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Parenteral Nutrition, Critical Illness, Paneth Cell Function and the Innate Immune Response

  • Xinying Wang
  • Joseph F. Pierre
  • Kenneth A. Kudsk
Reference work entry

Abstract

Parenteral nutrition, an important mode of nutrition support in patients who have loss absorptive and digestive ability of the intestine, is associated with an increased susceptibility to infection compared to enteral nutrition. One probable cause of this increased infectious risk is impaired acquired and innate mucosal immunity of the gastrointestinal and respiratory tract associated with lack of enteral stimulation. Innate immunity is a teleologically ancient defense system which includes Paneth cells and goblet cells that function as specialized secreting epithelial cells. Each plays critical roles in innate immune function of the gut. Paneth cells contain dense granules abundant in antibiotic proteins and peptides as well as proinflammatory mediators. These biological molecules not only protect the host from enteric pathogens but also affect the composition of the colonizing microbiota. The goblet cells produce a mucin layer that coats the mucosa and concentrates the biologic molecules. Experimentally, lack of enteral stimulation significantly impairs innate mucosal immune function by diminishing Paneth cell antimicrobial proteins (secretory phospholipase A2, lysozyme, and cryptdin 4), reducing goblet cell p-products (mucin2, trefoil peptides, and resistin-like molecule β), shifting the microbiome composition, and decreasing the bactericidal activity of intestinal secretions. Taken in total, these changes impair the antibacterial defenses protecting the mucosa against invasion. This review examines the experimental changes in innate immunity and Paneth cell function that occurs during parenteral nutrition without enteral stimulation.

Keywords

Parenteral Nutrition Goblet Cell Enteral Nutrition Paneth Cell Mucosal Immunity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

AMPs

Antimicrobial peptides

BBS

Bombesin

CFUs

Colony-forming units

CED

Complex enteral diet

EN

Enteral nutrition

Fcgbp

Fc-γ-binding protein

GALT

Gut-associated lymphoid tissue

ICU

Intensive care unit

MadCAM-1

Mucosal addressin cellular adhesion molecule-1

NOD2

Nucleotide oligomerization domain 2

PN

Parenteral nutrition

PAMPs

Pathogen-associated molecular patterns

pIgR

Polymeric immunoglobulin receptor

RELMβ

Resistin-like molecule β

sIgA

Secretory immunoglobulin-A

sPLA2

Secretory phospholipase A2

TLRs

Toll-like receptors

TFF

Trefoil peptides

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Xinying Wang
    • 1
  • Joseph F. Pierre
    • 2
  • Kenneth A. Kudsk
    • 2
  1. 1.Department of SurgerySchool of Medicine, Jinling Hospital, Nanjing UniversityNanjingChina
  2. 2.Department of SurgeryG5/341 Clinical Sciences Center, University of Wisconsin- MadisonMadisonUSA

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