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Li S, Li D, Li Y, Liu X, Song Y, Xie X, Luo P, Yuan H, Shen C. Development and validation of a nomogram for pneumonia risk in burn patients with inhalation injury: a multicenter retrospective cohort study. Int J Surg 2024; 110:2902-2909. [PMID: 38348866 PMCID: PMC11093435 DOI: 10.1097/js9.0000000000001190] [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: 11/14/2023] [Accepted: 01/31/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Burn patients with inhalation injury are at higher risk of developing pneumonia, and yet there is no reliable tool for the assessment of the risk for such patients at admission. This study aims to establish a predictive model for pneumonia risk for burn patients with inhalation injury based on clinical findings and laboratory tests. METHOD This retrospective study enrolled 546 burn patients with inhalation injury. They were grouped into a training cohort and a validation cohort. The least absolute shrinkage and selection operator (LASSO) regression analysis and binary logistic regression analysis were utilized to identify risk factors for pneumonia. Based on the factors, a nomogram for predicting pneumonia in burn patients with inhalation injury was constructed. Areas under the receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis (DCA) were used to evaluate the efficiency of the nomogram in both the training and validation cohorts. RESULTS The training cohort included 432 patients, and the validation cohort included 114 patients, with a total of 225 (41.2%) patients experiencing pneumonia. Inhalation injury, tracheal intubation/tracheostomy, low serum albumin, and high blood glucose were independent risk factors for pneumonia in burn patients with inhalation injury and they were further used to build the nomogram. The AUC of the nomogram in the training and validation cohorts were 0.938 (95% CI: 0.917-0.960) and 0.966 (95% CI: 0.931-1), respectively. The calibration curve for probability of pneumonia showed optimal agreement between the prediction by nomogram and the actual observation, and the DCA indicated that the constructed nomogram conferred high clinical net benefit. CONCLUSION This nomogram can accurately predict the risk of developing pneumonia for burn patients with inhalation injury, and help professionals to identify high-risk patients at an early stage as well as to make informed clinical decisions.
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Affiliation(s)
- Shijie Li
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Dawei Li
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Yalong Li
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Xinzhu Liu
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
| | - Yaoyao Song
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Xiaoye Xie
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Peng Luo
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, People’s Republic of China
| | - Huageng Yuan
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
| | - Chuan’an Shen
- Senior Department of Burns and Plastic Surgery, The Fourth Medical Center of PLA General Hospital
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Hu Y, Huang Y, Jiang Y, Weng L, Cai Z, He B. The Different Shades of Thermogenic Adipose Tissue. Curr Obes Rep 2024:10.1007/s13679-024-00559-y. [PMID: 38607478 DOI: 10.1007/s13679-024-00559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW By providing a concise overview of adipose tissue types, elucidating the regulation of adipose thermogenic capacity in both physiological contexts and chronic wasting diseases (a protracted hypermetabolic state that precipitates sustained catabolism and consequent progressive corporeal atrophy), and most importantly, delving into the ongoing discourse regarding the role of adipose tissue thermogenic activation in chronic wasting diseases, this review aims to provide researchers with a comprehensive understanding of the field. RECENT FINDINGS Adipose tissue, traditionally classified as white, brown, and beige (brite) based on its thermogenic activity and potential, is intricately regulated by complex mechanisms in response to exercise or cold exposure. This regulation is adipose depot-specific and dependent on the duration of exposure. Excessive thermogenic activation of adipose tissue has been observed in chronic wasting diseases and has been considered a pathological factor that accelerates disease progression. However, this conclusion may be confounded by the detrimental effects of excessive lipolysis. Recent research also suggests that such activation may play a beneficial role in the early stages of chronic wasting disease and provide potential therapeutic effects. A more comprehensive understanding of the changes in adipose tissue thermogenesis under physiological and pathological conditions, as well as the underlying regulatory mechanisms, is essential for the development of novel interventions to improve health and prevent disease.
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Affiliation(s)
- Yunwen Hu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yijie Huang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yangjing Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Lvkan Weng
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Zhaohua Cai
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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Gao S, Zhao X, Leng Y, Xia Z. Dietary supplementation with inulin improves burn-induced skeletal muscle atrophy by regulating gut microbiota disorders. Sci Rep 2024; 14:2328. [PMID: 38282163 PMCID: PMC10822858 DOI: 10.1038/s41598-024-52066-8] [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: 07/09/2023] [Accepted: 01/12/2024] [Indexed: 01/30/2024] Open
Abstract
Inulin, as a prebiotic, could modulate the gut microbiota. Burn injury leads to gut microbiota disorders and skeletal muscle catabolism. Therefore, whether inulin can improve burn-induced muscle atrophy by regulating microbiota disorders remains unknown. This study aimed to clarify that inulin intake alleviates gut microbiota disorders and skeletal muscle atrophy in burned rats. Rats were divided into the sham group, burn group, prebiotic inulin intervention group, and pseudo-aseptic validation group. A 30% total body surface area (TBSA) third-degree burn wound on dorsal skin was evaluated in all groups except the sham group. Animals in the intervention group received 7 g/L inulin. Animals in the validation group received antibiotic cocktail and inulin treatment. In our study inulin intervention could significantly alleviate the burn-induced skeletal muscle mass decrease and skeletal myoblast cell apoptosis. Inulin intake increased the abundances of Firmicutes and Actinobacteria but decreased the abundance of Proteobacteria. The biosynthesis of amino acids was the most meaningful metabolic pathway distinguishing the inulin intervention group from the burn group, and further mechanistic studies have shown that inulin can promote the phosphorylation of the myogenesis-related proteins PI3K, AKT and P70S6K and activate PI3K/AKT signaling for protein synthesis. In conclusion, inulin alleviated burn induced muscle atrophy through PI3K/AKT signaling and regulated gut microbiota dysbiosis.
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Affiliation(s)
- Shan Gao
- Department of Anaesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoshuai Zhao
- Department of Anaesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yan Leng
- Department of Anaesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhongyuan Xia
- Department of Anaesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
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Shaw P, Sharma AK, Kalonia A, Shukla A, Kumar R, Kirti, Shukla SK. Early cutaneous inflammatory response at different degree of burn and its significance for clinical diagnosis and management. J Tissue Viability 2023; 32:550-563. [PMID: 37414707 DOI: 10.1016/j.jtv.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
A complete characterization of the burn wound based on cutaneous architectural changes and inflammatory response is extremely important to provide evidence for progressive changes in the burn wound. Burn wounds are highly susceptible to conversion into deeper wounds, which need special care and attention; thereby, the complete characterization of burn wound type and their subsequent inflammatory status in the cutaneous system at the earliest is of paramount importance. Inflammatory markers at different degrees will help clinicians devise better and more specific treatment strategies for each burn type. The present study is carried out to profile pro-inflammatory gene expression along with immune cell quantification, vascular perfusion, and histopathological assessment in the cutaneous system of murine models. The study revealed that burn injury caused an immediate increase in vascular perfusion in superficial and partial-thickness burns, whereas there was a decrease in vascular perfusion in full-thickness burns. An influx of lymphocytes at the edges of burn wounds in each type of burn injury was well-orchestrated with the event of vascular perfusion. Further, pro-inflammatory gene expression profiling revealed significant upregulation vis-à-vis upregulation of TNF-α and MCP-1 genes, with an increase in the number of neutrophils following 72 h of injury that evidently cemented the conversion of superficial burn into partial-thickness burn. The molecular findings were profoundly supported by the histopathological changes. Thus, our foundational studies show distinct characteristic cutaneous changes correlated with the expression of key pro-inflammatory genes in three different types of burn injuries. Characterization of these cutaneous inflammatory responses provides a promising future for medical interventions involved with different degrees of burn injury, and it will also help in the pre-clinical testing of therapies for burn injury.
