O papel da suplementação oral com imunonutrientes na resposta inflamatória nos pacientes com COVID-19
DOI:
https://doi.org/10.33448/rsd-v9i9.7115Palavras-chave:
Nutriente; Sistema imunológico; Citocinas; Infecção; Coronavírus.Resumo
Introdução: O coronavírus relacionado ao SARS-CoV-2 se espalhou por quase todos os países, causando a COVID-19. A gravidade da COVID-19 é baseada na inflamação causada pela tempestade de citocinas. Marcadores inflamatórios sugerem uma explicação molecular para a ocorrência de doenças graves e representam um possível tratamento. Objetivo: Esta revisão tem como objetivo analisar a plausibilidade do uso da suplementação oral com imunonutrientes. Discussão: A imunonutrição estuda as interações entre nutrição, sistema imunológico, infecção e inflamação dos tecidos. Arginina é um aminoácido fundamental em processos de estresse metabólico. Sua deficiência implica na capacidade de resposta imune. Os ácidos graxos ω-3 demonstraram melhorar a complacência pulmonar, oxigenação, tempo de ventilação mecânica e de unidade de terapia intensiva em pacientes com síndrome de angústia respiratória aguda. Essencial para imunidade mediada por células e função de linfócitos T, os nucleotídeos dietéticos têm demonstrado melhorar a citotoxicidade das células natural killer. Considerando que a relação inversamente proporcional entre a presença de IL-6 e TNF-α e a função das células T é bem estabelecida em pacientes com COVID-19, isso reforça a ideia de que o controle de liberação desses biomarcadores pode ser uma forma de tratar essa doença. Conclusão: Nesse cenário, esta revisão levanta a possibilidade de uso da imunonutrição para melhorar a resposta imune dos indivíduos afetados pela COVID-19.
Referências
Aggarwal, N. R., King, L. S., & D’Alessio, F. R. (2014). Diverse macrophage populations mediate acute lung inflammation and resolution. American Journal of Physiology - Lung Cellular and Molecular Physiology, 306(8). https://doi.org/10.1152/ajplung.00341.2013
Ahn, D. G., Shin, H. J., Kim, M. H., Lee, S., Kim, H. S., Myoung, J., … Kim, S. J. (2020). Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19). Journal of Microbiology and Biotechnology, 30(3), 313–324. https://doi.org/10.4014/jmb.2003.03011
Bansal, V., & Ochoa, J. B. (2003). Arginine availability, arginase, and the immune response. Current Opinion in Clinical Nutrition and Metabolic Care, 6(2), 223–228. https://doi.org/10.1097/00075197-200303000-00012
Beale, R. J., Bryg, D. J., & Bihari, D. J. (1999). Immunonutrition in the critically ill: A systematic review of clinical outcome. Critical Care Medicine, 27(12), 2799–2805. https://doi.org/10.1097/00003246-199912000-00032
Bistrian, B. R., & McCowen, K. C. (2006, maio). Nutritional and metabolic support in the adult intensive care unit: Key controversies. Critical Care Medicine, 34(5), 1525–1531. https://doi.org/10.1097/01.CCM.0000216704.54446.FD
Braga, M., & Gianotti, L. (2005). Preoperative Immunonutrition: Cost-Benefit Analysis. Journal of Parenteral and Enteral Nutrition, 29(1_suppl), S57–S61. https://doi.org/10.1177/01486071050290s1s57
Caccialanza, R., Laviano, A., Lobascio, F., Montagna, E., Bruno, R., Ludovisi, S., … Cereda, E. (2020, junho 1). Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition. https://doi.org/10.1016/j.nut.2020.110835
Calder, P. C. (2003, julho 19). Immunonutrition. British Medical Journal, 327(7407), 117–118. https://doi.org/10.1136/bmj.327.7407.117
