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Review
. 2017 Mar 1;312(3):G246-G256.
doi: 10.1152/ajpgi.00321.2016. Epub 2017 Feb 2.

Gastrointestinal immune and microbiome changes during parenteral nutrition

Joseph F Pierre  1
Affiliations
Review

Gastrointestinal immune and microbiome changes during parenteral nutrition

Joseph F Pierre. Am J Physiol Gastrointest Liver Physiol. .

Abstract

Parenteral nutrition (PN) is a lifesaving therapy that provides intravenous nutrition support to patients who cannot, or should not, feed via the gastrointestinal (GI) tract. Unfortunately, PN also carries certain risks related to infection and metabolic complications compared with enteral nutrition. In this review, an overview of PN and GI immune and microbiome changes is provided. PN impacts the gut-associated lymphoid tissue functions, especially adaptive immune cells, changes the intestinal epithelium and chemical secretions, and significantly alters the intestinal microbiome. Collectively, these changes functionally result in increased susceptibility to infectious and injurious challenge. Since PN remains necessary in large numbers of patients, the search to improve outcomes by stimulating GI immune function during PN remains of interest. This review closes by describing recent advances in using enteric nervous system neuropeptides or microbially derived products during PN, which may improve GI parameters by maintaining immunity and physiology.

Keywords: GALT; Paneth cells; enteral nutrition; gastrointestinal immunity; microbiome; mucosal immunity; parenteral nutrition; sIgA.

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Figures

Fig. 1.
Fig. 1.
Overview of the global changes that occur in the intestine during PN compared with enteral feeding. Following PN, reduced cell recruitment leads to fewer lymphocytes in the GALT, resulting in less IgA production and release at mucosal surfaces. These changes are associated with reduced tight-junction protein expression, antimicrobial production, and mucus release. The altered mucosal secretions and absence of enteral nutrients results in microbial community dysbiosis, which may independently lead to further barrier disruption.
See this image and copyright information in PMC

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