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Affiliation(s)
- Priyanka Shaw
- Molecular and Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi, 110054, India
| | - Ajay Kumar Sharma
- Molecular and Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi, 110054, India
| | - Aman Kalonia
- Molecular and Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi, 110054, India
| | - Amit Shukla
- Department of Pharmacology and Toxicology, College of Veterinary Science and Animal Husbandry, UP Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go-Anusandhan Sansthan (DUVASU), Mathura, 281001, India
| | - Rishav Kumar
- Molecular and Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi, 110054, India
| | - Kirti
- Molecular and Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi, 110054, India
| | - Sandeep Kumar Shukla
- Molecular and Radiation Biosciences, Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, Lucknow Road, Timarpur, New Delhi, 110054, India.
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Li Y, Long Y, Chen X, Wang T, Guo J, Jin L, Wang L, Hou Z. Cytokine patterns in the blister fluid and plasma of patients with fracture blisters. Int Immunopharmacol 2023; 123:110738. [PMID: 37536187 DOI: 10.1016/j.intimp.2023.110738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Fracture blister (FB) is a complication of fracture, which damages to the skin integrity and increases the risk of infection. Inflammation plays an important role in the formation and development of FBs, but its specific mechanism is still unclear. The aim of this study was to investigate the patterns and dynamic changes of inflammatory cytokines in fracture blister fluid (FBF) and plasma. MATERIALS AND METHODS FBF and plasma were collected simultaneously from patients with lower extremity fractures with FBs on the first and fifth day after blisters formation. 92 inflammation-related protein biomarkers were measured in plasma and FBF using Proximity Extension Assay (PEA). We analyzed the cytokine patterns and their dynamic changes in FBF and plasma. Cytokine patterns in plasma from FB patients, fracture without blister patients, and healthy subjects were also analyzed. RESULT The cytokine pattern in FBF and plasma of patients with FBs was different but 11 cytokines were significantly correlated in the two sample types. 23 cytokines were different in plasma across FB patients, fracture without blister patients and healthy subjects. In the analysis of plasma from FB patients and fracture without blister patients, 15 cytokines were significantly different and they may be potential risk factors for the occurrence of FBs. The FBF and plasma showed different cytokine patterns in the early and late stages, with 50 cytokines significantly changed in FBF and 20 cytokines in plasma. CONCLUSION The different cytokine patterns in plasma between FB patients and fracture without blisters patients may be the potential factors for the occurrence of blisters. The cytokine patterns in FBF and plasma showed a dynamic change from the inflammatory stage to the proliferative and repair stage, which indicates that FBs may have new clinical importance in addition to being a soft tissue injury.
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Affiliation(s)
- Yiran Li
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yubin Long
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Country Department of Orthopaedic Surgery, Baoding No. 1 Central Hospital, Baoding, China
| | - Xiaojun Chen
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Wang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jialiang Guo
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China; The School of Medicine, Nankai University, Tianjin, China
| | - Lin Jin
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling Wang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Zhiyong Hou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Kuvvet Yoldaş T, Atalay A, Demirağ K, Uyar M, Çankayalı İ. Changes in Energy Expenditure Determined by Indirect Calorimetry in Severe Burn Patients During the Acute Phase. Cureus 2023; 15:e46705. [PMID: 37818121 PMCID: PMC10560960 DOI: 10.7759/cureus.46705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Severe burn injuries are a major health problem globally. A profound and prolonged hypermetabolic response develops in severe burn injuries and it is crucial to monitor the patients' energy requirements in order to meet them adequately. The aim of the present study was to examine the energy changes during the acute phase using the indirect calorimetry (IC) method in severe burn patients. METHODS The study included 15 severe burn patients. Patients with FiO2 >60%, tube thoracostomy, closed underwater drain (CUWD) and air leakage were excluded from the study. Patients' demographic data, burn percentages, burn types, duration of stay in intensive care, mortality and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were recorded. Indirect calorimeter measurements were taken once from the patients upon their first arrival and during the following four weeks. Resting energy expenditure (REE), basal metabolic rate (BMR), oxygen consumption (VO₂), carbon dioxide production (VCO₂), body temperatures, presence of sepsis, Sequential Organ Failure Assessment (SOFA) and Modified Nutrition Risk in Critically Ill (mNUTRIC) scores were recorded. The data were analysed using SPSS 24 and p-values <0.05 were considered statistically significant. RESULTS In the study, 13 (86.67%) of the patients were male. Patients' mean age was 45.27±18.16 years, and mean BMI 25.99±4.22 kg/m2. Five patients (33.33%) had chronic diseases. The average burn percentage was 45%, with 7 (46.67%) patients having a burn percentage of ≤40%, while 8 (53.33%) had a burn percentage of >40%. A total of 14 (93.33%) had flame burns; 3 (20.00%) patients deceased, and 12 (80.00%) were discharged. The mean APACHE II score was 11.53±6.83. The measured mean values of REE, VO₂, VCO₂ and fever were seen to be the highest in the first week after admission and decreases were observed in the subsequent weeks. SOFA score averages were the highest at admission, and decreased in the following weeks. CONCLUSION Severe burn patients were observed to go through the hypermetabolic process in the acute phase and their energy requirements were high particularly in the first week. It was concluded that regular IC monitoring can be beneficial to fully meet the energy requirements of severe burn patients due to the prolonged hypermetabolic process.
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Affiliation(s)
- Tuba Kuvvet Yoldaş
- Clinic of Anesthesiology and Reanimation, University of Health Sciences, Tepecik Education and Research Hospital, İzmir, TUR
| | - Alev Atalay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
| | - Kubilay Demirağ
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
| | - Mehmet Uyar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
| | - İlkin Çankayalı
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ege University, İzmir, TUR
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Ćertić B, Jovanović M, Karamarković M, Živković M. Challenges in Treating COVID-19 Patients With Severe Burn Injuries. ANNALS OF BURNS AND FIRE DISASTERS 2023; 36:209-213. [PMID: 38680432 PMCID: PMC11042047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 05/01/2024]
Abstract
Here we present a case report of a young female patient with severe burn injury inflicting 27% of total body surface area (TBSA) associated with COVID-19 infection. Upon admission, Acinetobacter spp. (sensitive only to Colistin) was isolated from the wound swabs of the right arm, hand and thorax. On the fifth day after admission, a surgical excision was performed and 12% of TBSA was covered with homotransplants. The following day the patient had a sudden drop in oxygen saturation with hypotension (85/45 mmHg). Additionally, agitation, visual and auditory hallucinations were noticed. We found a massive pleural effusion on the left side and pneumonic foci on the right side. On the thirteenth day after admission the final surgical excision and homotransplantation of the skin were performed. In the following days, debridement of all necrotic tissue and covering of all the burned areas with homotransplants were done. Hemodynamic instability of the patient progressed along with the finding on the chest radiography, despite the local finding including adherent homotransplants with no signs of lysis or local infection at the wound beds. Due to low oxygen saturation, the patient was intubated on the fourteenth day after admission. Despite the measures taken, the lethal outcome occurred on the twenty-fifth day after admission to our Clinic. A decision on the right timing for surgical treatment in severely burned COVID-19 patients needs to be investigated in order to enable surgeons to make evidence-based decisions during the pandemic.