Calder, P. C., Carr, A. C., Gombart, A. F., & Eggersdorfer, M. (2020, abril 23). Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients, 12(4), 1181. https://doi.org/10.3390/nu12041181
Cheng, V. C. C., Lau, S. K. P., Woo, P. C. Y., & Kwok, Y. Y. (2007, outubro). Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clinical Microbiology Reviews, 20(4), 660–694. https://doi.org/10.1128/CMR.00023-07
Chiarla, C., Giovannini, I., & Siegel, J. H. (2006, fevereiro). Plasma arginine correlations in trauma and sepsis. Amino Acids, 30(1), 81–86. https://doi.org/10.1007/s00726-005-0211-z
de Groot, R. J., Baker, S. C., Baric, R. S., Brown, C. S., Drosten, C., Enjuanes, L., … Ziebuhr, J. (2013, julho 15). Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Announcement of the Coronavirus Study Group. Journal of Virology, 87(14), 7790–7792. https://doi.org/10.1128/jvi.01244-13
Diao, B., Wang, C., Tan, Y., Chen, X., Liu, Y., Ning, L., … Chen, Y. (2020, maio 1). Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19). Frontiers in Immunology, 11, 827. https://doi.org/10.3389/fimmu.2020.00827
Donoghue, M., Hsieh, F., Baronas, E., Godbout, K., Gosselin, M., Stagliano, N., … Acton, S. (2000). A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circulation research, 87(5). https://doi.org/10.1161/01.res.87.5.e1
García de Acilu, M., Leal, S., Caralt, B., Roca, O., Sabater, J., & Masclans, J. R. (2015). The Role of Omega-3 Polyunsaturated Fatty Acids in the Treatment of Patients with Acute Respiratory Distress Syndrome: A Clinical Review. BioMed Research International, 2015, 653750. https://doi.org/10.1155/2015/653750
Glatzle, J., Kasparek, M. S., Mueller, M. H., Binder, F., Meile, T., Kreis, M. E., … Steurer, W. (2007, junho 11). Enteral immunonutrition during sepsis prevents pulmonary dysfunction in a rat model. Journal of Gastrointestinal Surgery, 11(6), 719–724. https://doi.org/10.1007/s11605-007-0144-9
Grau-Carmona, T., Morán-García, V., García-de-Lorenzo, A., Heras-de-la-Calle, G., Quesada-Bellver, B., López-Martínez, J., Acosta, J. (2011, outubro). Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients. Clinical Nutrition, 30(5), 578–584. https://doi.org/10.1016/j.clnu.2011.03.004
Guo, Y. R., Cao, Q. D., Hong, Z. S., Tan, Y. Y., Chen, S. D., Jin, H. J., & Yan, Y. (2020, março 13). The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak- A n update on the status. Military Medical Research, 7(1). https://doi.org/10.1186/s40779-020-00240-0
Heyland, D. K., Novak, F., Drover, J. W., Jain, M., Su, X., & Suchner, U. (2001, agosto 22). Should immunonutrition become routine in critically III patients? A systematic review of the evidence. JAMA - Journal of the American Medical Association, 286(8), 944–953. https://doi.org/10.1001/jama.286.8.944
Heys, S. D., Walker, L. G., Smith, I., & Eremin, O. (1999, abril). Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: A meta-analysis of randomized controlled clinical trials. Annals of Surgery, 229(4), 467–477. https://doi.org/10.1097/00000658-199904000-00004
Hoehl, S., Rabenau, H., Berger, A., Kortenbusch, M., Cinatl, J., Bojkova, D., … Ciesek, S. (2020, março 26). Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. New England Journal of Medicine, 382(13), 1278–1280. https://doi.org/10.1056/NEJMc2001899
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., & Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
Huppert, L. A., Matthay, M. A., & Ware, L. B. (2019). Pathogenesis of Acute Respiratory Distress Syndrome. Seminars in Respiratory and Critical Care Medicine, 40(1), 31–39. https://doi.org/10.1055/s-0039-1683996
