the advantage of soy formula with lcpufa in immunity and allergy
TRANSCRIPT
THE ADVANTAGE OF SOY FORMULA WITH LCPUFA
IN IMMUNITY AND ALLERGY
Prof. Ariyanto Harsono MD PhD SpAK
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Pendahuluan
Pencegahan alergi makanan: Primer
Sekunder Tertier
Makanan Padat Menyesuaikan dengan formula Susu yang digunakan
Suplemen yang Lain: LCPUFA, vitamin, mikronutrien
Soy Formula mempunyai efek positif dalam imunitas dan Alergi 2
Immunol 2007:116:34-37
Environment
Antibiotics
3Prof DR Dr Ariyanto Harsono SpA(K)
Aktivasi sel-selImuno-kompeten•Sel T•Sel B•Sel Mast•Sel Langer- hans
Aktivasi sel-selstruk-tural
•Sel endotel•Sel epitel
Aktivasi dan Rekruitmen
•Sel Mast•Eosinofil•Basofil
Pelepasan mediator
Kerusakan epitel
Stimulasi neural
Dilatasi & peningkatan permeabilitas vaskulerl
Bronkokonstriksi
Perbaikan epitel
•Proliferasi fibroblast•Deposisi kolagen•Hipertropi/hiperplasia otot polos•Ekspansi vaskuler
Penyempitan saluran nafas bawah
Symptom alergi
Bronkus hiper-reaktif
ALERGEN
A B C D E
Imunopatologi alergi
Airway remodelling
Primary Prevention Secondary Prevention
Tertiary PreventionJ Allergy Clin Immunol 2005;116:3-14
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Ag
APC MHC-II Th0
IL-12/ IL-1
Th-2
Th.1
IL-1 IL-2, IFN-γ
B-Cell
IL-4
IL-5
SEL PLASMASEL MEMORI
IL-6
IL-10
AAKTIVASI SEL-SEL IMUNOKOMPETEN OLEH ANTIGEN
Memory Cells
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VACCINATION
ACTIVATIONANTIGEN SPECIFIC
B CELL
GENERATION OF MEMORY
ACTIVATED CD4
+ Th-2 CELL IL-4
DIFFERENTIATION
& AFFINITYMATURATION
ANTIBODY SECRETING PLASMA CELLS
ANTIGEN PROCESSING &PRESENTATION
MHC Class II B CELL IMMUNOGLOBULINE
T CELL RECEPTOR ANTIGEN
B CELL
IL-5,IL-13
Cow’s Milk Protein
Cow’s Milk epitope
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IgG7Prof DR Dr Ariyanto Harsono
SpA(K)
IgA
TReg
TGF
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IgG
Th1 Cell
CTL
DTH9Prof DR Dr Ariyanto Harsono
SpA(K)
BAKTIVASI SEL-SEL STRUKTURAL
Nature Rev Immunol 2003; 3: 867-78
Eosinophil
Eosinophil
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CPELEPASAN MEDIATOR
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D EFEK PELEPASAN MEDIATOR PADA TARGET ORGAN
Nature Rev Immunol 2004: 3:234-23712Prof DR Dr Ariyanto Harsono
SpA(K)
Target Organ
IgE-mediated disorder Non IgE-mediated disorder
Skin
Gastro-intestinal
Respiratory Tract Multi-system
Urticaria and angioedemaAtopic Dermatitis
Oral Allergy SyndromeGastrointestinal anaphylaxisAllergic eosinophilic gastroenteritis Asthma; Allergic Rhinitis
Food-induced anaphylaxisFood associated, exercise-induced anaphylaxis
Atopic DrmatitisDermatitis Herpetiformis
ProctocolitisEnterocolitisAllergic eosinophilic-GEEnteropathy syndromeCeliac DiseaseGI Haemorrhage
Heiner Syndrome
Clinical ManifestationE Symptoms
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Kehamilan = “Th2-disease”
*Anti-oksidan
*Hindari asap rokok
*Probiotik trimester terakhir kehamilan
Pencegahan Primer: Masa Kehamilan
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Prevensi Primer dengan susu Formula
FORMULA H.A.Partially hydrolyzed formulas:
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Prof DR Dr Ariyanto Harsono SpA(K)
Tujuan Prevensi Primer
1. Menimbulkan Toleransi Oral
2. Menurunkan prevalensi alergi
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Formula HA dalam Pencegahan primerBagaimana seharusnya?
