and antiinflammatory response in lung infection. Mice fed either a control diet or a diet enriched with EPA and DHA were infected intratracheally and we studied lung expression of proinflammatory markers [CXCL1, interleukin (IL)-6, tumor necrosis factor-alpha], antiinflammatory markers (IL-10, A20, and IkappaB alpha), and PPARalpha and PPARgamma. The inflammatory response was assessed using recruitment of neutrophils and macrophages into bronchoalveolar lavage fluid, bacterial clearance from the lung, pulmonary injury, and 7-d survival rate. Compared with the control group, EPA and DHA delayed the expression of proinflammatory markers during the first 2 h (P < 0.05), upregulated proinflammatory marker expression (P < 0.05), and induced overexpression of antiinflammatory markers at 8 h (P < 0.05), enhanced recruitment of neutrophils at 16 h (P < 0.05), and induced PPARalpha and PPARgamma overexpression at 4 and 8 h (P < 0.01), respectively. Pulmonary bacterial load decreased and pulmonary injury and mortality were reduced during the first 24 h (P < 0.05). In conclusion, EPA and DHA modulate the balance between pro- and antiinflammatory cytokines, alter the early response of the host to P. aeruginosa infection, and affect the early outcome of infection.

Long-term feeding of the cis-9,trans-11 isomer of conjugated linoleic acid reinforces the specific immune response in rats

Several effects on the immune system have been ascribed to the cis9,trans11 conjugated linoleic acid (CLA) isomer. We studied whether feeding a diet enriched with an 80:20 CLA isomer mix of cis9,trans11 and trans10,cis12 CLA from gestation to adulthood affects the capacity of adult rats to achieve a specific immune response. Pregnant Wistar rats were fed a 1% CLA diet or a control diet beginning on d 7 of gestation. Weaned pups received the same diet as dams until they were 15 wk old. Rats from both groups were immunized with ovalbumin (OVA) when they were 9 wk old. Dietary CLA enhanced splenocyte OVA-specific proliferation by approximately 50% (P < 0.05) and decreased the mitogen-induced proliferative responses of these cells by approximately 10-20% (P < 0.05). The diminished splenocyte proliferative response was accompanied by a lower interleukin-2 secretion (P < 0.05). Long-term CLA supplementation did not increase serum, spleen, or mesenteric lymph node production of OVA-specific antibodies (Ab) or the number of spleen anti-OVA Ab-secreting cells. Interestingly, dietary CLA increased intestinal anti-OVA IgA production by approximately 75% (P < 0.05). In conclusion, a 1% CLA diet administered from gestation to adulthood enhanced specific systemic cell-mediated immunity as well as the mucosal IgA immune response, whereas it downregulated the polyclonal activation of the immune system. These data support the long-term effects of dietary cis9,trans11 CLA isomer on the immune system.

Histological evaluation of Curcuma longa-ghee formulation and hyaluronic acid on gingival healing in dog

ETHNOPHARMACOLOGICAL RELEVANCE

The experimental finding of Asian traditional medicine revealed the pharmacological effect of the local application of ghee which was taken from cow butterfat and the rhizomes of Curcuma longa. These materials significantly improved the healing process of the wound. In addition, ancient physicians of Middle East discovered that the powdered rhizomes of Curcuma longa (common turmeric) also had impressive medicinal qualities. Over the centuries, this spice has been used as a pain relieving, anti-inflammatory agent to relieve pain and inflammation in the skin and muscles.

AIM OF THE STUDY

We decided to mix ghee which was taken from sheep butterfat with the powdered rhizomes of Curcuma longa to formulate a novel cost-benefit material and then, evaluate its potential therapeutic effect on acceleration of surgical wound healing; moreover, this present study was performed to compare the effects of Curcuma longa-ghee formulation and hyaluronic acid on gingival wound healing following surgery.

