151 LEUKOTRIENES IN PROTEIN ENERGY MALNUTRITION: NEW ASPECTS IN THE PATHOPHYSIOLOGY OF KWASHIORKOR

Abstract

The actions of cysteinyl leukotrienes include production of oedema. We investigated whether these mediators might be involved in the oedematous malnutrition syndrome kwashiorkor.Methods: The capacity of leukotriene (LT) synthesis by stimulated whole blood and urinary LTE4 excretion was measured by specific immunoassays after HPLC purification in 12 children with kwashiorkor, and compared with that in 24 marasmic and 12 control children.Results: Urinary LTE4 excretion was significantly higher in patients with kwashiorkor when compared to controls (118.8±28.5 vs 31.1±19.3 nmol/mol creatinine. p<0.01). Whole blood cysteinyl LT synthesis was increased in kwashiorkor patients by a factor of 3.5 (p<0.01). In marasmic children, LTE4 excretion and whole blood cysteinyl LT synthesis did not differ from those in controls. LTB4 synthesis, however, was greatly reduced in kwashiorkor patients (11.5±2.4 vs 46.5±6.4 ng/mL; p<0.01).Conclusion: Inability to synthesise the immunoregulator LTB4 may lead to inefficient chemoattraction of phagocytes and an inadequate inflammatory response in kwashiorkor. The increased endogenous cysteinyl LT generation in kwashiorkor suggests that these lipid mediators are involved in the pathophysiology of the syndrome, esp. in oedema formation.