The anti-apoptotic impact of immunonutrition in pancreatic cancer patients is questionable

Abstract

Aim: To investigate whether preoperative enteral immunonutrition possesses some anti-apoptotic properties and can influence the lymphocyte apoptotic signalling pathways in patients with pancreatic cancer. Material and methods: The studies were performed in 48 patients operated on for pancreatic cancer. Thirty-four malnourished patients were randomized to receive either the enteral preoperative standard diet (group I) or the immune-enhancing enteral diet (immunonutrition) (group II). Fourteen patients (group III) of normal nutritional status did not receive the preoperative nutrition. The control group comprised 30 healthy volunteers. The expression of Bcl-2, Bax, caspase-3 and -9, NF-κB, PARP-1/89 kDa, and TNFR1/CD120a in peripheral blood lymphocytes was assessed by Western blot analysis before and after preoperative nutrition and after surgery. Results: In malnourished patients before and after surgery (group I, II) the expression of Bcl-2, Bax, NF-κB, and PARP-1 was significantly lower, whereas the expression of caspases and TNFR1 was significantly higher as compared with the control group. There was no difference in Bcl-2, Bax and PARP-1 expression between the control group and the patients with normal nutritional status (group III) before surgery. The differences between groups I and II in all proteins' expression were not statistically significant both before and after pancreatic surgery. Conclusions: Our findings suggest the down-regulation of anti-apoptotic and up-regulation of pro-apoptotic signalling systems in lymphocytes of malnourished patients with pancreatic cancer and a switch to apoptosis. Preoperative enteral immunonutrition has no significant effect on the apoptotic signalling pathways and the anti-apoptotic impact of such nutrition in pancreatic cancer patients is questionable.