About

Bruce Ryan Bistrian is a professor in the Department of Medicine and serves as the Chief of the Division of Clinical Nutrition at Beth Israel Deaconess Medical Center. He has held a position at Harvard Medical School for 45 years, progressing from Assistant Professor to Full Professor. Dr. Bistrian is a former president of the American Society of Clinical Nutrition, the American Society of Parenteral and Enteral Nutrition, and the Federation of American Societies of Experimental Biology. His research and clinical interests encompass areas such as immunology, malnutrition, nutrition support, obesity, and related fields, with a focus on clinical nutrition and metabolic diseases.

Research topics

• Internal medicine
• Medicine
• Biochemistry
• Chemistry
• Anesthesia
• Cardiology
• Biology
• Gastroenterology
• Endocrinology
• Physiology

Selected publications

• Cytokine release syndrome and CAR T Cell therapy: Modulating the intensity of the inflammatory response and resolution within the tumor microenvironment

  Frontiers in Pharmacology · 2025-06-10 · 4 citations

  reviewOpen accessSenior author

  CAR T cell therapy achieves high degrees of success with respect to complete response and overall response rates in many hematological cancers, especially lymphomas. Compared to other immunotherapies, these "activated" blood products are plagued by a high incidence of a severe systemic inflammatory response syndrome, resulting from the exaggerated release of cytokines, chemokines, and other pro-inflammatory protein and lipid mediators. These can produce what is known as the "cytokine release syndrome" (CRS), associated with significant morbidity and mortality. Although successful CAR T cell therapy reduces the tumor load, the killing of large numbers of cancer cells and the persistence of apoptotic cellular debris within the tumor microenvironment (TME) may also be tumorigenic. We propose a single active pharmaceutical ingredient (API), the highly polyunsaturated omega-3 fatty acids eicosapentaenoic and docosahexaenoic acids, applying a refined and enriched fish oil, with multiple therapeutic targets that can be administered in precise doses. First, they rapidly modulate the intensity of the systemic inflammatory response, by modifying eicosanoid metabolism via intravenous administration. Second, as substrates for the production of specialized pro-resolving mediators (SPMs) of inflammation, they can help clear cellular debris within the TME, perhaps reducing the risks of new tumor formation. The employment of such a drug either in a prophylactic and/or a treatment manner might further improve the outcome of CAR T cell therapy.

  PublisherOA PDFDOI

• The physiological and pharmaceutical roles of MCTs and other ingredients in intravenous emulsions containing omega-3 enriched fish oil designed to mitigate cytokine release syndrome

  Frontiers in Pharmacology · 2025-09-22

  reviewOpen accessSenior author

  Cytokine release syndrome (CRS) is a serious adverse effect often seen following the administration of cancer immunotherapy, particularly with chimeric antigen receptor (CAR) T cell therapy. Recently, we proposed the administration of precise amounts of the primary active ingredients found in fish oil (EPA + DHA) in combination with medium chain triglycerides (MCTs). Although there is a commercial injectable emulsion containing a refined-only fish oil, it is indicated as a nutritional supplement because it contains highly variable concentrations of the primary active ingredients (±50% of EPA + DHA). We suggested the application of a refined and enriched fish oil in order to provide the desired pharmacological doses according to the typical limits for drugs, i.e., EPA + DHA, within ±10% of the labeled amount. This tight tolerance is not achievable with "refined-only" fish oil indicated for nutrition support. The purpose of this review is to further describe the details of such a dosage form, with particular focus on other active ingredients in the proposed formulation. They play important roles in delivering a safe final product with multiple therapeutic targets for the acute systemic inflammatory response from CRS, as well as addressing chronic inflammation within the tumor microenvironment (TME).

  PublisherOA PDFDOI

• Cytokine Release Syndrome Associated With Immune‐Modulating Chemotherapy: Potential Mitigating Role of Intravenous Omega‐3 Fatty Acid Triglycerides

  Cancer Reports · 2024-10-01 · 4 citations

  reviewOpen accessSenior author

  BACKGROUND: Patient susceptibility to cytokine release syndrome (CRS) resulting from immune-modulating chemotherapy has profound implications for clinical outcome. This is particularly true for patients receiving CAR T-cell therapy. First-line pharmacotherapy for CRS includes the administration of the IL-6 receptor-binding monoclonal antibody tocilizumab, or tocilizumab and corticosteroids. Other agents, such as siltuximab, anakinra, and dasatinab are also being explored for refractory cases of CRS. This review summarizes the potential role of omega-3 fatty acids, that is, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) at ameliorating CRS in cancer patients receiving immune-modulating chemotherapy, and is compared with current treatment strategies to reduce the severity of the inflammatory response. RECENT FINDINGS: Selective blockade of specific proinflammatory mediators (e.g., IL-6) is effective, but carries a significant risk of serious opportunistic infections. In contrast, omega-3 fatty acids affect multiple triggers underlying the inflammatory response (i.e., prostaglandins, leukotrienes, transcription factors, and specialized proresolving molecules), and its major limitation is avoidance of hypertriglyceridemia, which can be managed by reducing the rate of intravenous administration. This discussion proposes a novel approach by continuous infusion of omega-3 fatty acids to modulate the intensity of the severe systemic inflammatory response from CRS. The purpose of this review is to highlight the potential clinical benefits of a specialized omega-3 fatty acids dosage form to mitigate the severity of CRS as a hypothetical alternative to current treatment. CONCLUSION: Optimizing the formulation, for example, enriched fish oil that meets drug concentration standards for EPA and DHA, a continuous infusion rate, reductions in long-chain saturated fatty acids concentrations, and addition of medium-chain triglycerides to improve EPA + DHA utilization and physical stability are key pharmaceutical factors. This may result in a safer and more effective option than targeted abrogation of cytokines and consequent risks of adverse drug reactions, but will require formal study in randomized control trials in humans.

