THE CALORIC EQUIVALENT OF FEVER. II. INFLUENCE OF MAJOR TRAUMA

Metabolism, bioenergetics and thermal physiology: influences of the human intestinal microbiota

The micro-organisms which inhabit the human gut (i.e. the intestinal microbiota) influence numerous human biochemical pathways and physiological functions. The present review focuses on two questions, 'Are intestinal microbiota effects measurable and meaningful?' and 'What research methods and variables are influenced by intestinal microbiota effects?'. These questions are considered with respect to doubly labelled water measurements of energy expenditure, heat balance calculations and models, measurements of RMR via indirect calorimetry, and diet-induced energy expenditure. Several lines of evidence suggest that the intestinal microbiota introduces measurement variability and measurement errors which have been overlooked in research studies involving nutrition, bioenergetics, physiology and temperature regulation. Therefore, we recommend that present conceptual models and research techniques be updated via future experiments, to account for the metabolic processes and regulatory influences of the intestinal microbiota.

Manipulating the immune system for pigs to optimise performance

Disease and enhanced microbial load are considered to be major factors limiting the performance and overall efficiency of feed use by pigs in Australian piggeries. It is recognised that pigs exposed to conventional housing systems with high microbial loads grow 10–20% more slowly than do gnotobiotic pigs or pigs kept in ‘clean’ environments. Consequently, a proportion of pigs in any production cycle are continuously being challenged by their immediate environment, which can cause an immune response to be mounted. Such a process is physiologically expensive in terms of energy and protein (comprised of amino acids), with, for example, the enhanced rate of protein turnover associated with the production of immune cells, antibodies and acute-phase proteins increasing energy expenditure by 10–15% of maintenance needs and protein requirements by 7–10%. The requirements for lysine, tryptophan, sulfur-containing amino acids and threonine can be increased by a further 10%. The over-stimulation of the immune response with excess production of pro-inflammatory cytokines causes excessive production primarily of the prostaglandin E2 (PGE2), which contributes to anorexia, fever and increased proteolysis, and a concomitant reduction in pig performance. Prostaglandin E2 is produced from dietary and cell-membrane phospholipids via secretory phospholipase A2 (sPLA2) to produce arachidonic acid, which is catalysed by the COX-2 enzyme. Negating the negative effects of PGE2 appears not to adversely affect the ability of the immune system to combat pathogens, but improves pig performance. There are negative outcomes for pig health and productivity through both under- and over-stimulation of the immune response. This review briefly outlines the impact of immune stimulation on pigs and discusses strategies to optimise the immune response for pig health and performance.

Climatic anomaly affects the immune competence of California sea lions

The past decades have been characterized by a growing number of climatic anomalies. As these anomalies tend to occur suddenly and unexpectedly, it is often difficult to procure empirical evidence of their effects on natural populations. We analysed how the recent sea surface temperature (SST) anomaly in the northeastern Pacific Ocean affects body condition, nutritional status, and immune competence of California sea lion pups. We found that pup body condition and blood glucose levels of the pups were lower during high SST events, although other biomarkers of malnutrition remained unchanged, suggesting that pups were experiencing early stages of starvation. Glucose-dependent immune responses were affected by the SST anomaly; specifically, pups born during high SST events had lower serum concentrations of IgG and IgA, and were unable to respond to an immune challenge. This means that not only were pups that were born during the SST anomaly less able to synthesize protective antibodies; they were also limited in their ability to respond rapidly to nonspecific immune challenges. Our study provides empirical evidence that atypical climatic conditions can limit energetic reserves and compromise physiological responses that are essential for the survival of a marine top predator.

