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T Lymphocyte Numbers in Human Gut Associated Lymphoid Tissue Are Reduced Without Enteral Nutrition

Koichi Okamoto, MD^*, Kazuhiko Fukatsu, MD, Chikara Ueno, MD^*, Eiji Shinto, MD, Yojiro Hashiguchi, MD^*, Hidetoshi Nagayoshi, MD^*, Hoshio Hiraide, MD and Hidetaka Mochizuki, MD^*

From the ^* Department of Surgery I and Department of Pathology II, National Defense Medical College, Saitama, Japan; and the Division of Basic Traumatology, National Defense Medical College Research Institute, Saitama, Japan

Correspondence: Kazuhiko Fukatsu, MD, Division of Basic Traumatology, National Defense Medical College Research Institute, 3–2 Namiki, Tokorozawa, Saitama, Japan. Electronic mail may be sent to fukatsu{at}res.ndmc.ac.jp.

Background: Clinically, in the absence of enteral nutrition, the morbidity of infectious complication is high. Although experiments using mice have shown alterations in gut-associated lymphoid tissue (GALT) to be an important mechanism underlying impaired host defense, there are no clinical studies on the effects of nutritional routes on GALT. Methods: A total of 27 colon cancer cases who underwent right colectomy or hemicolectomy were reviewed. Six patients did not receive enteral nutrition for 4 to 28 days before surgery because of bowel obstruction (parenteral nutrition [PN] group). Twenty-one patients were enterally fed before surgery (enteral nutrition [EN] group). The terminal ileum from resected specimens was examined microscopically. T-cell numbers in intraepithelial spaces (IE) and the lamina propria (LP) were determined immunohistochemically in blinded fashion. Results: There were no significant differences in baseline characteristics between the 2 groups. T-cell number in the LP was significantly lower in the PN group than in the EN group, with no difference in IE cell numbers. Conclusions: Lack of enteral delivery of nutrients reduces GALT cell number in patients with colon cancer, as is the case in mice.

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