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Bieerkehazhi S, Abdullahi A, Khalaf F, Barayan D, de Brito Monteiro L, Samadi O, Rix G, Jeschke MG. β-Adrenergic blockade attenuates adverse adipose tissue responses after burn. J Mol Med (Berl) 2024; 102:1245-1254. [PMID: 39145814 DOI: 10.1007/s00109-024-02478-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024]
Abstract
Severe burn injuries are defined by a prolonged hypermetabolic response characterized by increases in resting energy expenditure, systemic catabolism, and multi-organ dysfunction. The sustained elevation of catecholamines following a burn injury is thought to significantly contribute to this hypermetabolic response, leading to changes in adipose tissue such as increased lipolysis and the browning of subcutaneous white adipose tissue (WAT). Failure to mitigate these adverse changes within the adipose tissue has been shown to exacerbate the post-burn hypermetabolic response and lead to negative outcomes. Propranolol, a non-selective β-blocker, has been clinically administered to improve outcomes of pediatric and adult burn patients, but there is inadequate knowledge of its effects on the distinct adipose tissue depots. In this study, we investigated the adipose depot-specific alterations that occur in response to burn injury. Moreover, we explored the therapeutic effects of β-adrenoceptor blockade via the drug propranolol in attenuating these burn-induced pathophysiological changes within the different fat depots. Using a murine model of thermal injury, we show that burn injury induces endoplasmic reticulum (ER) stress in the epididymal (eWAT) but not in the inguinal (iWAT) WAT depot. Conversely, burn injury induces the activation of key lipolytic pathways in both eWAT and iWAT depots. Treatment of burn mice with propranolol effectively mitigated adverse burn-induced alterations in the adipose by alleviating ER stress in the eWAT and reducing lipolysis in both depots. Furthermore, propranolol treatment in post-burn mice attenuated UCP1-mediated subcutaneous WAT browning following injury. Overall, our findings suggest that propranolol serves as an effective therapeutic intervention to mitigate the adverse changes induced by burn injury, including ER stress, lipotoxicity, and WAT browning, in both adipose tissue depots. KEY MESSAGES: Burn injury adversely affects adipose tissue metabolism via distinct changes in both visceral and subcutaneous adipose depots. Propranolol, a non-selective β-adrenergic blocker, attenuates many of the adverse adipose tissue changes mediated by burn injury.
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Affiliation(s)
- Shayahati Bieerkehazhi
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Abdikarim Abdullahi
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Fadi Khalaf
- Department of Biochemistry, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Dalia Barayan
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lauar de Brito Monteiro
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Osai Samadi
- Sunnybrook Research Institute, Toronto, ON, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Graham Rix
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, ON, Canada.
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Biochemistry, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- David Braley Research Institute, C5-104, 20 Copeland Ave., Hamilton, ON, L8L 2X2, Canada.
- Centre for Burn Research, Hamilton Health Sciences, Hamilton, ON, Canada.
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2
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Warren JD, Hughes KM. Pharmacologic Management of Pediatric Burns. J Burn Care Res 2024; 45:277-291. [PMID: 37948608 DOI: 10.1093/jbcr/irad177] [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: 08/09/2023] [Indexed: 11/12/2023]
Abstract
Many pediatric patients with burn injuries may be initially treated in a hospital where pediatric specialized care, including resources and trained personnel may be limited. This includes resuscitation in adult emergency departments and inpatient care in mixed adult-pediatric burn units. The intent of this review is to provide a compilation of topics for the adult trained pharmacist or another healthcare practitioner on the management of pediatric patients with burn injuries. This article focuses on several key areas of pharmacologic burn management in the pediatric patient that may differ from the adult patient, including pain and sedation, fluid resuscitation, nutrition support, antimicrobial selection, anticoagulation, and inhalation injury. It is important that all clinicians have resources to help optimize the management of burn injuries in the pediatric population as, in addition to burn injury itself, pediatric patients have different pharmacokinetics and pharmacodynamics affecting which medications are used and how they are dosed. This article highlights several key differences between pediatric and adult patients, providing an additional resource to assist adult-trained pharmacists or other healthcare practitioners with making clinical decisions in the pediatric burn population.
