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Al-Khalaifah H. Modulatory Effect of Dietary Polyunsaturated Fatty Acids on Immunity, Represented by Phagocytic Activity. Front Vet Sci 2020; 7:569939. [PMID: 33195556 PMCID: PMC7536543 DOI: 10.3389/fvets.2020.569939] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
Lately, dietary polyunsaturated fatty acids (PUFAs) have shown substantial importance in human and animal nutrition, especially those of the n-3 group. Development and optimal functioning of the immune system are directed affected by diet. These dietary fatty acids have an important impact on the health and immune competence of various species including human beings. They are essential for the modulation of immune responses in health and disease. Fatty acid composition of immune cells can be modulated by the action of dietary fats and the outcomes in the composition can produce functional effects on reactivity and functioning of immune cells in a short period. There are several mechanisms involved in impacting dietary fatty acids on immune function; however, lipid mediator synthesis from PUFAs is of great importance in terms of inflammation. The objectives of this article are reviewing studies on the impact of PUFA in the diet on phagocytosis of chickens, murine, rats, ruminants, and humans. It also sheds light on the possible mechanism by which this immunomodulation occurs.
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Affiliation(s)
- Hanan Al-Khalaifah
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Kuwait City, Kuwait
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2
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Guesdon W, Kosaraju R, Brophy P, Clark A, Dillingham S, Aziz S, Moyer F, Willson K, Dick JR, Patil SP, Balestrieri N, Armstrong M, Reisdroph N, Shaikh SR. Effects of fish oils on ex vivo B-cell responses of obese subjects upon BCR/TLR stimulation: a pilot study. J Nutr Biochem 2017; 53:72-80. [PMID: 29195133 DOI: 10.1016/j.jnutbio.2017.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 12/29/2022]
Abstract
The long-chain n-3 polyunsaturated fatty acids (LC-PUFAs) eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) in fish oil have immunomodulatory properties. B cells are a poorly studied target of EPA/DHA in humans. Therefore, in this pilot study, we tested how n-3 LC-PUFAs influence B-cell responses of obese humans. Obese men and women were assigned to consume four 1-g capsules per day of olive oil (OO, n=12), fish oil (FO, n=12) concentrate or high-DHA-FO concentrate (n=10) for 12 weeks in a parallel design. Relative to baseline, FO (n=9) lowered the percentage of circulating memory and plasma B cells, whereas the other supplements had no effect. There were no postintervention differences between the three supplements. Next, ex vivo B-cell cytokines were assayed after stimulation of Toll-like receptors (TLRs) and/or the B-cell receptor (BCR) to determine if the effects of n-3 LC-PUFAs were pathway-dependent. B-cell IL-10 and TNFα secretion was respectively increased with high DHA-FO (n=10), relative to baseline, with respective TLR9 and TLR9+BCR stimulation. OO (n=12) and FO (n=12) had no influence on B-cell cytokines compared to baseline, and there were no differences in postintervention cytokine levels between treatment groups. Finally, ex vivo antibody levels were assayed with FO (n=7) after TLR9+BCR stimulation. Compared to baseline, FO lowered IgM but not IgG levels accompanied by select modifications to the plasma lipidome. Altogether, the results suggest that n-3 LC-PUFAs could modulate B-cell activity in humans, which will require further testing in a larger cohort.
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Affiliation(s)
- William Guesdon
- Department of Biochemistry & Molecular Biology, Brody School of Medicine, East Carolina University; East Carolina Diabetes & Obesity Institute, East Carolina University
| | - Rasagna Kosaraju
- Department of Biochemistry & Molecular Biology, Brody School of Medicine, East Carolina University; East Carolina Diabetes & Obesity Institute, East Carolina University
| | - Patricia Brophy
- East Carolina Diabetes & Obesity Institute, East Carolina University
| | - Angela Clark
- East Carolina Diabetes & Obesity Institute, East Carolina University
| | | | - Shahnaz Aziz
- Department of Psychology, East Carolina University
| | - Fiona Moyer
- Department of Psychology, East Carolina University
| | - Kate Willson
- Department of Nutrition Science, East Carolina University
| | - James R Dick
- Institute of Aquaculture, University of Stirling, UK
| | | | - Nicholas Balestrieri
- Department of Biochemistry & Molecular Biology, Brody School of Medicine, East Carolina University
| | - Michael Armstrong
- Department of Pharmaceutical Sciences, University of Colorado, Denver, CO
| | - Nichole Reisdroph
- Department of Pharmaceutical Sciences, University of Colorado, Denver, CO
| | - Saame Raza Shaikh
- Department of Biochemistry & Molecular Biology, Brody School of Medicine, East Carolina University; East Carolina Diabetes & Obesity Institute, East Carolina University; Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill.
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Waitzberg DL, Torrinhas RS, Jacintho TM. New Parenteral Lipid Emulsions for Clinical Use. JPEN J Parenter Enteral Nutr 2017; 30:351-67. [PMID: 16804134 DOI: 10.1177/0148607106030004351] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Routine use of parenteral lipid emulsions (LE) in clinical practice began in 1961, with the development of soybean oil (SO) - based LE. Although clinically safe, experimental reports indicated that SO-based LE could exert a negative influence on immunological functions. Those findings were related to its absolute and relative excess of omega-6 polyunsaturated fatty acids (PUFA) and the low amount of omega-3 PUFA and also to its high PUFA content with an increased peroxidation risk. This motivated the development of new LE basically designed along the reduction of omega-6 PUFA and the omega-3 PUFA addition in order to obtain balanced levels of the omega-6/omega-3 ratio. The new LE for clinical use (available in Europe and South America) are differentiated by their content in polyunsaturated (omega-6 and omega-3), monounsaturated, and saturated fatty acids (FA), as well as FA source of their origin, including soy, coconut, olive, and fish oil. This article presents the new LE nutrition and energy functions but also its biochemical, metabolic, and immunomodulating aspects, according to their FA content. LE at 20% when infused from 1.0 to 2.0 g/kg body weight/day rates, either alone or in association with amino acids and glucose, are safe and well tolerated in routine clinical practice. LE combining SO with medium-chain triglycerides and/or olive oil have less omega-6 PUFA and are better metabolized, with less inflammatory and immunosuppressive effects than in relation to pure SO-based LE. The omega-3 PUFA used alone or as component of a new and complex LE (soy, MCT, olive and fish oil) has demonstrated anti-inflammatory and immunomodulatory effects.
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Affiliation(s)
- Dan L Waitzberg
- Laboratório de Fisiologia e Distúrbios Esfincterianos of University of São Paulo, School of Medicine, Department of Gastroenterology, Surgical Division, São Paulo, Brazil.
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Hall JA, Chinn RM, Vorachek WR, Gorman ME, Greitl JL, Joshi DK, Jewell DE. Influence of dietary antioxidants and fatty acids on neutrophil mediated bacterial killing and gene expression in healthy Beagles. Vet Immunol Immunopathol 2010; 139:217-28. [PMID: 21112644 DOI: 10.1016/j.vetimm.2010.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/17/2010] [Accepted: 10/21/2010] [Indexed: 12/21/2022]
Abstract
Dietary (n-3) fatty acids from fish oil have been used to modulate immune function in many mammalian species. Together, dietary antioxidants and behavioral enrichment have been shown to enhance neutrophil phagocytosis in geriatric Beagle dogs. The purpose of this study was to further investigate the effects of vitamins E and C, in combination with dietary fish oil, on neutrophil mediated bacterial killing, and on transcript levels of selected neutrophil mRNA. Fifty adult Beagle dogs were randomized into five dietary treatment groups for 60 days. All foods were complete and balanced and met the nutrient profiles of AAFCO for adult dogs. For 60 days before study initiation, dogs consumed a pretrial food that contained 74 IU/kg vitamin E and 0 mg/kg vitamin C. The five experimental foods were confirmed by analytical methods to contain ≥640 IU/kg vitamin E and 130 mg/kg vitamin C (as fed). Experimental foods ranged from low levels of EPA and DHA (pretrial food and lowest experimental food had 0.01% EPA and no detectable DHA) to the highest experimental food with 0.25% EPA and 0.17% DHA. Ex vivo bactericidal activity of activated, peripheral-blood neutrophils against Lactococcus lactis was determined after 1 h incubation. Bactericidal activity was calculated as a percentage of control values (bacteria incubated in media without neutrophils). Transcript levels of genes involved in neutrophil-mediated immune functions were determined by real-time qPCR. Dogs in all treatment groups had increased serum vitamin E concentration (P<0.01). After consuming experimental food for 60 days, neutrophils from dogs in all 5 treatment groups also had increased bactericidal activity (P<0.01). Dietary fish oil however, had no effect on bactericidal activity. Stepwise multiple regression analysis demonstrated that the change in neutrophil mediated bacterial killing was significantly correlated to changes in gene expression of interleukin-8 receptor (IL-8R), interleukin converting enzyme (ICE), and myeloperoxidase (MPO; r(2)=0.33; P=0.003). When stepwise multiple regression analysis was performed considering each mRNA as a dependent variable and change in selected individual and summed fatty acid concentrations as independent variables, change in the ratio of saturated fatty acids (SFA) to polyunsaturated fatty acids (PUFA) was significant (P≤0.05) in the mRNA regression analyses for IL-8R, ICE, MPO, and cyclooxygenase-2. In summary, circulating neutrophils from dogs fed diets enriched in vitamins E and C had significantly increased bactericidal activity as well as altered gene expression. Change in SFA to PUFA ratio also altered neutrophil gene expression.