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Affiliation(s)
- B. Ćertić
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
| | - M. Jovanović
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
- School of Medicine University of Belgrade, Belgrade, Serbia
| | - M. Karamarković
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
| | - M. Živković
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
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Sobczak J, Burzyńska M, Sikora A, Wysocka A, Karawani J, Sikora JP. Post-Traumatic Stress Response and Appendicitis in Children-Clinical Usefulness of Selected Biomarkers. Biomedicines 2023; 11:1880. [PMID: 37509519 PMCID: PMC10377452 DOI: 10.3390/biomedicines11071880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Acute appendicitis is an inflammatory process which is one of the most frequent global causes of surgical interventions in children. The goal of the study was to determine whether acute phase proteins, that is, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL-6), transforming growth factor-beta1 (TGF-β1) and cortisol (HC) play a role in the pathomechanism of post-trauma stress response of the organism and to establish the impact of the applied surgical procedure and/or of inflammation on their concentrations. An additional purpose was to establish the clinical usefulness of the studied biomarkers in the diagnostics of appendicitis. CRP concentrations were quantified via the immunoturbidimetric method, while the levels of IL-6 and PCT were assessed using a bead-based multiplexed immunoassay system in a microplate format (Luminex xMAP technology); NGAL, TGF-β1 and cortisol concentrations were determined via the enzyme-linked immunosorbent assay (ELISA) technique. All the investigated biomarkers were assayed twice, i.e., immediately before the surgery and 12-24 h after its completion. Significant increases in CRP, IL-6 and PCT concentrations were found in all children subjected to laparoscopic surgeries (p = 0.001, p = 0.006, and p = 0.009, respectively) and open (classic) surgeries (p = 0.001, p = 0.016, and p = 0.044, respectively) compared to the initial concentrations. The patients undergoing classical surgery moreover presented with significant (p = 0.002, and p = 0.022, respectively) increases in NGAL and TGF-β1 levels after the procedures. In a group of children undergoing laparoscopic surgery, the appendicitis induced an increase in cortisol concentration, whereas in patients undergoing classical surgery the increase in the levels of this biomarker was caused by the type of performed surgical procedure. Simultaneously assaying the levels of CRP, NGAL and IL-6 (p = 0.008, p = 0.022, and p = 0.000, respectively) may prove useful in clinical practice, enabling the diagnosis of appendicitis in paediatric patients reporting to a hospital with abdominal pains, in addition to data from anamnesis and from clinical or ultrasound examination. The performed study confirms the participation of examined biomarkers in the pathomechanism of post-injury stress reaction of the organism to surgical trauma.
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Affiliation(s)
- Jarosław Sobczak
- Department of Paediatric Emergency Medicine, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
- Department of Management and Logistics in Healthcare, Medical University of Łódź, ul. Lindleya 6, 90-131 Łódź, Poland
| | - Monika Burzyńska
- Department of Epidemiology and Biostatistics, Chair of Social and Preventive Medicine, Medical University of Łódź, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Anna Sikora
- Department of Intensive Care and Anaesthesiology, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
| | - Anna Wysocka
- Department of Paediatric Surgery and Oncology, Chair of Surgical Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
| | - Jakub Karawani
- Faculty of Medicine, Lazarski University, ul. Świeradowska 43, 02-662 Warsaw, Poland
| | - Janusz P Sikora
- Department of Paediatric Emergency Medicine, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
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Rehou S, Abdullahi A, Jeschke MG. CLASSIC IL-6 SIGNALING IS ASSOCIATED WITH POOR OUTCOMES IN BURN PATIENTS. Shock 2023; 59:155-160. [PMID: 36427079 DOI: 10.1097/shk.0000000000002051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Background: Interleukin (IL)-6 is a multifunctional cytokine with both a proinflammatory and anti-inflammatory role. In many studies, IL-6 increases rapidly after burn injury and is associated with poor outcomes. However, there are two aspects to IL-6; it can signal via its soluble IL-6 receptor (sIL-6R), which is referred to as trans-signaling and is regarded as the proinflammatory pathway. The role of sIL-6R postburn injury has yet to be explored in its entirety. We hypothesized that patients with a lower ratio of IL-6 to sIL-6R would have worse outcomes. Methods: Patients admitted to our burn center within 7 days of injury were included in this study. Patients were divided into two groups based on IL-6 and sIL-6R levels measured within the first 7 days postburn injury. Patients were in the high ratio group if their IL-6/sIL-6R ratio was ≥0.185. Clinical outcomes included organ biomarkers, morbidities, and hospital length of stay. Groups were compared using Student's t test, Mann-Whitney U , and Fisher's exact test as appropriate; a P value of <0.05 was considered statistically significant. Results: We studied 86 patients with a median age of 50 years (36-66 years) and a median total body surface area burn of 18% (10-31). There were 40 patients categorized with a low IL-6/sIL-6R ratio and 46 patients with a high IL-6/sIL-6R ratio. Patients in the high IL-6/sIL-6R ratio group had a significantly greater total body surface area burn ( P < 0.001) and a significantly greater proportion of patients with inhalation injury ( P = 0.001). Levels of IL-6 were significantly higher in patients with a high IL-6/sIL-6R ratio ( P < 0.0001). However, levels of sIL-6R were not significantly different among the low and high groups ( P = 0.965). Mortality was significantly greater in the high IL-6/sIL-6R ratio group (3% vs. 26%; P = 0.002). Conclusions: Interestingly, patients with a higher ratio of IL-6/sIL-6R had significantly greater mortality. Using sIL-6R as a marker for the proinflammatory immune response, we expected patients with a lower IL-6/sIL-6R ratio to have poor outcomes, typically associated with a hyperinflammatory or exaggerated immune response. However, the absolute value of sIL-6R did not differ. This suggests that classical signaling of IL-6 via its membrane-bound receptor, with an anti-inflammatory function, is important.
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Schneider I, Calcagni M, Buschmann J. Adipose-derived stem cells applied in skin diseases, wound healing and skin defects: a review. Cytotherapy 2023; 25:105-119. [PMID: 36115756 DOI: 10.1016/j.jcyt.2022.08.005] [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: 04/06/2022] [Revised: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 01/18/2023]
Abstract
Adipose tissue presents a comparably easy source for obtaining stem cells, and more studies are increasingly investigating the therapeutic potential of adipose-derived stem cells. Wound healing, especially in chronic wounds, and treatment of skin diseases are some of the fields investigated. In this narrative review, the authors give an overview of some of the latest studies concerning wound healing as well as treatment of several skin diseases and concentrate on the different forms of application of adipose-derived stem cells.
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Affiliation(s)
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Johanna Buschmann
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
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Ghanbari A, Masoumi S, Kazemnezhad Leyli E, Mahdavi-Roshan M, Mobayen M. Effects of Flaxseed Oil and Olive Oil on Markers of Inflammation and Wound Healing in Burn Patients: A Randomized Clinical Trial. Bull Emerg Trauma 2023; 11:32-40. [PMID: 36818058 PMCID: PMC9923033 DOI: 10.30476/beat.2022.97070.1399] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 02/24/2023] Open
Abstract
Objectives To study the anti-inflammatory and antioxidant effects of flaxseed oil and olive oil on inflammatory markers for facilitating wound healing. Methods One hundred and twelve patients were randomly selected to four groups with a total burn surface area (TBSA) of 20-50%. The four groups includes olive oil (OO), flaxseed oil (FO), mixture of olive oil and flaxseed oil (OF), and control group and received 30g of oils for three weeks. Serum high-sensitivity C-reactive protein (hs-CRP), ferritin and albumin level as inflammatory markers, as well as cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) as the lipid profile were explored. Wound healing was assessed by photographing on days 2, 8, 15, and 22 (during three weeks of intervention) and were analyzed in imageJ software. Results The greatest reduction in the level of hs-CRP and ferritin was observed in the OF (-21.38±44.41) (-132.79±165.36), while the lowest reduction was reported in the control group (-36.36±79.03) (141.08±262.36). Compared to control group, OO significantly increased albumin (0.88±0.65). Reduction of wound healing at the end of the first week of intervention was not significant in the study groups. However, the stereology examination showed significant improvement in wound healing at the end of the second and third weeks in the OF. Conclusion Based on the findings, combination of herbal oils reduce inflammation and improve wound healing and showed positive effects on the size of wounds in burn patients.