*Harus mengandung sejumlah kecil protein SS
*Tujuan adalah menginduksi toleransi imun, bukan eliminasi SS
*Harus mengandung kasein dan whey supaya terjadi toleransi thd keduanya
*Probiotik: dapat menyebabkan supresi deviasi imun
US Nutrition guidelines
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Induction of Oral Tolerance
T-cells regulation:
1. Intra Epithelial Lymphocytes: extrathymically derived, have limited TCR repertoir, capable of recognizing common microbiologic Ags, and demonstrate predominantly cytolytic functions
2. Lamina Propria Lymphocytes: thymicaly derived, contributes to limiting TCR/CD3-mediated signals in the mucosa.
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Other Milk supplement
• Vitamin A juga dikenal dengan nama retinol merupakan vitamin yang berperan dalam indra penglihatan yang baik, terutama di malam hari, dan sebagai salah satu komponen penyusun pigmen di retina. Selain itu, vitamin ini juga berperan penting dalam menjaga kesehatan kulit dan imunitas tubuh.
• Apabila terjadi defisiensi vitamin A, penderita akan mengalami rabun senja dan katarak, mudah mengalami infeksi saluran pernafasan.
Prof DR Dr Ariyanto Harsono SpA(K)
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Other Milk supplement…
* Lipid-soluble vitamin E has a capacity of defense against oxidant-induced membrane injury. Studies have consistently demonstrated beneficial associations between dietary vitamin E and ventilatory function, and few have demonstrated beneficial association with asthma and atopy.
J Allergy Clin Immunol 2005;115:1109-17.21Prof DR Dr Ariyanto Harsono
SpA(K)
Water-soluble vitamin C provides anti-oxidant capacity primarily by scavenging oxygen free radicals and suppressing macrophage secretion of super oxide anions, therefore play a role in preventing mucosal shedding caused by mediators released from eosinophils and oxydants.
n-3 polyunsaturated fatty acid (Omega-3), eicosapantaenoic acid, and docahexaenoic acid might have contributed to the decrease in asthma and atopic disease morbidity.
Micronutrents: Fe, Zn, Se
J Allergy Clin Immunol 2005;115:1109-17.
Eur Respir J 1997;10:6-12.
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Arachidonic Acid (ARA)
Phospholiphase A
Cyccloxygenase Lipoxygenase
Prostaglandine
TXA
Prostacyclin
Leukotriene A
Leukotriene B
Leukotriene C
Omega-3, DHAecosapantaenoic acid
HETE,5-HETE, PAF
PGD2/E2
PGD3 LTC4
LTC523
Prevensi Sekunder
Formula Advanved Hydrolyzed
Formula Soy Isolate
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Phytoestrogen Biological consequences of soy-rich diets
have been attributed to the presence of soy isoflavones, which are members of the phytoestrogen family.
Phytoestrogens are plant-derived, estrogen-like compounds capable of interacting with the estrogen receptors ER and ER because their structure resembles that of the endogenous hormone 17-estradiol.
J. Clin. Invest. 2006 116:16-19
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Adrenocortical effects of oral estrogens and soy isoflavones in female monkeys.
Results of study suggest that long-term estrogen treatment may contribute to an androgen-deficient and hypercortisolemic state in animal model.
J Clin Endocrinol Metab 2004; 89: 2319-25
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Phytoestrogen...
Four groups of phenolic compounds are classified as phytoestrogens:
isoflavones, stilbenes, coumestans, and lignans. The main isoflavones, found mostly in soybeans,
are: genistein, daidzein, and glycitein.
J. Clin. Invest. 2006 116:16-1927Prof DR Dr Ariyanto Harsono SpA(K)
Phytoestrogen...