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Affiliation(s)
- Jean A Hall
- Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331-4802, United States.
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Ellinger S, Linscheid KP, Jahnecke S, Goerlich R, Enbergs H. The Effect of Mare's Milk Consumption on Functional Elements of Phagocytosis of Human Neutrophil Granulocytes From Healthy Volunteers. FOOD AGR IMMUNOL 2010. [DOI: 10.1080/09540100220145000b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Sanderson P, Yaqoob P, Calder PC. Effects of Dietary Lipid Manipulation upon Rat Spleen Lymphocyte Functions and the Expression of Lymphocyte Surface Molecules. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/13590849509000211] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Butler LM, Wang R, Koh WP, Stern MC, Yuan JM, Yu MC. Marine n-3 and saturated fatty acids in relation to risk of colorectal cancer in Singapore Chinese: a prospective study. Int J Cancer 2009; 124:678-86. [PMID: 18973226 PMCID: PMC2736597 DOI: 10.1002/ijc.23950] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Experimental data support multiple roles for fatty acids in colorectal carcinogenesis. We examined dietary fatty acids and incidence of colorectal cancer, and evaluated effect modification by sex and stage of disease among a population-based cohort of 61,321 Singapore Chinese that was established between 1993 and 1998. As of December 31, 2005, 961 incident colorectal cancers were diagnosed. Presented hazard ratios (HRs) are for highest versus lowest quartiles with adjustment for potential confounders. Among women, we observed a dose-dependent, positive association between saturated fat and localized colorectal cancer (Dukes A or B) [(HR=1.69, 95% confidence interval (CI)=1.08-2.63, p for trend=0.01)]. No such associations were noted in men (p for interaction by sex=0.04). Marine n-3 polyunsaturated fatty acid (PUFA) intake was positively associated with advanced disease (Dukes C or D) (HR=1.33, 95% CI=1.05-1.70, p for trend=0.01), regardless of sex. The association with marine n-3 PUFAs was strongest among those with the shortest (10 years) (HR=0.62, 95% CI=0.29-1.34, p for trend=0.55). Our findings suggest that subtypes of fatty acids may differentially influence risk of colorectal cancer of a specified stage.
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Affiliation(s)
- Lesley M Butler
- Department of Public Health Sciences, University of California-Davis, Davis, CA 95616, USA.
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Kew S, Gibbons ES, Thies F, McNeill GP, Quinlan PT, Calder PC. The effect of feeding structured triacylglycerols enriched in eicosapentaenoic or docosahexaenoic acids on murine splenocyte fatty acid composition and leucocyte phagocytosis. Br J Nutr 2007; 90:1071-80. [PMID: 14641966 DOI: 10.1079/bjn2003996] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The effects of altering the type of n-3 polyunsaturated fatty acid (PUFA) in the mouse diet on the ability of monocytes and neutrophils to perform phagocytosis were investigated. Male weanling mice were fed for 7 d on one of nine diets which contained 178 g lipid/kg and which differed in the type of n-3 PUFA and in the position of these in dietary triacylglycerol (TAG). The control diet contained 4·4 g α-linolenic acid/100 g total fatty acids. In the other diets, eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) replaced a proportion (50 or 100 %) of the α-linolenic acid, and were in the sn-2 or the sn-1(3) position of dietary TAG. There were significant increases in the content of n-3 PUFA in spleen-cell phospholipids when EPA or DHA was fed. These increases were largely independent of the position of EPA or DHA in dietary TAG except when EPA was fed at the highest level, when the incorporation was greater when it was fed in the sn-2 than in the sn-1(3) position. There was no significant effect of dietary DHA on monocyte or neutrophil phagocytic activity. Dietary EPA dose-dependently decreased the number of monocytes and neutrophils performing phagocytosis. However, when EPA was fed in the sn-2 position, the ability of active monocytes or neutrophils to engulf bacteria was increased in a dose-dependent fashion. This did not occur when EPA was fed in the sn-1(3) position. Thus, there appears to be an influence of the position of EPA, but not of DHA, in dietary TAG on its incorporation into cell phospholipids and on the activity of phagocytic cells.
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Affiliation(s)
- Samantha Kew
- Institute of Human Nutrition, University of Southampton, Southampton SO16 7PX, UK
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Gorjão R, Verlengia R, Lima TMD, Soriano FG, Boaventura MFC, Kanunfre CC, Peres CM, Sampaio SC, Otton R, Folador A, Martins EF, Curi TCP, Portiolli EP, Newsholme P, Curi R. Effect of docosahexaenoic acid-rich fish oil supplementation on human leukocyte function. Clin Nutr 2006; 25:923-38. [PMID: 16697494 DOI: 10.1016/j.clnu.2006.03.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 03/10/2006] [Accepted: 03/17/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of a docosahexaenoic acid (DHA)-rich fish oil (FO) supplementation on human leukocyte function was investigated. METHODS Ten male volunteers were supplemented with 3g/day FO containing 26% eicosapentaenoic acid (EPA, 20:5, n-3) and 54% DHA (22:6, n-3) for 2 months. RESULTS FO supplementation changed the fatty acid (FA) composition of leukocytes resulting in an increase of n-3/n-6 ratio from 0.18 to 0.62 in lymphocytes and from 0.15 to 0.70 in neutrophils. DHA-rich FO stimulated an increase in phagocytic activity by 62% and 145% in neutrophils and monocytes, respectively. Neutrophil chemotactic response was increased by 128%. The rate of production of reactive oxygen species by neutrophils was also increased, as it was with lymphocyte proliferation. These changes were partially reversed after a 2-month wash out period. With respect to cytokine production by lymphocytes, interleukin (IL)-4 release was not altered, whereas secretions of IL-10, interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha were raised. These results are in contrast to those described by others using EPA-rich FO supplementation. Lymphocyte pleiotropic gene expression was analyzed by a macroarray technique. Of the analyzed genes (588 in total), 77 were modified by the supplementation. FO supplementation resulted in up-regulation of 6 genes (GATA binding protein 2, IL-6 signal transducer, transforming growth factor alpha, TNF, heat shock 90kDa protein 1-alpha and heat shock protein 70kDa 1A) and a down regulation of 71 genes (92.2% of total genes changed). The largest functional group of altered genes was that related to signaling pathways (22% of the total modified genes). CONCLUSIONS Therefore, although EPA and DHA are members of n-3 FA family, changes in the proportion of DHA and EPA exert different effects on neutrophil, monocyte and lymphocyte function, which may be a result of specific changes in gene expression.
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Affiliation(s)
- Renata Gorjão
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 1524, 05508-900, Butantã, São Paulo, SP, Brazil.
