Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2799
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
The imbalance of Th17/Treg cells and 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. Therefore, 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.
The aim of this study was to test the hypothesis 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.
The main objective of this prospective clinical trial was to investigate the effects of EEN on Th17/Treg cell ratios and IL-23/IL-17 axis in septic patients.
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.
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 significantly 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 significantly shorter than those of the DEN group (P < 0.05). However, no significant difference in the 28-d mortality was found between the two groups (P = 0.728).
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.
More large-scale clinical studies and basic science investigations should be performed to test the accuracy of our results in future.