MATERIALS AND METHODS

Five healthy 3-year-old male beagle dogs were used in this study. They had intact teeth and the clinical and radiographic examination revealed no periodontal disease. Ghee was obtained from the refined sheep butterfat heated to 70 degrees C mixed with the powdered rhizomes of Curcuma longa and was applied with two different ratios including materials A and B. Randomly, these three materials including hyaluronic acid, materials A and B were applied topically in test regions and then covered with periodontal pack. Histological changes were monitored in days 4 and 7 after operation to evaluate the inflammatory and repair stage of healing process.

RESULTS

We observed significant difference in the inflammatory and repair parameters of the healing process between cases treated with this new formulation and cases of hyaluronic acid application.

CONCLUSION

The results suggested a positive potential therapeutic effect on surgical wound healing particularly improvement of periodontal treatment consequences after surgery.

Dietary polyunsaturated fatty acids modulate resistance to Mycobacterium tuberculosis in guinea pigs

It is well established that the nutritional status of the host affects resistance to disease. The impact of dietary lipids on experimental pulmonary infection with mycobacteria has not been investigated. Therefore, the purpose of this study was to determine the role of dietary (n-3) and (n-6) fatty acids on immunity and resistance to aerosol infection with virulent Mycobacterium tuberculosis in guinea pigs. Weanling guinea pigs were fed purified, isocaloric diets differing only in lipid source, and the effects of diet on specific immune cell functions were evaluated after 3 or 6 wk. Dietary (n-3) fatty acid consumption reduced in vivo skin test and in vitro lympho-proliferative responses (P < 0.05) relative to (n-6) fatty acid consumption. The effect of diet on resistance to mycobacterial infection was assessed by enumerating viable mycobacteria in the lungs and spleens of guinea pigs infected with virulent M. tuberculosis by the aerosol route. (n-3) Fatty acid-fed guinea pigs had more bacteria in the lungs compared with (n-6) fatty acid-fed guinea pigs at 3 (P < 0.05) and 6 wk postinfection (P < 0.01). These data document the immunomodulatory effects of (n-3) fatty acid consumption in the context of tuberculosis resistance. The loss of antigen-specific T-cell functions in addition to impaired resistance to mycobacterial disease suggests a susceptible phenotype in (n-3) fatty acid-fed guinea pigs.

Fatty acid deficiency profile in children with food allergy managed with elimination diets

AIM

To evaluate plasma fatty acid (FA) composition of children with food allergy undergoing elimination diets that avoided the offending antigens.

METHODS

Twenty-five children (14 male, 11 female) aged 3.8 +/- 1.6 years (range 2-7 years) affected of multiple food allergy and managed with elimination diets participated in a cross-sectional study. Results of plasma fatty acids were compared with data obtained in 61 healthy children.

RESULTS

The patients had significantly lower values for plasma content in total polyunsaturated fatty acids, omega3 polyunsaturated fatty acids and long-chain omega3 polyunsaturated fatty acids (p < 0.001) and particularly, in eicosapentaenoic acid (EPA) (20:5omega3) and docosahexaenoic acid (DHA) (22:6omega3) (p < 0.001). Moreover, all established indices (essential fatty acid [EFA] index ((omega3 +omega6)/(omega7 +omega9)) (p < 0.001) and sufficiency of docosahexaenoic acid index (C22:6omega3/C22:5omega6) (p < 0.001)) confirmed the presence of EFA deficiency.

CONCLUSION

Children with food allergy managed with restricted intake of foods such as milk, egg, fish and vegetables are at risk of developing a deficiency in EFA and particularly in omega3 long-chain polyunsaturated fatty acids, which are especially necessary for adequate growth, neurological development and cardiovascular health.

Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ PUFA, inflammatory processes and rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease manifested by swollen and painful joints, bone erosion and functional impairment. The joint lesions are characterised by infiltration of T lymphocytes, macrophages and B lymphocytes into the synovium and by synovial inflammation involving eicosanoids, cytokines and matrix metalloproteinases. In relation to inflammatory processes, the main fatty acids of interest are the n-6 PUFA arachidonic acid, which is the precursor of inflammatory eicosanoids such as PGE2 and leukotriene B4, and the n-3 PUFA EPA and DHA, which are found in oily fish and fish oils. Eicosanoids derived from the n-6 PUFA arachidonic acid play a role in RA, and the efficacy of non-steroidal anti-inflammatory drugs in RA indicates the importance of pro-inflammatory cyclooxygenase pathway products of arachidonic acid in the pathophysiology of the disease. EPA and DHA inhibit arachidonic acid metabolism to inflammatory eicosanoids. EPA also gives rise to eicosanoid mediators that are less inflammatory than those produced from arachidonic acid and both EPA and DHA give rise to resolvins that are anti-inflammatory and inflammation resolving. In addition to modifying the lipid mediator profile, n-3 PUFA exert effects on other aspects of immunity relevant to RA such as antigen presentation, T-cell reactivity and inflammatory cytokine production. Fish oil has been shown to slow the development of arthritis in an animal model and to reduce disease severity. Randomised clinical trials have demonstrated a range of clinical benefits in patients with RA that include reducing pain, duration of morning stiffness and use of non-steroidal anti-inflammatory drugs.

Multi-targeted therapy of cancer by omega-3 fatty acids

Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are essential fatty acids necessary for human health. Currently, the Western diet contains a disproportionally high amount of n-6 PUFAs and low amount of n-3 PUFAs, and the resulting high n-6/n-3 ratio is thought to contribute to cardiovascular disease, inflammation, and cancer. Studies in human populations have linked high consumption of fish or fish oil to reduced risk of colon, prostate, and breast cancer, although other studies failed to find a significant association. Nonetheless, the available epidemiological evidence, combined with the demonstrated effects of n-3 PUFAs on cancer in animal and cell culture models, has motivated the development of clinical interventions using n-3 PUFAs in the prevention and treatment of cancer, as well as for nutritional support of cancer patients to reduce weight loss and modulate the immune system. In this review, we discuss the rationale for using long-chain n-3 PUFAs in cancer prevention and treatment and the challenges that such approaches pose in the design of clinical trials.

Long-chain polyunsaturated fatty acids influence the immune system of infants

Several events occur during the first months of life that allow the immune system to become competent and functional. The aim of this article is to review the rationale and evidence of an influence of (n-3) long-chain PUFA (LCPUFA) on the immune system of infants. The (n-3) LCPUFA exert their immunomodulatory activities at different levels. The (n-3) LCPUFA metabolites induce eicosanoid production, alter gene expression, and modify lipid raft composition, altering T-cell signaling; all contribute to immunological functional changes. However, the roles of these mechanisms and the types of T or other immunological cells involved remain unclear at present. Moreover, the effect of (n-3) LCPUFA on the immune system of infants may vary according to dose, time of exposure, and profile of the immune system (T-helper, Th1/Th2). Most of the interventional studies in infancy have been performed for the prevention of allergy. They all confirmed influence on T-cell function and cytokine profiles, but clinically beneficial effects are more conflicting. Supplementation of the maternal diet in pregnancy or early childhood with (n-3) LCPUFA is potentially a noninvasive intervention strategy to prevent the development of allergy, infection, and possibly other immune-mediated diseases. However, any long-term in vivo effects on (n-3) LCPUFA early in life for immunomodulatory defense in infants and later on immune status and health remain to be assessed.

The relationship between the fatty acid composition of immune cells and their function

The immune system, including its inflammatory components, is fundamental to host defence against pathogenic invaders. It is a complex system involving interactions amongst many different cell types dispersed throughout the body. Central to its actions are phagocytosis of bacteria, processing of antigens derived from intracellular and extracellular pathogens, activation of T cells with clonal expansion (proliferation) and production of cytokines that elicit effector cell functions such as antibody production and killing cell activity. Inappropriate immunologic activity, including inflammation, is a characteristic of many common human disorders. Eicosanoids produced from arachidonic acid have roles in inflammation and regulation of T and B lymphocyte functions. Eicosapentaenoic acid (EPA) also gives rise to eicosanoids and these may have differing properties from those of arachidonic acid-derived eicosanoids. EPA and docosahexaenoic acid (DHA) give rise to newly discovered resolvins which are anti-inflammatory and inflammation resolving. Human immune cells are typically rich in arachidonic acid, but arachidonic acid, EPA and DHA contents can be altered through oral administration of EPA and DHA. This results in a changed pattern of production of eicosanoids and probably also of resolvins, although the latter are not well examined in the human context. Changing the fatty acid composition of immune cells also affects phagocytosis, T cell signaling and antigen presentation capability. These effects appear to mediated at the membrane level suggesting important roles of fatty acids in membrane order, lipid raft structure and function, and membrane trafficking. Thus, the fatty acid composition of human immune cells influences their function and the cell membrane contents of arachidonic acid, EPA and DHA are important. Fatty acids influence immune cell function through a variety of complex mechanisms and these mechanisms are now beginning to be unraveled.