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Abstract
Research describing fatty acids as modulators of inflammation and immune responses abounds. Many of these studies have focused on one particular group of fatty acids, omega-3. The data from animal studies have shown that these fatty acids can have powerful anti-inflammatory and immunomodulatory activities in a wide array of diseases (e.g., autoimmunity, arthritis, and infection). However, the evidence from human trials is more equivocal. In this review, a historical framework for understanding how and why fatty acids may affect the immune system is provided. Second, highlights of two recent landmark reports from the Agency for Healthcare Research and Quality are presented. These reports critically evaluate the evidence from human clinical trials of omega-3 fatty acids and rheumatoid arthritis, asthma, and a few other immune-mediated diseases. Third, the data from human clinical trials investigating the impact of various bioactive fatty acids on ex vivo and in vivo immune response are reviewed. Limitations in experimental design and immune assays commonly used are discussed. The discordance between expectation and evidence in this field has been a disappointment. Recommendations for improving both animal-based and human studies are provided.
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MESH Headings
- Animals
- Arthritis, Rheumatoid/diet therapy
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/metabolism
- Asthma/diet therapy
- Asthma/immunology
- Asthma/metabolism
- Dietary Fats, Unsaturated/immunology
- Dietary Fats, Unsaturated/metabolism
- Disease Models, Animal
- Evidence-Based Medicine
- Fatty Acids, Omega-3/immunology
- Fatty Acids, Omega-3/metabolism
- Fatty Acids, Omega-6/immunology
- Fatty Acids, Omega-6/metabolism
- Fatty Acids, Unsaturated/immunology
- Fatty Acids, Unsaturated/metabolism
- Humans
- Inflammation/diet therapy
- Inflammation/immunology
- Inflammation/metabolism
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Affiliation(s)
- Kevin Fritsche
- Division of Animal Sciences, Departments of Nutritional Sciences, and Microbiology & Molecular Immunology, University of Missouri-Columbia, Columbia, Missouri 65211, USA.
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Lee JY, Plakidas A, Lee WH, Heikkinen A, Chanmugam P, Bray G, Hwang DH. Differential modulation of Toll-like receptors by fatty acids: preferential inhibition by n-3 polyunsaturated fatty acids. J Lipid Res 2003; 44:479-86. [PMID: 12562875 DOI: 10.1194/jlr.m200361-jlr200] [Citation(s) in RCA: 413] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Human subjects consuming fish oil showed a significant suppression of cyclooxygenase-2 (COX-2) expression in blood monocytes when stimulated in vitro with lipopolysaccharide (LPS), an agonist for Toll-like receptor 4 (TLR4). Results with a murine monocytic cell line (RAW 264.7) stably transfected with COX-2 promoter reporter gene also demonstrated that LPS-induced COX-2 expression was preferentially inhibited by docosahexaenoic acid (DHA, C22:6n-3) and eicosapentaenoic acid (EPA, C20:5n-3), the major n-3 polyunsaturated fatty acids (PUFAs) present in fish oil. Additionally, DHA and EPA significantly suppressed COX-2 expression induced by a synthetic lipopeptide, a TLR2 agonist. These results correlated with the preferential suppression of LPS- or lipopeptide-induced NF kappa B activation by DHA and EPA. The target of inhibition by DHA is TLR itself or its associated molecules, but not downstream signaling components. In contrast, COX-2 expression by TLR2 or TRL4 agonist was potentiated by lauric acid, a saturated fatty acid. These results demonstrate that inhibition of COX-2 expression by n-3 PUFAs is mediated through the modulation of TLR-mediated signaling pathways. Thus, the beneficial or detrimental effects of different types of dietary fatty acids on the risk of the development of many chronic inflammatory diseases may be in part mediated through the modulation of TLRs.
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Affiliation(s)
- Joo Y Lee
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA
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Wu FC, Ting YY, Chen HY. Dietary docosahexaenoic acid is more optimal than eicosapentaenoic acid affecting the level of cellular defence responses of the juvenile grouper Epinephelus malabaricus. FISH & SHELLFISH IMMUNOLOGY 2003; 14:223-238. [PMID: 12681278 DOI: 10.1006/fsim.2002.0433] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The combined effects of dietary docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids on phagocytic, respiratory burst, and leucocyte proliferative activities of the juvenile grouper, Epinephelus malabaricus, were investigated. The test fish were fed for 12wk on test diets containing 1g 100g(-1) diet of DHA and EPA in combinations (DHA/EPA: 3/1, 2/1, 1/1, 0.7/1, 0.3/1). In addition to promoting fish growth, high dietary DHA/EPA ratio significantly enhanced phagocytic and respiratory burst activities of grouper head-kidney leucocytes compared with low ratio. Significant correlations were found between leucocyte phagocytic or respiratory burst activities and concentrations of 20:3(n-3), DHA and EPA in fish liver and muscle tissues. Leucocyte proliferation was significantly higher (P< 0.05) when the diets were high in DHA/EPA ratio than low in DHA/EPA ratio, when stimulated by Con A and PHA-P, but not by LPS. Tissue DHA concentrations and leucocyte proliferation were significantly and positively correlated. Fortification of dietary DHA, thus increased T-cell proliferation and phagocytic function of grouper leucocytes. DHA is the only member in the (n-3) highly unsaturated fatty acid family that stimulated phagocytic functions of leucocytes and T-cell proliferation, and is more optimal than EPA affecting the cellular defence responses of the E. malabaricus juveniles.
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MESH Headings
- Animals
- Cell Division/immunology
- Dietary Fats, Unsaturated/immunology
- Dietary Fats, Unsaturated/metabolism
- Dietary Fats, Unsaturated/pharmacology
- Docosahexaenoic Acids/immunology
- Docosahexaenoic Acids/metabolism
- Docosahexaenoic Acids/pharmacology
- Eicosapentaenoic Acid
- Fatty Acids, Unsaturated/immunology
- Fatty Acids, Unsaturated/metabolism
- Fatty Acids, Unsaturated/pharmacology
- Immunity, Cellular/drug effects
- Immunity, Cellular/immunology
- Leukocytes/cytology
- Leukocytes/immunology
- Leukocytes/metabolism
- Lipids/analysis
- Liver/chemistry
- Liver/metabolism
- Lymphocyte Activation/drug effects
- Lymphocyte Activation/immunology
- Muscle, Skeletal/chemistry
- Muscle, Skeletal/metabolism
- Perciformes/immunology
- Perciformes/metabolism
- Phagocytosis/drug effects
- Phagocytosis/immunology
- Random Allocation
- Respiratory Burst/drug effects
- Respiratory Burst/immunology
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Affiliation(s)
- F C Wu
- Institute of Marine Biology, National Sun Yat-sen University, Kaohsiung 804, Taiwan
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13
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Wang YW, Ajuyah AO, Sunwoo HH, Cherian G, Sim JS. Maternal dietary N-3 fatty acids alter the spleen fatty acid composition and bovine serum albumin-induced wing web swelling in broilers. Poult Sci 2002; 81:1722-7. [PMID: 12455601 DOI: 10.1093/ps/81.11.1722] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Effects of maternal dietary polyunsaturated fatty acids (PUFA) on the spleen fatty acid composition and BSA-induced wing web swellings were investigated in broilers. One hundred twenty broiler breeder hens 26 wk of age were randomly assigned to diets containing mainly wheat, corn, soy meal, barley, oat and 5% (wt/wt) added sunflower oil, fish oil, or a mix of sunflower and fish oils (1:1). After 2 wk on the experimental diets, birds were inseminated, eggs were collected and incubated. Progeny chicks were then fed identical diets for 6 wk. The maternal dietary oils affected (P < 0.05) n-6 and n-3 PUFA in the spleens of hatching chicks. After 2 wk, n-6 PUFA did not differ among the groups; n-3 PUFA, docosapentaenoic, and docosahexaenoic (DHA) acids were higher (P < 0.05) in the spleens of broilers from hens fed 2.5 or 5% fish oil. After 4 wk, broilers from hens fed 5% fish oil still had higher levels of DHA (P < 0.05) in their spleens than those from hens fed 5% sunflower oil. The BSA-induced wing web swelling response was suppressed (P < 0.05) by n-3 PUFA in breeder hens. Broilers from hens fed high levels of n-3 PUFA had lower (P < 0.05) wing web swelling reactions to BSA at 2 wk (2.5% fish oil) and 4 wk (2.5 and 5% fish oil). In conclusion, n-3 PUFA in breeder hen diets suppressed the BSA-induced wing web swellings of the hens, increased the spleen n-3 fatty acids (especially DHA), and decreased BSA-induced wing web swellings of progeny up to 4 wk of age.