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Affiliation(s)
- Jontae D Warren
- Ochsner Baptist-A Campus of Ochsner Medical Center, Pharmacy Department, New Orleans, LA, 70115, USA
| | - Kaitlin M Hughes
- Riley Hospital for Children, Pharmacy Department, Indianapolis, IN, 46202, USA
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3
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Freiha M, Achim M, Gheban BA, Moldovan R, Filip GA. In Vivo Study of the Effects of Propranolol, Timolol, and Minoxidil on Burn Wound Healing in Wistar Rats. J Burn Care Res 2023; 44:1466-1477. [PMID: 37099384 DOI: 10.1093/jbcr/irad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Indexed: 04/27/2023]
Abstract
Propranolol, timolol, and minoxidil have all shown benefits in treatment of burn injury and other skin wounds. The study evaluated their effects on full-thickness thermal skin burns in a Wistar rat model. Performed on 50 female rats; two dorsal skin burns were created on each animal. On the next day, the rats were divided into 5 groups (n = 10); each has received a specific treatment daily for 14 days: group I-topical vehicle (control), group II-topical silver sulfadiazine (SSD), group III-oral propranolol (5.5 mg) associated with topical vehicle, group IV-topical timolol 1% cream, and group V-topical minoxidil 5% cream. Wound contraction rates, malondialdehyde (MDA), glutathione (GSH, GSSG), and catalase activity in skin and/or serum were evaluated, and histopathological analyses were performed. Propranolol did not show advantages in necrosis prevention and wound contraction and healing, and did not reduce oxidative stress. It impaired keratinocyte migration, and promoted ulceration, chronic inflammation, and fibrosis, yet reducing the necrotic zone. Timolol prevented necrosis and promoted contraction and healing, increased antioxidant capacity and promoted keratinocyte migration and neo capillarization in comparison to the other treatments. Minoxidil reduced necrosis and enhanced contraction, resulting in positive outcomes after 1 week of treatment regarding local antioxidant defense, keratinocyte migration, neo capillarization, chronic inflammation, and fibrosis rates. However, after 2 weeks, it resulted in contrasting outcomes. In conclusion, topical timolol promoted wound contraction and healing, reducing local oxidative stress and improving keratinocyte migration, bringing arguments for potential benefits in skin epithelization.
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Affiliation(s)
- Michel Freiha
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcela Achim
- Department of Pharmaceutical Technology and Biopharmaceutics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan-Alexandru Gheban
- Department of Anatomic Pathology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Remus Moldovan
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela Adriana Filip
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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4
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Randall SM, Wood FM, Fear MW, Boyd J, Rea S, Duke JM. Retrospective cohort study of health service use for cardiovascular disease among adults with and without a record of injury hospital admission. BMJ Open 2020; 10:e039104. [PMID: 33148745 PMCID: PMC7640521 DOI: 10.1136/bmjopen-2020-039104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To quantify postinjury cardiovascular-related health service use experienced by mid to older aged adults hospitalised for injury, compared with uninjured adults. Additionally, to explore the effect of beta-blocker medications on postinjury cardiovascular hospitalisations among injury patients, given the potential cardioprotective effects of beta blockers. DESIGN A retrospective cohort study using linked administrative and survey data. PARTICIPANTS Records of 35 026 injured and 60 823 uninjured matched adults aged over 45 from New South Wales, Australia, who completed the 45 and up survey. PRIMARY AND SECONDARY OUTCOME MEASURES Admission rates and cumulative lengths of stay for cardiovascular hospitalisations, and prescription rates for cardiovascular medications. Negative binomial and Cox proportional hazards regression modelling were used to generate incident rate ratios (IRRs) and HR. RESULTS Compared with the uninjured, those with injury had a 19% higher adjusted rate of postinjury cardiovascular admissions (IRR 1.19, 95% CI 1.14 to 1.25), spent 40% longer in hospital for ardiovascular disease (IRR 1.40, 95% CI 1.26 to 1.57) and had slightly higher cardiovascular prescription rates (IRR 1.04, 95% CI 1.02 to 1.06), during study follow-up. Those in the injury cohort that used beta blockers both prior to and after injury (continuous) appeared to have reduced need for post-injury cardiovascular hospitalisation (IRR 1.09, 95% CI 1.17 to 1.42) compared with those commencing on beta blockers after injury (after 30 days: IRR 1.69, 95% CI 1.37 to 2.08). CONCLUSIONS Apparent increased postinjury hospitalisation rates and prolonged length of stay related to cardiovascular disease suggest that injury patients may require clinical support for an extended period after injury. Additionally, injury patients who were on continuous beta blocker treatment appeared to have lower need for post-injury cardiovascular hospitalisations. However, the data do not allow us to draw clear conclusions and further clinical research is required.