Fatty acids and immune function: new insights into mechanisms

Fatty acids are known to play diverse roles in immune cells. They are important as a source of energy, as structural components of cell membranes, as signaling molecules and as precursors for the synthesis of eicosanoids and similar mediators. Recent research has suggested that the localization and organisation of fatty acids into distinct cellular pools has a direct influence on the behaviour of a number of proteins involved in immune cell activation, including those associated with T cell responses, antigen presentation and fatty acid-derived inflammatory mediator production. This article reviews these studies and places them in the context of existing literature in the field. These studies indicate the existence of several novel mechanisms by which altered fatty acid availability can modulate immune responses and impact upon clinical outcomes.

Molecular mechanisms of the effects of olive oil and other dietary lipids on cancer

Cancer is one of the main causes of mortality worldwide. Geographical differences in incidence rates suggest a key effect of environmental factors, especially diet, in its aetiology. Epidemiologic and experimental studies have found a role of dietary lipids in cancer, particularly breast, colorectal, and prostate cancers. Their incidence in the Mediterranean countries, where the main source of fat is olive oil, is lower than in other areas of the world. Human studies about the effects of dietary lipids are little conclusive, probably due to methodological issues. On the other hand, experimental data have clearly demonstrated that the influence of dietary fats on cancer depends on the quantity and the type of lipids. Whereas a high intake of n-6 PUFA and saturated fat has tumor-enhancing effects, n-3 PUFA, conjugated linoleic acid and gamma-linolenic acid have inhibitory effects. Data regarding MUFA have not always been conclusive, but high olive oil diets seem to have protective effects. Such effects can be due to oleic acid, the main MUFA in olive oil, and to certain minor compounds such as squalene and phenolic compounds. This work aims to review the current knowledge about the relationship between dietary lipids and cancer, with a special emphasis on olive oil, and the molecular mechanisms underlying these effects: modifications on the carcinogenesis stages, hormonal status, cell membrane structure and function, signal transduction pathways, gene expression, and immune system.

Fatty acids in cord blood plasma, the relation to soluble CD23 and subsequent atopy

Atopy is suggested to be linked to the balance between levels of n-6 and n-3 series of long chain polyunsaturated fatty acids (PUFAs) in the diet. In a nested case-control study, levels of fatty acids, IgE and soluble low affinity IgE receptor (sCD23) were measured in cord blood in 35 children who subsequently developed allergic sensitisation and atopic dermatitis before the age of 3, and similarly in 35 matched children without a history of atopy. We found a tendency to lower levels of the n-3 PUFAs eicosapentaenoic acid (EPA) and alpha-linolenic acid (ALA) in the cord blood plasma of atopics compared to non-atopics. Levels of sCD23 were negatively correlated to levels of n-3 series of PUFAs and n-9 eicosenoic acid, and levels of n-9 eicosenoic acid was negatively correlated to levels of IgE. There was no association between the levels of sCD23 and n-6 PUFAs. Lower levels of n-3 PUFAs in cord blood may be associated with the development of atopy in children. A possible mechanism may be through the regulation of CD23, thereby influencing IgE synthesis.