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Affiliation(s)
- Atefeh Ghanbari
- Department of Nursing (MedicalSurgical), Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Sanaz Masoumi
- Burn and Regenerative Medicine Research center, Velayat Burn University Hospital, Guilan University of Medical Sciences, Rasht, Iran,Corresponding author: Sanaz Masoumi Address: Burn and Regenerative Medicine Research center, Guilan University of Medical Sciences, Rasht, Iran. e-mail:
| | - Ehsan Kazemnezhad Leyli
- Department of Biostatistics, Social Determinants of Health Research Center (SDHRC), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Marjan Mahdavi-Roshan
- Cardiovascular Diseased Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research center, Guilan University of Medical Sciences, Rasht, Iran
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12
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Zhong C, Liang G, Li P, Shi K, Li F, Zhou J, Xu D. Inflammatory response: The target for treating hyperpigmentation during the repair of a burn wound. Front Immunol 2023; 14:1009137. [PMID: 36817442 PMCID: PMC9929571 DOI: 10.3389/fimmu.2023.1009137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Hyperpigmentation is a common complication in patients with burn injuries during wound healing; however, the mechanisms underlying its occurrence and development remain unclear. Recently, postinflammatory hyperpigmentation (PIH) was found to result from overproduction of melanin. Local or systemic inflammatory responses are often observed in patients who develop hyperpigmentation. However, we lack studies on the relationship between PIH and burn injury. Therefore, we comprehensively reviewed the existing literature on the melanogenesis of the skin, inflammatory mechanisms in pigmentation, and local or systemic alteration in inflammatory cytokines in patients suffering from burn trauma to elucidate the relationship between PIH and burn injury. We believe that this review will guide further research on regulating melanin production in the burn management process.
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Affiliation(s)
- Chi Zhong
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Geao Liang
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Peiting Li
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ke Shi
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Fuyin Li
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianda Zhou
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dan Xu
- Department of Plastic Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
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13
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Labuz DR, Lewis G, Fleming ID, Thompson CM, Zhai Y, Firpo MA, Leung DT. Targeted multi-omic analysis of human skin tissue identifies alterations of conventional and unconventional T cells associated with burn injury. eLife 2023; 12:82626. [PMID: 36790939 PMCID: PMC9931389 DOI: 10.7554/elife.82626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023] Open
Abstract
Burn injuries are a leading cause of unintentional injury, associated with a dysfunctional immune response and an increased risk of infections. Despite this, little is known about the role of T cells in human burn injury. In this study, we compared the activation and function of conventional T cells and unconventional T cell subsets in skin tissue from acute burn (within 7 days from initial injury), late phase burn (beyond 7 days from initial injury), and non-burn patients. We compared T cell functionality by a combination of flow cytometry and a multi-omic single-cell approach with targeted transcriptomics and protein expression. We found a significantly lower proportion of CD8+ T cells in burn skin compared to non-burn skin, with CD4+ T cells making up the bulk of the T cell population. Both conventional and unconventional burn tissue T cells show significantly higher IFN-γ and TNF-α levels after stimulation than non-burn skin T cells. In sorted T cells, clustering showed that burn tissue had significantly higher expression of homing receptors CCR7, S1PR1, and SELL compared to non-burn skin. In unconventional T cells, including mucosal-associated invariant T (MAIT) and γδ T cells, we see significantly higher expression of cytotoxic molecules GZMB, PRF1, and GZMK. Multi-omics analysis of conventional T cells suggests a shift from tissue-resident T cells in non-burn tissue to a circulating T cell phenotype in burn tissue. In conclusion, by examining skin tissue from burn patients, our results suggest that T cells in burn tissue have a pro-inflammatory rather than a homeostatic tissue-resident phenotype, and that unconventional T cells have a higher cytotoxic capacity. Our findings have the potential to inform the development of novel treatment strategies for burns.
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Affiliation(s)
- Daniel R Labuz
- Division of Infectious Disease, Department of Internal Medicine, University of UtahSalt Lake CityUnited States,Division of Microbiology & Immunology, Department of Pathology, University of UtahSalt Lake CityUnited States
| | - Giavonni Lewis
- Department of Surgery, School of Medicine, University of UtahSalt Lake CityUnited States
| | - Irma D Fleming
- Department of Surgery, School of Medicine, University of UtahSalt Lake CityUnited States
| | - Callie M Thompson
- Department of Surgery, School of Medicine, University of UtahSalt Lake CityUnited States
| | - Yan Zhai
- Department of Surgery, School of Medicine, University of UtahSalt Lake CityUnited States
| | - Matthew A Firpo
- Department of Surgery, School of Medicine, University of UtahSalt Lake CityUnited States
| | - Daniel T Leung
- Division of Infectious Disease, Department of Internal Medicine, University of UtahSalt Lake CityUnited States,Division of Microbiology & Immunology, Department of Pathology, University of UtahSalt Lake CityUnited States
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14
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Mahung C, Stepp WH, Long C, Malfitano M, Saklayici I, Wallet SM, Zhou LY, Zhou H, Cairns BA, Maile R. Early expression of IL-10, IL-12, ARG1, and NOS2 genes in peripheral blood mononuclear cells synergistically correlate with patient outcome after burn injury. J Trauma Acute Care Surg 2022; 93:702-711. [PMID: 35363228 PMCID: PMC9522922 DOI: 10.1097/ta.0000000000003602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND No methods exist to rapidly and accurately quantify the immune insult created by burn injuries. The development of a rapid, noninvasive clinical biomarker assay that evaluates a burn patient's underlying immune dysfunction and predicts clinical outcomes could transform burn care. We aimed to determine a set of peripheral biomarkers that correlates with clinical outcomes of burn patients. METHODS This prospective observational study enrolled two patient cohorts within a single burn center into an institutionally approved institutional review board study. Blood draws were performed <48 hours after injury. Initial unbiased immune gene expression analysis compared 23 burn patients and 6 healthy controls using multiplex immune gene expression analysis of RNA from peripheral blood mononuclear cells. We then performed confirmatory outcomes analysis in 109 burn patients and 19 healthy controls using a targeted rapid quantitative polymerase chain reaction. Findings were validated and modeled associations with clinical outcomes using a regression model. RESULTS A total of 149 genes with a significant difference in expression from burn patients compared with controls were identified. Pathway analysis identified pathways related to interleukin (IL)-10 and inducible nitric oxide synthase signaling to have significant z scores. quantitative polymerase chain reaction analysis of IL-10, IL-12, arginase 1 (ARG1), and inducible nitric oxide synthase demonstrated that burn injury was associated with increased expression of ARG1 and IL-10, and decreased expression of nitric oxide synthase 2 (NOS2) and IL-12. Burn severity, acute lung injury, development of infection, failure of skin autograft, and mortality significantly correlated with expression of one or more of these genes. Ratios of IL-10/IL-12, ARG1/NOS2, and (ARG1-IL-10)/(NOS2-IL-12) transcript levels further improved the correlation with outcomes. Using a multivariate regression model, adjusting for patient confounders demonstrated that (ARG1-IL-10)/(NOS2-IL-12) significantly correlated with burn severity and development of acute lung injury. CONCLUSION We present a means to predict patient outcomes early after burn injury using peripheral blood, allowing early identification of underlying immune dysfunction. LEVEL OF EVIDENCE Prognostic/Epidemiological; Level II.
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15
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Lin JC, Wu GH, Zheng JJ, Chen ZH, Chen XD. Prognostic Values of Platelet Distribution Width and Platelet Distribution Width-to-Platelet Ratio in Severe Burns. Shock 2022; 57:494-500. [PMID: 34812187 PMCID: PMC8906250 DOI: 10.1097/shk.0000000000001890] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Platelet distribution width (PDW) and PDW-to-platelet ratio (PPR) have been proven to be good prognostic indicators for many diseases. However, their prognostic values in severe burns have not been reported. OBJECTIVE To investigate the early time course of PDW and PPR in severe burn patients and investigate their prognostic values. METHODS This is a 16-year, single-center retrospective study of 590 severe burn patients. The complete blood count parameters on day 1, day 3, and day 7 postburn, including PDW and PPR, were collected. Receiver operating characteristic curves (ROC) analysis, multiple logistic regression analysis and Kaplan-Meier survival analysis were performed to evaluate the prognostic values of PDW and PPR in severe burn patients. RESULTS According to 120-day follow-up records, 96 patients were nonsurvivors and 494 patients were survivors. ROC and area under the curve (AUC) analysis showed that, for predicting 120-day prognosis, the AUC of PDW (0.782) and PPR (0.816) on day 3 was the highest, followed by the AUC of PDW (0.764) and PPR (0.750) on day 7. The ROC-AUC of PPR (0.816) on day 3 was very close to that of the ABSI score (0.818). Multiple logistic regression analysis showed that the PDW (P = 0.033 and P = 0.009) and PPR (P = 0.052 and P = 0.046) on day 3 and day 7 were all significantly independently positively associated with 120-day mortality. Kaplan-Meier survival analysis showed that high PDW and PPR were both significantly associated with a high 120-day mortality rate on day 3 and day 7. CONCLUSION PDW and PPR on day 3 and day 7 were independent risk factors for 120-day mortality in severe burn patients. These objective and readily available prognostic indicators may be more clinically favored.
