Abstract
Females with sepsis have a better prognosis than males, while those of both genders with cirrhosis have a high mortality. Impaired immunity accompanies liver cirrhosis. The potential association between sex and immunologic response of cirrhotic rats in sepsis following immunonutrition was investigated. One hundred and forty-three rats were randomly divided into groups. Liver cirrhosis was produced by weekly feeding of CCl4 for 8 weeks. Among them, 24 male and 19 female underwent castration one month before studying. The rats were fed with either immune enhancing diet or control diet for five days, then sepsis was induced with cecal ligation and two holes puncture. Main outcomes included mortality and serum cytokines (IL-1β, 6, and 10). Comparisons were made both within and between genders. Cirrhotic non-castrated male rats showed a significant decrease in mortality (64.1% vs. 32.1%, p = 0.032) with better survival than control diet following immune enhancing diet. Lower mortality of cirrhotic non-castrated female rats was found after immune enhancing diet (69.6% vs. 52.1%, p = 0.365). Cirrhotic castrated male rats showed a lower mortality (44.4%) following immune enhancing diet, and cirrhotic castrated female rats also showed significantly lower mortality and better survival than control diet after immune enhancing diet (87.5% vs. 33.3%, p = 0.004). Plasma concentrations of IL-1β were higher in non-oophorectomized female rats fed with control diet compared to immune enhancing diet. Non-orchidectomized males and non-oophorectomized females exhibited similar increases in IL-10 after immune enhancing diet. Our results demonstrated that immunonutrition was more beneficial for male than female cirrhotic rats following sepsis. Though orchidectomy was not found to be more advantageous for the normal male rats in sepsis, immunonutrition seemed to be as important as sex hormone for female rats in sepsis.
Highlights
Behind heart disease and cancer, cirrhosis is the third most common cause of death among people aged 45 to 65 years
The mortality induced by cecal ligation and puncture (CLP) in cirrhotic male rats following feeding with non-immune enhancing control diet showed no difference to that in the cirrhotic female rats
These results demonstrated the important role of immunonutrition for cirrhotic male rats during sepsis
Summary
Behind heart disease and cancer, cirrhosis is the third most common cause of death among people aged 45 to 65 years. Many people with mild cirrhosis usually have no symptoms and appear to be well for years. Such cases are usually discovered during routine tests for other problems or during surgery. Gender differences have been reported following trauma and sepsis; female patients have a better outcome than males, which may relate to increased levels of anti-inflammatory cytokines [3,4,5,6,7,8]. Sexual dimorphism may be influenced by the effects of sex hormones and a different ratio of pro-inflammatory and anti-inflammatory cytokines in women compared to men [7]. Enhanced immune response in females may result from the absence of androgenic hormones in females or the immunostimulating effects of female sex steroids [18]
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