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Brock K. King, MD; Jian Li, MD; Kenneth A. Kudsk, MD

Arch Surg. 1997;132(12):1303-1309.

Abstract
Background
Total parenteral nutrition (TPN) is associated with decreases in small-intestinal gut-associated lymphoid tissue (GALT) T cells, B cells, and IgA levels and impairs IgA-mediated defenses in the respiratory tract. The impaired respiratory tract defenses are speculated to be due to reduced respiratory tract IgA levels.

Objectives
To determine the time course of GALT cell reductions and document any changes in respiratory tract IgA levels in mice receiving TPN.

Design
Prospective randomized trial.

Setting
Animal research laboratory.

Materials
Thirty-five male ICR mice weighing 25 to 35 g.

Interventions
Mice underwent cannulation with intravenous catheters and received chow for 2 days followed by TPN for 0 (n=6), 1 (n=6), 2 (n=6), 3 (n=6), 4 (n=6), or 5 (n=5) days. Mice were killed after receiving TPN their respective number of days. The small intestine was harvested, and washings were obtained from the small intestine and the respiratory tract. Lymphocytes and IgA levels were analyzed by flow cytometry and enzymelinked immunosorbent assay, respectively.

Main Outcome Measures
Lymphocyte yields from Peyer patches, intraepithelial spaces, and the lamina propria; IgA levels from the small intestine and the respiratory tract.

Results
T- and B-cell yields in the Peyer patches and lamina propria were significantly reduced by day 2 (P<.05) and thereafter compared with day 0. The lamina propria CD4⁺/CD8⁺ ratio declined significantly by day 4 (P<.05) compared with day 0. Small-intestinal and respiratory tract IgA levels were significantly diminished by day 3 (P<.05) and thereafter compared with day 0.

Conclusion
Total parenteral nutrition produces rapid changes in GALT cell profiles and reduces respiratory tract IgA levels consistent with the impairment of respiratory IgA-mediated defenses.

Arch Surg. 1997;132:1303-1309

Author Affiliations
From the Department of Surgery, The University of Tennessee, Memphis.

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