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Mulder PPG, Hooijmans CR, Vlig M, Middelkoop E, Joosten I, Koenen HJPM, Boekema BKHL. Kinetics of Inflammatory Mediators in the Immune Response to Burn Injury: Systematic Review and Meta-Analysis of Animal Studies. J Invest Dermatol 2024; 144:669-696.e10. [PMID: 37806443 DOI: 10.1016/j.jid.2023.09.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
Burns are often accompanied by a dysfunctional immune response, which can lead to systemic inflammation, shock, and excessive scarring. The objective of this study was to provide insight into inflammatory pathways associated with burn-related complications. Because detailed information on the various inflammatory mediators is scattered over individual studies, we systematically reviewed animal experimental data for all reported inflammatory mediators. Meta-analyses of 352 studies revealed a strong increase in cytokines, chemokines, and growth factors, particularly 19 mediators in blood and 12 in burn tissue. Temporal kinetics showed long-lasting surges of proinflammatory cytokines in blood and burn tissue. Significant time-dependent effects were seen for IL-1β, IL-6, TGF-β1, and CCL2. The response of anti-inflammatory mediators was limited. Burn technique had a profound impact on systemic response levels. Large burn size and scalds further increased systemic, but not local inflammation. Animal characteristics greatly affected inflammation, for example, IL-1β, IL-6, and TNF-α levels were highest in young, male rats. Time-dependent effects and dissimilarities in response demonstrate the importance of appropriate study design. Collectively, this review presents a general overview of the burn-induced immune response exposing inflammatory pathways that could be targeted through immunotherapy for burn patients and provides guidance for experimental set-ups to advance burn research.
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Affiliation(s)
- Patrick P G Mulder
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands; Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Carlijn R Hooijmans
- Meta-Research Team, Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Vlig
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands
| | - Esther Middelkoop
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Irma Joosten
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans J P M Koenen
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bouke K H L Boekema
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Quintana HT, Baptista VIDA, Lazzarin MC, Antunes HKM, Le Sueur-Maluf L, de Oliveira CAM, de Oliveira F. Insulin Modulates Myogenesis and Muscle Atrophy Resulting From Skin Scald Burn in Young Male Rats. J Surg Res 2020; 257:56-68. [PMID: 32818785 DOI: 10.1016/j.jss.2020.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Burn injuries (BIs) due to scalding are one of the most common accidents among children. BIs greater than 40% of total body surface area are considered extensive and result in local and systemic response. We sought to assess morphological and myogenic mechanisms through both short- and long-term intensive insulin therapies that affect the skeletal muscle after extensive skin BI in young rats. MATERIALS AND METHODS Wistar rats aged 21 d were distributed into four groups: control (C), control with insulin (C + I), scald burn injury (SI), and SI with insulin (SI + I). The SI groups were submitted to a 45% total body surface area burn, and the C + I and SI + I groups received insulin (5 UI/Kg/d) for 4 or 14 d. Glucose tolerance and the homeostatic model assessment of insulin resistance index were determined. Gastrocnemius muscles were analyzed for histopathological, morphometric, and immunohistochemical myogenic parameters (Pax7, MyoD, and MyoG); in addition, the expression of genes related to muscle atrophy (MuRF1 and MAFbx) and its regulation (IGF-1) were also assessed. RESULTS Short-term treatment with insulin favored muscle regeneration by primary myogenesis and decreased muscle atrophy in animals with BIs, whereas the long-term treatment modulated myogenesis by increasing the MyoD protein. Both treatments improved histopathological parameters and secondary myogenesis by increasing the MyoG protein. CONCLUSIONS Treatment with insulin benefits myogenic parameters during regeneration and modulates MuRF1, an important mediator of muscle atrophy.
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Affiliation(s)
| | | | | | | | | | | | - Flavia de Oliveira
- Departamento de Biociências, Universidade Federal de São Paulo, Santos, SP, Brazil.