Iddir, M., Brito, A., Dingeo, G., Fernandez Del Campo, S., Samouda, H., La Frano, M., & Bohn, T. (2020). Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients, 12(6), 1562. https://doi.org/10.3390/nu12061562
Jin, Y., Yang, H., Ji, W., Wu, W., Chen, S., Zhang, W., & Duan, G. (2020). Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses, 12(4), 372. https://doi.org/10.3390/v12040372
Ksiazek, T. G., Erdman, D., Goldsmith, C. S., Zaki, S. R., Peret, T., Emery, S., & Anderson, L. J. (2003). A novel coronavirus associated with severe acute respiratory syndrome. New England Journal of Medicine, 348(20), 1953–1966. https://doi.org/10.1056/NEJMoa030781
Lan, L., Xu, D., Ye, G., Xia, C., Wang, S., Li, Y., & Xu, H. (2020). Positive RT-PCR Test Results in Patients Recovered from COVID-19. JAMA - Journal of the American Medical Association, 323(15), 1502–1503. https://doi.org/10.1001/jama.2020.2783
Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., & Feng, Z. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New England Journal of Medicine, 382(13), 1199–1207. https://doi.org/10.1056/NEJMoa2001316
Li, T., Zhang, Y., Gong, C., Wang, J., Liu, B., Shi, L., & Duan, J. (2020). Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. European Journal of Clinical Nutrition, 1. https://doi.org/10.1038/s41430-020-0642-3
Liu, F., Li, L., Xu, M. Da, Wu, J., Luo, D., Zhu, Y. S., & Zhou, X. (2020). Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. Journal of Clinical Virology, 127. https://doi.org/10.1016/j.jcv.2020.104370
Liu, G., Zhang, S., Mao, Z., Wang, W., & Hu, H. (2020). Clinical significance of nutritional risk screening for older adult patients with COVID-19. European Journal of Clinical Nutrition. https://doi.org/10.1038/s41430-020-0659-7
Messina, G., Polito, R., Monda, V., Cipolloni, L., Di Nunno, N., Di Mizio, G., & Sessa, F. (2020). Functional Role of Dietary Intervention to Improve the Outcome of COVID-19: A Hypothesis of Work. International Journal of Molecular Sciences, 21(9), 3104. https://doi.org/10.3390/ijms21093104
Meyer, N. J., & Christie, J. D. (2013). Genetic heterogeneity and risk of acute respiratory distress syndrome. Seminars in Respiratory and Critical Care Medicine, 34(4), 459–474. https://doi.org/10.1055/s-0033-1351121
Mizock, B. A. (2010). Immunonutrition and critical illness: An update. Nutrition, 26(7–8), 701–707. https://doi.org/10.1016/j.nut.2009.11.010
Mizock, B. A., & DeMichele, S. J. (2004). The acute respiratory distress syndrome: Role of nutritional modulation of inflammation through dietary lipids. Nutrition in Clinical Practice, 19(6), 563–574. https://doi.org/10.1177/0115426504019006563
Nassar, M. S., Bakhrebah, M. A., Meo, S. A., Alsuabeyl, M. S., & Zaher, W. A. (2018). Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics. European review for medical and pharmacological sciences, 22(15), 4956–4961. https://doi.org/10.26355/eurrev_201808_15635
Ochoa, J. B., Makarenkova, V., & Bansal, V. (2004). A rational use of immune enhancing diets: When should we use dietary arginine supplementation? Nutrition in Clinical Practice, 19(3), 216–225. https://doi.org/10.1177/0115426504019003216
Pepys, M. B., & Hirschfield, G. M. (2003). C-reactive protein: a critical update. Journal of Clinical Investigation, 111(12), 1805–1812. https://doi.org/10.1172/jci18921
Pereira, A. S., et al (2018). Methodology of cientific research. [e-Book]. Santa Maria City. UAB / NTE / UFSM Editors. Retrieved from https://repositorio.ufsm.br/bitstream /handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1.
