Clinical Trials Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2019; 25(22): 2799-2808
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2799
Effects of early enteral nutrition on Th17/Treg cells and IL-23/IL-17 in septic patients
Jia-Kui Sun, Wen-Hao Zhang, Wen-Xiu Chen, Xiang Wang, Xin-Wei Mu
Jia-Kui Sun, Wen-Hao Zhang, Wen-Xiu Chen, Xiang Wang, Xin-Wei Mu, Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
Author contributions: Sun JK, Wang X, and Mu XW designed the research; Sun JK, Zhang WH, and Chen WX performed the research; Sun JK and Zhang WH analyzed the data; and Sun JK wrote the paper.
Supported by: the National Natural Science Foundation of China, No. 81701881; and the Nanjing Medical Science and Technology Development Foundation, No. YKK15098 and No. YKK17102.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee of Nanjing First Hospital (Approval Number: KY20170921-02).
Clinical trial registration statement: This study is registered at https://www.clinicaltrials.gov. The registration identification number is NCT03385850.
Informed consent statement: All involved persons (legally authorized representative) gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiang Wang, MD, Doctor, Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, Jiangsu Province, China. njdrwx2016@163.com
Telephone: +86-25-52271234 Fax: +86-25-52271326
Received: March 14, 2019
Peer-review started: March 14, 2019
First decision: March 27, 2019
Revised: April 4, 2019
Accepted: April 29, 2019
Article in press: April 29, 2019
Published online: June 14, 2019
Processing time: 93 Days and 18.5 Hours
Abstract
BACKGROUND

The imbalance of Th17/Treg cells and the IL-23/IL-17 axis have been confirmed to be associated with sepsis and various inflammatory diseases. Early enteral nutrition (EEN) can modulate the inflammatory response, improve immune dysfunction, and prevent enterogenic infection in critically ill patients; however, the precise mechanisms remain unclear. Considering the important roles of Th17 and Treg lymphocytes in the development of inflammatory and infectious diseases, we hypothesized that EEN could improve the immune dysfunction in sepsis by maintaining a balanced Th17/Treg cell ratio and by regulating the IL-23/IL-17 axis.

AIM

To investigate the effects of EEN on the Th17/Treg cell ratios and the IL-23/IL-17 axis in septic patients.

METHODS

In this prospective clinical trial, patients were randomly divided into an EEN or delayed enteral nutrition (DEN) group. Enteral feeding was started within 48 h in the EEN group, whereas enteral feeding was started on the 4th day in the DEN group. The Th17 and Treg cell percentages and the interleukin levels were tested on days 1, 3, and 7 after admission. The clinical severity and outcome variables were also recorded.

RESULTS

Fifty-three patients were enrolled in this trial from October 2017 to June 2018. The Th17 cell percentages, Th17/Treg cell ratios, IL-17, IL-23, and IL-6 levels of the EEN group were lower than those of the DEN group on the 7th day after admission (P < 0.05). The duration of mechanical ventilation and of the intensive care unit stay of the EEN group were shorter than those of the DEN group (P < 0.05). However, no difference in the 28-d mortality was found between the two groups (P = 0.728).

CONCLUSION

EEN could regulate the imbalance of Th17/Treg cell ratios and suppress the IL-23/IL-17 axis during sepsis. Moreover, EEN could reduce the clinical severity of sepsis but did not reduce the 28-d mortality of septic patients.

Keywords: Early enteral nutrition; Enteral nutrition; T helper lymphocytes; Th17/Treg cells; IL-23/IL-17 axis; Sepsis

Core tip: The aim of this prospective clinical trial was to investigate the effects of early enteral nutrition (EEN) on Th17/Treg cell ratios and the IL-23/IL-17 axis in septic patients. Patients were randomly divided into an EEN or delayed enteral nutrition (DEN) group. As a result, the Th17 cell percentages, Th17/Treg cell ratios, IL-17, IL-23, and IL-6 levels of the EEN group were lower than those of the DEN group on the 7th day after admission. In other words, EEN could regulate the imbalance of Th17/Treg cell ratios and suppress the IL-23/IL-17 axis during sepsis. Moreover, EEN could reduce the clinical severity but did not reduce the 28-d mortality of sepsis.