Total parenteral nutrition directly impairs cytokine production after bacterial challenge

Background/Purpose: Previous studies have shown that total parenteral nutrition (TPN) influences host immunity, but the mechanism is unclear. This study explored the effect of TPN solution on neutrophil phagocytosis and whole-blood cytokine production in response to coagulase-negative staphylococci in vitro challenge. Methods: Blood samples were taken from five enterally fed infants (age <6 months) and six healthy adults. Samples were incubated for 45 minutes with four isovolemic solutions: (A) control (saline), (B) TPN (0.1 mu L/mL of blood), (C) TPN (1 mu L/mL), (D) TPN (10 mu L/mL). Solution C (1 mu L/mL) corresponded to TPN-blood ratio used in clinical practice. After incubation, blood was challenged with coagulase-negative staphylococci. Neutrophil phagocytosis was measured by flow cytometry after 40 minutes of bacterial challenge, and tumour necrosis factor alpha (TNF-alpha) was measured by enzyme-linked immunosorbent assay (ELISA) after 2 hours of bacterial challenge. Results: In infant blood, TNF-alpha production after coagulase-negative staphylococci challenge was impaired after the addition of a "physiological" dose of TPN solution (1 mu L/mL of blood) as well as "supranormal" doses (10 mu L/mL of blood). In adult blood, a similar effect was observed only after the addition of a supranormal dose of TPN. In both the infant and adult blood, there was no direct effect of TPN solution on neutrophil phagocytosis. Conclusions: These results suggest that infants are more susceptible than adults to TPN-related depression of cytokine production. The level of proinflammatory cytokines may be important in the host defence against bacterial infection.