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1、Immunemodulationbyparenterallipidemulsions×÷ÕߣºGeertJAWantenandPhilipCCalder,¡¾ÕªÒª¡¿Totalparenteralnutritionisthefinaloptionfornutritionalsupportofpatientswithsevereintestinalfailure.Lipidemulsionsconstitutethemainsourceoffuelcaloriesandfattyacids(FAs)inparenteralnutritionformulations.However,adv
2、erseeffectsonpatientoutcomeshavebeenattributedtotheuseoflipids,mostlyinrelationtoimpairedimmunedefensesandalteredinflammatoryresponses.Overtheyears,thisissuehasremainedinthelimelight,alsobecausetechnicaladvanceshaveprovidednosafeguardagainstthemostdauntingproblems,ie,infectiouscomplications.Neverth
3、eless,numerousinvestigationshavefailedtoproduceaclearpictureoftheimmunologiccharacteristicsofthemostcommonlyusedsoybeanoilCderivedlipidemulsions,althoughtheirhighcontentofnC6polyunsaturatedFAs(PUFAs)hasbeenconsideredadrawbackbecauseoftheirproinflammatorypotential.Thisconcerninitiatedthedevelopmento
4、femulsionsinwhichpartofthenC6FAcomponentisreplacedbyless82bioactiveFAs,suchascoconutoil(richinmedium-chainsaturatedFAs)oroliveoil(richinthenC9monounsaturatedFAoleicacid).Anotherapproachhasbeentousefishoil(richinnC3PUFA),theFAsofwhichhavebiologicalactivitiesdifferentfromthoseofnC6PUFAs.Recentstudies
5、onthemodulationofhostdefensesandinflammationbyfish-oilemulsionshaveyieldedconsistentdata,whichindicatethattheseemulsionsmayprovideatooltobeneficiallyalterthecourseofimmune-mediatedconditions.AlthoughmostoftheselipidshavenotyetbecomeavailableontheUSmarket,thisreviewsynthesizesavailableinformationoni
6、mmunologiccharacteristicsofthedifferentlipidsthatcurrentlycanbeappliedviaparenteralnutritionsupport.¡¾¹Ø¼ü´Ê¡¿totalparenteralnutritionlipidemulsionimmunologyinflammationfattyacidseicosanoidsINTRODUCTION82Overthepast4decades,parenteralnutritionhasprovenitselftobethetherapeuticstrategyofchoicefornutr
7、itionalsupportofpatientswithseverechronicintestinalfailure(1).Totalparenteralnutrition(TPN)impliesthatallmacronutrient(carbohydrates,aminoacids,andlipids)andmicronutrient(electrolytes,vitamins,andtraceeleme