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Affiliation(s)
- Jian-Chang Lin
- Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China
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16
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Therapeutic Effect of Darkling Beetle ( Zophobas morio) Hemolymph on Skin Thermal Injury in Mice Infected by Staphylococcus haemolyticus. Vet Sci 2021; 8:vetsci8120319. [PMID: 34941846 PMCID: PMC8705897 DOI: 10.3390/vetsci8120319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 01/18/2023] Open
Abstract
Staphylococci are the most common pathogens isolated from skin infections in livestock or companion animals. Antibiotic therapy is the best treatment for infections, but local or systemic use of antimicrobials increases the risk of bacterial resistance. Insects are rich in antimicrobial peptides, which can reduce bacterial resistance and can be used to treat bacterial infections after skin burns. We propose that the use of the darkling beetle (Z. morio) hemolymph to treat skin infections in mice by Staphylococcus haemolyticus is one of the alternatives. Z. morio hemolymph alleviated the increase in wound area temperature in mice with a skin infection, reduced the bacterial load of the wound, and accelerated the wound healing speed significantly. Pathological sections showed that Z. morio hemolymph can significantly reduce inflammatory cell infiltration, and promote skin tissue repair. Real-time fluorescent quantitative polymerase chain reaction (PCR) revealed that the Z. morio hemolymph can significantly reduce the levels of pro-inflammatory cytokines, including interleukin-1 beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and chemokine interleukin-8 (IL-8). Our findings suggest that Z. morio antibacterial hemolymph can promote wound contraction, relieve local inflammatory responses and promote wound healing in mice infected with a heat injury, which has a positive therapeutic effect and enormous potential for skin thermal injury.
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17
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Ma D, Li X, Wang Y, Cai L, Wang Y. Excessive fat expenditure in cachexia is associated with dysregulated circadian rhythm: a review. Nutr Metab (Lond) 2021; 18:89. [PMID: 34627306 PMCID: PMC8502262 DOI: 10.1186/s12986-021-00616-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/20/2021] [Indexed: 01/06/2023] Open
Abstract
Cachexia is a progressive metabolic disorder characterized by the excessive depletion of adipose tissue. This hypermetabolic condition has catastrophic impacts on the survival and quality of life for patients suffering from critical illness. However, efficient therapies to prevent adipose expenditure have not been discovered. It has been established that the circadian clock plays an important role in modulating fat metabolic processes. Recently, an increasing number of studies had provided evidence showing that disrupted circadian rhythm leads to insulin resistance and obesity; however, studies analyzing the relationship between circadian misalignment and adipose tissue expenditure in cachexia are scarce. In the present review, we cover the involvement of the circadian clocks in the regulation of adipogenesis, lipid metabolism and thermogenesis as well as inflammation in white and brown adipose tissue. According to the present review, we conclude that circadian clock disruption is associated with lipid metabolism imbalance and elevated adipose tissue inflammation. Moreover, under cachexia conditions, lipid synthesis and storage processes lost rhythm and decreased, while lipolysis and thermogenesis activities remained high for 24 h. Therefore, disordered circadian clock may be responsible for fat expenditure in cachexia by adversely influencing lipid synthesis/ storage/lipolysis/utilization. Further study needs to be performed to explore the direct interaction between circadian clock and fat expenditure in cachexia, it will likely provide potential efficient drugs for the treatment of fat expenditure in cachexia.
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Affiliation(s)
- Dufang Ma
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, 250014, Shandong, China
| | - Xiao Li
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, 250014, Shandong, China
| | - Yongcheng Wang
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, 250014, Shandong, China
| | - Lu Cai
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, 250014, Shandong, China
| | - Yong Wang
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, 250014, Shandong, China.
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18
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Darden DB, Brakenridge SC, Efron PA, Ghita GL, Fenner BP, Kelly LS, Mohr AM, Moldawer LL, Moore FA. Biomarker Evidence of the Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) in Chronic Critical Illness (CCI) After Surgical Sepsis. Ann Surg 2021; 274:664-673. [PMID: 34506322 PMCID: PMC8592255 DOI: 10.1097/sla.0000000000005067] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze serial biomarkers of the persistent inflammation, immunosuppression, and catabolism syndrome (PICS) to gain insight into the pathobiology of chronic critical illness (CCI) after surgical sepsis. BACKGROUND Although early deaths after surgical intensive care unit sepsis have decreased and most survivors rapidly recover (RAP), one third develop the adverse clinical trajectory of CCI. However, the underlying pathobiology of its dismal long-term outcomes remains unclear. METHODS PICS biomarkers over 14 days from 124 CCI and 225 RAP sepsis survivors were analyzed to determine associations and prediction models for (1) CCI (≥14 intensive care unit days with organ dysfunction) and (2) dismal 1-year outcomes (Zubrod 4/5 performance scores). Clinical prediction models were created using PIRO variables (predisposition, insult, response, and organ dysfunction). Biomarkers were then added to determine if they strengthened predictions. RESULTS CCI (vs RAP) and Zubrod 4/5 (vs Zubrod 0-3) cohorts had greater elevations in biomarkers of inflammation (interleukin [IL]-6, IL-8, interferon gamma-induced protein [IP-10], monocyte chemoattractant protein 1), immunosuppression (IL-10, soluble programmed death ligand-1), stress metabolism (C-reactive protein, glucagon-like peptide 1), and angiogenesis (angiopoietin-2, vascular endothelial growth factor, vascular endothelial growth factor receptor-1, stromal cell-derived factor) at most time-points. Clinical models predicted CCI on day 4 (area under the receiver operating characteristics curve [AUC] = 0.89) and 1 year Zubrod 4/5 on day 7 (AUC = 0.80). IL-10 and IP-10 on day 4 minimally improved prediction of CCI (AUC = 0.90). However, IL-10, IL-6, IL-8, monocyte chemoattractant protein 1, IP-10, angiopoietin-2, glucagon-like peptide 1, soluble programmed death ligand-1, and stromal cell-derived factor on day 7 considerably improved the prediction of Zubrod 4/5 status (AUC = 0.88). CONCLUSIONS Persistent elevations of PICS biomarkers in the CCI and Zubrod 4/5 cohorts and their improved prediction of Zubrod 4/5 validate that PICS plays a role in CCI pathobiology.