Anti-inflammatory effects of isoflavone powder produced from soybean cake

Soybean cake, a byproduct obtained during the processing of soybean oil, has been shown to be a rich source of isoflavones. The objectives of this study were to use soybean cake as raw material for processing into powder and to evaluate the anti-inflammatory activity. Eleven treatments, including powders of malonylglucoside, glucoside, acetylglucoside, aglycone, ISO-1, and ISO-2, as well as genistein standard, gamma-PGA, control, normal, and PDTC, were used for evaluation. A total of 77 mice were each provided daily with tube feeding for 4 weeks at a dose of 0.3 mL of aqueous solution from each treatment, and inflammation was induced with intraperitoneal injection of 1 mg/kg of body weight lipopolysaccharide (LPS). Results showed that all of the isoflavone powders and genistein standard were effective in inhibiting LPS-induced inflammation, lowering leukocyte number in mice blood and reducing production of IL-1beta, IL-6, NO, and PGE2 in both peritoneal exudate cell supernatant and peritoneal exudate fluid. All of the isoflavone treatments failed to retard T cell proliferation; however, both ISO-1 and ISO-2 could inhibit B cell proliferation. The difference in anti-inflammatory activity was minor between any of the isoflavone treatments.

Dietary α-linolenic acid and health-related outcomes: a metabolic perspective

α-Linolenic acid (αLNA; 18: 3n-3) is essential in the human diet, probably because it is the substrate for the synthesis of longer-chain, more unsaturatedn-3 fatty acids, principally EPA (20: 5n-3) and DHA (22: 6n-3), which confer important biophysical properties on cell membranes and so are required for tissue function. The extent to which this molecular transformation occurs in man is controversial. The present paper reviews the recent literature on the metabolism of αLNA in man, including the use of dietary αLNA in β-oxidation, recycling of carbon by fatty acid synthesisde novoand conversion to longer-chain PUFA. Sex differences in αLNA metabolism and the possible biological consequences are discussed. Increased consumption of EPA and DHA in fish oil has a number of well-characterised beneficial effects on health. The present paper also reviews the efficacy of increased αLNA consumption in increasing the concentrations of EPA and DHA in blood and cell lipid pools, and the extent to which such dietary interventions might be protective against CVD and inflammation. Although the effects on CVD risk factors and inflammatory markers are variable, where beneficial effects have been reported these are weaker than have been achieved from increasing consumption of EPA+DHA or linoleic acid. Overall, the limited capacity for conversion to longer-chainn-3 fatty acids, and the lack of efficacy in ameliorating CVD risk factors and inflammatory markers in man suggests that increased consumption of αLNA may be of little benefit in altering EPA+DHA status or in improving health outcomes compared with other dietary interventions.

Integrative medicine and asthma

Childhood asthma is a spectrum of symptoms and clinical presentations. The treatment begins with developing goals of therapy for a child by the health care provider, the family, and the child as a team. The primary objective is to reduce symptoms and exacerbations using therapies that include conventional medications, environmental controls, and lifestyle modification while reducing the potential for adverse effects of medications and the disease. Complementary and alternative medicine (CAM) may play a role in meeting these objectives, and through the integration of conventional and CAM therapies, an integrative medicine approach may facilitate reaching these objectives in a more effective manner.

Immunomodulation by omega-3 fatty acids

The immune system, including its inflammatory components, is fundamental to host defense against pathogenic invaders. It is a complex system involving interactions amongst many different cell types dispersed throughout the body. Central to its actions are phagocytosis, processing of antigens derived from intracellular and extracellular pathogens, activation of T cells with proliferation and production of cytokines that elicit effector cell functions such as antibody production and killing cell activity. Inappropriate immunologic activity, including inflammation, is a characteristic of many common human disorders. Eicosanoids produced from arachidonic acid have roles in inflammation and regulation of T and B lymphocyte functions. Eicosapentaenoic acid (EPA) also gives rise to eicosanoids and docosahexaenoic acid (DHA) to docosanoids; these may have differing properties to arachidonic acid-derived eicosanoids. EPA and DHA give rise to newly discovered resolvins. Human immune cells are typically rich in arachidonic acid, but arachidonic acid, EPA and DHA contents can be altered through oral administration of those fatty acids. This results in a change pattern of production of eicosanoids and probably also of docosanoids and resolvins, although the latter are not well examined in the human context. Changing the fatty acid composition of immune cells also affects phagocytosis, T-cell signaling and antigen presentation capability. These effects appear to mediated at the membrane level suggesting important roles of fatty acids in membrane order, lipid raft structure and function and membrane trafficking.