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Affiliation(s)
- Sean M Randall
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Fiona Stanley Hospital and Perth Children's Hospital, Burns Service of Western Australia, Perth, Western Australia, Australia
| | - Mark W Fear
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - James Boyd
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Suzanne Rea
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Fiona Stanley Hospital and Perth Children's Hospital, Burns Service of Western Australia, Perth, Western Australia, Australia
| | - Janine M Duke
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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5
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Kaur S, Auger C, Jeschke MG. Adipose Tissue Metabolic Function and Dysfunction: Impact of Burn Injury. Front Cell Dev Biol 2020; 8:599576. [PMID: 33251224 PMCID: PMC7676399 DOI: 10.3389/fcell.2020.599576] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
For decades, adipose tissue had been considered as merely a storage depot and cushion to protect organs against trauma and injury. However, in recent years, a number of impactful studies have pinpointed the adipose tissue as an endocrine organ mediating systemic dysfunction in not only metabolic disorders such as obesity, but also in the stages following traumatic events such as severe burns. For instance, thermal injury induces a chronic β-adrenergic response associated with drastic increases in adipose lipolysis, macrophage infiltration and IL-6 mediated browning of white adipose tissue (WAT). The downstream consequences of these physiological changes to adipose, such as hepatomegaly and muscle wasting, are only now coming to light and suggest that WAT is both a culprit in and initiator of metabolic disorders after burn injury. To that effect, the aim of this review is to chronicle and critically analyze the scientific advances made in the study of adipose tissue with regards to its role in orchestrating the hypermetabolic response and detrimental effects of burn injury. The topics covered include the magnitude of the lipolytic response following thermal trauma and how WAT browning and inflammation perpetuate this cycle as well as how WAT physiology impacts insulin resistance and hyperglycemia post-burn. To conclude, we discuss how these findings can be translated from bench to bedside in the form of therapeutic interventions which target physiological changes to WAT to restore systemic homeostasis following a severe burn.
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Affiliation(s)
- Supreet Kaur
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Departments of Surgery and Immunology, University of Toronto, Toronto, ON, Canada
| | - Christopher Auger
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Departments of Surgery and Immunology, University of Toronto, Toronto, ON, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Departments of Surgery and Immunology, University of Toronto, Toronto, ON, Canada
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6
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Sepsis Increases Muscle Proteolysis in Severely Burned Adults, but Does not Impact Whole-Body Lipid or Carbohydrate Kinetics. Shock 2020; 52:353-361. [PMID: 30239418 DOI: 10.1097/shk.0000000000001263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sepsis is a common and often fatal consequence of severe burn injury, but its exact effects on whole body and muscle metabolism in the burn patient is unclear. To address this, 13 septic and 11 nonseptic patients (age: 36.9 ± 13.0 years) with burns encompassing >30% of their total body surface area underwent muscle protein kinetic studies under postabsorptive conditions using bolus injections of ring-C6 and N phenylalanine isotopes. In parallel, whole-body lipid and carbohydrate kinetics were assessed using constant infusions of [U-C6]palmitate, [6,6-H2]glucose, and [H5]glycerol, and during a 2-h hyperinsulinemic euglycemic clamp. Muscle mRNA levels of genes implicated in the development of muscle cachexia were assessed by qPCR. Fractional breakdown rates of mixed-muscle proteins were found to be 2.4-fold greater in septic versus nonseptic patients (P < 0.05). No discernable differences in fractional synthetic rate of mixed-muscle proteins or rate of appearance of plasma free fatty acids, glycerol, or glucose could be observed between patient groups, although the latter was significantly associated with burn size (P < 0.05). Hyperinsulinemia stimulated whole-body glucose uptake and suppressed endogenous glucose production and whole-body lipolytic rate to equivalent degrees in both groups. Muscle mRNA levels of genes spanning autophagy, lysosomal, and ubiquitin proteasome-mediated proteolysis were not enhanced in septic versus nonseptic patients. Our results demonstrate that accelerated muscle proteolysis appears to be the principal metabolic consequence of sepsis in severe burn patients and could be a contributing factor to the accelerated loss of muscle mass in these individuals. The exact mechanistic basis for these changes remains unclear.