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Zhu Z, Hu T, Wang Z, Wang J, Liu R, Yang Q, Zhang X, Xiong Y. Anti-inflammatory and organ protective effect of insulin in scalded MODS rats without controlling hyperglycemia. Am J Emerg Med 2018; 36:202-207. [DOI: 10.1016/j.ajem.2017.07.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/16/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022] Open
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Wang ZK, Chen RJ, Wang SL, Li GW, Zhu ZZ, Huang Q, Chen ZL, Chen FC, Deng L, Lan XP, Hu T. Clinical application of a novel diagnostic scheme including pancreatic β‑cell dysfunction for traumatic multiple organ dysfunction syndrome. Mol Med Rep 2017; 17:683-693. [PMID: 29115473 DOI: 10.3892/mmr.2017.7898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/22/2017] [Indexed: 11/06/2022] Open
Abstract
A novel diagnostic scheme that includes pancreatic β‑cell dysfunction analysis for the diagnosis of traumatic multiple organ dysfunction syndrome (MODS) was investigated to assist in the early diagnosis and detection of MODS. Early intervention and treatment of MODS has been associated with a reduced mortality rate. A total of 2,876 trauma patients (including patients post‑major surgery) were admitted to the intensive care unit of the authors' hospital between December 2010 and December 2015 and enrolled in the present study. There were 205 cases where the patient succumbed to their injuries. In addition to the conventional diagnostic scheme for traumatic MODS, indexes of pancreatic β‑cell dysfunction [fasting blood‑glucose (FBG), homeostatic model assessment‑β and (blood insulin concentration 30 min following glucose loading‑fasting insulin concentration)/(blood glucose concentration 30 min following glucose loading‑FBG concentration)] were included to establish an improved diagnostic scheme for traumatic MODS. The novel scheme was subsequently used in clinical practice alongside the conventional scheme and its effect was evaluated. The novel scheme had a significantly higher positive number of MODS diagnoses for all trauma patients compared with the conventional scheme (12.48 vs. 8.87%; P<0.01). No significant difference was identified in the final percentage of positive of MODS diagnoses for trauma‑associated mortality patients between the novel (88.30%) and the conventional scheme (86.34%). The novel scheme had a significantly higher positive number of MODS diagnoses for trauma‑associated mortality patients 3 days prior to patients succumbing to MODS compared with the conventional scheme (80.98 vs. 64.39%; P<0.01). The consensus of the MODS diagnosis of all trauma patients between the novel scheme and the conventional scheme was 100%; however, out of the patients diagnosed as positive by novel scheme 71.03% were positive by the conventional scheme. The consensus between the final MODS diagnosis and the MODS diagnosis 3 days prior to patients succumbing to their injuries between the novel scheme and the conventional scheme was 100%; however, out of the patients diagnosed as positive by novel scheme 97.79 were positive by the conventional scheme of the 205 patients who succumbed to MODS and out of the patients diagnosed as positive for MODS by novel scheme 3 days prior to succumbing, 79.52% were positive by the conventional scheme. The results of the present study demonstrated that the novel diagnostic scheme using the relevant indexes of pancreatic β‑cell dysfunction for diagnosis of traumatic MODS, was able to diagnose MODS early without excessively extending the diagnostic scope. Its clinical application should be promoted.