Omega-3 fatty acid regulates inflammatory cytokine/mediator messenger RNA expression in Porphyromonas gingivalis-induced experimental periodontal disease

INTRODUCTION

Porphyromonas gingivalis is strongly implicated in the etiology of adult periodontitis by inducing inflammatory cytokines, resulting in gingival and periodontal tissue inflammation and alveolar bone resorption. This study tested the hypothesis that supplementing the diet with omega-3 fatty acid (omega-3 FA; i.e. fish oil) would exert anti-inflammatory effects in the gingival tissues of P. gingivalis-infected rats.

METHODS

Rats were fed either fish oil or corn oil diets ad libitum for 22 weeks and infected with P. gingivalis strain 381 or strain A7A1-28. After sacrifice, rat gingival tissues were excised and the RNA was isolated and analyzed for proinflammatory mediators [interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), IL-6], T helper type 1 and type 2 cytokines [interferon-gamma (IFN-gamma), IL-4, IL-10), antioxidant enzymes [catalase (CAT), superoxide dismutase (SOD)], and genes critical for eicosanoid mediator production [cyclo-oxygenase-2 (COX-2), 5-lipoxygenase (5-LO)] by reverse transcription-polymerase chain reaction using rat-specific primers.

RESULTS

Rats on the omega-3 FA diet exhibited decreased proinflammatory cytokine gene expression (IL-1beta, TNF-alpha) and enhanced IFN-gamma, CAT and SOD messenger RNA expression compared to rats fed a corn oil diet, supporting a diet-induced modulation of host inflammatory reactions. Analyses of alveolar bone resorption in the rats related to gene expression profiles demonstrated significant positive correlations with IL-1beta, IL-6 and COX-2 and negative correlations with CAT and SOD.

CONCLUSION

These findings suggest that diets enriched for omega-3 FA modulate the local gingival inflammatory milieu of the host following oral P. gingivalis infection, which impacts on alveolar bone resorption in rats.

Early life events in asthma--diet

It has been hypothesized that the recent increase in the prevalence of asthma may, in part, be a consequence of changing diet. There is now increasing interest in the possibility that childhood asthma may be influenced by maternal diet during pregnancy and/or diet during early childhood. A number of observational studies and a childhood fish oil supplementation study provide little support for the notion that early childhood intake of polyunsaturated fatty acids (PUFAs) influence the development of childhood asthma. Recent work however, suggests that supplementation of maternal diet with fish oil is associated with altered neonatal immune responses to allergens. Further work is required to establish whether this immunological observation is translated into clinical outcomes. Two birth cohorts have now reported reduced maternal intake of vitamin E, zinc and vitamin D during pregnancy to be associated with increased asthma and wheezing outcomes in children up to the age of 5 years. Early life diet could modulate the likelihood of childhood asthma by affecting fetal airway development and/or influencing the initial early life interactions between allergens and the immune system. In animal models, vitamin E, zinc and vitamin D have been shown to modify fetal lung development and vitamin E, zinc, vitamin D and PUFA can modulate T-cell responses. Further research, particularly, early life intervention studies need to be carried out to establish whether early life dietary intervention can be used as a public health measure to reduce the prevalence of childhood asthma.

Differential immunomodulation with long-chain n-3 PUFA in health and chronic disease

