PERAN MINERAL DALAM

IMUNITAS

dr Aryu Candra MKes(Epid)

 Why we need minerals?
• A prolonged dietary deficit in any essential
trace element in the adult organism results
in morbidity and potentially death.
• Deficiency during prenatal or early
postnatal development can result prenatal
early postnatal death, congenital
abnormalities, low birth weight, and
functional disturbances of systems
 Epidemiological findings
• The prevalence of primary trace element
and mineral deficiencies in most
developed countries is thought to be low
but the opposite is true for developing
countries.
• The exceptions are iron and zinc
deficiencies that are widespread
throughout the world
 Causative Factors in Mineral Deficiencies
• Primary deficiency: low dietary intake of a
micronutrient
• Secondary (conditioned) deficiency
1. Genetic factors: gene defects
2. Nutritional interactions:
– Dietary binding factors (e.g., fiber and phytate)
– Micronutrient-micronutrient interactions (e.g., zinc–copper,
iron–manganese, cadmium–zinc, and zinc–vitamin A
interactions)
3. Physiological stressors
– Disease-associated changes in micronutrient metabolism
– (e.g., diabetes and hypertension-induced changes in mineral
metabolism)
 Causative Factors in Mineral Deficiencies
4. Drugs or other chemicals and toxicants
• Antimetabolites (e.g., dicumarol)
• Metal chelation (e.g., decreased
absorption and increased excretion)
5. Toxicant-induced changes in tissue pools
(secondary to inflammatory or acute
phase response)
 zinc
• Zinc is involved in a variety of cellular functions
including membrane stabilization,free radical
defense, signal transduction, transcription, and
cell replication
• It is required for the activity of over 300 enzymes
and is involved in the regulation of numerous
genes
• Zinc is known to influence endocrine function
 zinc
• Classical signs of zinc deficiency include
diarrhea and dermatitis
• Acrodermatitis enteropathica, a genetic disorder
of zinc malabsorption, is characterized by thymic
atrophy, reduced lymphocyte proliferative
responses, and a high frequency of infections
• Defisiensi zinc juga dapat menghambat
penyembuhan luka.
• Defisiensi zinc meningkatkan angka kejadian
investasi parasit cacing nematoda
 zinc
• In healthy adult subjects, high levels of zinc
supplementation can result in impaired lymphocyte
proliferative responses and reduced polymorphonuclear
leukocyte chemotaxisand phagocytosis .
• The above may be caused in part by a zinc-induced
secondary copper deficiency
• Indicators of Zinc Status:
1 plasma zinc concentrations may be indicative of
zinc status, but they may also simply reflect an
inflammatory state
2 Hair zinc concentrations; useful for identifying
populations with low zinc status
 Selenium
• terdapat dimana-mana diseluruh jaringan tubuh seperti
tulang, otot dan darah walaupun kandungannya sangat
rendah
• Most of the selenium in tissue is found as
selenomethionine or selenocysteine
• selenomethionine is not synthesized in tissues and must
be obtained from the diet
• Selenocysteine is the predominant form of
selenium used in biological processes
• Dietary selenium intake is very low in some populations.
In certain regionsof China, selenium deficiency is a
major contributor to Keshan Disease, a syndrome
characterized by myocardial necrosis.
 selenium
• selenium is essential for both innate and
acquired immunity
• Serum IgG and IgM concentrations were
reduced with selenium deficiency
• Marginal selenium deficiency wasreported to be
a risk factor for autoimmiune thyroiditis
• Selenium deficiency was a risk factor forHIV-
related mortality
 selenium
• selenium supplements were associated with
improved immune system function and a
reduced risk of lung, colorectal, and prostate
cancers
• Blood and plasma selenium concentrations can
reflect marginal or severe selenium deficiency
• Urine selenium concentrations are thought to
reflect recent dietary intake of the element rather
than body status
 Copper
• severe copper deficiency is uncommon, marginal
copper deficiency may be prevalent in humans

• Environmental or physiological conditions that

perturb copper metabolism can trigger a
subclinical copper deficiency.

• For example, exercise, infection, inflammation,

diabetes and hypertension, and the consumption
of zinc supplements and diets high in fructose
can alter copper metabolism
 Copper

• copper deficiency resulting in neutropenia,

anemia, and impaired immune function.
• Indicators of copper status include serum,
plasma, and urinary copper
concentrations, plasma ceruloplasmin
activity, erythrocyte copper, zinc
superoxide dismutase (CuZnSOD) activity,
and leukocyte or platelet cytochrome-c
oxidase activity
 IODINE
• Iodine can stimulate IgG synthesis in human
lymphocytes in vitro
• Deficiency has been reported to be a risk factor
for gastric cancer
• iodine is thought to protect the stomach through
antioxidant mechanisms
• iodine deficiency has been reported to be a risk
factor for the development of immune
deficiencies
• Urinary iodine is the standard method for
assessing iodine status and adequacy of intake
 IRON
• Iron deficiency is the most common known
mineral deficiency in the world.
• Prolonged iron deficiency can result in multiple
immunological abnormalities:
 reduced inflammatory responses
 impairments in neutrophil and macrophage
cytotoxic activity
 reductions in lymphocyte proliferation, T-cell
numbers, cytokine release, and antibody
production
 lymphoid tissue atrophy
 Indicators of Iron Status
• Plasma ferritin
• Plasma transferrin
• plasma total iron binding capacity
• Plasma-solubleserum transferrin receptor
(sTfR) concentration
 MAGNESIUM
• severe magnesium deficiency is rare in humans,
low plasma magnesium concentrations are a
common clinical finding
• A number of studies suggest that most
population groups including young children and
pregnant women may not ingest adequate
magnesium
• Magnesium intake has decreased over the years
caused partly by increased consumption of
refined and processed foods that generally have
low magnesium content
 MAGNESIUM
• A low magnesium intake and status may
be involved in the development of asthma
and chronic obstructive airway disease
• Indicators of Magnesium Status: Serum or
plasma magnesium levels, Intravenous
magnesium loading (magnesium tolerance
test)
 Manganese
• Manganese deficiency is thought to be rare in human
subjects
• Low blood manganese has been reported to be
associated with several diseases
including osteoporosis and epilepsy
• high dietary iron intakes have been associated with low
blood manganese concentrations
• very high dietary manganese intakes a secondary iron
deficiency can arise
• manganese toxicity signs include severe neurological
damage and behavioral abnormalities
 Indicators of Manganese Status

• Plasma and whole blood manganese

concentrations reflect dietary intake
• Lymphocyte MnSOD (Manganese
Superoxyda Dismutase) activity can also
be reflective of manganese status.
• Magnetic resonance imaging is being
used to assess manganese concentrations
in the globus pallidus, a target tissue for
manganese