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Affiliation(s)
- Dijoia B Darden
- Department of Surgery, University of Florida, Gainesville, Florida
| | | | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Gabriela L Ghita
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | | | - Lauren S Kelly
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Alicia M Mohr
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Lyle L Moldawer
- Department of Surgery, University of Florida, Gainesville, Florida
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19
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Alipoor E, Hosseinzadeh-Attar MJ, Salehi S, Dahmardehei M, Yaseri M, Emami MR, Hajian M, Rezayat SM, Jazayeri S. Effect of Collagen Hydrolysate and Fish Oil on High-Sensitivity C-Reactive Protein and Glucose Homeostasis in Patients with severe Burn; a Randomized Clinical Trial. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e50. [PMID: 34405148 PMCID: PMC8366458 DOI: 10.22037/aaem.v9i1.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Collagen and omega-3 fatty acids (FAs) are suggested to have anti-inflammatory, anti-oxidant, and insulin-sensitizing properties. The aim of this study was to investigate the effect of collagen hydrolysate and omega-3 FAs on inflammation and insulin resistance in patients with major burns. Methods: In this double-blind randomized clinical trial, 66 patients with 20-45% burns were assigned to either of the three groups of collagen (40 gr/d), collagen (40 gr/d) plus fish oil (10 ml/d), or control. High-sensitivity C-reactive protein (hs-CRP), fasting blood glucose (FBG) and insulin concentrations, and homeostatic model assessment for insulin resistance (HOMA-IR) were assessed at baseline, as well as end of weeks two and three. Results: Based on post-hoc analyses, hs-CRP levels were significantly lower in the collagen (p=0.026) and collagen+omega-3 (p=0.044) groups compared to the control group, at week three. However, pre- to post- (week three) changes of hs-CRP were significantly higher only in the collagen+omega-3 group compared to the control group (173.2 vs. 103.7 mg/l, p=0.024). After three weeks of the intervention, insulin (11.3 and 11.9 vs. 22.8 µIU/ml) and HOMA-IR (2.9 and 2.8 vs. 7.9) values seemed to be clinically, but not statistically, lower in both intervention groups compared to the control group. Pre- to post- (week three) values of FBG decreased significantly in the collagen (p=0.002) and collagen+omega-3 (p=0.036) groups. Insulin (p=0.008) and HOMA-IR (p=0.001) decreased significantly only in the collagen+omega-3 group at week three compared to the baseline. Conclusions: Supplementation with collagen hydrolysate and omega-3 FAs can improve hs-CRP concentration and probably insulin resistance in patients with severe burns. Omega-3 FAs had additional effects on modulating inflammation. Larger clinical trials are needed to confirm the current findings especially in terms of glucose homeostasis.
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Affiliation(s)
- Elham Alipoor
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Salehi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Emami
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hajian
- Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mahdi Rezayat
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nanomedicine, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Jazayeri
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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20
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Wu SC, Rau CS, Kuo PJ, Shih FY, Lin HP, Wu YC, Hsieh TM, Liu HT, Hsieh CH. Profiling the Expression of Circulating Acute-Phase Proteins, Cytokines, and Checkpoint Proteins in Patients with Severe Trauma: A Pilot Study. J Inflamm Res 2021; 14:3739-3753. [PMID: 34393495 PMCID: PMC8354739 DOI: 10.2147/jir.s324056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/28/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose Severe trauma may lead to the systemic release of inflammatory mediators into the circulation with profound acute-phase responses; however, the understanding of the expression of these mediators remains limited. This study aimed to characterize the alterations in the expression of circulating acute-phase proteins, cytokines, and checkpoint proteins in patients with severe trauma injuries. Patients and Methods The study population included trauma patients in the intensive care unit (ICU) with an injury severity score equal to or greater than 16 and who had used a ventilator for 48 hours. A total of 12 female and 28 male patients were recruited for the study; six patients died and 34 survived. Blood samples collected at acute stages were compared with those drawn at the subacute stage, the time when the patients were discharged from the ICU, or before the discharge of the patients from the hospital. Results The study identified that the expression of acute-phase proteins, such as alpha-1-acid glycoprotein and C-reactive protein, and cytokines, including granulocyte colony-stimulating factor, interleukin-6, and interleukin-1 receptor antagonist, was elevated in the circulation after severe trauma. In contrast, the levels of acute-phase proteins, such as alpha-2-macroglobulin, serum amyloid P, and von Willebrand factor, and cytokines, including interleukin-4 and interferon gamma-induced protein 10, were reduced. However, there were no significant differences in the expression of checkpoint proteins in the circulation. Conclusion The dysregulated proteins identified in this study may serve as potential therapeutic targets or biomarkers for treating patients with severe trauma. However, the related biological functions of these dysregulated factors require further investigation to validate their functions.
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Affiliation(s)
- Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Jen Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Yuan Shih
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Ping Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chan Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ting-Min Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hang-Tsung Liu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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21
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Carlton M, Voisey J, Jones L, Parker TJ, Punyadeera C, Cuttle L. An exploratory study demonstrating that salivary cytokine profiles are altered in children with small area thermal injury. J Burn Care Res 2021; 43:613-624. [PMID: 34323997 DOI: 10.1093/jbcr/irab147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Serum can be used to investigate changes in cytokine concentration following burn injury in children, however for children receiving treatment in an outpatient setting, blood is not routinely collected and therefore cannot be used for monitoring. The aim of this study was to investigate the use of saliva as a non-invasive tool for predicting burn outcomes by measuring the concentration of salivary cytokines in children with small area burns. A multiplex cytokine assay was used to measure 17 cytokines in the saliva of paediatric patients with burns (n = 20) and healthy controls (n = 20). After the removal of cytokines that had >30% of samples below the assay lower detection limit, six cytokines including IL-1β, IL-4, IL-7, IL-8, MCP-1 and TNFα were analysed for association with burns. IL-1β and IL-4 were found to be significantly elevated in the paediatric burn patients compared to healthy controls. Interestingly, IL-1β was also significantly elevated in scald burns, compared to contact burns. In addition, biologically meaningful differences in cytokine concentration were identified in patients with different burn characteristics, which warrant further investigation. This exploratory study provides evidence that cytokines can be detected in the saliva of children and that salivary cytokine profiles differ between healthy controls and children with burns. Overall, this study demonstrates the value of saliva for the investigation of cytokines and its potential application in paediatric diagnostics, specifically in situations where blood collection is not appropriate.
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Affiliation(s)
- Morgan Carlton
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Joanne Voisey
- Centre for Genomics and Personalised Health, School of Biomedical Science, Faculty of Health, Queensland University of Technology
| | - Lee Jones
- Research Methods Group & Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Tony J Parker
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Leila Cuttle
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
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22
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Barayan D, Abdullahi A, Vinaik R, Knuth CM, Auger C, Jeschke MG. Interleukin-6 blockade, a potential adjunct therapy for post-burn hypermetabolism. FASEB J 2021; 35:e21596. [PMID: 33871073 DOI: 10.1096/fj.202100388r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023]
Abstract
Severe burns remain a leading cause of death and disability worldwide. Despite advances in patient care, the excessive and uncontrolled hypermetabolic stress response induced by this trauma inevitably affects every organ system causing substantial morbidity and mortality. Recent evidence suggests interleukin-6 (IL-6) is a major culprit underlying post-burn hypermetabolism. Indeed, genetic deletion of IL-6 alleviates various complications associated with poor clinical outcomes including the adverse remodeling of adipose tissue, cachexia and hepatic steatosis. Thus, pharmacological blockade of IL-6 may be a more favorable treatment option to fully restore metabolic function after injury. To test this, we investigated the safety and effectiveness of blocking IL-6 for post-burn hypermetabolism using a validated anti-IL-6 monoclonal antibody (mAb) in our experimental murine model. Here, we show daily anti-IL-6 mAb administration protects against burn-induced weight loss (P < .0001) without any adverse effect on mortality. At the organ level, post-burn treatment with the IL-6 blocker suppressed the thermogenic activation of adipose tissue (P < .01) and its associated wasting (P < .05). The reduction of browning-induced lipolysis (P < .0001) indirectly decreased hepatic lipotoxicity (P < .01) which improved liver dysfunction (P < .05). Importantly, the beneficial effects of this anti-IL-6 agent extended to the skin, reflected by the decrease in excessive collagen deposition (P < .001) and genes involved in pathologic fibrosis and scarring (P < .05). Together, our results indicate that post-burn IL-6 blockade leads to significant improvements in systemic hypermetabolism by inhibiting pathological alterations in key immunometabolic organs. These findings support the therapeutic potential of anti-IL-6 interventions to improve care, quality of life, and survival in burned patients.