The balance of intake of n-6 and n-3 PUFA, and consequently their relative incorporation into immune cells, is important in determining the development and severity of immune and inflammatory responses. Some disorders characterised by exaggerated inflammation and excessive formation of inflammatory markers have become among the most important causes of death and disability in man in modern societies. The recognition that long-chain n-3 PUFA have the potential to inhibit (excessive) inflammatory responses has led to a large number of clinical investigations with these fatty acids in inflammatory conditions as well as in healthy subjects. The present review explores the presence of dose-related effects of long-chain n-3 PUFA supplementation on immune markers and differences between healthy subjects and those with inflammatory conditions, because of the important implications for the transfer of information gained from studies with healthy subjects to patient populations, e.g. for establishing dose levels for specific applications. The effects of long-chain n-3 PUFA supplementation on ex vivo lymphocyte proliferation and cytokine production by lymphocytes and monocytes in healthy subjects have been studied in twenty-seven, twenty-five and forty-six treatment cohorts respectively, at intake levels ranging from 0.2 g EPA+DHA/d to 7.0 g EPA+DHA/d. Most studies, particularly those with the highest quality study design, have found no effects on these immune markers. Significant effects on lymphocyte proliferation are decreased responses in seven of eight cohorts, particularly in older subjects. The direction of the significant changes in cytokine production by lymphocytes is inconsistent and only found at supplementation levels > or =2.0 g EPA+DHA/d. Significant changes in inflammatory cytokine production by monocytes are decreases in their production in all instances. Overall, these studies fail to reveal strong dose-response effects of EPA+DHA on the outcomes measured and suggest that healthy subjects are relatively insensitive to immunomodulation with long-chain n-3 PUFA, even at intake levels that substantially raise their concentrations in phospholipids of immune cells. In patients with inflammatory conditions cytokine concentrations or production are influenced by EPA+DHA supplementation in a relatively large number of studies. Some of these studies suggest that local effects at the site of inflammation might be more pronounced than systemic effects and disease-related markers are more sensitive to the immunomodulatory effects, indicating that the presence of inflamed tissue or 'sensitised' immune cells in inflammatory disorders might increase sensitivity to the immunomodulatory effects of long-chain n-3 PUFA. In a substantial number of these studies clinical benefits related to the inflammatory state of the condition have been observed in the absence of significant effects on immune markers of inflammation. This finding suggests that condition-specific clinical end points might be more sensitive markers of modulation by EPA+DHA than cytokines. In general, the direction of immunomodulation in healthy subjects (if any) and in inflammatory conditions is the same, which indicates that studies in healthy subjects are a useful tool to describe the general principles of immunomodulation by n-3 PUFA. However, the extent of the effect might be very different in inflammatory conditions, indicating that studies in healthy subjects are not particularly suitable for establishing dose levels for specific applications in inflammatory conditions. The reviewed studies provide no indications that the immunomodulatory effects of long-chain n-3 PUFA impair immune function or infectious disease resistance. In contrast, in some conditions the immunomodulatory effects of EPA+DHA might improve immune function.

Dietary fish oil n-3 fatty acids increase regulatory cytokine production and exert anti-inflammatory effects in two murine models of inflammation

The higher incidence of inflammatory diseases in Western countries might be related, in part, to a high consumption of saturated fatty acids and n-6 polyunsaturated fatty acids (PUFA) and an insufficient intake of n-3 fatty acids. The purpose of this study was to examine the effects of dietary n-3 fatty acids on innate and specific immune response and their anti-inflammatory action in models of contact and atopic dermatitis. Balb/C mice were fed for 3 wk either n-6 or n-3 PUFA-fortified diets. After inducing a contact or an atopic dermatitis, immunological parameters were analyzed to evaluate the anti-inflammatory potential of these n-3 PUFA. n-3 PUFA reduced innate and specific immune responses through inhibition of TH1 and TH2 responses, increase of immunomodulatory cytokines such as IL-10, and regulation of gene expression. The inhibition of both kinds of responses was confirmed by the anti-inflammatory effect observed in contact and atopic dermatitis. Reduction in weight, edema, thickness, leukocyte infiltration, and enhancement of antioxidant defenses in the inflamed ears of mice from both models along with the prevention of delayed-type hypersensitivity induced in atopic dermatitis proved n-3 PUFA efficacy. Our data suggest that dietary fish oil-derived n-3 fatty acids have immunomodulatory effects and could be useful in inflammatory disorders.

