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The advantage of soy formula with lcpufa in immunity and allergy

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  • CYTOKONES PROFILE IN LONG-TERM USE OF CORTICOSTEROID INHALATION IN CHILDHOOD ASTHMA RECEIVING IMMUNOTHERAPY

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  • 1. THE ADVANTAGE OF SOYFORMULA WITH LCPUFAIN IMMUNITY ANDALLERGYProf. Ariyanto Harsono MD PhD SpAK1
  • 2. PendahuluanPencegahan alergi makanan: Primer Sekunder TertierMakanan Padat Menyesuaikan dengan formula Susuyang digunakanSuplemen yang Lain: LCPUFA, vitamin, mikronutrienSoy Formula mempunyai efek positif dalam imunitasdan Alergi 2
  • 3. Immunol 2007:116:34-37EnvironmentAntibiotics3Prof DR Dr Ariyanto HarsonoSpA(K)
  • 4. Aktivasisel-selImuno-kompeten•Sel T•Sel B•Sel Mast•SelLanger-hansAktivasisel-selstruk-tural•Selendotel•SelepitelAktivasi danRekruitmen•Sel Mast•Eosinofil•BasofilPelepasanmediatorKerusakanepitelStimulasineuralDilatasi &peningkatanpermeabilitasvaskulerlBronkokonstriksiPerbaikanepitel•Proliferasifibroblast•Deposisikolagen•Hipertropi/hiperplasia otot polos•EkspansivaskulerPenyempitansaluran nafasbawahSymptomalergiBronkushiper-reaktifALERGENA B C D EImunopatologi alergiAirwayremodellingPrimary Prevention Secondary PreventionTertiary PreventionJ Allergy Clin Immunol 2005;116:3-144
  • 5. AgAPC MHC-II Th0IL-12/ IL-1Th-2Th.1IL-1 IL-2, IFN-γB-CellIL-4IL-5SEL PLASMASEL MEMORIIL-6IL-10AAKTIVASI SEL-SEL IMUNOKOMPETEN OLEHANTIGENMemory Cells5
  • 6. VACCINATIONACTIVATIONANTIGENSPECIFICB CELLGENERATION OFMEMORYACTIVATEDCD4+Th-2 CELL IL-4DIFFERENTIATION& AFFINITYMATURATIONANTIBODY SECRETINGPLASMA CELLSANTIGENPROCESSING &PRESENTATIONMHC Class II B CELL IMMUNOGLOBULINET CELL RECEPTOR ANTIGENB CELLIL-5,IL-13Cow’s Milk ProteinCow’s Milk epitope6Prof DR Dr Ariyanto HarsonoSpA(K)
  • 7. IgG7Prof DR Dr Ariyanto HarsonoSpA(K)
  • 8. IgATRegTGF−β8Prof DR Dr Ariyanto HarsonoSpA(K)
  • 9. IgGTh1 CellCTLDTH9Prof DR Dr Ariyanto HarsonoSpA(K)
  • 10. BAKTIVASI SEL-SEL STRUKTURALNature Rev Immunol 2003; 3: 867-78EosinophilEosinophil10Prof DR Dr Ariyanto HarsonoSpA(K)
  • 11. CPELEPASAN MEDIATOR11Prof DR Dr Ariyanto HarsonoSpA(K)
  • 12. D EFEK PELEPASAN MEDIATOR PADA TARGET ORGANNature Rev Immunol 2004: 3:234-23712Prof DR Dr Ariyanto HarsonoSpA(K)
  • 13. TargetOrganIgE-mediated disorder Non IgE-mediateddisorderSkinGastro-intestinalRespiratoryTractMulti-systemUrticaria and angioedemaAtopic DermatitisOral Allergy SyndromeGastrointestinal anaphylaxisAllergic eosinophilicgastroenteritisAsthma; Allergic RhinitisFood-induced anaphylaxisFood associated, exercise-induced anaphylaxisAtopic DrmatitisDermatitis HerpetiformisProctocolitisEnterocolitisAllergic eosinophilic-GEEnteropathy syndromeCeliac DiseaseGI HaemorrhageHeiner SyndromeClinical ManifestationE Symptoms13
  • 14. Kehamilan = “Th2-disease”*Anti-oksidan*Hindari asap rokok*Probiotik trimesterPencegahan Primer: Masa Kehamilan14
  • 15. 15Prof DR Dr Ariyanto HarsonoSpA(K)
  • 16. Prevensi Primer dengan susuFormulaFORMULA H.A.Partially hydrolyzedformulas:16Prof DR Dr Ariyanto HarsonoSpA(K)
  • 17. Tujuan Prevensi Primer1. Menimbulkan Toleransi Oral2. Menurunkan prevalensi alergi17Prof DR Dr Ariyanto HarsonoSpA(K)
  • 18. Formula HA dalam Pencegahan primerBagaimana seharusnya?*Harus mengandung sejumlah kecilprotein SS*Tujuan adalah menginduksi toleransiimun, bukan eliminasi SS*Harus mengandung kasein dan wheysupaya terjadi toleransi thd keduanya*Probiotik: dapat menyebabkan supresideviasi imunUS Nutrition guidelines18Prof DR Dr Ariyanto Harsono SpA(K)