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Affiliation(s)
| | | | - Roohi Vinaik
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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23
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Krbcová Moudrá V, Zajíček R, Bakalář B, Bednář F. Burn-Induced Cardiac Dysfunction: A Brief Review and Long-Term Consequences for Cardiologists in Clinical Practice. Heart Lung Circ 2021; 30:1829-1833. [PMID: 34275754 DOI: 10.1016/j.hlc.2021.06.444] [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: 03/11/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe burn injury is a specific type of trauma, which induces a unique complex of responses in the body and leads to an extreme increase in stress hormones and proinflammatory cytokines. These hypermetabolic and stress responses are desirable in the acute phase but can persist for several years and lead - due to several mechanisms - to many late complications, including myocardial dysfunction. METHODS The databases of PubMed, ScienceDirect, National Institutes of Health (NIH) of the United States, and Google Scholar were searched. Studies relevant to the topic of late cardiovascular dysfunction after burn injury were compiled using key words. RESULTS Burn-induced heart disease significantly increases morbidity and mortality and contributes to the reduction in the quality of life of patients after severe burn trauma. A variety of mechanisms causing myocardial dysfunction after burn trauma have been detailed but understanding all of the exact consequences is limited, especially regarding chronic cardiovascular changes. CONCLUSION A detailed understanding of the pathophysiology of chronic cardiac changes can contribute to a comprehensive and preventive treatment plan and improve long-term outcomes of burn patients.
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Affiliation(s)
- Veronika Krbcová Moudrá
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Cardiology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Robert Zajíček
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; The Burn Center Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Bohumil Bakalář
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; The Burn Center Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - František Bednář
- Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Cardiology, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
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24
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Abstract
Severely burned patients suffer from a hypermetabolic syndrome that can last for years after the injury has resolved. The underlying cause of these metabolic alterations most likely involves the persistent elevated catecholamine levels that follow the surge induced by thermal injury. At the cellular level, endoplasmic reticulum (ER) stress in metabolic tissues is a hallmark observed in patients following burn injury and is associated with several detrimental effects. Therefore, ER stress could be the underlying cellular mechanism of persistent hypermetabolism in burned patients. Here, we show that catecholamines induce ER stress and that adreno-receptor blockers reduce stress responses in the HepG2 hepatocyte cell line. Our results also indicate that norepinephrine (NE) significantly induces ER stress in HepG2 cells and 3T3L1 mouse adipocytes. Furthermore, we demonstrate that the alpha-1 blocker, prazosin, and beta blocker, propranolol, block ER stress induced by NE. We also show that the effects of catecholamines in inducing ER stress are cell type-specific, as NE treatment failed to evoke ER stress in human fibroblasts. Thus, these findings reveal the mechanisms used by catecholamines to alter metabolism and suggest inhibition of the receptors utilized by these agents should be further explored as a potential target for the treatment of ER stress-mediated disease.
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25
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Chronic Critical Illness and PICS Nutritional Strategies. J Clin Med 2021; 10:jcm10112294. [PMID: 34070395 PMCID: PMC8197535 DOI: 10.3390/jcm10112294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/26/2022] Open
Abstract
The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI.
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26
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Glucose Metabolism in Burns-What Happens? Int J Mol Sci 2021; 22:ijms22105159. [PMID: 34068151 PMCID: PMC8153015 DOI: 10.3390/ijms22105159] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Severe burns represent an important challenge for patients and medical teams. They lead to profound metabolic alterations, trigger a systemic inflammatory response, crush the immune defense, impair the function of the heart, lungs, kidneys, liver, etc. The metabolism is shifted towards a hypermetabolic state, and this situation might persist for years after the burn, having deleterious consequences for the patient's health. Severely burned patients lack energy substrates and react in order to produce and maintain augmented levels of glucose, which is the fuel "ready to use" by cells. In this paper, we discuss biological substances that induce a hyperglycemic response, concur to insulin resistance, and determine cell disturbance after a severe burn. We also focus on the most effective agents that provide pharmacological modulations of the changes in glucose metabolism.
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27
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Al-Benna S. Inflammatory and coagulative pathophysiology for the management of burn patients with COVID-19: systematic review of the evidence. ANNALS OF BURNS AND FIRE DISASTERS 2021; 34:3-9. [PMID: 34054381 PMCID: PMC8126364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/13/2020] [Indexed: 06/12/2023]
Abstract
The pathogenesis of coronavirus disease 2019 (COVID-19) involves a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system and acute phase proteins. This hyperinflammatory response predisposes patients to thromboembolic disease, acute lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. In burn injuries, damaged tissues induce a local and systemic inflammatory response through pathways associated to COVID-19. As such, a COVID-19 positive patient sustaining burn injuries may have an amplified response to the burn insult due to their baseline hyperinflammatory and hypercoagulable states. Burn patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. The concurrent pathogenesis of COVID-19 and the inflammatory response in burn injury have serious implications on the management of burn patients.
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Affiliation(s)
- S. Al-Benna
- Division of Plastic and Reconstructive Surgery, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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28
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Moins-Teisserenc H, Cordeiro DJ, Audigier V, Ressaire Q, Benyamina M, Lambert J, Maki G, Homyrda L, Toubert A, Legrand M. Severe Altered Immune Status After Burn Injury Is Associated With Bacterial Infection and Septic Shock. Front Immunol 2021; 12:586195. [PMID: 33737924 PMCID: PMC7960913 DOI: 10.3389/fimmu.2021.586195] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/09/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Burn injury is associated with a high risk of death. Whether a pattern of immune and inflammatory responses after burn is associated with outcome is unknown. The aim of this study was to explore the association between systemic immune and inflammatory responses and outcome in severely-ill burn patients. Materials and Methods: Innate immunity, adaptive immunity, activation and stress and inflammation biomarkers were collected at admission and days 2, 7, 14, and 28 in severely-ill adult burn patients. Primary endpoint was mortality at day 90, secondary endpoint was secondary infections. Healthy donors (HD) served as controls. Multiple Factorial Analysis (MFA) was used to identify patterns of immune response. Results: 50 patients were included. Age was 49.2 (44.2–54.2) years, total burn body surface area was 38.0% (32.7–43.3). Burn injury showed an upregulation of adaptive immunity and activation biomarkers and a down regulation of innate immunity and stress/inflammation biomarkers. High interleukin-10 (IL-10) at admission was associated with risk of death. However, no cluster of immune/inflammatory biomarkers at early timepoints was associated with mortality. HLA-DR molecules on monocytes at admission were associated with bacterial infections and septic shock. Later altered immune/inflammatory responses in patients who died may had been driven by the development of septic shock. Conclusion: Burn injury induced an early and profound upregulation of adaptive immunity and activation biomarkers and a down regulation of innate immunity and stress/inflammation biomarkers. Immune and inflammatory responses were associated with bacterial infection and septic shock. Absence of immune recovery patterns was associated with poor prognosis.
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Affiliation(s)
- Hélène Moins-Teisserenc
- Université de Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,INSERM UMR-1160, Institut de Recherche Saint-Louis, Paris, France.,Biological Haematology Laboratory, Saint-Louis Hospital, Paris, France
| | - Debora Jorge Cordeiro
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Immunology-Histocompatibility Laboratory, Saint-Louis Hospital, Paris, France
| | | | - Quentin Ressaire
- Université de Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis Hospital, Paris, France
| | - Mourad Benyamina
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis Hospital, Paris, France
| | - Jérome Lambert
- Université de Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Département of Biostatistics, Saint-Louis Hospital, Paris, France
| | - Guitta Maki
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Immunology-Histocompatibility Laboratory, Saint-Louis Hospital, Paris, France
| | - Laurence Homyrda
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Immunology-Histocompatibility Laboratory, Saint-Louis Hospital, Paris, France
| | - Antoine Toubert
- Université de Paris, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,INSERM UMR-1160, Institut de Recherche Saint-Louis, Paris, France.,Immunology-Histocompatibility Laboratory, Saint-Louis Hospital, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis Hospital, Paris, France.,Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, CA, United States
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29
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Sikora JP, Sobczak J, Zawadzki D, Przewratil P, Wysocka A, Burzyńska M. Respiratory Burst and TNF-α Receptor Expression of Neutrophils after Sepsis and Severe Injury-Induced Inflammation in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042187. [PMID: 33672270 PMCID: PMC7926345 DOI: 10.3390/ijerph18042187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
Systemic inflammatory response syndrome (SIRS) is defined as the systemic host response to infection or a non-infectious factor. The purpose of this study was to evaluate the involvement of reactive oxygen species (ROS) in severe inflammation and to assess the discrimination strength of the neutrophil BURSTTEST assay regarding its etiology in three groups of patients (sepsis, burns, and bone fractures) who met the SIRS criteria. The neutrophil activation (respiratory burst of granulocytes as well as p55 and p75 tumor necrosis factor (TNF-α) receptor expression) was evaluated twice using flow cytometry, and the results were compared with healthy controls and among SIRS subjects. A decreased oxygen metabolism in neutrophils after E.coli stimulation and increased TNF-α receptor expression were found in septic and burned patients on admission, while ROS production augmented and TNF-α receptor expression diminished with the applied therapy. The significant differences in neutrophil respiratory burst intensity among septic and burned patients and those with sepsis and bone fractures were found (however, there were not any such differences between patients with thermal and mechanical injuries). This study indicates that the neutrophil BURSTTEST evaluation might be a clinically reliable marker for differentiating the SIRS etiology.
