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Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada T6G 2P5
2To whom correspondence should be addressed. E-mail: Catherine.field{at}ualberta.ca
| ABSTRACT |
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and tumor
necrosis factor-
) production (P < 0.05).
Upregulated immune function in tumor-bearing rats fed the high
(n-3) diet occurred concurrently with specific changes in the major
membrane phospholipids phosphatidylcholine and phosphatidylethanolamine
in high (n-3)-fed rats. Because membrane composition plays a critical
role in immune function, additional work is needed to determine the
relationship between alterations in the phospholipid composition of
immune cells during cancer and subsequent upregulation of host defense
in the tumor-bearing state.
KEY WORDS: dietary (n-3) fatty acids R3230AC mammary tumor immune mitogen phospholipids rats
| INTRODUCTION |
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Diets rich in fish oil-derived long-chain (n-3) fatty acids,
eicosapentaenoic [C20:5(n-3)] and docosahexaenoic [C22:6(n-3)]
acids, can affect components of both the innate and acquired
cell-mediated immune systems (Robinson and Field 1998
). The mechanism for the immunomodulatory effect of (n-3)
fatty acids may involve changes in membrane-mediated functions
through alterations in membrane lipid composition (Calder 1998
). Changes in dietary fat composition can induce
significant alterations in the composition and function of immune cell
membranes (Field et al. 2000
, Hosack-Fowler et al. 1993,
Peterson et al. 1998
). In lymphocytes,
membrane-associated events play a pivotal role in signal
transduction (Hosack-Fowler et al. 1993
), the expression
of surface markers (Jenski et al. 1995
) and cellular
activation (Calder et al. 1994
), all of which are
important in immune cell function. Thus, changing the membrane
composition of such cells, through modulating dietary lipids, may
influence immune responses important in anticancer defense. Less is
known about how the lipid composition of immune cell membranes is
altered during tumor growth, when immune cells are activated or
suppressed by the presence of the tumor. Furthermore, it is not
currently known how dietary fat and tumor growth interact to affect
immune cell membrane composition and function. The objectives of this
study were to determine the effects of dietary long-chain (n-3)
fatty acids and tumor burden on immune cell membrane phospholipid
composition and membrane-mediated immune defense in rats implanted
with the R3230AC mammary adenocarcinoma.
| MATERIALS AND METHODS |
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RPMI 1640 culture media, fetal calf serum, glutamine,
antimycotic-antibiotic solution (1 x 105 U/L
penicillin, 100 mg/L streptomycin, 25 mg/L amphotericin B) and HEPES
were purchased from Gibco BRL (Burlington, ON, Canada). Bovine serum
albumin, 2-mercaptoethanol, ionomycin, hyaluronidase,
8-anilino-1-naphthalene-sulfonic acid and phospholipid standards were
obtained from Sigma (St. Louis, MO). Phorbol myristate acetate (PMA)
was purchased from ICN (Montréal, QB, Canada). The OX19, w3/25,
OX8, OX12 and OX42 monoclonal antibodies were kindly provided by A.
Rabinovitch (University of Alberta, Edmonton, Canada). All monoclonal
antibodies were mouse anti-rat immunoglobulin G (IgG).
Phycoerythrin-conjugated goat anti-mouse IgG and all other
monoclonal antibodies (except JJ319) were purchased from Cedarlane
Laboratories (Hornby, ON, Canada). Fluorescein
isothiocyanate-conjugated goat anti-mouse IgG was obtained from
Organon Teknika (Scarborough, ON, Canada). Antibody JJ319 was purchased
from PharMingen (Mississauga, ON, Canada). Antibodies and reagents for
the interferon (IFN)-
and tumor necrosis factor (TNF)-
assays
were obtained from Genzyme Diagnostics (Cambridge, MA) and R&D Systems
(Minneapolis, MN), respectively. For cytokine assays, Immulon® high
binding flat-bottom microtiter plates were obtained from Dynex
Technologies (Chantilly, VA).
Animals and diets.
Experiments were reviewed and approved by the Faculty of Agriculture
and Forestry Animal Policy and Welfare Committee and were conducted in
accordance with the Canadian Council on Animal Care guidelines.
