Glutamine abolishes the TLR-4 gene expression levels in pancreatic cancer patients: A preliminary study

Abstract

Aim of the study: The purpose of the study was to investigate the effect of pancreatic cancer and preoperative enteral immune-enhancing diet (immunonutirtion) on the expression of TLR4 gene in leukocytes of the malnourished patients with pancreatic cancer. Material and methods: Sixteen malnourished patients with pancreatic cancer received for 5 days preoperative enteral immune-enhancing diet containing glutamine (20 g per day), antioxidative vitamins and trace elements (GlutaminePlus, Fresenius Kabi). The expression of TLR-4 gene in leukocytes of peripheral blood was measured in all patients twice before surgery (before and after immunonutrition) and ones after surgery. The control group comprised 15 healthy sex-and age-matched volunteers. Results: The expression of TLR-4 gene in leukocytes of pancreatic cancer patients before surgery was significantly higher as compared to the healthy volunteers. Expression of TLR-4 gene significantly decreased after preoperative immunonutrition with glutamine. After surgery expression of TLR-4 gene in leukocytes decreased insignificantly as compared to expression at day before surgery but this decrease abolished the significant differences of TLR-4 gene expression between group of pancreatic cancer patients and control group. Conclusions: The high expression level of TLR-4 gene in leukocytes of pancreatic cancer patients may reveal the up-regulation of the innate antibacterial response. This disorders may contribute to increased susceptibility to postoperative infectious and septic complications. Preoperative enteral supplementation of glutamine by decreasing TLR-4 expression may reduce of susceptibility to infectious and septic complications in pancreatic cancer patients.