Carotenoids buffer the acute phase response on fever, sickness behavior, and rapid bill color change in zebra finches

Carotenoids are finite resources that animals can allocate to self-maintenance, attractiveness, or reproduction. Here we test how carotenoids affect the acute phase response (APR), an intense rapid systemic response characterized by fever, sickness behavior, and production of acute phase proteins, which serves to reduce pathogen persistence. We conducted a 2x2 factorial design experiment in captive adult male and female zebra finches (Taeniopygia guttata) to determine the effects of carotenoid supplementation on the intensity of the APR. We measured changes in feeding rate, activity level, and body temperature of the birds. We found that, relative to unsupplemented controls, carotenoid-supplemented birds exhibited less severe reductions in feeding and activity, smaller increases in body temperature, and lower circulating levels of haptoglobin (an acute phase protein) 24 h after inducing an APR. Among supplemented individuals, those with higher blood carotenoid levels exhibited a lower reduction in activity rate after 24 h. Forty-eight hours after APR induction, birds exhibited a significant decrease in plasma carotenoid levels and a decrease in bill hue, with less reduction in hue in carotenoid-supplemented individuals. These results demonstrate that carotenoids can alleviate several important behavioral and physiological effects of an APR and that bill color can change rapidly following induction of the costly APR immune defense. In particular, immune activation may have caused birds to preferentially draw down carotenoids from the bloodstream, ostensibly for use in health. Rapid bill color changes over a 48-hr period support growing evidence that bills may serve as short-term signals of health and condition.

Elevational variation in body-temperature response to immune challenge in a lizard

Immunocompetence benefits animal fitness by combating pathogens, but also entails some costs. One of its main components is fever, which in ectotherms involves two main types of costs: energy expenditure and predation risk. Whenever those costs of fever outweigh its benefits, ectotherms are expected not to develop fever, or even to show hypothermia, reducing costs of thermoregulation and diverting the energy saved to other components of the immune system. Environmental thermal quality, and therefore the thermoregulation cost/benefit balance, varies geographically. Hence, we hypothesize that, in alpine habitats, immune-challenged ectotherms should show no thermal response, given that (1) hypothermia would be very costly, as the temporal window for reproduction is extremely small, and (2) fever would have a prohibitive cost, as heat acquisition is limited in such habitat. However, in temperate habitats, immune-challenged ectotherms might show a febrile response, due to lower cost/benefit balance as a consequence of a more suitable thermal environment. We tested this hypothesis in Psammodromus algirus lizards from Sierra Nevada (SE Spain), by testing body temperature preferred by alpine and non-alpine lizards, before and after activating their immune system with a typical innocuous pyrogen. Surprisingly, non-alpine lizards responded to immune challenge by decreasing preferential body-temperature, presumably allowing them to save energy and reduce exposure to predators. On the contrary, as predicted, immune-challenged alpine lizards maintained their body-temperature preferences. These results match with increased costs of no thermoregulation with elevation, due to the reduced window of time for reproduction in alpine environment.

It takes two to tango: Phagocyte and lymphocyte numbers in a small mammalian hibernator

Immunity is energetically costly and competes for resources with other physiological body functions, which may result in trade-offs that impair fitness during demanding situations. Endocrine mediators, particularly stress hormones, play a central role in these relationships and directly impact leukocyte differentials. To determine the effects of external stressors, energetic restraints and competing physiological functions on immune parameters and their relevance for fitness, we investigated leukocyte profiles during the active season of a small obligate hibernator, the edible dormouse (Glis glis), in five different study sites in south-western Germany. The highly synchronized yearly cycle of this species and the close adaptation of its life history to the irregular abundance of food resources provide a natural experiment to elucidate mechanisms underlying variations in fitness parameters. In contrast to previous studies on hibernators, that showed an immediate recovery of all leukocyte subtypes upon emergence, our study revealed that hibernation results in depleted phagocyte (neutrophils and monocytes) stores that recovered only slowly. As the phenomenon of low phagocyte counts was even more pronounced at the beginning of a low food year and primarily immature neutrophils were present in the blood upon emergence, preparatory mechanisms seem to determine the regeneration of phagocytes before hibernation is terminated. Surprisingly, the recovery of phagocytes thereafter took several weeks, presumably due to energetic restrictions. This impaired first line of defense coincides with lowest survival probabilities during the annual cycle of our study species. Reduced survival could furthermore be linked to drastic increases in the P/L ratio (phagocytes/lymphocytes), an indicator of physiological stress, during reproduction. On the other hand, moderate augmentations in the P/L ratio occurred during periods of low food availability and were associated with increased survival, but reproductive failure. In this case, the stress response probably represents an adaptive reaction that contributes to survival by activating energy resources. In contrast to our expectation, we could not detect an amplification of stress through high population densities. Summarized, results of our study clearly reveal that the leukocyte picture of active edible dormice responds sensitively to physiological conditions associated with hibernation, reproductive activity and food availability and can be linked to fitness parameters such as survival. Thus edible dormice represent an excellent model organism to investigate regulatory mechanisms of the immune system under natural conditions.