Several epidemiological studies have concluded that phytoestrogens confer:
cardioprotection by downregulating cardiovascular disease risk markers,
consistent improvement in endothelial function
antioxidant activity. J. Clin. Invest. 2006 116:16-19
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H2O
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Phytoestrogen...
Soy product consumption has been associated with the following:
reduced serum cholesterol levels via reductions in total and low-density lipoprotein levels;
vasodilatory activity under certain conditions
enhanced activity of certain antioxidant enzymes to increase antioxidant activities.
J. Clin. Invest. 2006 116:16-19
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A high intake of Soy and Isoflavones may be associated with a reduced prevalence of allergic Rhinitis
J Allery Clin Immunol 2005;115:1176-83
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Tujuan Prevensi Sekunder
1. Menurunkan morbiditas
2. Meningkatkan kualitas hidup
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IMMUNOMODULATORY AND IMMUNOSUPRESSIVE EFFECTS OF
PUFAs
PUFAs modulate :
1. Cytokine production
2. Lymphocyte proliferation
3. Surface molecule expression
4. Phagocytosis and apoptosis
5. Inhibit natural killer (NK)cell activity
33Prof DR Dr Ariyanto Harsono SpA(K)
N-3 PUFA are better than n-6 PUFA The ratio of n-3 to n-6 may be an
important factor in modulating inflammation
Increasing the ratio of n-3 to n-6 antiinflammatory effect especially with atopic disease
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Fish oil consumption during first year of life and allergy
Effect of fish oil consumption in a cohort of 2531 Norwegian infantEffect of fish oil consumption in a cohort of 2531 Norwegian infant
J Asthma 2003;40:34337Prof DR Dr Ariyanto Harsono
SpA(K)
LC-PUFA and immune response
ARA DHA
Prostaglandine E2
Push B cells to produce IgE
Th1 Response
pro-inflammatoryanti-inflammatory
Antagonizes ARA
Prostaglandine E2
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Prostacyclin
Kesimpulan Pencegahan Primer dengan formula hipo-alergenik
harus dimulai sejak trimester pertama kehidupan, tidak menunggu terjadinya gejala alergi. Makanan tambahan seharusnya juga hipo-alergenik
Pencegahan Sekunder menggunakan formula advance hydrolyzed atau formula Soy Isolate
Suplemen nutrisi lain: omega-3, ecosapentaenoic acid, DHA berperan dalam modulasi imun mediator inflamasi
Anti-oksidan: Vitamin A, C, E Micronutrients: Fe, Zn, Se
39Prof DR Dr Ariyanto Harsono SpA(K)
Summary
1. In term infants, there are few indications for their use in place of cow milk-based
formula:• (a) for infants with galactosemia and hereditary lactase deficiency (rare) and • (b) in situations in which a vegetarian diet is preferred.
2. For infants with documented cow milk protein allergy, extensively hydrolyzed protein formula should be considered, because 10% to 14% of these infants will also have a soy protein allergy.
3. Most previously well infants with acute gastroenteritis can be managed after
rehydration with continued use of human milk or standard dilutions of cow milk-based formulas. Isolated soy protein-based formulas may be indicated when secondary lactose intolerance occurs.
40Prof DR Dr Ariyanto Harsono SpA(K)
4. Isolated soy protein-based formula has no advantage over cow milk protein-based formula as a supplement for the breastfed infant, unless the infant has 1 of the indications noted previously.
5. Soy protein-based formulas are not recommended for preterm infants.
6. The routine use of isolated soy protein-based formula has no proven value in the prevention or management of infantile colic or fussiness.
7. Infants with documented cow milk protein-induced enteropathy or enterocolitis frequently are as sensitive to soy protein and should not be given isolated soy protein-based formula. They should be provided formula derived from hydrolyzed protein or synthetic amino acids.
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8. The routine use of isolated soy protein-based formula has no proven value in the prevention of atopic disease in healthy or high-risk infants.
42Prof DR Dr Ariyanto Harsono SpA(K)
Thank You43