Thirty-three female Fischer 344 rats (145 ± 2 g) were
obtained from a colony maintained at the University of Alberta and were
housed in individual wire-mesh cages in a temperature controlled
room (23°C) maintained on a 12-h light/dark cycle. Body weight and
food intake were recorded every 3rd d throughout the study. Rats were
randomly assigned to be fed nutritionally complete semipurified diets
(Teklad Test Diets, Madison, WI) containing (per kg) 270 g high
protein casein, 408 g carbohydrate and 200 g fat. Both diets
met the (n-6) and (n-3) fatty acid requirements of growing rats. The
complete nutrient composition of the diets has been reported
(Robinson and Field 1998
). The dietary polyunsaturated
to saturated fatty acids ratio was 0.35 as determined by
gas-liquid chromatography (Field et al. 1988
). The
two diets differed only in the composition of fat, providing two
different levels of long chain (n-3) fatty acids from a mixed fish oil
source (P-28 Nisshin lot 28020; Nisshin Flour Milling, Tokyo, Japan):
low (0 g/kg) or high (50 g/kg of total fat). The only source of (n-3)
fatty acids in the low (n-3) diet was
-linolenic acid [18:3(n-3)],
provided by linseed oil (Galaxy Enterprises, Edmonton, Canada). The
fatty acid composition of the diets is presented in Table 1
. All rats were given free access to food and water. After 21 d of
feeding, a freshly harvested R3230AC mammary tumor from a rat implanted
23 wk earlier was finely chopped under sterile conditions to prepare
a tumor brei and 50 µL were injected subcutaneously in the inguinal
region of experimental rats. Rats were killed by
CO2 asphyxiation and cervical dislocation 17 d after tumor implantation. At necropsy, the tumor and spleen were
removed, weighed and used for the measurements described below. There
were 14 tumor-bearing rats (7/diet) and 19 healthy (control) rats
[9 rats were fed the low (n-3) diet and 10 rats were fed the high
(n-3) diet].
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Splenocytes were isolated aseptically as previously described
(Field et al. 1990
) in Krebs-Ringer HEPES buffer (pH
7.4) supplemented with bovine serum albumin (5 g/L). Isolated
splenocytes (3.0 x 109 cells/L) in complete culture
media [RPMI 1640 supplemented with 4% (v/v) heat-inactivated
fetal calf serum, 1% (v/v) antimycotic-antibiotic solution,
glutamine (4 mmol/L), HEPES (25 mmol/L), and 2-mercaptoethanol (2.5
µmol/L)] were incubated in 24-well sterile plates for 48 h in a
humidified atmosphere at 37°C in the presence of 5% CO2.
The cell culture medium either contained no mitogen (unstimulated
cells) or was supplemented with PMA (30 µg/L) plus ionomycin (0.75
µmol/L). After 48 h, splenocyte culture supernatants were
collected and stored at -70°C for subsequent cytokine analysis.
Splenocytes that had been cultured with PMA plus ionomycin were washed
twice in Krebs-Ringer HEPES buffer (pH 7.4) supplemented with
bovine serum albumin (5 g/L) and used for indirect immunofluorescence
analyses or frozen at -70°C for subsequent lipid analysis.
Splenocyte mitogenic response (proliferation) assay.
Splenocytes (1.25 x 109 cells/L) were cultured in
triplicate in 96-well microtiter plates in complete culture media with
or without PMA (30 µg/L) plus ionomycin (0.75 µmol/L) for 66 or
78 h as previously described (Shewchuk et al. 1996
). Twelve hours before harvesting the cells, each well was
pulsed with 18.5 kBq of [methyl-3H]-thymidine.
Indirect immunofluorescence (phenotype) assay.
Immune cell subsets in mitogen-stimulated splenocytes were
identified by indirect immunofluorescence assay as previously described
(Robinson and Field 1998
). The following monoclonal
antibodies were used: OX19 (CD5), w3/25 (CD4), OX8 (CD8
), OX12 (B
cells), OX42 (CD11b/c), 3.2.3 (CD161), OX39 (CD25) and JJ319 (CD28).
Because the monoclonal antibodies were not prelabeled with a
fluorescent marker, they were incubated with either fluorescein
isothiocyanate (FITC)-conjugated goat anti-mouse IgG or
phycoerythrin-conjugated goat anti-mouse IgG. The percentage of
cells expressing each marker was determined by flow cytometry (FACScan;
Becton Dickinson, Sunnyvale, CA) and was corrected for background
fluorescence using the analysis of cells incubated with FITC or
phycoerythrin alone. FITC and phycoerythrin background fluorescence
were 5% and 0%, respectively (data not shown). Unwanted events (dead
cells and debris) were detected by forward scatter and side scatter and
were excluded from subsequent phenotype analyses by electronic gating
of the viable splenocyte population. We have expressed the
mitogen-stimulated phenotyping data as the percentage of live cells
remaining after culture.