  • 19. Induction of Oral ToleranceT-cells regulation:1. Intra Epithelial Lymphocytes: extrathymically derived,have limited TCR repertoir, capable of recognizingcommon microbiologic Ags, and demonstratepredominantly cytolytic functions2. Lamina Propria Lymphocytes: thymicaly derived,contributes to limiting TCR/CD3-mediated signals in themucosa.19Prof DR Dr Ariyanto HarsonoSpA(K)
  • 20. Other Milk supplement• Vitamin A juga dikenal dengan nama retinol merupakanvitamin yang berperan dalam indra penglihatan yangbaik, terutama di malam hari, dan sebagai salah satukomponen penyusun pigmen di retina. Selain itu, vitaminini juga berperan penting dalam menjaga kesehatankulit dan imunitas tubuh.• Apabila terjadi defisiensi vitamin A, penderita akanmengalami rabun senja dan katarak, mudah mengalamiinfeksi saluran pernafasan.Prof DR Dr Ariyanto HarsonoSpA(K)20
  • 21. Other Milk supplement…* Lipid-soluble vitamin E has a capacity ofdefense against oxidant-inducedmembrane injury. Studies haveconsistently demonstrated beneficialassociations between dietary vitamin Eand ventilatory function, and few havedemonstrated beneficial association withasthma and atopy.J Allergy Clin Immunol 2005;115:1109-17.21Prof DR Dr Ariyanto HarsonoSpA(K)
  • 22.  Water-soluble vitamin C provides anti-oxidantcapacity primarily by scavenging oxygen freeradicals and suppressing macrophage secretionof super oxide anions, therefore play a role inpreventing mucosal shedding caused bymediators released from eosinophils andoxydants. n-3 polyunsaturated fatty acid (Omega-3),eicosapantaenoic acid, and docahexaenoic acidmight have contributed to the decrease inasthma and atopic disease morbidity.Micronutrents: Fe, Zn, SeJ Allergy Clin Immunol2005;115:1109-17.Eur Respir J 1997;10:6-12.22Prof DR Dr Ariyanto HarsonoSpA(K)
  • 23. Arachidonic Acid (ARA)Phospholiphase ACyccloxygenase LipoxygenaseProstaglandineTXAProstacyclinLeukotriene ALeukotriene BLeukotriene COmega-3, DHAecosapantaenoicacidHETE,5-HETE, PAFPGD2/E2PGD3 LTC4LTC523
  • 24. Prevensi SekunderFormula Advanved HydrolyzedFormula Soy Isolate24Prof DR Dr Ariyanto HarsonoSpA(K)
  • 25. PhytoestrogenBiological consequences of soy-rich dietshave been attributed to the presence ofsoy isoflavones, which are members of thephytoestrogen family.Phytoestrogens are plant-derived,estrogen-like compounds capable ofinteracting with the estrogen receptors ERand ERβ because their structureresembles that of the endogenoushormone 17β-estradiol.J. Clin. Invest. 2006 116:16-1925Prof DR Dr Ariyanto HarsonoSpA(K)
  • 26. Adrenocortical effects of oral estrogens and soy isoflavones in femalemonkeys.Results of study suggest that long-termestrogen treatment may contribute to anandrogen-deficient and hypercortisolemicstate in animal model.J Clin Endocrinol Metab 2004; 89: 2319-2526Prof DR Dr Ariyanto HarsonoSpA(K)
  • 27. Phytoestrogen...Four groups of phenolic compounds are classifiedas 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 HarsonoSpA(K)
  • 28. Phytoestrogen...Several epidemiological studies haveconcluded that phytoestrogens confer:cardioprotection by downregulatingcardiovascular disease risk markers,consistent improvement in endothelialfunctionantioxidant activity. J. Clin. Invest. 2006 116:16-1928Prof DR Dr Ariyanto HarsonoSpA(K)
  • 29. H2O29Prof DR Dr Ariyanto HarsonoSpA(K)
  • 30. Phytoestrogen...Soy product consumption has beenassociated with the following:reduced serum cholesterol levels viareductions in total and low-densitylipoprotein levels;vasodilatory activity under certainconditionsenhanced activity of certain antioxidantenzymes to increase antioxidant activities.J. Clin. Invest. 2006 116:16-1930Prof DR Dr Ariyanto HarsonoSpA(K)