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7
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Hassoun-Kheir N, Henig O, Avni T, Leibovici L, Paul M. The Effect of β-Blockers for Burn Patients on Clinical Outcomes: Systematic Review and Meta-Analysis. J Intensive Care Med 2020; 36:945-953. [PMID: 32686565 DOI: 10.1177/0885066620940188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the effects and safety of β-blockers in hospitalized patients with burns. METHODS A systematic review and meta-analysis of the literature. A broad search was conducted to identify all randomized controlled trials (RCTs) comparing β-blockers to control in hospitalized patients with burns. The primary outcome was 3-month all-cause mortality. Secondary outcomes were clinical patient-relevant end points. We subgrouped results by children/adults and burn severity. Risk of bias was assessed using the individual domain approach. RESULTS Four RCTs reported in 11 publications were included. Primary outcome of mortality was assessed in children (2 trials, n = 424) and adults (2 trials, n = 148) with severe burns. No significant difference was found between propranolol and control for mortality (risk ratio [RR] = 0.82, 95% CI = 0.48-1.39, 4 trials with broad confidence intervals in adults and children), sepsis (RR = 0.81, 95% CI = 0.46-1.43, 2 trials), and survivors' length of stay (absolute mean difference = 2.53, 95% CI = -2.58-7.63, 3 trials). There was no significant difference in bradycardia (RR = 1.33, 95% CI = 0.77-2.3, 2 trials), hypotension (RR = 1.26, 95% CI = 0.73-2.17, 3 trials), or cardiac arrhythmia (RR: 2.97, 95% CI: 0.12-71.87, 1 trial). The evidence was graded as very low certainty, due to trial's internal risk of bias, imprecision, and possible selective reporting. CONCLUSIONS No sufficient evidence was found to support or refute an advantage for β-blocker use in children or adults after burns. Additional studies are needed to create a consensus and formulate practice guidelines on the optimal β-blocker to use, indications for initiation, and duration of treatment.
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Affiliation(s)
- Nasreen Hassoun-Kheir
- Infectious Diseases Unit, 58878Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Haifa, Israel
| | - Oryan Henig
- Infectious Diseases Unit, 58878Rambam Health Care Campus, Haifa, Israel
| | - Tomer Avni
- Department of Medicine E, 36632Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonard Leibovici
- Department of Medicine E, 36632Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Mical Paul
- Infectious Diseases Unit, 58878Rambam Health Care Campus, Haifa, Israel.,Technion-Israel Institute of Technology, Haifa, Israel
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8
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Gus EI, Shahrokhi S, Jeschke MG. Anabolic and anticatabolic agents used in burn care: What is known and what is yet to be learned. Burns 2019; 46:19-32. [PMID: 31852612 DOI: 10.1016/j.burns.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/17/2018] [Accepted: 03/18/2018] [Indexed: 12/15/2022]
Abstract
Major thermal injury induces profound metabolic derangements secondary to an inflammatory "stress-induced" hormonal environment. Several pharmacological interventions have been tested in an effort to halt the hypermetabolic response to severe burns. Insulin, insulin growth factor 1, insulin growth factor binding protein 3, metformin, human growth hormone, thyroid hormones, testosterone, oxandrolone, and propranolol, among others, have been proposed to have anabolic or anticatabolic effects. The aim of this broad analysis of pharmacological interventions was to raise awareness of treatment options and to help establishing directions for future clinical research efforts. A PubMed search was conducted on the anabolic and anticatabolic agents used in burn care. One hundred and thirty-five human studies published between 1999 and 2017 were included in this review. The pharmacological properties, rationale for the treatments, efficacy considerations and side effect profiles are summarized in the article. Many of the drugs tested for investigational purposes in the severely thermally injured are not yet gold-standard therapies in spite of their potential benefit. Propranolol and oxandrolone have shown great promise but further evidence is still needed to clarify their potential use for anabolic and anticatabolic purposes.
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Affiliation(s)
- Eduardo I Gus
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, D704, Toronto, ON M4N 3M5, Canada
| | - Shahriar Shahrokhi
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, D704, Toronto, ON M4N 3M5, Canada; Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, D704, Toronto, ON M4N 3M5, Canada; Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Immunology, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada.
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9
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Kaley VR, Aregullin EO, Samuel BP, Vettukattil JJ. Trends in the off-label use of β-blockers in pediatric patients. Pediatr Int 2019; 61:1071-1080. [PMID: 31571355 DOI: 10.1111/ped.14015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 06/10/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Abstract
The use of US Food and Drug Administration (FDA)-approved drugs for the treatment of an unapproved indication or in an unapproved age group, or at doses or route of administration not indicated on the label is known as off-label use. Off-label use may be beneficial in circumstances when the standard-of-care treatment has failed, and/or no other FDA-approved medications are available for a particular condition. In pediatric patients, off-label use may increase the risk of adverse events as pharmacokinetic and pharmacodynamic data are limited in children. Approximately 73% of off-label drugs currently prescribed for various conditions do not have sufficient scientific evidence for safety and efficacy. For example, β-blockers are a class of drugs with FDA-approval for very few indications in pediatrics but are commonly used for various off-label indications. Interestingly, the proportion of off-label use of β-blockers in adults is at about 52% (66.2 million) of the total number of β-blockers prescribed. The frequency of off-label use of β-blockers in children is also high with limited data on the indications as well as safety and efficacy. We present trends in off-label use of β-blockers in children to discuss drug safety and efficacy and include recommendations for pediatric providers.