Cytokine production.
The concentrations of IFN-
and TNF-
in culture supernatants
collected from unstimulated and stimulated splenocytes were determined
by enzyme-linked immunosorbent assay. Briefly, flat-bottom
microtiter plates were coated overnight with appropriately diluted
purified rabbit anti-rat IFN-
or TNF-
. After washing, plates
were blocked with PBS plus 10% (v/v) fetal calf serum to prevent
nonspecific binding. Recombinant standards and appropriately diluted
splenocyte culture supernatants were then added in triplicate at 100
µL per well, incubated for 4 h at room temperature, washed and
further incubated with appropriately diluted biotinylated mouse
anti-rat IFN-
or TNF-
. After extensive washing, the plates
were incubated for 30 min with horseradish peroxidase avidin D. The
absorbance was measured at 450 nm (IFN-
) or 405 nm (TNF-
) in a
plate reader (Bio-Tek Instruments, Burlington, VT). The recombinant
standard concentrations used were 201620 ng/L for IFN-
and
152000 ng/L for TNF-
.
Splenocyte fatty acid analysis.
Lipids were extracted from splenocytes by a modified Folch procedure as
previously described (Field et al. 1988
). Individual
phospholipids were separated on thin layer chromatography plates (HPK
silica gel 60 nm 10 x 10 cm; Whatman, Clifton, NJ) as previously
described (Touchstone et al. 1980
). Separated
phospholipids were visualized with 8-anilino-1-naphthalene-sulfonic
acid and identified under ultraviolet light with appropriate standards.
Phosphatidylcholine (PC) and phosphatidylethanolamine (PE) fatty acid
methyl esters were prepared from the scraped silica band using 140 g/L
(wt/v) BF3/methanol reagent (Morrison and Smith 1964
) and separated by automated gas liquid chromatography
(Vista 6010; Varian Instruments, Georgetown, ON) on a fused silica BP20
capillary column (25-m x 0.25-mm internal diameter; Varian
Instruments) as previously described (Field et al. 1988
).
Statistical analysis.
Results are presented as means ± SEM. All statistical
analyses were conducted using the SAS Statistical Package, Version 6.11
(SAS Institute, Cary, NC). The effects of diet and tumor were
determined by two-way ANOVA followed by a Duncans multiple range
test to identify significant (P
0.05)
differences between individual treatments (Steele and Torrie 1980
). Body weight changes and food intake were compared among
groups by repeated-measures ANOVA (Steele and Torrie 1980
). Paired t tests were used to compare
cytokine production by immune cells with or without mitogen.
| RESULTS |
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Neither dietary long-chain (n-3) fatty acids nor the tumor significantly affected food intake (overall mean = 63 ± 1 g · kg body-1 · d-1; n = 29), final body weight (overall mean = 158 ± 2 g; n = 33), weight increase (overall mean = 13 ± 1 g; n = 33), relative spleen weight (overall mean = 2.8 ± 0.1 g/kg body; n = 33), or the number of spleen cells (x106) isolated per gram of spleen (overall mean = 433 ± 13; n = 32).
R3230AC mammary tumor weight.
Final tumor weight tended to be lower (-31%; P = 0.1) when rats were fed long-chain (n-3) fatty acids (0.9 ± 0.1 vs. 1.3 ± 0.2 g/100 g body; n = 7/diet).
Splenocyte mitogenic response.
Neither diet nor the tumor affected
[3H]thymidine incorporation by unstimulated
splenocytes at 66 and 78 h (overall 66-h mean = 2422 ± 251 dpm, n = 33; overall 78-h mean = 1898 ± 244 dpm, n = 33). Diet also did not significantly
affect [3H]thymidine uptake by PMA plus
ionomycin-stimulated cells at 66 and 78 h; therefore, rats in
the low and high (n-3) diet groups within either the healthy or
tumor-bearing group were combined for statistical analysis to
examine the effect of tumor burden (Fig. 1
). Splenocytes from tumor-bearing rats had a lower response to PMA
plus ionomycin at 66 and 78 h (P < 0.01) compared
with cells from healthy rats (Fig. 1)
.