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Abstract
Athletes are exposed to acute and chronic stress that may lead to suppression of the immune system and increased oxidative species generation. In addition, the tendency to consume fewer calories than expended and to avoid fats may further compromise the immune system and antioxidant mechanisms. The exercise stress is proportional to the intensity and duration of the exercise, relative to the maximal capacity of the athlete. Muscle glycogen depletion compromises exercise performance and it also increases the stress. Glycogen stores can be protected by increased fat oxidation (glycogen sparing). The diets of athletes should be balanced so that total caloric intake equals expenditure, and so that the carbohydrates and fats utilised in exercise are replenished. Many athletes do not meet these criteria and have compromised glycogen or fat stores, have deficits in essential fats, and do not take in sufficient micronutrients to support exercise performance, immune competence and antioxidant defence. Either overtraining or under nutrition may lead to an increased risk of infections. Exercise stress leads to a proportional increase in stress hormone levels and concomitant changes in several aspects of immunity, including the following: high cortisol; neutrophilia; lymphopenia; decreases in granulocyte oxidative burst, nasal mucociliary clearance, natural killer cell activity, lymphocyte proliferation, the delayed-type sensitivity response, the production of cytokines in response to mitogens, and nasal and salivary immunoglobulin A levels; blunted major histocompatibility complex II expression in macrophages; and increases in blood granulocyte and monocyte phagocytosis, and pro- and anti-inflammatory cytokines. In addition to providing fuel for exercise, glycolysis, glutaminlysis, fat oxidation and protein degradation participate in metabolism and synthesis of the immune components. Compromising, or overusing, any of these components may lead to immunosuppression. In some cases, supplementation with micronutrients may facilitate the immune system and compensate for deficits in essential nutrients. In summary, athletes should eat adequate calories and nutrients to balance expenditure of all nutrients. Dietary insufficiencies should be compensated for by supplementation with nutrients, with care not to over compensate. By following these rules, and regulating training to avoid overtraining, the immune system can be maintained to minimise the risk of upper respiratory tract infections.
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Affiliation(s)
- Jaya T Venkatraman
- Department of Physical Therapy, Exercise and Nutrition Sciences, School of Health Related Professions, University at Buffalo, Buffalo, New York 14214, USA.
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15
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Abstract
The fatty acid composition of inflammatory and immune cells is sensitive to change according to the fatty acid composition of the diet. In particular, the proportion of different types of polyunsaturated fatty acids (PUFA) in these cells is readily changed, and this provides a link between dietary PUFA intake, inflammation, and immunity. The n-6 PUFA arachidonic acid (AA) is the precursor of prostaglandins, leukotrienes, and related compounds, which have important roles in inflammation and in the regulation of immunity. Fish oil contains the n-3 PUFA eicosapentaenoic acid (EPA). Feeding fish oil results in partial replacement of AA in cell membranes by EPA. This leads to decreased production of AA-derived mediators. In addition, EPA is a substrate for cyclooxygenase and lipoxygenase and gives rise to mediators that often have different biological actions or potencies than those formed from AA. Animal studies have shown that dietary fish oil results in altered lymphocyte function and in suppressed production of proinflammatory cytokines by macrophages. Supplementation of the diet of healthy human volunteers with fish oil-derived n-3 PUFA results in decreased monocyte and neutrophil chemotaxis and decreased production of proinflammatory cytokines. Fish oil feeding has been shown to ameliorate the symptoms of some animal models of autoimmune disease. Clinical studies have reported that fish oil supplementation has beneficial effects in rheumatoid arthritis, inflammatory bowel disease, and among some asthmatics, supporting the idea that the n-3 PUFA in fish oil are anti-inflammatory and immunomodulatory.
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Affiliation(s)
- P C Calder
- Institute of Human Nutrition, University of Southampton, Southampton 5016 7PX, United Kingdom.
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16
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Abstract
Dietary essential fatty acids are the precursors for eicosanoids. Among the eicosanoids derived from arachidonic acid, prostaglandin (PG) E2 is known to possess immunosuppressive actions. Thus, it has been a prevailing hypothesis that the immuno-modulatory roles of dietary fatty acids are mediated at least in part through the alteration of PG biosynthesis. PGs exert their biological effects through their cognate receptors. There are four subtypes of PGE receptors (EP1, EP2, EP3, and EP4) so far identified. Although the association of EP receptors with G proteins coupled to adenylate cyclase and the mobilization of intracellular calcium are well documented, downstream signaling pathways for these receptors are virtually unknown. Identification of downstream signaling pathways for each subtype of EP receptors and target genes regulated by the activation of the receptor will help with our understanding of the mechanism by which dietary fatty acids affect immune responses through the modulation of PGE2 biosynthesis. Emerging evidence suggests that fatty acids can additionally act as second messengers, regulators of signal transducing molecules or transcription factors. Acylation with long-chain fatty acids can occur on a variety of signaling molecules and can affect their membrane translocation and functions. Dietary fatty acids can alter functional properties of lipid mediators by changing the composition of acyl moieties of these molecules. Evidence accumulated recently indicates that long-chain unsaturated fatty acids and their metabolites bind and activate peroxisome proliferator-activated receptors (PPARs). PPARs are nuclear hormone receptors and transcription factors that regulate the expression of broad arrays of genes involved not only in lipid and glucose metabolism, but also in immune and inflammatory responses. PPARs may therefore be important cellular targets that mediate modulation of immune responses by dietary fatty acids. Together, it becomes clear now that multiple steps in various receptor-mediated signaling pathways can be modulated by dietary fatty acids. It will be a challenging task to quantitatively determine how different fatty acids alter functional properties of multitude of signaling components and final cellular responses. Elucidating the mechanism of actions of fatty acids on receptor-mediated signaling pathways in immuno-competent cells will provide a new insight for understanding the immuno-modulatory roles of dietary fatty acids.
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Affiliation(s)
- D Hwang
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana 70808, USA.
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17
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Wiesenfeld PW, Babu US, O'Donnell MW. Effect of long-chain fatty acids in the culture medium on fatty acid composition of WEHI-3 and J774A.1 cells. Comp Biochem Physiol B Biochem Mol Biol 2001; 128:123-34. [PMID: 11163311 DOI: 10.1016/s1096-4959(00)00305-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As a first step in determining the mechanism of action of specific fatty acids on immunological function of macrophages, a comparative study of the effect of long-chain polyunsaturated fatty acids (PUFA) in the medium was conducted in two macrophage cell lines, J774A.1 and WEHI-3. The baseline fatty-acid profiles of the two cell lines differed in the % distribution of saturated (SFA) and unsaturated fatty acids (UFA). J774A.1 cells had a higher % of SFA (primarily palmitic acid) than WEHI-3 cells. Conversely, WEHI-3 cells had a higher % of UFA (primarily oleic acid) than J774A.1 cells. Neither cell line had detectable amounts of alpha-linolenic acid (ALA) or eicosapentaenoic acid (EPA). The most abundant polyunsaturated fatty acid in both cells lines was arachidonic acid (AA). The efficiency of transport of fatty acids from the medium to the macrophages by two delivery vehicles (BSA complexes and ethanolic suspensions) was compared. Overall, fatty acids were transported satisfactorily by both delivery systems. Alpha-linolenic acid and doscosahexenoic acid (DHA) were transported more efficiently by the ethanolic suspension system. Linoleic acid (LA) was taken up more completely than ALA, and DHA was taken up more completely than EPA by both cell cultures and delivery systems. A dose-response effect was demonstrated for LA, ALA, EPA and DHA in both J774A.1 and WEHI-3 cells. Addition of polyunsaturated fatty acids (PUFA) to the cell cultures modified the total lipid fatty acid composition of the cells. The presence of ALA in the culture medium resulted in a significant decrease in AA in both cell lines. The omega-3/omega-6 fatty acid ratio (omega-3/omega-6), polyunsaturated/saturated fatty acid ratio (P/S), and unsaturation index (UI) increased directly with the amount of PUFA and omega-3 fatty acid provided in the medium. The results indicate that the macrophage cell lines have similar, but not identical, fatty acid profiles that may be the result of differences in fatty acid metabolism. These distinctions could in turn produce differences in immunological function. The ethanol fatty-acid delivery system, when compared with the fatty acid-BSA complex system, is preferable for measurement of dose-response effects, because the cellular fatty acid content increased in proportion to the amount of fatty acid provided in the medium. Similar dose-response results were observed in a previous in vivo study using flaxseed, rich in ALA, as a source of PUFA.