Mechanisms of fever production and lysis: lessons from experimental LPS fever

Fever is a cardinal symptom of infectious or inflammatory insults, but it can also arise from noninfectious causes. The fever-inducing agent that has been used most frequently in experimental studies designed to characterize the physiological, immunological and neuroendocrine processes and to identify the neuronal circuits that underlie the manifestation of the febrile response is lipopolysaccharide (LPS). Our knowledge of the mechanisms of fever production and lysis is largely based on this model. Fever is usually initiated in the periphery of the challenged host by the immediate activation of the innate immune system by LPS, specifically of the complement (C) cascade and Toll-like receptors. The first results in the immediate generation of the C component C5a and the subsequent rapid production of prostaglandin E2 (PGE2). The second, occurring after some delay, induces the further production of PGE2 by induction of its synthesizing enzymes and transcription and translation of proinflammatory cytokines. The Kupffer cells (Kc) of the liver seem to be essential for these initial processes. The subsequent transfer of the pyrogenic message from the periphery to the brain is achieved by neuronal and humoral mechanisms. These pathways subserve the genesis of early (neuronal signals) and late (humoral signals) phases of the characteristically biphasic febrile response to LPS. During the course of fever, counterinflammatory factors, "endogenous antipyretics," are elaborated peripherally and centrally to limit fever in strength and duration. The multiple interacting pro- and antipyretic signals and their mechanistic effects that underlie endotoxic fever are the subjects of this review.

Sirtuin-1 is a nutrient-dependent modulator of inflammation

Inflammation accompanies obesity and its comorbidities—type 2 diabetes, non-alcoholic fatty liver disease and atherosclerosis, among others—and may contribute to their pathogenesis. Yet the cellular machinery that links nutrient sensing to inflammation remains incompletely characterized. The protein deacetylase sirtuin-1 (SirT1) is activated by energy depletion and plays a critical role in the mammalian response to fasting. More recently it has been implicated in the repression of inflammation. SirT1 mRNA and protein expression are suppressed in obese rodent and human white adipose tissue, while experimental reduction of SirT1 in adipocytes and macrophages causes low-grade inflammation that mimics that observed in obesity. Thus suppression of SirT1 during overnutrition may be critical to the development of obesity-associated inflammation. This effect is attributable to multiple actions of SirT1, including direct deacetylation of NFκB and chromatin remodeling at inflammatory gene promoters. In this work, we report that SirT1 is also suppressed by diet-induced obesity in macrophages, which are key contributors to the ontogeny of metabolic inflammation. Thus, SirT1 may be a common mechanism by which cells sense nutrient status and modulate inflammatory signaling networks in accordance with organismal energy availability.

Chronic hypoxia stimulates an enhanced response to immune challenge without evidence of an energetic tradeoff

There is broad interest in whether there is a tradeoff between energy metabolism and immune function, and how stress affects immune function. Under hypoxic stress, maximal aerobic metabolism is limited, and other aspects of energy metabolism of animals may be altered as well. Although acute hypoxia appears to enhance certain immune responses, the effects of chronic hypoxia on immune function are largely unstudied. We tested: (1) whether chronic hypoxia affects immune function and (2) whether hypoxia affects the metabolic cost of immune function. First, flow cytometry was used to monitor the peripheral blood immunophenotype of mice over the course of 36 days of hypoxic exposure. Second, hypoxic and normoxic mice were subjected to an adaptive immune challenge via keyhole limpet hemocyanin (KLH) or to an innate immune challenge via lipopolysaccharide (LPS). The resting metabolic rates of mice in all immune challenge treatments were also measured. Although hypoxia had little effect on the peripheral blood immunophenotype, hypoxic mice challenged with KLH or LPS had enhanced immunological responses in the form of higher antibody titers or increased TNF-α production, respectively. Initially, mice exposed to hypoxia had lower metabolic rates, but this response was transitory and resting metabolic rates were normal by the end of the experiment. There was no effect of either immune challenge on resting metabolic rate, suggesting that mounting either the acute phase response or a humoral response is not as energetically expensive as previously thought. In addition, our results suggest that immune responses to chronic and acute hypoxia are concordant. Both forms of hypoxia appear to stimulate both innate and adaptive immune responses.