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There was a significant (P
0.01) diet by tumor
interaction on the proportion of CD8+ T
suppressor/cytotoxic cells and
CD25+CD8+ T cells after
splenocytes were stimulated with PMA plus ionomycin (Table 2
). In rats fed the high (n-3) diet, those bearing tumors had a
significantly higher proportion of CD8+ and
CD25+CD8+ T cells and a
significantly lower CD4:CD8 ratio compared with healthy rats (Table 2)
.
In contrast, tumor burden did not significantly affect the proportion
of CD8+ or
CD25+CD8+ T cells or the
CD4:CD8 ratio when rats were fed the low (n-3) diet (Table 2)
.
Furthermore, tumor-bearing rats fed the high (n-3) diet had a
significantly higher proportion of
CD25+CD8+ T cells compared
with those fed the low (n-3) diet (Table 2)
. In both diet groups,
splenocytes from tumor-bearing rats had a significantly lower
proportion of CD4+ Th cells and B cells after
mitogen stimulation compared with healthy rats (Table 2)
. Diet did not
significantly affect CD25+ expression on other
cell types; therefore, rats in the low and high (n-3) diet groups
within either the healthy or tumor-bearing group were combined for
statistical analysis to examine the effect of tumor burden (Fig. 2
). Tumor-bearing rats had a significantly lower proportion of
CD25+CD4+ Th cells,
CD25+ B cells and CD25+
macrophages after mitogen stimulation compared with healthy rats (Fig. 2)
.
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| Cytokine production |
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.
Splenocytes from all groups cultured for 48 h without mitogen
(unstimulated) produced undetectable levels of IFN-
in the culture
supernatants (results not shown). In tumor-bearing rats, IFN-
production by splenocytes stimulated with PMA plus ionomycin was
significantly higher when rats were fed the high (n-3) diet compared
with the low (n-3) diet (Fig. 3
).
|
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Neither diet nor the tumor significantly affected TNF-
production by
splenocytes cultured for 48 h without mitogen (overall mean = 31 ± 6 ng · L-1 ·
106 cells-1; n
= 24). There was a significant diet by tumor interaction
(P
0.01) on splenocyte TNF-
production after PMA
plus ionomycin stimulation (Fig. 3)
. In both healthy and
tumor-bearing rats, TNF-
production was greater (P
< 0.0001) in rats fed the high (n-3) diet compared with the low
(n-3) diet (Fig. 3)
. Furthermore, tumor-bearing rats fed the high
(n-3) diet produced more (P < 0.0001) TNF-
than
healthy rats fed the same diet (Fig. 3)
.
Fatty acid composition of immune cells after PMA plus ionomycin stimulation.
The proportions of fatty acids from 14:0 to 24:1(n-9) in PC and PE were
measured, but only major fatty acids are reported (Table 3
).
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Both healthy and tumor-bearing rats fed the high (n-3) diet had a
greater proportion of 22:5(n-3) and total (n-3) fatty acids in PC in
splenocytes stimulated with PMA plus ionomycin compared with those fed
the low (n-3) diet (Table 3)
. Healthy rats fed the high (n-3) diet also
had a significantly lower proportion of 20:2(n-6), 22:5(n-6) and
22:4(6) and a lower (n-6):(n-3) fatty acid ratio in PC compared with
those fed the low (n-3) diet (Table 3)
. However, diet did not affect
the proportions of these fatty acids in tumor-bearing rats. The
tumor affected only the fatty acid composition of PC when rats were fed
the low (n-3) diet. For example, low (n-3)-fed tumor-bearing rats
had a significantly lower percentage of 20:2(n-6), 20:3(n-6) and
22:4(n-6) and total (n-6) fatty acids and a lower (n-6):(n-3) fatty
acid ratio in PC compared with healthy rats fed the same diet (Table 3)
.
PE.