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Affiliation(s)
- Vishal R Kaley
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - E Oliver Aregullin
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Bennett P Samuel
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Joseph J Vettukattil
- Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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10
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Herndon D, Capek KD, Ross E, Jay JW, Prasai A, Ayadi AE, Foncerrada-Ortega G, Blears E, Sommerhalder C, McMullen K, Amtmann D, Cox R, Hundeshagen G, Jennings K, Sousse LE, Suman OE, Meyer WJ, Finnerty CC. Reduced Postburn Hypertrophic Scarring and Improved Physical Recovery With Yearlong Administration of Oxandrolone and Propranolol. Ann Surg 2018; 268:431-441. [PMID: 30048322 PMCID: PMC6478032 DOI: 10.1097/sla.0000000000002926] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Massive burns induce a hypermetabolic response that leads to total body wasting and impaired physical and psychosocial recovery. The administration of propranolol or oxandrolone positively affects postburn metabolism and growth. The combined administration of oxandrolone and propranolol (OxProp) for 1 year restores growth in children with large burns. Here, we investigated whether the combined administration of OxProp for 1 year would reduce scarring and improve quality of life compared with control. STUDY DESIGN Children with large burns (n = 480) were enrolled into this institutional review board-approved study; patients were randomized to control (n = 226) or administration of OxProp (n = 126) for 1 year postburn. Assessments were conducted at discharge and 6, 12, and 24 months postburn. Scar biopsies were obtained for histology. Physical scar assessments and patient reported outcome measures of physical and psychosocial function were obtained. RESULTS Reductions in cellularity, vascular structures, inflammation, and abnormal collagen (P < 0.05) occurred in OxProp-treated scars. With OxProp, scar severity was attenuated and pliability increased (both P < 0.05). Analyses of patient-reported outcomes showed improved general and emotional health within the OxProp-treated group (P < 0.05). CONCLUSIONS Here, we have shown improvements in objective and subjective measures of scarring and an increase in overall patient-reported physical function. The combined administration of OxProp for up to a year after burn injury should be considered for the reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns.
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Affiliation(s)
- David Herndon
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Karel D Capek
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Evan Ross
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Jayson W Jay
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Anesh Prasai
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Amina El Ayadi
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Guillermo Foncerrada-Ortega
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Elizabeth Blears
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Christian Sommerhalder
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Kara McMullen
- Department of Rehabilitation Medicine, The University of Washington, Seattle, WA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, The University of Washington, Seattle, WA
| | - Robert Cox
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX
| | - Gabriel Hundeshagen
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Kristofer Jennings
- Department of Preventative Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX
| | - Linda E Sousse
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Oscar E Suman
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Science, The University of Texas Medical Branch, Galveston, TX
| | - Celeste C Finnerty
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
- Shriners Hospitals for Children - Galveston, Galveston, TX
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
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11
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El Ayadi A, Prasai A, Wang Y, Herndon DN, Finnerty CC. β-Adrenergic Receptor Trafficking, Degradation, and Cell Surface Expression Are Altered in Dermal Fibroblasts from Hypertrophic Scars. J Invest Dermatol 2018; 138:1645-1655. [PMID: 29476776 DOI: 10.1016/j.jid.2018.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 01/06/2018] [Accepted: 01/28/2018] [Indexed: 01/04/2023]
Abstract
Burn trauma elevates catecholamines for up to 2 years and causes hypertrophic scarring. Propranolol, a nonspecific β1-, β2-adrenergic receptor (AR) inverse agonist, counters the hypermetabolic response to elevated catecholamines and may decrease hypertrophic scarring by an unknown mechanism. We investigated the effect of burn injury on β1-, β2-, and β3-AR expression, trafficking, and degradation in human dermal fibroblasts from hypertrophic scar [HSF], non-scar fibroblasts, and normal fibroblasts. We also investigated the modulation of these events by propranolol. Catecholamine-stimulated cAMP production was lower in HSFs and non-scar fibroblasts than in normal fibroblasts. β1- and β2-AR cell surface expression was lowest in HSFs, but propranolol increased cell surface expression of these receptors. Basal β2-AR ubiquitination was higher in HSFs than non-scar or normal fibroblasts, suggesting accelerated receptor degradation. β-AR degradation was mainly driven by lysosomal-specific polyubiquitination at Lys-63 in normal fibroblasts and HSFs, which was abrogated by propranolol. Propranolol also targeted β-AR to the proteasome in HSFs. Confocal imaging showed a lack of β2-AR-GFP trafficking to lysosomal compartments in catecholamine-stimulated HSFs. These data suggest that burn trauma alters the expression, trafficking, and degradation of β-ARs in dermal fibroblasts, which may then affect fibroblast responses to propranolol.
