Changes of apoptotic signaling pathways in pancreatic cancer patients after enteral immunonutrition

The purpose of our study was to investigate the effect of pancreatic cancer, extensive surgery and enteral immune-enhancing diet versus enteral standard nutrition on the apoptotic signaling pathways. The randomized studies were performed in 72 patients before and after pancreatic cancer resection with preoperative standard or enteral immunonutrition. The expressions of Bcl-2, Bax, caspases-3, 9, NF-kappa B, PARP-1/89kDa, TNF-R1/CD120a and Fas/CD95 in lymphocytes were assessed before and after surgery. In malnourished patients before and after surgery the expression of Bcl-2, Bax, NF kappa B, PARP-1 was significantly lower, whereas the expression of caspases, as well as the percentage of cells with death receptors were significantly higher. In comparison to the standard nutrition, the preoperative immunonutrition increased the Bcl-2 and Bax expression inconsiderably but significantly increased the percentage of CD95 and CD120a positive lymphocytes after surgery. In conclusion, our findings suggest the down-regulation of antiapoptotic signaling systems in lymphocytes of malnourished patients with pancreatic cancer and a switch to apoptosis. The preoperative enteral immunonutrition has a modulative effect on the apoptotic signaling pathways.