Both healthy and tumor-bearing rats fed the high (n-3) diet had a
significantly lower (n-6):(n-3) fatty acid ratio in PE in splenocytes
stimulated with PMA plus ionomycin than in rats fed the low (n-3) diet
(Table 3)
. Tumor-bearing rats fed the high (n-3) diet had a
significantly higher proportion of 20:5(n-3), 22:5(n-3), 22:6(n-3) and
total (n-3) fatty acids compared with those fed the low (n-3) diet
(Table 3)
. The tumor only affected the fatty acid composition of PE
when rats were fed the high (n-3) diet. For example, high (n-3)-fed
tumor-bearing rats had a significantly higher percentage of
22:5(n-3) and 22:6(n-3) and total (n-3) fatty acids, and a
significantly lower monounsaturated fatty acid content in PE compared
with healthy rats fed the same diet (Table 3)
.
| DISCUSSION |
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Immune surveillance against tumors involves various effector cells,
such as T and B cells, NK cells and macrophages that are able to
recognize tumor antigens and mediate tumor cell killing (Adams et al. 1982
, Robins 1986
, Whiteside and Herberman 1995
). In particular, tumor immunity is mediated, to
a large extent, by activated CD8+ cytotoxic T
lymphocytes that induce apoptotic death in tumor cells
(Kiessling et al. 1999
). The activation and function of
CD8+ cytotoxic T cells is supported by type-1
cytokines, such as IL-2 and IFN-
and TNF-
, which are produced by
CD4+ Th1 cells and CD8+ T
cells (Pardoll and Topalian 1998
, Mosmann and Sad 1996
). T cell activation requires at least two independent
signals, one via the T cell receptor and a second via CD28, which
provides a signal critical to for T cell proliferation, cytokine
production and expression of cytokine receptors, such as the IL-2
receptor CD25 (June et al. 1994
). In the present study,
tumor-bearing rats had a lower proportion of activated
(CD25+) CD4+ Th cells,
CD28+ cells, B cells and macrophages compared
with healthy rats after splenocytes were stimulated in vitro with PMA
plus ionomycin. Activated macrophages play a key role in anticancer
defense through production of TNF-
and IL-1. Although the precise
biological importance of IL-2 receptor expression on macrophages has
not been established, Pleau and Hancock (1989
) showed
that IL-2 binding to IL-2 receptor-positive macrophages increased
IL-1 production. Overall, the observed decrease in activation marker
expression in tumor-bearing rats was accompanied by suppressed
[3H]thymidine incorporation by splenocytes. Our
results suggest that tumor-bearing rats did not respond as well to
mitogen stimulation compared with healthy rats, supporting that there
is impaired cell-mediated immune function in these rats at 17 d postimplantation. However, despite the observed decrease in
activation marker expression and splenocyte proliferation in
tumor-bearing rats, production of the cytokines IFN-
and TNF-
was higher in tumor-bearing rats compared with healthy rats.
Although the proportion of activated CD4+ Th
cells, which produce IFN-
and TNF-
, was decreased with tumor
growth, we cannot determine whether there was a potential shift in
CD4+ Th1 and Th2 cell subsets during tumor
growth, which may have altered cytokine production. It is possible that
more CD4+ Th1 versus Th2 cells were present in
spleen at 17 d postimplantation, resulting in increased IFN-
and TNF-
in tumor-bearing rats. As well, these type-1 cytokines
are produced by other cell types such as CD8+ T
cells, macrophages and NK cells (Mosmann and Sad 1996
).
Although there are limited data on the effect of the R3230AC mammary
tumor on host immune function, other work supports suppressed host
immunity with tumor growth (Kiessling et al. 1999
,
Shewchuk et al. 1996
). Although energy restriction
alters both tumor growth (Kritchevsky 1990
) and immune
function (Corman 1985
), it is unlikely that the observed
tumor-induced immune changes were due to energy malnutrition
because tumor-bearing rats had similar weight gain and food intake
compared with control (healthy) rats at 17 d postimplantation. We
suggest that immune changes induced by the tumor were mediated via
signals at the primary tumor site and are unlikely caused by
metastasized tumor cells as the R3230AC mammary adenocarcinoma in a
nonmetastasizing rodent tumor (Hilf et al. 1965
).
However, additional work is needed to determine whether our observed
changes in immune measures are important in growth of the R3230AC tumor
model in vitro.
