**6.4 Minerals related to immune function contained in coconut fruit for the treatment of infectious diseases and sepsis**

## *6.4.1 Zinc (Zn)*

Zinc is an important component in the regulation of gene expression through its role in gene transcription, division, differentiation, and cell apoptosis [86]. Zinc in the immune system plays a role in mechanical barriers (the structure and function of the gastrointestinal epithelium), as an antioxidant, in thymid kinase activity (plays a role in the proliferation of lymphoid cells), thiomulin and increases IgAs [87, 88].

Zinc is a co-factor of more than 200 enzymes that play a role in the immune system. It is very important for the wound healing process, regenerate new cells and balance acid base. Zinc has a very important role for the immune system, oxidative stress response, wound healing process and protective homeostasis. Symptoms of zinc deficiency and sepsis are difficult to distinguish. Several enzymes that play a role in regulating oxidant defense, including SOD, catalase, and glutathione reductase, depend on normal zinc conditions. It is suitable because in sepsis there is a decrease in the detoxification capacity of ROS [88].

#### *6.4.2 Selenium (Se)*

Selenium is a component of selenoproteins with antioxidant, anti-inflammatory and immunomodulatory properties. Low selenium concentrations in patients with systemic inflammation or sepsis are associated with impaired neutrophil and macrophage function and decreased antioxidant defenses. The effect of selenium treatment may depend on dose, route of administration, combination with other nutrients, and the patient population studied [89].

Selenium has an antioxidant function through the activity of the enzyme glutathione peroxidase which protects cell membranes and organelles from peroxide damage and has a synergistic effect with vitamins C and E. In addition, selenoproteins (selenium derivatives) are components of the body's defenses that affect the function of neutrophils, macrophages, NK cells and lymphocytes T [79].

#### *6.4.3 Copper (Cu)*

Sepsis is often accompanied by acidosis and the release of cupric ions from ceruloplasmin and other proteins. With increased oxygen demand that is not accompanied by oxygen availability causes ischemia and acidosis in early sepsis and the release of cupric ions [90].

#### *Infections and Sepsis Development*

Copper is an essential trace mineral necessary for survival. It is found in all body tissues and plays a role in making red blood cells and maintaining nerve cells and the immune system. Copper may also have an antioxidant function. It may help reduce the production of free radicals [91].

Copper is an important component of several enzymes such as superoxide dismutase (SOD), cytochrome oxidase and several coenzymes. Necessary for hemoglobin formation, antioxidant effect, immune function and collagen synthesis. Copper consumption is limited for patients with liver failure and cholestasis because it is excreted through the gallbladder and will cause poisoning if it accumulates [92].

#### *6.4.4 Iron (Fe)*

Iron affects the function of lymphocytes and macrophages, which is related to its role as a cofactor for enzymes in various processes. Lymphocyte activation requires iron because iron plays an important role in the work of several enzymes including nucleotide reductase which is involved in DNA synthesis. Iron uptake is regulated by transferrin mRNA receptors by binding to iron regulatory proteins (IRPs). In the state of iron deficiency, transferrin only binds a small amount of iron which will interfere with proliferation, on the contrary, in iron overload, transferrin saturation will increase and will inhibit lymphocyte proliferation [93].

In sepsis, the decrease in iron concentration occurs because of increased permeability so that transferrin moves from the intravascular to the interstitial fluid. The increase in ferritin production in the liver is caused by the induction of IL-6 so that more Fe is stored in the liver. In sepsis, hepcidin production is increased and will inhibit Fe transport [94]. Neutrophils and macrophages require Fe for phagocytosis and the formation of oxygen intermediates which are toxic in killing bacteria. The reduction of nitroblue tetrazolium and hydrogen peroxide to neutrophils and macrophages is decreased in the presence of iron deficiency. Iron also plays a role in the Crebs cycle as an essential source of energy. Several enzymes such as glutathione, peroxidase, catalase and dehydrogenase require iron as a free radical scavenger [95, 96]. Increased venous permeability causes leakage of transferrin into the interstitial fluid. Iron stimulates bacterial growth because of its role as an essential nutrient for bacterial growth [94]. Polymorphonuclear (PMN) releases lactoferrin through the inflammatory process and bends iron which is then processed by macrophages. Neutrophils and macrophages need iron for phagocytosis and killing bacteria. Otherwise, excessive iron can decrease the ability of macrophages to carry out phagocytosis. This happens because the production of free radicals is increasing and damaging the lipid peroxidase contained in the phagosome membrane. Iron is also a growth factor for some bacteria and promotes overall proliferation in vivo [96].

#### **7. Conclusions**

An immunonutrient test preparation containing 20% young coconut flesh in coconut water and added kaffir lime juice has a very strong antioxidant activity influenced by the components found in coconut fruit (*Cocos nucifera* L.,) namely a component of a mixture of phytonutrients that can be used as immunonutrient agents in sepsis caused by Lipopolysaccaride *Escherichia coli* through antioxidant activity. The addition of kaffir lime juice can inhibit rancidity or rancidity arising from the oxidation of unsaturated fatty acids contained in processed coconut meat so as to maintain the stability of the components of the active compounds contained in processed coconuts so that these preparations can provide good treatment results.

*Potential Natural Product from Tropical Fruits: A Mixture Young Coconut Fruit and Kaffir… DOI: http://dx.doi.org/10.5772/intechopen.99005*