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Affiliation(s)
- P W Wiesenfeld
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 8301 Murikirk Road, Mod-1, HFS-842, Laurel, MD 20708, USA.
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18
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Healy DA, Wallace FA, Miles EA, Calder PC, Newsholm P. Effect of low-to-moderate amounts of dietary fish oil on neutrophil lipid composition and function. Lipids 2000; 35:763-8. [PMID: 10941877 DOI: 10.1007/s11745-000-0583-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although essential to host defense, neutrophils are also involved in numerous inflammatory disorders including rheumatoid arthritis. Dietary supplementation with relatively large amounts of fish oil [containing >2.6 g eicosapentaenoic acid (EPA) plus 1.4 g docosahexaenoic acid (DHA) per day] can attenuate neutrophil functions such as chemotaxis and superoxide radical production. In this study, the effects of more moderate supplementation with fish oil on neutrophil lipid composition and function were investigated. The rationale for using lower supplementary doses of fish oil was to avoid adverse gastrointestinal problems, which have been observed at high supplementary concentrations of fish oil. Healthy male volunteers aged <40 yr were randomly assigned to consume one of six dietary supplements daily for 12 wk (n = 8 per treatment group). The dietary supplements included four different concentrations of fish oil (the most concentrated fish oil provided 0.58 g EPA plus 1.67 g DHA per day), linseed oil, and a placebo oil. The percentages of EPA and DHA increased (both P < 0.05) in neutrophil phospholipids in a dose-dependent manner after 4 wk of supplementation with the three most concentrated fish oil supplements. No further increases in EPA or DHA levels were observed after 4 wk. The percentage of arachidonic acid in neutrophil phospholipids decreased (P < 0.05) after 12 wk supplementation with the linseed oil supplement or the two most concentrated fish oil supplements. There were no significant changes in N-formyl-met-leu-phe-induced chemotaxis and superoxide radical production following the dietary supplementations. In conclusion, low-to-moderate amounts of dietary fish oil can be used to manipulate neutrophil fatty acid composition. However, this may not be accompanied by modulation of neutrophil functions such as chemotaxis and superoxide radical production.
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Affiliation(s)
- D A Healy
- Department of Biochemistry, The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Ireland
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19
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Abstract
Dietary lipid manipulation may affect a great number of immune parameters, such as lymphocyte proliferation, cytokine synthesis, natural killer (NK) cell activity, phagocytosis and so on. The immunomodulation induced by dietary fatty acids may be applied in the amelioration of inflammatory disorders, such as autoimmune diseases. However, the mechanisms that participate in these processes are still poorly understood. It is probable that modulation of immune system by fatty acids of the diet may occur by alteration of membrane fluidity, lipid peroxide formation, eicosanoid production or regulation of gene expression. However, recent studies have reported the effects of several free fatty acids on apoptosis induction of in vitro cultures. In fact, a possible explanation of the effects that fatty acids promote on the immune system cells could be associated with an apoptotic process performed in an irreversible way. In vivo studies have demonstrated the ability of fatty acids to alter the survival of animals fed diets containing oils and infected with a pathogenic bacterium. Experimental infection in animals fed dietary lipids produces a modification of resistance to micro-organisms. The present review analyses all of these parameters that dietary fatty acids are capable of altering in order to modify the immune response. Further studies will be needed to establish the mechanisms involved in immune system regulation, reduction of symptoms derived from autoimmune pathologies and so on.
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Affiliation(s)
- M A de Pablo
- School of Experimental Sciences, Department of Health Sciences, University of Jaén, Jaén, Spain.
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Tomobe YI, Morizawa K, Tsuchida M, Hibino H, Nakano Y, Tanaka Y. Dietary docosahexaenoic acid suppresses inflammation and immunoresponses in contact hypersensitivity reaction in mice. Lipids 2000; 35:61-9. [PMID: 10695925 DOI: 10.1007/s11745-000-0495-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study was designed to examine the immunomodulatory effects of dietary docosahexaenoic acid (DHA) in the absence of eicosapentaenoic acid (EPA). We investigated the effects of feeding dietary DHA ethyl ester (DHA-Et) (97% pure) at levels of 4.8 wt% of the total diet and of feeding EPA ethyl ester (EPA-Et) (99% pure) at 4.8 wt% on the inflammatory response in the challenge phase of the contact hypersensitivity reaction (CHR) in the ears of mice sensitized with 2,4-dinitro-1-fluorobenzene (DNFB). The effect of DHA-Et on T lymphocytes at the CHR site was examined using anti-CD4 antibodies. Furthermore, we examined the cytokines formed at the CHR site on the mRNA level. It was found that 24 h after the challenge, DHA-Et but not EPA-Et reduced the ear swelling. Infiltration of inflammatory cells, in particular, CD4-positive T lymphocytes, into the ears in the challenge phase of CHR was observed. DHA-Et reduced the infiltration of CD4-positive T lymphocytes into the ears. DHA-Et also decreased the expression of interferon-gamma, interleukin (IL)-6, IL-1beta, and IL-2 mRNA in ears. These observations suggest that DHA, but not EPA, may exert an antiinflammatory and immunosuppressive effect. The immunosuppressive effectiveness of fish oil may be attributed mainly to DHA.
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Affiliation(s)
- Y I Tomobe
- Tsukuba Research Laboratory, NOF Corporation, Ibaraki, Japan
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Heine J, Scheinichen D, Jaeger K, André M, Leuwer M. In vitro influence of parenteral lipid emulsions on the respiratory burst of neutrophils. Nutrition 1999; 15:540-5. [PMID: 10422083 DOI: 10.1016/s0899-9007(99)00112-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The in vitro effect of a fish oil-derived lipid emulsion (omega-3) on the superoxide anion production during the respiratory burst (RB) of human neutrophils was compared to a LCT lipid (Intralipid), and an LCT/MCT emulsion (Lipofundin MCT). The effects of two concentrations (60 and 600 micrograms/mL) were evaluated by rhodamine in a flow cytometer. The RB was induced either by stimulation with Escherichia coli (E. coli) or by priming with TNF-alpha and FMLP stimulation. The results (mean +/- SD%, P < 0.05) were compared to positive control responses (RB without lipids). omega-3 (60 micrograms/mL, -8.2 [9.3]%; 600 micrograms/mL, -9.6 [11.1]%) and LCT (600 micrograms/mL, -8.0 [9.3]%) significantly suppressed the RB after stimulation with E. coli. LCT/MCT increased the RB after E. coli (60 micrograms/mL, 15.7 [15.4]%; 600 micrograms/mL, 42.7 [21.4]%) as well as after TNF-alpha/FMLP stimulation (600 micrograms/mL, 27.4 [23.7]%). The in vitro influence of parenteral lipid emulsions on the superoxide anion production of human neutrophils is dependent on the length of the fatty acid molecule.
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Affiliation(s)
- J Heine
- Department of Anesthesiology, Hannover Medical School, Germany.
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22
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Kelley DS, Taylor PC, Nelson GJ, Schmidt PC, Ferretti A, Erickson KL, Yu R, Chandra RK, Mackey BE. Docosahexaenoic acid ingestion inhibits natural killer cell activity and production of inflammatory mediators in young healthy men. Lipids 1999; 34:317-24. [PMID: 10443964 DOI: 10.1007/s11745-999-0369-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to examine the effects of feeding docosahexaenoic acid (DHA) as triacylglycerol on the fatty acid composition, eicosanoid production, and select activities of human peripheral blood mononuclear cells (PBMNC). A 120-d study with 11 healthy men was conducted at the Metabolic Research Unit of Western Human Nutrition Reach Center. Four subjects (control group) were fed the stabilization diet throughout the study; the remaining seven subjects were fed the basal diet for the first 30 d, followed by 6 g DHA/d for the next 90 d. DHA replaced an equivalent amount of linoleic acid; the two diets were comparable in their total fat and all other nutrients. Both diets were supplemented with 20 mg D alpha-tocopherol acetate per day. PBMNC fatty acid composition and eicosanoid production were examined on day 30 and 113; immune cell functions were tested on day 22, 30, 78, 85, 106, and 113. DHA feeding increased its concentration from 2.3 to 7.4 wt% in the PBMNC total lipids, and decreased arachidonic acid concentration from 19.8 to 10.7 wt%. It also lowered prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) production, in response to lipopolysaccharide, by 60-75%. Natural killer cell activity and in vitro secretion of interleukin-1beta and tumor necrosis factor alpha were significantly reduced by DHA feeding. These parameters remained unchanged in the subjects fed the control diet. B-cell functions as reported here and T-cell functions that we reported previously were not altered by DHA feeding. Our results show that inhibitory effects of DHA on immune cell functions varied with the cell type, and that the inhibitory effects are not mediated through increased production of PGE2 and LTB4.