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Affiliation(s)
- Zhan-Ke Wang
- Department of Clinical Laboratory, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Rong-Jian Chen
- Department of General Surgery, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Shi-Liang Wang
- Department of Burns, Third Military Medical University, Chongqing 400038, P.R. China
| | - Guang-Wei Li
- Department of Endocrinology, China‑Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Zhong-Zhen Zhu
- Department of Clinical Laboratory, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Qiang Huang
- Trauma Emergency Center, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Zi-Li Chen
- Department of Intensive Medicine, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Fan-Chang Chen
- Department of General Surgery, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Lei Deng
- Department of Neurosurgery, The 94th Hospital of People's Liberation Army, Nanchang, Jiangxi 330002, P.R. China
| | - Xiao-Peng Lan
- Department of Clinical Laboratory, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian 350025, P.R. China
| | - Tian Hu
- Department of Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Trauma Centre of Postgraduate Medical School, Chinese People's Liberation Army General Hospital, Beijing 100853 P.R. China
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Glucose-Insulin-Potassium Alleviates Intestinal Mucosal Barrier Injuries Involving Decreased Expression of Uncoupling Protein 2 and NLR Family-Pyrin Domain-Containing 3 Inflammasome in Polymicrobial Sepsis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4702067. [PMID: 28428961 PMCID: PMC5385915 DOI: 10.1155/2017/4702067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/05/2017] [Indexed: 12/18/2022]
Abstract
Uncoupling protein 2 (UCP2) may be critical for intestinal barrier function which may play a key role in the development of sepsis, and insulin has been reported to have anti-inflammatory effects. Male Sprague-Dawley rats were randomly allocated into five groups: control group, cecal ligation and puncture (CLP) group, sham surgery group, CLP plus glucose-insulin-potassium (GIK) group, and CLP plus glucose and potassium (GK) group. Ileum tissues were collected at 24 h after surgery. Histological and cytokine analyses, intestinal permeability tests, and western blots of intestinal epithelial tight junction component proteins and UCP2 were performed. Compared with CLP group, the CLP + GIK group had milder histological damage, lower levels of cytokines in the serum and ileum tissue samples, and lower UCP2 expression, whereas the CLP + GK group had no such effects. Moreover, the CLP + GIK group exhibited decreased epithelial permeability of the ileum and increased expression of zonula occludens-1, occludin, and claudin-1 in the ileum. The findings demonstrated that the UCP2 and NLR family-pyrin domain-containing 3/caspase 1/interleukin 1β signaling pathway may be involved in intestinal barrier injury and that GIK treatment decreased intestinal barrier permeability. Thus, GIK may be a useful treatment for intestinal barrier injury during sepsis.
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Effects of insulin combined with ethyl pyruvate on inflammatory response and oxidative stress in multiple-organ dysfunction syndrome rats with severe burns. Am J Emerg Med 2016; 34:2154-2158. [DOI: 10.1016/j.ajem.2016.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/01/2016] [Accepted: 08/06/2016] [Indexed: 01/08/2023] Open
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Dal S, Jeandidier N, Schaschkow A, Spizzo AH, Seyfritz E, Sookhareea C, Bietiger W, Péronet C, Moreau F, Pinget M, Maillard E, Sigrist S. Portal or subcutaneous insulin infusion: efficacy and impact on liver inflammation. Fundam Clin Pharmacol 2015; 29:488-98. [PMID: 26095147 DOI: 10.1111/fcp.12129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/20/2015] [Accepted: 05/18/2015] [Indexed: 01/10/2023]
Abstract
Intraperitoneal insulin allows physiological portal insulin administration and first-pass hepatic insulin extraction, but the impact on liver metabolism and inflammation is unknown. Our objective was to compare the impact, on metabolic control and liver function, of the same dose of insulin administered either intraperitoneally or subcutaneously during continuous infusion in diabetic rats. Wistar rats were randomly divided into 4 groups: control (C), untreated diabetic (streptozotocin, 100 mg/kg) and diabetic rats treated by continual subcutaneous Insuplant® infusion (CSII) and continual intraperitoneal Insuplant(®) infusion (CPII) of 2 UI/200 g/day (via an osmotic mini-pump for 1-4 weeks). Insulin signalling pathways were analysed through hepatic expression of growth hormone receptor and phosphorylated insulin receptor substrate 1. Metabolic control was determined by measurement of body weight, blood glucose and fructosamine. Liver function was assessed by measuring insulin-like growth factor-1 (IGF-1), with global inflammation assessed by levels of alpha-2-macroglobulin (α2M) and lipid peroxidation in plasma. Liver inflammation was evaluated by quantification of hepatic macrophage infiltration and reactive oxygen species production. CPII induced a better improvement in metabolic control and liver function than CSII, producing a significant decrease in blood glucose and fructosamine, coupled with increased IGF-1 and hepatic glycogen storage. Moreover, liver oxidative stress and liver inflammation were reduced. Such observations indicate that the same insulin level in CPII improves glucose control and hepatic glucose metabolism and function, attenuating the hepatic inflammatory response to diabetes. These data demonstrate the importance of focusing on therapeutics to allow first-pass hepatic insulin extraction or prevent diabetic complications.