Validation of an equation for resting metabolic rate in older obese, critically ill patients

BACKGROUND

In previous studies, the Penn State (PSU) equation was found to be a valid way to predict resting metabolic rate (RMR) in critically ill patients, with the exception of those who were aged 60 years or older and had a body mass index (BMI) ≥30 kg/m(2). A modification of the equation was proposed in this specific patient population. The current study was designed to test the validity of that equation and to retest the validity of the original equation.

METHODS

RMR was measured using a standardized evidence-based protocol. Metabolic rates predicted with the PSU equation and a modification of it (PSU[m]) were compared with the measured values. Fifty patients were studied prospectively. Data were used from an additional 75 subjects from previous studies that had not been used to develop either of the equations being tested in the current study. This brought the final number of subjects for each equation to 74 for PSU(m) and 106 for PSU.

RESULTS

The PSU(m) equation was found to be biased by a narrow margin (95% confidence interval, -87 to -4 kcal/d), but both versions of the equation were precise. Accuracy rate for the PSU(m) equation was 74%, compared with 58% for the PSU equation (P < .04).

CONCLUSIONS

The PSU(m) equation for predicting RMR in critically ill, mechanically ventilated patients is valid in patients aged cases where age is ≥60 years or older whose BMI is ≥30 kg/m(2).

Population differences in fever and sickness behaviors in a wild passerine: a role for cytokines

Immune responses benefit hosts by clearing pathogens, but they also incur physiological costs and tissue damage. While wild animals differ in how they balance these costs and benefits, the physiological mechanisms underlying such differential investment in immunity remain unknown. Uncovering these mechanisms is crucial to determining how and where selection acts to shape immunological defense. Among free-living song sparrows (Melospiza melodia) in western North America, sickness-induced lethargy and fever are more pronounced in Southern California than in Washington and Alaska. We brought song sparrows from two populations (Southern California and Washington) into captivity to determine whether these differences persist in a common environment and what physiological signals facilitate such differences. As in free-living sparrows, captive California birds exhibited more pronounced fever and lethargy than Washington birds in response to lipopolysaccharide, a non-pathogenic antigen that mimics bacterial infection. After treatment, the two populations showed similar reductions in luteinizing hormone levels, food intake and body mass, although treated birds from California lost more breast muscle tissue than treated birds from Washington. Moreover, California birds displayed higher bioactivity of interleukin-6, a pro-inflammatory cytokine, and marginally higher levels of corticosterone, a steroid hormone involved in stress, metabolism and regulating inflammatory responses. Our results show that immunological differences between these populations cannot be explained by immediate environment alone and may reflect genetic, maternal or early-life effects. Additionally, they suggest that cytokines play a role in shaping immunological variation among wild vertebrates.

Positive effects of testosterone and immunochallenge on energy allocation to reproductive organs

A number of studies have suggested the incompatibility of simultaneous increases in immune and reproductive functions. Other research has indicated that immune responses may be modulated depending on the relative benefits of increased survival and prospects for current and future reproduction. We tested the hypothesis that energy allocation to reproductive and other organ systems is not affected by testosterone level and energy expenditure on immune functions. Adult male white-footed mice (Peromyscus leucopus) with or without elevated testosterone levels and with or without immunochallenges were tested. Testosterone treatment was associated with reduced humoral immune response indicating immunosuppressive effects, reduced masses of gastrointestinal organs, reduced corticosterone level, increased kidney and seminal vesicle masses, and increased hematocrit. Immunochallenge was associated with increased resting metabolic rate and testes and seminal vesicle masses. Reproductive organ masses were greatest in immunochallenged mice with exogenous testosterone. Simultaneous increases in energy allocation to immune and reproductive structures may be an adaptive response that would enhance survival and current prospects for reproduction.