  PublisherOA PDFDOI

• Pharmaceutical Considerations and Metabolic Fate of Parenteral Lipid Nanoparticle Dosage Forms

  Journal of Pharmaceutical Sciences · 2024-04-28 · 2 citations

  reviewSenior author
  PublisherDOI

• Secretory protein response to parenteral compared with enteral nutrition, inflammatory or nutritional?

  American Journal of Clinical Nutrition · 2024-06-05 · 1 citations

  letter1st authorCorresponding
  PublisherDOI

• Iron homeostasis in obesity and metabolic and bariatric surgery: a narrative review

  Surgery for Obesity and Related Diseases · 2024-08-16 · 2 citations

  reviewSenior author
  PublisherDOI

• Hypoalbuminemia and increased surgical risk: some new thoughts

  Surgery for Obesity and Related Diseases · 2023-07-24 · 3 citations

  letterSenior author
  PublisherDOI

• Cytokine storm associated with severe <scp>COVID</scp> ‐19 infections: The potential mitigating role of omega‐3 fatty acid triglycerides in the <scp>ICU</scp>

  The FASEB Journal · 2023-06-30 · 5 citations

  reviewOpen accessSenior author

  Cytokine storm during severe COVID-19 infection increases the risk of mortality in critically ill patients in the intensive care unit. Multiple therapeutic proposals include, for example, anti-inflammatory and immunosuppressive agents, selective inhibitors of key pro-inflammatory receptors, and key enzymes necessary for viral replication. Unfortunately, safe and effective therapy remains an elusive goal. An alternative anti-inflammatory approach vis á vis omega-3 fatty acids, which yields less pro-inflammatory mediators by altering eicosanoid metabolism, has been proposed. Although theoretically promising, enteral tube delivery or oral capsules containing specific doses of omega-3 fatty acids take precious time (7 days to 6 weeks) to be incorporated in plasma cell membranes to be most effective, making this route of administration in the acute care setting an unfeasible therapeutic approach. Parenteral administration of precise doses of omega-3 fatty acid triglycerides in an injectable emulsion can greatly accelerate the incorporation and potential therapeutic effects (within hours), but at present, there is no commercially available product designed for this purpose. We describe a potential formulation that may address this deficiency, while recognizing that the high incidence of hyperlipidemia that occurs during severe COVID-19 infection must be recognized as a complicating factor, and, therefore, caution is advised.

  PublisherOA PDFDOI

• Application of creatinine height index in patients with trauma for the evaluation of psoas muscle mass: A clinical validation study

  Journal of Parenteral and Enteral Nutrition · 2023-05-23

  articleOpen access

  BACKGROUND: The creatinine height index (CHI) is an estimate of lean body mass. We hypothesize that a modified CHI estimate using serum creatinine (sCr) levels in patients with normal renal function when performed soon after injury would reflect preinjury protein nutrition status. METHODS: The urine CHI (uCHI) was calculated using the 24-h urine sample. The serum-derived estimated CHI (sCHI) was calculated using the sCr on admission. Correlation between abdominal computed tomography images at specific lumbar vertebral levels and total body fat and muscle content was used for comparison as an independent measurement of nutrition status unlikely to be substantially altered by trauma. RESULTS: A total of 45 patients were enrolled, all with a significant injury burden (median injury severity score [ISS] = 25; interquartile range, 17-35). The calculated sCHI on admission was 71.0% (SD = 26.9%) and likely underestimates the CHI when compared with uCHI (mean = 112.5%, SD = 32.6%). Stratifying by degree of stress demonstrated that in a group of 23 moderately and severely stressed patients, uCHI (mean = 112.7%, SD = 5.7%) and sCHI (mean = 60.8%, SD = 1.9%) were significantly different and without correlation (r = -0.26, P = 0.91). In patients without stress, there was a significant negative correlation between sCHI and psoas muscle area (r = -0.869, P = 0.03), and in patients with severe stress there was a significant positive correlation between uCHI and psoas muscle area (r = 0.733, P = 0.016). CONCLUSION: The CHI calculated from the initial sCr is not an appropriate estimate of uCHI in critically ill trauma patients and is not a valid measure of psoas muscle mass in this setting.

  PublisherOA PDFDOI

• Erratum to “Cytokine storm associated with severe <scp>COVID</scp> ‐19 infections: The potential mitigating role of omega‐3 fatty acid triglycerides in the <scp>ICU</scp> ”

  The FASEB Journal · 2023-07-25

  erratumOpen accessSenior author
  PublisherOA PDFDOI

Recent grants

• NIH Grant R01DK041128

  NIH · $632k · 1994

• NIH Grant R01AM035494

  NIH · $86k · 1989

• NIH Grant R01CA035352

  NIH · $183k · 1987

• NIH Grant R01DK031933

  NIH · $1.4M · 1996

• NIH Grant R01DK040252

  NIH · $937k · 1994

Frequent coauthors

• George L. Blackburn

  489 shared

• Lyle L. Moldawer

  Florida College

  180 shared

• Pei‐Ra Ling

  116 shared

• Nawfal W. Istfan

  94 shared

• Vigen K. Babayan

  91 shared

• David F. Driscoll

  University of Massachusetts Chan Medical School

  90 shared

• Peter N. Benotti

  Geisinger Medical Center

  76 shared

• Pei‐Ling Chi

  Kaohsiung Veterans General Hospital

  69 shared

Awards & honors

• Former president of American Society of Clinical Nutrition
• Former president of American Society of Parenteral and Enter…
• Former president of Federation of American Societies of Expe…