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Affiliation(s)
- D S Kelley
- USDA, ARS, Western Human Nutrition Research Center, Presidio of San Francisco, California 94129, USA.
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23
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Kelley DS, Taylor PC, Nelson GJ, Mackey BE. Dietary docosahexaenoic acid and immunocompetence in young healthy men. Lipids 1998; 33:559-66. [PMID: 9655370 DOI: 10.1007/s11745-998-0240-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The purpose of this study was to examine the effect of dietary docosahexaenoic acid (DHA), in the absence of eicosapentaenoic acid, on human immune response (IR). A 120-d study with 11 healthy men was conducted at the Metabolic Research Unit of the Western Human Nutrition Research Center. Four subjects (control group) were fed the stabilization or basal diet (15, 30, and 55% energy from protein, fat, and carbohydrate, respectively) throughout the study; the remaining seven subjects (DHA group) were fed the basal diet for the first 30 d, followed by 6 g DHA/d for the next 90 d. DHA replaced an equivalent amount of linoleic acid; the two diets were comparable in their total fat and all other nutrients. Both diets were supplemented with 20 mg d-alpha-tocopherol acetate per day. Indices of IR were examined on study day 22, 30, 78, 85, 106, and 113. Addition of DHA at moderately high levels did not alter the proliferation of peripheral blood mononuclear cells cultured with phytohemagglutinin or concanavalin A, or the delayed hypersensitivity skin response. Also, additional DHA did not alter the number of T cells producing interleukin 2 (IL2), the ratio between the helper/suppressor T cells in circulation, or the serum concentrations of immunoglobulin G, C3, and interleukin 2 receptor (IL2R). DHA supplementation, however, caused a significant (P = 0.0001) decrease in the number of circulating white blood cells which was mainly due to a decrease in the number of circulating granulocytes. The number of lymphocytes in peripheral circulation was not affected by Dietary DHA enrichment, but the percentage of lymphocytes in white blood cells increased because of a reduction in granulocyte numbers. None of these indices was changed in the control group. Our results show that when total fat intake is low and held constant, DHA consumption does not inhibit many of the lymphocyte functions which have been reported to be inhibited by fish oil consumption.
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Affiliation(s)
- D S Kelley
- USDA, ARS, Western Human Nutrition Research Center, Presidio of San Francisco, California 94129, USA.
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24
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Affiliation(s)
- M Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, USA
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25
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Calder PC. N-3 polyunsaturated fatty acids and immune cell function. ADVANCES IN ENZYME REGULATION 1997; 37:197-237. [PMID: 9381972 DOI: 10.1016/s0065-2571(96)00004-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The amount and type of eicosanoids made can be affected by the type of fat consumed in the diet. It is now apparent that both eicosanoids and n-3 PUFAs are potent modulators of lymphocyte and M phi functions in vitro. Inclusion in the diet of high levels of certain lipids containing n-3 PUFAs markedly affects the functions of cells of the immune system subsequently tested in vitro. Cellular components of both natural and acquired immunity are affected. In vivo tests are perhaps the most appropriate approach for determining the effect of different dietary n-3 PUFAs upon immune function. Several studies indicate that diets rich in n-3 PUFAs are anti-inflammatory and immunosuppressive in vivo, although there have been relatively few studies in man. Although some of the effects of n-3 PUFAs may be brought about by modulation of the amount and types of eicosanoids made, it is clear that these fatty acids can also elicit their effects by eicosanoid-independent mechanisms (Fig. 12). Such n-3 PUFA-induced effects may be of use as a therapy for acute and chronic inflammation, for disorders which involve an inappropriately-activated immune response and for the enhancement of graft survival.
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Affiliation(s)
- P C Calder
- School of Biological Sciences, University of Southampton, U.K
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26
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Halvorsen DS, Hansen JB, Grimsgaard S, Bønaa KH, Kierulf P, Nordøy A. The effect of highly purified eicosapentaenoic and docosahexaenoic acids on monocyte phagocytosis in man. Lipids 1997; 32:935-42. [PMID: 9307933 DOI: 10.1007/s11745-997-0120-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The n-3 fatty acids (FA) from marine sources are known to exert antiinflammatory effects on monocyte function. There is still controversy whether n-3 FA may increase the susceptibility to infections. The present study was designed to assess the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on monocyte phagocytosis and respiratory burst activity. Fifty-eight healthy men were randomized to take a daily supplement of 3.8 g highly purified EPA (n = 20), 3.6 g DHA (n = 19), or corn oil (n = 19) for 7 wk. Mononuclear leukocytes were collected, isolated, and cryopreserved prior to and after dietary supplementation. Paired samples were analyzed in the presence of autologous serum in a crossover design. Monocyte phagocytosis and respiratory burst activity were measured by flow cytometry after ingestion of Escherichia coli. Monocytes retained their phagocytic ability and respiratory burst activity after supplementation. No reduction in internalization of bacteria was registered. Dietary n-3 FA and particularly EPA improved bacterial adherence to the monocyte surface. In the crossover experiments, there was an adverse effect of serum enriched with n-3 FA on bacterial adherence. We conclude that monocytes retain their phagocytic potential after supplementation with purified EPA and DHA.
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Affiliation(s)
- D S Halvorsen
- Department of Medicine, University of Tromsø, Norway
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27
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Wander RC, Hall JA, Gradin JL, Du SH, Jewell DE. The ratio of dietary (n-6) to (n-3) fatty acids influences immune system function, eicosanoid metabolism, lipid peroxidation and vitamin E status in aged dogs. J Nutr 1997; 127:1198-205. [PMID: 9187636 DOI: 10.1093/jn/127.6.1198] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We studied the effects of feeding experimental diets containing (n-6) to (n-3) fatty acid ratios of 31:1, 5.4:1, and 1.4:1 to 20 healthy female geriatric Beagles (9.5-11.5 y) for 8-12 wk on various indices of the immune response. Compared with the 31:1 diet, consumption of the 5.4:1 and 1.4:1 diets significantly increased (n-3) fatty acids in plasma (2.17 +/- 0.64, 9.05 +/- 0.64, 17.46 +/- 0.64 g/100 g fatty acids, respectively, P < 0.0001). Although supplementation with (n-3) fatty acids did not significantly alter the humoral immune response to keyhole limpet hemocyanin (KLH), it significantly suppressed the cell-mediated immune response based on results of a delayed-type hypersensitivity (DTH) skin test. The DTH response after intradermal injection of KLH at 24 h was significantly lower in the group consuming the 1.4:1 diet compared with the group consuming the 5.4:1 (P = 0.02) or the 31:1 diets (P = 0.04), and remained significantly suppressed at 48 h in the group fed 1.4:1 relative to the group fed 31:1. After consumption of the 1.4:1 diet, stimulated mononuclear cells produced 52% less prostaglandin E2 (PGE2) than those from dogs fed the 31:1 diet (224 +/- 74 and 451 +/- 71 pmol/L, respectively, P = 0.04). Plasma concentration of alpha-tocopherol was 20% lower in dogs fed the 1.4:1 diet compared with those fed the 31:1 diet (P = 0.04), and lipid peroxidation was greater in both plasma (P = 0.03) and urine (P = 0.002). These data suggest that although a ratio of dietary (n-6) to (n-3) fatty acids of 1.4:1 depresses the cell-mediated immune response and PGE2 production, it increases lipid peroxidation and lowers vitamin E concentration.
