Sunderram Jag, Sofou Stavroula, Kamisoglu Kubra, Karantza Vassiliki, Androulakis Ioannis P
Biomedical Engineering Department, Rutgers University, Piscataway, NJ 08854, USA.
J Transl Med. 2014 Mar 28;12:79. doi: 10.1186/1479-5876-12-79.
It has been argued that circadian dysregulation is not only a critical inducer and promoter of adverse health effects, exacerbating symptom burden, but also hampers recovery. Therefore understanding the health-promoting roles of regulating (i.e., restoring) circadian rhythms, thus suppressing harmful effects of circadian dysregulation, would likely improve treatment. At a critical care setting it has been argued that studies are warranted to determine whether there is any use in restoring circadian rhythms in critically ill patients, what therapeutic goals should be targeted, and how these could be achieved. Particularly interesting are interventional approaches aiming at optimizing the time of feeding in relation to individualized day-night cycles for patients receiving enteral nutrition, in an attempt to re-establish circadian patterns of molecular expression. In this short review we wish to explore the idea of transiently imposing (appropriate, but yet to be determined) circadian rhythmicity via regulation of food intake as a means of exploring rhythm-setting properties of metabolic cues in the context of improving immune response. We highlight some of the key elements associated with his complex question particularly as they relate to: a) stress and rhythmic variability; and b) metabolic entrainment of peripheral tissues as a possible intervention strategy through time-restricted feeding. Finally, we discuss the challenges and opportunities for translating these ideas to the bedside.
有人认为，昼夜节律失调不仅是不良健康影响的关键诱导因素和促进因素，会加重症状负担，还会阻碍康复。因此，了解调节（即恢复）昼夜节律的健康促进作用，从而抑制昼夜节律失调的有害影响，可能会改善治疗效果。在重症监护环境中，有人认为有必要进行研究，以确定恢复重症患者的昼夜节律是否有用，应该针对哪些治疗目标，以及如何实现这些目标。特别有趣的是干预方法，旨在根据接受肠内营养患者的个性化昼夜周期优化喂食时间，试图重新建立分子表达的昼夜模式。在这篇简短的综述中，我们希望探讨通过调节食物摄入量来暂时施加（适当但尚未确定）昼夜节律性的想法，以此作为在改善免疫反应的背景下探索代谢信号的节律设定特性的一种手段。我们强调与这个复杂问题相关的一些关键要素，特别是它们与以下方面的关系：a）应激和节律变异性；b）作为一种可能的干预策略，通过限时喂养实现外周组织的代谢同步。最后，我们讨论将这些想法转化为床边实践所面临的挑战和机遇。