Energy expenditure in patients with multiple organ failure

We measured the level of resting energy expenditure (BEE) and its evolution in patients with multiple organ failure (MOF). We studied 30 patients requiring mechanical ventilation and sedation. REE was measured by means of a closed circuit method on days 1-5, 7, 10 and 14 after initiating the protocol. REE values between 115% and 145% of the REE calculated from the Harris-Benedict's formula were considered as moderate hypermetabolism and values above 145% as severe hypermetabolism. A predictive formula for determining caloric requirements was developed and validated in another 25 MOF patients. In the study group, 25 patients presented moderate hypermetabolism (83%) and two severe hypermetabolism(7%). Mean REE in the whole group was stable but individual patients may have had a large variability in REE. The anthropometric variables, body temperature and reason for admission predicted the REE with a coefficient of determination of 0.73, according to the model: REE= -3295 + 105.5S - 8A + 11.7 W + 7.7 H + 93.2 T + 123.1 Tr - 145.6 Su where: S = sex (male = 1, female = 0); A: age in years; W: weight in Kg; H: height in cm; T: temperature in degrees C; Tr: trauma (Tr = 1); Su: surgical (Su = 1). The reliability of the model, taken from the validation group, showed that the shrinkage was 0.8%. In conclusion, when MOF patients are sedated they present moderate hypermetabolism. Day-to-day variability of REE in the individual patients and the large variability in estimating REE with our formula preclude its clinical utility and we recommend to measure REE in MOF patients.

Temperature response to severe head injury and the effect on body energy expenditure and cerebral oxygen consumption

This study examines the relationship between core temperature and whole body energy expenditure, cerebral oxygen consumption (CMRO2), cerebral blood flow (CBF), and intracranial pressure (ICP) in severely head injured children. A total of 107 serial measurements of temperature, energy expenditure, CMRO2, CBF, and ICP were made in 18 head injured children receiving neurointensive care. Energy expenditure was measured using indirect calorimetry, and CMRO2 and CBF using the Kety-Schmidt technique. The mean rectal temperature was 37.8 degrees C (34-39.1 degrees C) despite modification with paracetamol. Within each child there was a positive relationship between rectal temperature and energy expenditure, energy expenditure increasing by a mean of 7.4% per degree C. There was no evidence of significant relationships between rectal temperature and CMRO2, CBF, or ICP. Mild induced hypothermia in two children did not result in decreased CMRO2 or CBF measurements. The efficacy of interventions aiming to modify cerebral energy metabolism by changing core temperature cannot be readily assessed by the response of the whole body.

Heart rate and metabolic response to burn injury in humans

BACKGROUND

Although frequently done, estimating the energy requirements of individual burn patients without measuring their resting metabolic rate is a less than satisfactory method of evaluation.

METHODS

We tested whether heart rate, which relates to the energy expenditure during physical activity, is also associated with postburn hypermetabolism (calculated as percentage increase of resting metabolic rate above the predicted normal fasting resting metabolic rate). Twenty-three patients [12 men and 11 women, aged 38 +/- 13 years (mean +/- SD); weight, 71.6 +/- 14.8 kg; body mass index, 25.4 +/- 3.6; total burn surface area, 35.3 +/- 17.8% (percentage of body surface)] were studied weekly for 3 weeks after an overnight fast.

RESULTS

Measured resting metabolic rates and heart rates were 2016 +/- 497 kcal/d, 101 +/- 13 bpm (n = 19); 2231 +/- 485 kcal/d, 107 +/- 13 bpm (n = 18); and 1903 +/- 598 kcal/d, 99 +/- 14 bpm (n = 11) for weeks 1, 2, and 3, respectively. Postburn hypermetabolism was +36% +/- 19%, +55% +/- 27%, and +36% +/- 35% in the first, second, and third week, respectively. In each week postburn hypermetabolism correlated with heart rate (r = 0.65, p = .003; r = 0.69, p = .001; and r = 0.80, p = .002, respectively). Only in the second week did postburn hypermetabolism correlate with total burn surface area (r = 0.52, p = .02); there was no correlation with body temperature. In a multiple regression analysis, predicted resting metabolic rate, heart rate, and total burn surface area together explained 77% of all of the variance observed in the 48 fasting resting metabolic rates that were measured in the study (r2 = 0.77, p < .0001), and each of these variables also had a significant partial correlation with fasting resting metabolic rates (r2 = 0.45, p < .0001; r2 = 0.29, p < .0001; and r2 = 0.03, p < .03, respectively).