A major focus of current research in immunology and oncology is the
development of methods to augment host antitumor immune defense. Our
goal was to determine whether dietary fish oil-derived long-chain
(n-3) fatty acids could enhance immune function in rats implanted with
the R3230AC mammary adenocarcinoma. Dietary long-chain (n-3) fatty
acids did not affect the suppressed mitogenic response in
tumor-bearing rats. Others have shown that long-chain (n-3)
fatty acids inhibit mitogen-induced lymphocyte proliferation
(Calder 1998
, Meydani et al. 1991
). This
seemingly contradictory observation may be due to the content of
polyunsaturated fats in the diets fed in these studies, because we have
found that feeding long-chain (n-3) fatty acids reduces splenocyte
proliferation in healthy rats when fed in a high polyunsaturated fat
diet (unpublished data). In the present study, long-chain (n-3)
fatty acids were supplemented in a diet with a low polyunsaturated fat
level (more similar to the dietary patterns of humans) and they did not
affect proliferation of immune cells isolated from either healthy or
tumor-bearing rats. This suggests that the immunomodulatory effects
of (n-3) fatty acids are dependent on the content polyunsaturated fat
in the diet. We think that these results are of importance because the
current conception that fish oil-derived (n-3) fatty acids are
generally immunosuppressive (Calder 1998
) has been
difficult to overcome. We have previously shown that feeding healthy
rats long-chain n-3 fatty acids enhanced NK cell cytotoxicity and
the proportion of activated (CD71+) immune cells
(Robinson and Field 1998
). Certain immunostimulatory
effects of long-chain (n-3) fatty acids were also observed in the
present study. Feeding the high (n-3) diet to tumor-bearing rats
significantly increased the proportion of activated
(CD25+) CD8+ T cells and
the production of IFN-
and TNF-
. The marked increase in
splenocyte TNF-
production in tumor-bearing rats fed the high
(n-3) is consistent with previous reports on
lipopolysaccharide-stimulated macrophage production in healthy,
fish-oil-fed mice (Chang et al. 1992
). Upregulated
mitogen-induced IFN-
and TNF-
production in tumor-bearing
rats fed the high (n-3) diet occurred concurrently with specific
changes in (n-6) and (n-3) fatty acid levels in immune cell
phospholipids during mitogen activation in rats fed the high (n-3)
diet. However, whether this contributes to the observed
diet-induced changes in immune function in tumor-bearing rats
needs to be studied further. It is not known whether alterations in
immune cell lipid composition are directly associated with changes in
eicosanoid production, receptor or enzyme function, cell permeability,
or second messenger pathways involved in cytokine production in this
model. However, dietary fat modulation of eicosanoids (Peterson et al. 1998
) and intracellular signaling pathways
(Hosack-Fowler et al. 1993
) has been reported in other
studies.
Although the length of time that diets were fed in the present study
(17 d postimplantation) was sufficient to alter immune cell membrane
composition, increase activated CD8+ T cells and
enhance splenocyte IFN-
and TNF-
production, it was perhaps not
long enough for these mechanisms to impact on tumor growth. R3230AC
mammary tumor growth was 31% lower in rats fed long-chain (n-3)
fatty acids, but this effect was not statistically significant. Because
tumor growth was not significantly inhibited by long-chain (n-3)
fatty acid supplementation, the potential importance of
diet-associated changes in the measured immune variables is not
clear. However, our results do not preclude benefits of long-chain
(n-3) fatty acids and/or enhanced immunity on later cancer stages, such
as improved response to chemotherapy (de Salis and Meckling-Gill 1995
), reduction of tumor metastasis
(Rose et al. 1995
), or prevention of cancer cachexia
(Barber et al. 1999
), or on earlier stages, such as
cancer prevention (Noguchi et al. 1997
). Overall, our
results suggest that feeding long-chain (n-3) fatty acids in a low
polyunsaturated fat diet may have beneficial effects on several host
immune defenses, including activation of CD8+ T
cells and IFN-
and TNF-
production. These immune benefits occur
simultaneously with specific changes in the major membrane
phospholipids in activated immune cells from high (n-3)-fed rats.
Because membrane composition plays a critical role in immune function,
additional work is needed to determine the relationship between
diet-induced alterations in the phospholipid composition of immune
cells during cancer and subsequent upregulation of immune responses.
| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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3 Abbreviations used: NK, natural killer; Th, T
helper; PMA, phorbol myristate acetate; IgG, immunoglobulin G; IFN, interferon; TNF, tumor necrosis factor; FITC, fluorescein isothiocyanate; PC, phosphatidylcholine; PE, phosphatidylethanolamine; IL, interleukin. ![]()
Manuscript received December 27, 2000. Initial review completed February 5, 2001. Revision accepted March 28, 2001.
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