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Affiliation(s)
- R C Wander
- Department of Nutrition and Food Management, Oregon State University, Corvallis 97331-5103, USA
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28
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Wigmore SJ, Fearon KC, Ross JA. Modulation of human hepatocyte acute phase protein production in vitro by n-3 and n-6 polyunsaturated fatty acids. Ann Surg 1997; 225:103-11. [PMID: 8998126 PMCID: PMC1190612 DOI: 10.1097/00000658-199701000-00012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The authors investigate the role of a variety of essential polyunsaturated fatty acids on the spontaneous and interleukin-6 stimulated production of acute phase proteins by isolated human hepatocytes. SUMMARY BACKGROUND DATA The altered production of acute phase proteins by the liver is one of the principal effects of the systemic inflammatory response in human disease. It has been shown that polyunsaturated fatty acids have certain anti-inflammatory properties that potentially are mediated through altered prostaglandin or proinflammatory cytokine production. However, the effect of polyunsaturated fatty acids on the responsiveness of the human hepatocyte to proinflammatory cytokines has not been studied in detail. METHODS Hepatocytes isolated from human livers were maintained in primary culture in the presence of a variety of bovine serum albumin-complexed fatty acids. The influence of these fatty acids on hepatocyte acute phase protein production was assessed, in the presence and absence of recombinant interleukin-6, by measurement of acute phase proteins by enzyme-linked immunosorbent assay. RESULTS Eicosapentaenoic and gammalinolenic acid increased spontaneous production of alpha 1-antichymotrypsin and prealbumin but decreased spontaneous production of transferrin and haptoglobin from isolated human hepatocytes. Eicosapentaenoic and gammalinolenic significantly increased interleukin-6-stimulated production of C-reactive protein and alpha 1-antichymotrypsin but reversed the stimulatory effect of interleukin-6 on haptoglobin production. These fatty acids also reversed the inhibitory effect of interleukin-6 on prealbumin production. CONCLUSIONS These results show that certain fatty acids have the potential to modulate spontaneous and cytokine-induced alterations in human hepatic acute phase protein metabolism. These data indicate the presence of complex mechanisms of regulation of human hepatic protein metabolism by fatty acids, and further study will be required to establish the nature of their influence in vivo.
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Affiliation(s)
- S J Wigmore
- University Department of Surgery, Royal Infirmary of Edinburgh, United Kingdom
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Jeffery NM, Yaqoob P, Wiggins D, Gibbons GF, Newsholme EA, Calder PC. Characterization of lipoprotein composition in rats fed different dietary lipids and of the effects of lipoproteins upon lymphocyte proliferation. J Nutr Biochem 1996. [DOI: 10.1016/0955-2863(96)00029-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- P C Calder
- Department of Biochemistry, University of Oxford
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31
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Meydani SN. Effect of (n-3) polyunsaturated fatty acidson cytokine production and their biologic function. Nutrition 1996. [DOI: 10.1016/s0899-9007(96)80004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Futamura Y. Effect of amiodarone on release of cytokines from mouse alveolar macrophages pretreated with eicosapentaenoic acid. JAPANESE JOURNAL OF PHARMACOLOGY 1995; 69:335-41. [PMID: 8786636 DOI: 10.1254/jjp.69.335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
I studied the effect of amiodarone, a cationic amphiphilic drug, on the cytokine release and protein kinase C (PKC) activity of mouse alveolar macrophages. In addition, I examined the relationship between amiodarone and eicosapentaenoic acid (EPA) with respect to the cytokine release. The decrease in cell number caused by amiodarone was depressed by pretreatment of the macrophages with EPA for 2 days and co-treatment for 1 day. These changes reflected the potency of EPA to protect against the cell injury elicited by amiodarone. As regards to the cytokine release, amiodarone caused an increase in interleukin (IL)-1 alpha, IL-1 beta and tumor necrosis factor (TNF) alpha release from macrophages. As EPA suppressed this increase in cytokine levels, I considered that the protective effect of EPA may be extended to the acute release of cytokines. PKC activity was increased by amiodarone, and this increase was depressed by EPA. These changes were well-related to the results on cytokine levels in this study, indicating that amiodarone firstly activated PKC, leading to the stimulation of release of cytokines and that pretreatment with EPA prevented these effects. I conclude that mouse alveolar macrophages treated with amiodarone show activated release of cytokines and that EPA depresses these increases, thereby demonstrating EPA's anti-inflammatory effect and protective action against injury of alveolar macrophages.
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Affiliation(s)
- Y Futamura
- Department of Pharmacology, Toho University School of Medicine, Tokyo, Japan
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DeLuca P, Rothman D, Zurier RB. MARINE AND BOTANICAL LIPIDS AS IMMUNOMODULATORY AND THERAPEUTIC AGENTS IN THE TREATMENT OF RHEUMATOID ARTHRITIS. Rheum Dis Clin North Am 1995. [DOI: 10.1016/s0889-857x(21)00466-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Grimminger F, Führer D, Papavassilis C, Schlotzer E, Mayer K, Heuer KU, Kiss L, Walmrath D, Piberhofer S, Lübbecke F. Influence of intravenous n-3 lipid supplementation on fatty acid profiles and lipid mediator generation in a patient with severe ulcerative colitis. Eur J Clin Invest 1993; 23:706-15. [PMID: 8307090 DOI: 10.1111/j.1365-2362.1993.tb01290.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
N-3 fatty acids were supplied to a 36-year-old female patient suffering from ulcerative colitis and severe steroid side-effects, in a sequence of parenteral and enteral administration. During a moderately active period of disease, 200 ml d-1 fish oil-derived lipid emulsion (eicosapentaenoic acid [EPA], 4.2 g; docosahexaenoic acid [DHA], 4.2 g) was infused for 9 days, in parallel with rapid tapering of the steroid dose. Disease activity declined rapidly, and the patient was subsequently provided with 16 fish oil capsules per day (EPA, 2.9 g; DHA, 1.9 g) for 2 months. At the end of this period of therapy, severe colitis recurred with intestinal and extraintestinal manifestations. The n-3 lipid emulsion was then used for intravenous alimentation (29 days, maximum dose 300 ml per day); during this time, marked improvement of the inflammatory bowel disease was noted. During both periods of parenteral n-3 lipid administration, total plasma EPA and DHA contents increased several-fold, surpassing that of arachidonic acid; this plasma n-3 fatty acid enrichment was only maintained to a minor extent during the intermediate period of dietary fish oil supplementation. The intravenously administered EPA-containing triglycerides were rapidly hydrolyzed, as evidenced by the appearance of substantial quantities of EPA in the plasma free fatty acid fraction. Platelet and neutrophil total membrane content of EPA and DHA as well as n-3 fatty acid/AA membrane ratios similarly increased during the periods of intravenous n-3 lipid administration and declined during oral fish oil uptake.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Grimminger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Germany
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Meydani SN, Dinarello CA. Influence of dietary fatty acids on cytokine production and its clinical implications. Nutr Clin Pract 1993; 8:65-72. [PMID: 8326925 DOI: 10.1177/011542659300800265] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cytokines and eicosanoids are important biologic mediators with tightly regulated production. Overproduction contributes to pathogenesis of chronic and acute inflammatory, autoimmune, atherosclerotic, and neoplastic diseases. Animal and human studies have shown that production of cytokines and eicosanoids can be reduced by certain dietary fatty acids, specifically those containing long-chain (n-3) polyunsaturated fatty acids (PUFAs). This in turn results in reduction of the severity of certain autoimmune, inflammatory, and atherosclerotic diseases. Because these cytokines are also involved in control of the host defense, substantial reduction in their production could also result in the impairment of normal immune response. Increased intake of (n-3) PUFAs without adequate antioxidant protection could result in increased free radical formation and lipid peroxidation. Thus, when (n-3) PUFAs are used to reduce the pathogenesis of these diseases, its possible adverse effects should be considered and prevented.
