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Intensive Care Medicine

, Volume 33, Issue 1, pp 25–35 | Cite as

Lipoproteins in inflammation and sepsis. II. Clinical aspects

  • Martina Wendel
  • Rüdiger Paul
  • Axel R. HellerEmail author
Mini series: Basic research-related topics in ICM

Abstract

Background

Systemic inflammation and sepsis are accompanied by severe metabolic alterations, including insulin resistance together with increased levels of triglycerides (TGs) and decreases in high- and low-density lipoproteins. Clinical studies have clearly established a link between lipid metabolism and systemic inflammation. Lipoproteins were shown to neutralize LPS and to exert direct anti-inflammatory actions. High- and low-density lipoproteins are thus thought to be important regulators of the host immune response during endotoxemia, which may also have the potential of improving the care of patients with Gram-negative sepsis.

Discussion

Nutritional lipids supplied during critical illness have been shown to modulate the host response to inflammation. In particular, inclusion of ω-3 fatty acids seems to have beneficial effects on cellular immunity and helps to maintain the balance between pro- and anti-inflammatory cytokines thereby preventing hyperinflammatory complications. In addition to improvements in the profile of lipid mediators generated, ω-3 fatty acids act as activating ligands of peroxisome proliferator-activated receptors and directly inhibit nuclear factor κB mediated proinflammatory signaling. We present an overview on the alterations in the metabolism of serum lipoproteins during sepsis and present data from clinical studies and discuss the significance of nutritional lipids and their role in immunomodulation with special emphasis on ω-3 fatty acids.

Keywords

High-density lipoproteins Sepsis ω-3 Fatty acids Fish oil Soybean oil Immunonutrition 

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© Springer-Verlag 2006

Authors and Affiliations

  • Martina Wendel
    • 1
  • Rüdiger Paul
    • 1
  • Axel R. Heller
    • 1
    Email author
  1. 1.Department of Anesthesiology and Critical Care MedicineCarl Gustav Carus University HospitalDresdenGermany

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