Pimentel, R. F. W., & Fernandes, S. L. (2020). Effects of parenteral glutamine in critically ill surgical patients: a systematic review and meta-analysis. Nutricion hospitalaria, 34(3). https://doi.org/10.20960/nh.02949
Popovic, P. J., Zeh III, H. J., & Ochoa, J. B. (2007, junho 1). Arginine and Immunity. The Journal of Nutrition, 137(6), 1681S-1686S. https://doi.org/10.1093/jn/137.6.1681S
Robb, C. T., Regan, K. H., Dorward, D. A., & Rossi, A. G. (2016, julho 1). Key mechanisms governing resolution of lung inflammation. Seminars in Immunopathology, 38(4), 425–448. https://doi.org/10.1007/s00281-016-0560-6
Rothan, H. A., & Byrareddy, S. N. (2020, maio 1). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity, 109, 102433. https://doi.org/10.1016/j.jaut.2020.102433
Serhan, C. N., Arita, M., Hong, S., & Gotlinger, K. (2004, novembro). Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their endogenous aspirin-triggered epimers. Lipids, 39(11), 1125–1132. https://doi.org/10.1007/s11745-004-1339-7
Singer, P. (2019, junho 14). Preserving the quality of life: Nutrition in the icu. Critical Care, 23(Suppl 1). https://doi.org/10.1186/s13054-019-2415-8
Singer, P., & Shapiro, H. (2009, março). Enteral omega-3 in acute respiratory distress syndrome. Current Opinion in Clinical Nutrition and Metabolic Care, 12(2), 123–128. https://doi.org/10.1097/MCO.0b013e328322e70f
Singh, R., Gopalan, S., & Sibal, A. (2002, maio). Immunonutrition. Indian Journal of Pediatrics, 69(5), 417–419. https://doi.org/10.1007/BF02722634
Sohrabi, C., Alsafi, Z., O’Neill, N., Khan, M., Kerwan, A., Al-Jabir, A., & Agha, R. (2020, abril 1). World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International Journal of Surgery, 76, 71–76. https://doi.org/10.1016/j.ijsu.2020.02.034
Tan, C., Huang, Y., Shi, F., Tan, K., Ma, Q., Chen, Y., & Li, X. (2020). C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. Journal of Medical Virology. https://doi.org/10.1002/jmv.25871
Thompson, B. T., Chambers, R. C., & Liu, K. D. (2017, agosto 10). Acute respiratory distress syndrome. New England Journal of Medicine, 377(6), 562–572. https://doi.org/10.1056/NEJMra1608077
Ware, L. B., Magarik, J. A., Wickersham, N., Cunningham, G., Rice, T. W., Christman, B. W., & Summar, M. L. (2013, janeiro 17). Low plasma citrulline levels are associated with acute respiratory distress syndrome in patients with severe sepsis. Critical Care, 17(1). https://doi.org/10.1186/cc11934
WHO. (2020). Clinical Management of Severe Acute Respiratory Infection when Novel Coronavirus (nCoV) Infection Is Suspected: Interim Guidance. Recuperado de https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-
Zapatera, B., Prados, A., Gómez-Martínez, S., & Marcos, A. (2015). Inmunonutrición: Metodología y aplicaciones. Nutricion Hospitalaria, 31, 145–154. https://doi.org/10.3305/nh.2015.31.sup3.8762
Zhong, J., Tang, J., Ye, C., & Dong, L. (2020, maio). The immunology of COVID-19: is immune modulation an option for treatment? The Lancet Rheumatology, 0(0). https://doi.org/10.1016/S2665-9913(20)30120-X
Zhou, P., Yang, X. Lou, Wang, X. G., Hu, B., Zhang, L., Zhang, W., & Shi, Z. L. (2020, março 12). A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 579(7798), 270–273. https://doi.org/10.1038/s41586-020-2012-7
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., & Tan, W. (2020, fevereiro 20). A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine, 382(8), 727–733. https://doi.org/10.1056/NEJMoa2001017
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Copyright (c) 2020 Rodrigo Fernandes Weyll Pimentel; Magno Conceição das Merces ; Dandara Almeida Reis da Silva; Márcio Costa de Souza ; Monique Magnavita Borba da Fonseca Cerqueira ; Pedro Carlos Muniz de Figueiredo; Amália Ivine Costa Santana; Douglas de Souza e Silva ; Sandra Lúcia Fernandes; Isolda Padro de Negreiros Nogueira Maduro; Eliene de Almeida Soriano; Anderson Reis de Sousa
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