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Affiliation(s)
- Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA; Shriners Hospitals for Children-Galveston, Galveston, Texas, USA.
| | - Anesh Prasai
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA; Shriners Hospitals for Children-Galveston, Galveston, Texas, USA
| | - Ye Wang
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA; Shriners Hospitals for Children-Galveston, Galveston, Texas, USA
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA; Shriners Hospitals for Children-Galveston, Galveston, Texas, USA
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA; Shriners Hospitals for Children-Galveston, Galveston, Texas, USA; Institute for Translational Sciences and Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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12
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Abstract
As a result of many years of research, the intricate cellular mechanisms of burn injury are slowly becoming clear. Yet, knowledge of these cellular mechanisms and a multitude of resulting studies have often failed to translate into improved clinical treatment for burn injuries. Perhaps the most valuable information to date is the years of clinical experience and observations in the management and treatment of patients, which has contributed to a gradual improvement in reported outcomes of mortality. This review provides a discussion of the cellular mechanisms and pathways involved in burn injury, resultant systemic effects on organ systems, current management and treatment, and potential therapies that we may see implemented in the future.
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13
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Abstract
Severe pediatric burns require a multidisciplinary team approach at a specialized pediatric burn center. Special attention must be paid to estimations of total body surface area, fluid resuscitation and metabolic demands, and adequate analgesia and sedation. Long-term effects involve scar management and psychosocial support to the child and their family. Compassionate comprehensive burn care is accomplished by a multidisciplinary team offering healing in the acute setting and preparing the child and family for long-term treatment and care.
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Affiliation(s)
- Amita R Shah
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Lillian F Liao
- Division of Trauma and Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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Guillory AN, Herndon DN, Silva MB, Andersen CR, Edgu-Fry E, Suman OE, Finnerty CC. Propranolol kinetics in plasma from severely burned adults. Burns 2017. [PMID: 28645713 DOI: 10.1016/j.burns.2016.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to determine the appropriate propranolol dosing strategy for reducing heart rate in severely burned adults. METHODS A total of 26 patients (≥18 years) with burns covering ≥30% of the total body surface area were included in this IRB-approved study. Plasma propranolol concentrations were determined in a placebo group (n=10) or following one of three dosing strategies: Q6 (n=4), Q8 (n=6), and Q24 (n=6). Blood was collected just before dosing and at regular intervals over two dosing periods with corresponding heart rate and blood pressure recordings. Statistical significance was determined by one-way ANOVA followed by the appropriate post-hoc test. RESULTS Heart rate was 86±2 bpm for Q6, 93±3 bpm for Q8, and 90±4 bpm for Q24. The Q8 group had a significantly higher heart rate than the Q6 group (p=0.0001). Plasma propranolol concentrations were significantly higher in the Q6 dosing strategy than in the Q8 dosing strategy (p=0.02). CONCLUSIONS Heart rate can be decreased to a similar degree with Q6 and Q24 dosing strategies, with the Q8 dosing strategy being less effective. Q6 dosing is recommended to maintain reduced heart rate throughout dosing periods.
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Affiliation(s)
- Ashley N Guillory
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Institute for Translational Sciences and Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States
| | - Michael B Silva
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States
| | - Clark R Andersen
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States
| | - Erge Edgu-Fry
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Institute for Translational Sciences and Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States.
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15
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Manzano-Nunez R, García-Perdomo HA, Ferrada P, Ordoñez Delgado CA, Gomez DA, Foianini JE. Safety and effectiveness of propranolol in severely burned patients: systematic review and meta-analysis. World J Emerg Surg 2017; 12:11. [PMID: 28265298 PMCID: PMC5335497 DOI: 10.1186/s13017-017-0124-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA >20%). METHODS Relevant articles from randomized controlled trials were identified by a literature search in MEDLINE, EMBASE, and CENTRAL. We included trials involving patients with a severe burn (>20% of total body surface area affected). Trials were eligible if they evaluated propranolol and compared to usual care or placebo. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We conducted a meta-analysis using a random-effects model. RESULTS We included ten studies in our systematic review. These studies randomized a total of 1236 participants. There were no significant differences between propranolol and placebo with respect to mortality (RD -0.02 [95% CI -0.06 to 0.02]), sepsis (RD -0.03 [95% CI -0.09 to 0.04]), and the overall hospital stay (MD -0.37 [-4.52 to 3.78]). Propranolol-treated adults had a decrease in requirements of blood transfusions (MD -185.64 [95% CI -331.06 to -40.43]) and a decreased heart rate (MD -26.85 [95% CI -39.95 to -13.75]). CONCLUSIONS Our analysis indicates that there were no differences in mortality or sepsis in severely burned patients treated with propranolol compared with those who had usual care or placebo. However, the use of propranolol in these patients resulted in lower requirements of blood transfusion and lower values of heart rate. The evidence synthesized in this systematic review is limited to conclude that propranolol reduces the length of hospital stay among severely burned patients. Future trials should assess the impact of propranolol on clinically relevant outcomes such as mortality and adverse events.