  • 31. A high intake of Soy and Isoflavones maybe associated with a reduced prevalenceof allergic RhinitisJ Allery Clin Immunol 2005;115:1176-8331Prof DR Dr Ariyanto HarsonoSpA(K)
  • 32. Tujuan Prevensi Sekunder1. Menurunkan morbiditas2. Meningkatkan kualitas hidup32Prof DR Dr Ariyanto HarsonoSpA(K)
  • 33. IMMUNOMODULATORY ANDIMMUNOSUPRESSIVE EFFECTS OFPUFAsPUFAs modulate :1. Cytokine production2. Lymphocyte proliferation3. Surface molecule expression4. Phagocytosis and apoptosis5. Inhibit natural killer (NK)cell activity33Prof DR Dr Ariyanto HarsonoSpA(K)
  • 34.  N-3 PUFA are better than n-6 PUFA The ratio of n-3 to n-6 may be animportant factor in modulatinginflammation Increasing the ratio of n-3 to n-6 antiinflammatory effect especially withatopic disease34Prof DR Dr Ariyanto HarsonoSpA(K)
  • 35. 35Prof DR Dr Ariyanto HarsonoSpA(K)
  • 36. 36
  • 37. Fish oil consumption during firstyear of life and allergyEffect of fish oil consumption in a cohort of 2531 Norwegian infantEffect of fish oil consumption in a cohort of 2531 Norwegian infantJ Asthma 2003;40:34337Prof DR Dr Ariyanto HarsonoSpA(K)
  • 38. LC-PUFA and immuneresponseARA DHAProstaglandine E2Push B cells to produce IgETh1 Responsepro-inflammatoryanti-inflammatoryAntagonizes ARAProstaglandine E238Prof DR Dr Ariyanto HarsonoSpA(K)Prostacyclin
  • 39. Kesimpulan Pencegahan Primer dengan formula hipo-alergenikharus dimulai sejak trimester pertama kehidupan,tidak menunggu terjadinya gejala alergi. Makanantambahan seharusnya juga hipo-alergenik Pencegahan Sekunder menggunakan formulaadvance hydrolyzed atau formula Soy Isolate Suplemen nutrisi lain: omega-3, ecosapentaenoicacid, DHA berperan dalam modulasi imun mediatorinflamasi Anti-oksidan: Vitamin A, C, EMicronutrients: Fe, Zn, Se39Prof DR Dr Ariyanto HarsonoSpA(K)
  • 40. Summary1. In term infants, there are few indications for their use in place of cowmilk-basedformula:• (a) for infants with galactosemiaand hereditary lactase deficiency(rare) and• (b) in situationsin which a vegetarian diet is preferred.2. For infants withdocumented cow milk protein allergy, extensivelyhydrolyzedprotein formula should be considered, because 10%to14% ofthese infants will also have a soy protein allergy.3. Most previouslywell infants with acute gastroenteritis canbemanaged afterrehydration with continued use of human milkorstandard dilutionsof cow milk-based formulas. Isolated soyprotein-based formulasmay be indicated when secondary lactoseintolerance occurs. 40Prof DR Dr Ariyanto HarsonoSpA(K)
  • 41. 4. Isolated soy protein-based formula has no advantage over cowmilkprotein-based formula as a supplement for the breastfedinfant,unless the infant has 1 of the indications noted previously.5. Soy protein-based formulas are not recommendedfor preterminfants.6. The routine use of isolated soy protein-basedformula has noprovenvalue in the prevention or managementof infantile colicor fussiness.7. Infants with documented cowmilk protein-induced enteropathyorenterocolitis frequentlyare as sensitive to soy proteinand should notbe given isolatedsoy protein-based formula.They should beprovided formula derivedfrom hydrolyzed proteinor synthetic aminoacids.41Prof DR Dr Ariyanto HarsonoSpA(K)
  • 42. 8. The routineuse of isolated soy protein-based formula has noproven valuein theprevention of atopic disease in healthyorhigh-riskinfants.42Prof DR Dr Ariyanto HarsonoSpA(K)
  • 43. Thank You43