CONCLUSIONS

In burn patients, variability in heart rate is associated with a significant part of postburn hypermetabolism variability. Therefore, heart rate may be considered a useful variable to be used for the evaluation of the energy requirements of severely burned patients.

Factors contributing to increased energy expenditure in thermal injury: a review of studies employing indirect calorimetry

In summary, a remarkably close agreement exists for the mean MEE measured in 28 studies of severe burn trauma. This is especially surprising given the variability in sample sizes, measurement techniques, study designs, and DPBs studied. The mean MEE calculated from the data published in these reports is listed in the final column of Table I. For more than 450 cases, an unweighted MEE is 2750 +/- 85 kcal/day. For those studies prior to 1980, the mean MEE exceeds 3000 kcal/day in eight of 14 reports vs only two of 14 published after 1980. Even so, the mean MEE for the pre-1980 reports differs by only 200 kcal/day (2960 +/- 120, n = 14). The accepted notion that the degree of elevation in MEE is in proportion to the % BSAB up to about 60% BSAB is useful in a general sense but must be applied with caution. The recent studies, which include proportionately more burns exceeding 80% BSAB, suggest an elevation in MEE in these cases. Nevertheless, a physiologic plateau apparently exists at or slightly below 2 x normal RMR at the peak of MEE. The magnitude of the MEE response results from an undefined interaction among several factors of which some have been examined while others such as inflammatory mediators are only beginning to receive study. The contributions to reduction in MEE from interventions to control cardiac output and peripheral cooling, core temperature, evaporative water (heat) loss, and substrate cycling have been reviewed. The importance of indirect calorimetry in patient care is highlighted by the large variability in similarly injured individuals and in the unexplained component of regression analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

The metabolic and nutritional effects of injury and sepsis

The existence of a co-ordinated response to stress of a variety of causes has clearly been established. Basically, this consists of an elevation in energy expenditure and an increased breakdown of skeletal muscle protein. In addition, glucose level in the plasma increases as a result of increased synthesis and decreased uptake of glucose into cells. Release of fatty acid into the plasma is also increased, and an elevation in the proportion of energy derived from oxidation of fatty acids is observed. This response is qualitatively very different from that seen in simple starvation, where a progressive reduction in energy expenditure and a reduction in the synthesis of glucose allows fat to become the major energy-producing substrate and also allows sparing of body protein stores. The mechanisms responsible for this altered pattern of metabolism are probably primarily hormonal in nature, with adrenaline, cortisol and glucagon being the major catabolic stimulants. Some evidence exists, however, for alteration in intracellular pathway metabolism. Within the past decade a new class of mediators of the stress response, the cytokines, has been recognized. These substances are protein products of circulating monocytes and the way in which they integrate into the control of the stress response has not been completely elucidated. At present there is evidence that they can stimulate production of catabolic hormones, and also they may well have direct effects in enhancing protein catabolism in muscle. At present the main method for modification of the stress response remains the provision of energy and amino acid, either intravenously or enterally. In the present state of our knowledge, 30-40 kcal kg-1 day-1 would appear to be adequate for most patients, with half provided as fat. Amino acids 3 g kg-1 day-1 will provide adequate nitrogen. It must be said, however, that the most effective method of modifying the stress response is removal of the source of stress by surgery, antibiotics or other primary therapy.

Indirect calorimetry in malnutrition: nutritional assessment or therapeutic reference?

The measurement of gas exchange for use in indirect calorimetry is a clinical research tool struggling to find its proper place in the care of acutely ill and nutritionally depleted patients. Some investigators have proposed that it should be used as part of the nutritional assessment. Unfortunately, in common with many other measurements for nutritional assessment, the information provided must be integrated with other information. It is recognized that factors other than malnutrition may influence the level of the metabolic rate. Despite the lack of precision and specificity, the measurement of energy expenditure provides an important reference for determining patients' requirements for energy intake. As with many other procedures in clinical medicine, the more severely ill the patient, the less the accuracy of standard formulas for estimating energy expenditure. Thus, actual measurements of energy expenditure assume special value.

Mechanisms for the high circulatory requirements in sepsis and septic shock

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Studies in burns. I. Water loss from the body surface

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