Membrane fatty acids, oxidative burst and phagocytosis after enrichment of P388D1 monocyte/macrophages with essential 18-carbon fatty acids

The fatty acid composition of cell membranes can be modified in cell culture. The role of different fatty acid families in modulating phagocytosis and oxidative burst is not clear and therefore the influence of 18-carbon polyunsaturated fatty acids (PUFA) on these processes was examined. The mouse monocyte/macrophage line P388D1 was cultured in medium supplemented with 2 or 20 micromol/l 18:2n-6 (linoleic acid; LA) or 18:3n-3 (alpha-linolenic acid; LNA) and fatty acid enrichment of the cells was tested after 8 days. The macrophages were activated with phorbol ester in order to promote oxidative burst and intracellular dihydrorhodamine oxidation was determined. To test phagocytosis capacity uptake of fluorescence-labeled Escherichia coli was determined. Activation of the transcription factor nuclear factor (NF)-kappaB was also determined. Cells grown in medium with 20 micromol/l LA contained 2- to 3-fold more n-6 PUFA including 4-fold more arachidonic acid. Cells grown in medium with 20 micromol/l LNA contained 4-fold more n-3 PUFA. Both LA and LNA enhanced phagocytosis and decreased oxidative burst, with little difference between the fatty acids. NF-kappaB activation at 1 h post-stimulation was not affected by adding LA or LNA to the culture medium. We conclude that the fatty acid composition of macrophages influences their ability to phagocytose and mount oxidative burst.

Effects of intravenous triacylglycerol emulsions on lymphocyte responses to mitogens in fasted dairy cows undergoing intense lipomobilization

The objective of the study was to assess the effects of intravenous infusion of triacylglycerol (TAG) emulsions derived from different lipid sources on responses to mitogens of peripheral blood mononuclear cells (PBMC) isolated from fasted dairy cows. Six multiparous, non-pregnant, non-lactating Holstein cows were used in a replicated 3×3 Latin Square design. For 4 d, cows were fasted and infused intravenously with a 20% TAG emulsions derived from tallow (TA), linseed oil (LO) or fish oil (FO). Fasting was employed to induce energy deficit and lipid mobilization. Emulsions were administered for 20 to 30 min every 4 h throughout the 4 d fast at a rate of 0·54 g TAG/kg BW/d. Blood samples were taken before the first infusion, and then every 24 h during the fast. Blood was utilized to assess DNA synthesis, IgM and interferon-gamma (IFN-γ) secretion by PBMC stimulated with mitogens. In TA infused cows there was a decline of PBMC ability to respond to mitogens, which was significant 48 h after initiation of the infusion period for DNA synthesis and IFN-γ secretion. In LO or FO infused cows, PBMC responses to mitogens were not altered during the infusion period, and in some cases PBMC responses to mitogen was improved at 72 and 96 h after initiation of treatments. Effects of TAG infusion on PBMC responses to mitogens depended on the lipid source suggesting that LO or FO can attenuate the negative effects of fasting on immune functions.

Prenatal fatty acid status and immune development: the pathways and the evidence

This review explores the effects of dietary long chain polyunsaturated fatty acids (LCPUFA) on various aspects of early immune development and their potential role in the development or the prevention of immune disease. Modern diets have become increasingly rich in n-6 LCPUFA and relatively n-3 LCPUFA deficient. These potentially "pro-inflammatory" dietary changes have clear implications for the immature and developing fetal immune system. It is now well known that immunological abnormalities precede the development of allergic disease and are frequently evident at birth or in the first months of life. This has lead to the hypothesis that potential effects of LCPUFA could be greatest in very early life before immune responses and clinical phenotype are established. Here we summarise the evidence that patterns of LCPUFA exposure in pregnancy can influence aspects of fetal immune in ways that are consistent with the immunological properties of these nutrients in adults. Specifically, human studies have shown that higher levels of n-3 LCPUFA are associated with reduction in neonatal oxidative stress, reduced production of inflammatory leukotienne B4 (LTB4) and altered T cell function. Inverse correlations between n-3 LCPUFA levels and neonatal T cell cytokine production, are consistent with adult studies showing reduction in T cell cytokine production with fish oil supplementation. At this stage the relevance of these effects in the prevention of disease is unclear. Although there have been no effects of postnatal fish oil supplementation (from 6 months of age) on allergy prevention, preliminary studies suggest possible merits in pregnancy and there are ongoing pregnancy intervention studies to address this more definitively.