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Affiliation(s)
- Ramiro Manzano-Nunez
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
- UROGIV Research Group, Universidad Del Valle, Cali, Colombia
| | | | - Paula Ferrada
- Surgical Critical Care, Virginia Commonwealth University, Richmond, VA USA
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Abstract
OBJECTIVE To describe a number of conditions and therapies associated with multiple organ dysfunction syndrome presented as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Multiple Organ Dysfunction Workshop (March 26-27, 2015). In addition, the relationship between burn injuries and multiple organ dysfunction syndrome is also included although it was not discussed at the workshop. DATA SOURCES Literature review, research data, and expert opinion. STUDY SELECTION Not applicable. DATA EXTRACTION Moderated by an expert from the field, issues relevant to the association of multiple organ dysfunction syndrome with a variety of conditions and therapies were presented, discussed, and debated with a focus on identifying knowledge gaps and the research priorities. DATA SYNTHESIS Summary of presentations and discussion supported and supplemented by relevant literature. CONCLUSIONS Sepsis and trauma are the two conditions most commonly associated with multiple organ dysfunction syndrome both in children and adults. However, many other pathophysiologic processes may result in multiple organ dysfunction syndrome. In this article, we discuss conditions such as liver failure and pancreatitis, pathophysiologic processes such as ischemia and hypoxia, and injuries such as trauma and burns. Additionally, therapeutic interventions such as medications, blood transfusions, transplantation may also precipitate and contribute to multiple organ dysfunction syndrome. The purpose of this article is to describe the association of multiple organ dysfunction syndrome with a variety of conditions and therapies in an attempt to identify similarities, differences, and opportunities for therapeutic intervention.
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17
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LeCompte MT, Rae L, Kahn SA. A survey of the use of propranolol in burn centers: Who, what, when, why. Burns 2017; 43:121-126. [DOI: 10.1016/j.burns.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/25/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Abstract
Severe burn injury produces a plethora of metabolic abnormalities which contribute to the prolonged morbidity of burn survivors. The authors have recently demonstrated trans-differentiation of white adipose tissue (WAT) after burn trauma, toward a more thermogenic phenotype. However, the impact of burn injury on subcutaneous WAT (sWAT) morphology in humans is unknown. Here, the authors studied the effect of severe burn injury on the architecture of sWAT. sWAT was collected from 11 severely burned children (11 ± 3 years; 55 ± 16% total BSA burned) and 12 nonburned healthy children (9 ± 3 years). Histology, electron microscopy, immunohistochemistry, and immunofluorescence were performed on fixed adipose tissue sections. sWAT cytokine and collagen concentrations were measured by multiplex assay and sirius/fast green staining method, respectively. sWAT histology demonstrated multiple fat droplets, significantly (P < .05) reduced mean cell size (104 ± 6 vs 68 ± 3 μm) and higher collagen content (7 ± 0.8 vs 4 ± 0.4) in burn patients. sWAT from burn victims stained positive for CD68 suggesting infiltration of macrophages. Furthermore, electron microscopic analysis showed multiple fat droplets and greater mitochondrial abundance in sWAT of burn survivors. In agreement with this, mitochondrial respiratory capacity in the leak and coupled state increased by 100% in sWAT of burned children from 1 to 3 weeks postinjury. The cytokines IL-6, IL-8, IL-13, IL-1a, IL-1b, MCP-1, and TNF-α were all significantly greater in the sWAT of burned children versus healthy children (P < .05). Furthermore, IL-6, IL-8, IL1-a, IL-1b, and TNF-α significantly increased after injury in sWAT of burned children (P < .05). This study provides detailed evidence of morphological and functional changes in sWAT of burn survivors which was associated with tissue inflammation. A better understanding of morphological and functional changes in sWAT will help discern the mechanisms underlying hypermetabolism in burned patients.