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Virella G, Fourspring K, Hyman B, Haskill-Stroud R, Long L, Virella I, La Via M, Gross AJ, Lopes-Virella M. Immunosuppressive effects of fish oil in normal human volunteers: correlation with the in vitro effects of eicosapentanoic acid on human lymphocytes. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1991; 61:161-76. [PMID: 1833105 DOI: 10.1016/s0090-1229(05)80021-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We have studied the effects of dietary supplementation with fish oil on immunological parameters in a group of six normal volunteers, four of whom received a fish oil extract (total EPA dose of 2.4 g/day, which is on the lower range of clinically effective doses) for 6 weeks and two of which received a placebo (olive oil) for an identical period of time. Each volunteer was followed up for a period of 23 weeks after the dietary intervention was ended. All volunteers were boosted with tetanus toxoid (TT) at the onset of the trial. Several immune parameters were followed longitudinally, including NBT reduction and lysozyme release to test neutrophil function; lymphocyte subpopulations; mitogenic responses to phytohemagglutinin (PHA), concanavalin A (Con A) and anti-CD3; IL-2 release after PHA and pokeweed mitogen (PWM) stimulation; immunoglobulin and anti-TT antibody (ATT) synthesis by stimulated lymphocytes; and serum levels of immunoglobulins and of ATT. No consistent changes were observed in neutrophil function tests, mitogenic responses to PHA and Con A, and lymphocyte subsets. The mitogenic response to anti-CD3 and the release of IL-2 after stimulation with PHA and PWM appeared reduced as a consequence of fish oil ingestion, and levels of serum immunoglobulins decreased in three of the volunteers receiving fish oil supplementation. The systemic humoral response after the TT booster appeared not to be influenced by the ingestion of fish oil. However, in those subjects who were given fish oil supplementation, the specific in vitro response of their peripheral blood lymphocytes to TT appeared to be compromised at Week 3. This could reflect the need for progressive accumulation of EPA in lymphocyte membranes for the suppressive effect to be detectable, but it could also reflect a differential sensitivity to the effects of fish oil of circulating B lymphocytes vs. bone marrow B lymphocytes. All the parameters apparently affected by fish oil ingestion were also affected by the incubation of normal lymphocytes with EPA in vitro. In conclusion, low doses of fish oil may have a mild immunosuppressive effect affecting both T and B cell functions. These observations stress the need for more extensive trials designed to determine whether immunosuppressive effects can be consistently elicited and for studies aimed at determining the mechanisms by which omega-3 fatty acids affect the immune system.
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Affiliation(s)
- G Virella
- Department of Microbiology and Immunology, Epidemiology and Systems Sciences, Charleston, South Carolina 29425
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Meydani SN, Lichtenstein AH, White PJ, Goodnight SH, Elson CE, Woods M, Gorbach SL, Schaefer EJ. Food use and health effects of soybean and sunflower oils. J Am Coll Nutr 1991; 10:406-28. [PMID: 1955619 DOI: 10.1080/07315724.1991.10718168] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This review provides a scientific assessment of current knowledge of health effects of soybean oil (SBO) and sunflower oil (SFO). SBO and SFO both contain high levels of polyunsaturated fatty acids (PUFA) (60.8 and 69%, respectively), with a PUFA:saturated fat ratio of 4.0 for SBO and 6.4 for SFO. SFO contains 69% C18:2n-6 and less than 0.1% C18:3n-3, while SBO contains 54% C18:2n-6 and 7.2% C18:3n-3. Thus, SFO and SBO each provide adequate amounts of C18:2n-6, but of the two, SBO provides C18:3n-3 with a C18:2n-6:C18:3n-3 ratio of 7.1. Epidemiological evidence has suggested an inverse relationship between the consumption of diets high in vegetable fat and blood pressure, although clinical findings have been inconclusive. Recent dietary guidelines suggest the desirability of decreasing consumption of total and saturated fat and cholesterol, an objective that can be achieved by substituting such oils as SFO and SBO for animal fats. Such changes have consistently resulted in decreased total and low-density-lipoprotein cholesterol, which is thought to be favorable with respect to decreasing risk of cardiovascular disease. Also, decreases in high-density-lipoprotein cholesterol have raised some concern. Use of vegetable oils such as SFO and SBO increases C18:2n-6, decreases C20:4n-6, and slightly elevated C20:5n-3 and C22:6n-3 in platelets, changes that slightly inhibit platelet generation of thromboxane and ex vivo aggregation. Whether chronic use of these oils will effectively block thrombosis at sites of vascular injury, inhibit pathologic platelet vascular interactions associated with atherosclerosis, or reduce the incidence of acute vascular occlusion in the coronary or cerebral circulation is uncertain. Linoleic acid is needed for normal immune response, and essential fatty acid (EFA) deficiency impairs B and T cell-mediated responses. SBO and SFO can provide adequate linoleic acid for maintenance of the immune response. Excess linoleic acid has supported tumor growth in animals, an effect not verified by data from diverse human studies of risk, incidence, or progression of cancers of the breast and colon. Areas yet to be investigated include the differential effects of n-6- and n-3-containing oil on tumor development in humans and whether shorter-chain n-3 PUFA of plant origin such as found in SBO will modulate these actions of linoleic acid, as has been shown for the longer-chain n-3 PUFA of marine oils.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- S N Meydani
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 02111
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Prospect for using eicosapentaenoic and docosahexaenoic acids as drugs (a review). Pharm Chem J 1991. [DOI: 10.1007/bf00777679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Virella G, Hyman B. Quantitation of anti-tetanus and anti-diphtheria antibodies by enzymoimmunoassay: methodology and applications. J Clin Lab Anal 1991; 5:43-8. [PMID: 1999762 DOI: 10.1002/jcla.1860050108] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We have developed enzymoimmunoassays (EIA) for the quantitation of antibodies (Ab) to tetanus and diphtheria toxoids (TT, DT) using Immulon I plates coated with the appropriate toxoid. A preparation of human tetanus immunoglobulin with a known concentration of anti-TT Ab was used as calibrator of the anti-TT antibody assay. The assay of anti-DT Ab is calibrated with a pool of human sera whose anti-DT Ab concentration was determined by quantitative immunoelectrophoresis, using a horse anti-DT with known Ab concentration as calibrator. A peroxidase-conjugated anti-human IgG was used in both assays. ABTS was used as substrate, and the reaction was stopped after 1 min incubation with citric acid and the OD measured at 414 nm on a Vmax reader. The assays have been applied to a variety of clinical situations. In patients suspected of having tetanus, the quantitation of antibodies has been helpful in establishing a diagnosis. In patients with a history of hypersensitivity to tetanus toxoid, verification of the levels of anti-TT antibody may prevent unnecessary and potentially harmful immunizations. The assays have also been used for the diagnostic evaluation of the humoral immune response to TT and DT, both in pediatric patients and in immunosuppressed patients. Several non-responders have been detected, and we have recently used the assay to monitor the effects of fish oil administration on the humoral immune response.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Virella
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston 29425
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Abstract
Cytokines play a key role as communication signals during both normal immunologic responses and pathologic conditions leading to infectious, inflammatory, and neoplastic diseases. Production and biologic function of cytokines are affected by changes in macro- and micronutrients. On the other hand, metabolic and catabolic consequences of the action of cytokines change nutrient status and the distribution of nutrients in tissues. The effect of some nutrients on cytokine production as well as some of the biologic effects of cytokines are mediated through metabolites of arachidonic acid (prostaglandins, leukotrienes, etc.). Other mechanisms involved in nutrient-induced changes of cytokines needs to be determined. Understanding the role of nutrients in cytokine production and biologic function during normal homeostasis, as well as under pathologic conditions, can help in designing proper dietary modification for the prevention and therapy of diseases.
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Affiliation(s)
- S N Meydani
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111
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Abstract
I have reviewed a small fraction of the vast literature on the influence of diet, food antigens, and environment on the immune response and would like to emphasize three points. Excess dietary lipid is thought to have a crucial role in inducing obesity and many age-related diseases including cardiovascular disease, malignancy and autoimmune diseases. Micronutrients are involved in protecting the functional integrity of the immune system, particularly to overcome the anti-oxidant deficiency present in refined diet components. Finally, environmental influences such as UV radiation or air pollutants may have an adverse effect in the modification of immune functions when combined with dietary and nutritional factors. It appears that future studies should be directed to understanding the overall interactions of diet and environmental factors, including those of food and viral antigens, and the impact that these have on the maintenance and gene expression of an active and vigorous immune system in healthy and diseased states.
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Affiliation(s)
- G Fernandes
- Department of Medicine, University of Texas Health Science Center, San Antonio
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