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Affiliation(s)
- Stéphanie Dal
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - Nathalie Jeandidier
- Structure d'Endocrinologie, Diabète -Nutrition et Addictologie, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, 67000, France
| | - Anaïs Schaschkow
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - Anne-Hélène Spizzo
- Structure d'Endocrinologie, Diabète -Nutrition et Addictologie, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, 67000, France
| | - Elodie Seyfritz
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - Cynthia Sookhareea
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - William Bietiger
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - Claude Péronet
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - François Moreau
- Structure d'Endocrinologie, Diabète -Nutrition et Addictologie, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, 67000, France
| | - Michel Pinget
- Structure d'Endocrinologie, Diabète -Nutrition et Addictologie, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, 67000, France
| | - Elisa Maillard
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
| | - Séverine Sigrist
- DIATHEC, EA 7294, Centre Européen d'Etude du Diabète, Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Bld René Leriche, Strasbourg, 67200, France
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Hrynyk M, Neufeld RJ. Insulin and wound healing. Burns 2014; 40:1433-46. [PMID: 24810536 DOI: 10.1016/j.burns.2014.03.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 02/27/2014] [Accepted: 03/28/2014] [Indexed: 12/11/2022]
Abstract
Skin is a dynamic and complex organ that relies on the interaction of different cell types, biomacromolecules and signaling molecules. Injury triggers a cascade of events designed to quickly restore skin integrity. Depending on the size and severity of the wound, extensive physiological and metabolic changes can occur, resulting in impaired wound healing and increased morbidity resulting in higher rates of death. While wound dressings provide a temporary barrier, they are inherently incapable of significantly restoring metabolic upsets, post-burn insulin resistance, and impaired wound healing in patients with extensive burns. Exogenous insulin application has therefore been investigated as a potential therapeutic intervention for nearly a century to improve wound recovery. This review will highlight the important achievements that demonstrate insulin's ability to stimulate cellular migration and burn wound recovery, as well as providing a perspective on future therapeutic applications and research directions.
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Affiliation(s)
- Michael Hrynyk
- Department of Chemical Engineering, Queen's University, Kingston, Ontario, Canada K7L 3N6
| | - Ronald J Neufeld
- Department of Chemical Engineering, Queen's University, Kingston, Ontario, Canada K7L 3N6.
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Animal models in burn research. Cell Mol Life Sci 2014; 71:3241-55. [PMID: 24714880 DOI: 10.1007/s00018-014-1612-5] [Citation(s) in RCA: 252] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 01/08/2023]
Abstract
Burn injury is a severe form of trauma affecting more than 2 million people in North America each year. Burn trauma is not a single pathophysiological event but a devastating injury that causes structural and functional deficits in numerous organ systems. Due to its complexity and the involvement of multiple organs, in vitro experiments cannot capture this complexity nor address the pathophysiology. In the past two decades, a number of burn animal models have been developed to replicate the various aspects of burn injury, to elucidate the pathophysiology, and to explore potential treatment interventions. Understanding the advantages and limitations of these animal models is essential for the design and development of treatments that are clinically relevant to humans. This review aims to highlight the common animal models of burn injury in order to provide investigators with a better understanding of the benefits and limitations of these models for translational applications. While many animal models of burn exist, we limit our discussion to the skin healing of mouse, rat, and pig. Additionally, we briefly explain hypermetabolic characteristics of burn injury and the animal model utilized to study this phenomena. Finally, we discuss the economic costs associated with each of these models in order to guide decisions of choosing the appropriate animal model for burn research.
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