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19
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The impact of non-severe burn injury on cardiac function and long-term cardiovascular pathology. Sci Rep 2016; 6:34650. [PMID: 27694999 PMCID: PMC5046146 DOI: 10.1038/srep34650] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/19/2016] [Indexed: 01/01/2023] Open
Abstract
Severe burn injury significantly affects cardiovascular function for up to 3 years. However, whether this leads to long-term pathology is unknown. The impact of non-severe burn injury, which accounts for over 80% of admissions in developed countries, has not been investigated. Using a rodent model of non-severe burn injury with subsequent echocardiography we showed significantly increased left ventricular end systolic diameter (LVESD) and ventricular wall thickness at up to 3 months post-injury. Use of propranolol abrogated the changes in cardiac measures observed. Subsequently we investigated changes in a patient cohort with non-severe injury. Echocardiography measured at baseline and at 3 months post-injury showed increased LVESD at 3 months and significantly decreased posterior wall diameter. Finally, 32 years of Western Australian hospital records were used to investigate the incidence of cardiovascular disease admissions after burn injury. People who had experienced a burn had increased hospital admissions and length of stay for cardiovascular diseases when compared to a matched uninjured cohort. This study presents animal, patient and population data that strongly suggest non-severe burn injury has significant effects on cardiovascular function and long-term morbidity in some burn patients. Identification of patients at risk will promote better intervention and outcomes for burn patients.
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20
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Duke JM, Randall SM, Fear MW, Boyd JH, Rea S, Wood FM. Understanding the long-term impacts of burn on the cardiovascular system. Burns 2016; 42:366-74. [DOI: 10.1016/j.burns.2015.08.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/11/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
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21
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Cardiovascular Dysfunction Following Burn Injury: What We Have Learned from Rat and Mouse Models. Int J Mol Sci 2016; 17:ijms17010053. [PMID: 26729111 PMCID: PMC4730298 DOI: 10.3390/ijms17010053] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/14/2015] [Accepted: 12/23/2015] [Indexed: 12/11/2022] Open
Abstract
Severe burn profoundly affects organs both proximal and distal to the actual burn site. Cardiovascular dysfunction is a well-documented phenomenon that increases morbidity and mortality following a massive thermal trauma. Beginning immediately post-burn, during the ebb phase, cardiac function is severely depressed. By 48 h post-injury, cardiac function rebounds and the post-burn myocardium becomes tachycardic and hyperinflammatory. While current clinical trials are investigating a variety of drugs targeted at reducing aspects of the post-burn hypermetabolic response such as heart rate and cardiac work, there is still a paucity of knowledge regarding the underlying mechanisms that induce cardiac dysfunction in the severely burned. There are many animal models of burn injury, from rodents, to sheep or swine, but the majority of burn related cardiovascular investigations have occurred in rat and mouse models. This literature review consolidates the data supporting the prevalent role that β-adrenergic receptors play in mediating post-burn cardiac dysfunction and the idea that pharmacological modulation of this receptor family is a viable therapeutic target for resolving burn-induced cardiac deficits.
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22
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Henig O, Avni T, Herndon DN, Finnerty CC, Leibovici L, Paul M. Beta adrenergic antagonists for hospitalized burned patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Oryan Henig
- Carmel Medical Centre; Infectious Disease Unit; Michal 7 Haifa Israel
| | - Tomer Avni
- Beilinson Hospital, Rabin Medical Center; Petah Tikva Israel
- Tel Aviv University; Sackler Faculty of Medicine; Tel Aviv Israel
| | - David N Herndon
- Shriners Hospitals for Children - Galveston; 815 Market Street Galveston TX USA 77550
| | - Celeste C Finnerty
- Shriners Hospitals for Children - Galveston; 815 Market Street Galveston TX USA 77550
- University of Texas Medical Branch; Department of Surgery; Galveston TX USA 77550
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical Center; Department of Medicine E; Kaplan Street Petah Tikva Israel 49100
| | - Mical Paul
- Rambam Health Care Campus; Division of Infectious Diseases; Ha-aliya 8 St Haifa Israel 33705
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23
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Abstract
The interaction between the sympathetic nervous system and the immune system has been documented over the last several decades. In this review, the neuroanatomical, cellular, and molecular evidence for neuroimmune regulation in the maintenance of immune homeostasis will be discussed, as well as the potential impact of neuroimmune dysregulation in health and disease.
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Affiliation(s)
- Caroline J Padro
- The Biomedical Sciences Graduate Program, The Ohio State University Wexner College of Medicine, Columbus, OH 43210, United States.
| | - Virginia M Sanders
- The Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University Wexner College of Medicine, Columbus, OH 43210, United States; The Institute of Behavioral Medicine Research, The Ohio State University Wexner College of Medicine, Columbus, OH 43210, United States.
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