Novel Strategies to Prevent Total Parenteral Nutrition-Induced Gut and Liver Inflammation, and Adverse Metabolic Outcomes.

Abstract

Total parenteral nutrition (TPN) is a life-saving therapy administered to millions of patients. However, it is associated with significant adverse effects, namely liver injury, risk of infections, and metabolic derangements. In this review, the underlying causes of TPN-associated adverse effects, specifically gut atrophy, dysbiosis of the intestinal microbiome, leakage of the epithelial barrier with bacterial invasion, and inflammation are first described. The role of the bile acid receptors farnesoid X receptor and Takeda G protein-coupled receptor, of pleiotropic hormones, and growth factors is highlighted, and the mechanisms of insulin resistance, namely the lack of insulinotropic and insulinomimetic signaling of gut-originating incretins as well as the potentially toxicity of phytosterols and pro-inflammatory fatty acids mainly released from soybean oil-based lipid emulsions, are discussed. Finally, novel approaches in the design of next generation lipid delivery systems are proposed. Propositions include modifying the physicochemical properties of lipid emulsions, the use of lipid emulsions generated from sustainable oils with favorable ratios of anti-inflammatory n-3 to pro-inflammatory n-6 fatty acids, beneficial adjuncts to TPN, and concomitant pharmacotherapies to mitigate TPN-associated adverse effects.

• Authors: Eliana Lucchinetti, Phing-How Lou, Paulina Wawrzyniak, Marcin Wawrzyniak, Michael Scharl, Gregory A Holtzhauer, Stefanie D Krämer, Martin Hersberger, Gerhard Rogler, Michael Zaugg
• Journal: Molecular nutrition & food research (Mol Nutr Food Res) Vol. 65 Issue 5 Pg. e1901270 (03 2021) ISSN: 1613-4133 [Electronic] Germany
• PMID: 32359213 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: © 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Chemical References

• Bile Acids and Salts
• Emulsions
• Insulin
• Lipids
• Receptors, Cytoplasmic and Nuclear
• farnesoid X-activated receptor

Topics

• Bile Acids and Salts (metabolism)
• Drug Delivery Systems (methods)
• Dysbiosis (etiology)
• Emulsions (administration & dosage, chemistry)
• Gastritis (etiology, prevention & control)
• Hepatitis (etiology, prevention & control)
• Humans
• Insulin (metabolism)
• Lipids (administration & dosage, pharmacology)
• Parenteral Nutrition, Total (adverse effects, methods)
• Receptors, Cytoplasmic and Nuclear (metabolism)