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Affiliation(s)
- Janusz P. Sikora
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (J.S.); (D.Z.)
- Correspondence: ; Tel.: +48-698861043
| | - Jarosław Sobczak
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (J.S.); (D.Z.)
- Department of Management and Logistics in Healthcare, Medical University of Łódź, 6 Lindleya St., 90-131 Łódź, Poland
| | - Dariusz Zawadzki
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (J.S.); (D.Z.)
| | - Przemysław Przewratil
- Department of Pediatric Surgery and Oncology, Chair of Surgical Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (P.P.); (A.W.)
| | - Anna Wysocka
- Department of Pediatric Surgery and Oncology, Chair of Surgical Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (P.P.); (A.W.)
| | - Monika Burzyńska
- Department of Epidemiology and Biostatistics, Chair of Social and Preventive Medicine, Medical University of Łódź, 7/9 Żeligowskiego St., 90-752 Łódź, Poland;
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30
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Hofmann E, Fink J, Eberl A, Prugger EM, Kolb D, Luze H, Schwingenschuh S, Birngruber T, Magnes C, Mautner SI, Kamolz LP, Kotzbeck P. A novel human ex vivo skin model to study early local responses to burn injuries. Sci Rep 2021; 11:364. [PMID: 33432026 PMCID: PMC7801530 DOI: 10.1038/s41598-020-79683-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023] Open
Abstract
Burn injuries initiate numerous processes such as heat shock response, inflammation and tissue regeneration. Reliable burn models are needed to elucidate the exact sequence of local events to be able to better predict when local inflammation triggers systemic inflammatory processes. In contrast to other ex vivo skin culture approaches, we used fresh abdominal skin explants to introduce contact burn injuries. Histological and ultrastructural analyses confirmed a partial-thickness burn pathology. Gene expression patterns and cytokine production profiles of key mediators of the local inflammation, heat shock response, and tissue regeneration were analyzed for 24 h after burn injury. We found significantly increased expression of factors involved in tissue regeneration and inflammation soon after burn injury. To investigate purely inflammation-mediated reactions we injected lipopolysaccharide into the dermis. In comparison to burn injury, lipopolysaccharide injection initiated an inflammatory response while expression patterns of heat shock and tissue regeneration genes were unaffected for the duration of the experiment. This novel ex vivo human skin model is suitable to study the local, early responses to skin injuries such as burns while maintaining an intact overall tissue structure and it gives valuable insights into local mechanisms at the very beginning of the wound healing process after burn injuries.
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Affiliation(s)
- Elisabeth Hofmann
- grid.8684.20000 0004 0644 9589COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Julia Fink
- grid.8684.20000 0004 0644 9589COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Anita Eberl
- grid.8684.20000 0004 0644 9589HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Eva-Maria Prugger
- grid.8684.20000 0004 0644 9589HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Dagmar Kolb
- grid.11598.340000 0000 8988 2476Core Facility Ultrastructure Analysis, Center for Medical Research, Medical University of Graz, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Hanna Luze
- grid.8684.20000 0004 0644 9589COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Simon Schwingenschuh
- grid.8684.20000 0004 0644 9589HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Thomas Birngruber
- grid.8684.20000 0004 0644 9589HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Christoph Magnes
- grid.8684.20000 0004 0644 9589HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria
| | - Selma I. Mautner
- grid.11598.340000 0000 8988 2476Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria ,grid.8684.20000 0004 0644 9589HEALTH-Institute for Biomedicine and Health Sciences, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Lars-Peter Kamolz
- grid.8684.20000 0004 0644 9589COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Petra Kotzbeck
- grid.8684.20000 0004 0644 9589COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria ,grid.11598.340000 0000 8988 2476Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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31
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Aslam S, Khan I, Jameel F, Zaidi MB, Salim A. Umbilical cord-derived mesenchymal stem cells preconditioned with isorhamnetin: potential therapy for burn wounds. World J Stem Cells 2020; 12:1652-1666. [PMID: 33505606 PMCID: PMC7789118 DOI: 10.4252/wjsc.v12.i12.1652] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Impaired wound healing can be associated with different pathological states. Burn wounds are the most common and detrimental injuries and remain a major health issue worldwide. Mesenchymal stem cells (MSCs) possess the ability to regenerate tissues by secreting factors involved in promoting cell migration, proliferation and differentiation, while suppressing immune reactions. Preconditioning of MSCs with small molecules having cytoprotective properties can enhance the potential of these cells for their use in cell-based therapeutics.
AIM To enhance the therapeutic potential of MSCs by preconditioning them with isorhamnetin for second degree burn wounds in rats.
METHODS Human umbilical cord MSCs (hU-MSCs) were isolated and characterized by surface markers, CD105, vimentin and CD90. For preconditioning, hU-MSCs were treated with isorhamnetin after selection of the optimized concentration (5 µmol/L) by cytotoxicity analysis. The migration potential of these MSCs was analyzed by the in vitro scratch assay. The healing potential of normal, and preconditioned hU-MSCs was compared by transplanting these MSCs in a rat model of a second degree burn wound. Normal, and preconditioned MSCs (IH + MSCs) were transplanted after 72 h of burn injury and observed for 2 wk. Histological and gene expression analyses were performed on day 7 and 14 after cell transplantation to determine complete wound healing.
RESULTS The scratch assay analysis showed a significant reduction in the scratch area in the case of IH + MSCs compared to the normal untreated MSCs at 24 h, while complete closure of the scratch area was observed at 48 h. Histological analysis showed reduced inflammation, completely remodeled epidermis and dermis without scar formation and regeneration of hair follicles in the group that received IH + MSCs. Gene expression analysis was time dependent and more pronounced in the case of IH + MSCs. Interleukin (IL)-1β, IL-6 and Bcl-2 associated X genes showed significant downregulation, while transforming growth factor β, vascular endothelial growth factor, Bcl-2 and matrix metallopeptidase 9 showed significant upregulation compared to the burn wound, showing increased angiogenesis and reduced inflammation and apoptosis.
CONCLUSION Preconditioning of hU-MSCs with isorhamnetin decreases wound progression by reducing inflammation, and improving tissue architecture and wound healing. The study outcome is expected to lead to an improved cell-based therapeutic approach for burn wounds.
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Affiliation(s)
- Shazmeen Aslam
- Stem Cell Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 74700, Sindh, Pakistan
| | - Irfan Khan
- Stem Cell Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 74700, Sindh, Pakistan
| | - Fatima Jameel
- Stem Cell Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 74700, Sindh, Pakistan
| | - Midhat Batool Zaidi
- Stem Cell Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 74700, Sindh, Pakistan
| | - Asmat Salim
- Stem Cell Laboratory, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 74700, Sindh, Pakistan
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Shifts of Immune Cell Populations Differ in Response to Different Effectors of Beige Remodeling of Adipose Tissue. iScience 2020; 23:101765. [PMID: 33294778 PMCID: PMC7683338 DOI: 10.1016/j.isci.2020.101765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/09/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022] Open
Abstract
White adipose tissue (WAT) is a dynamic tissue, which responds to environmental stimuli and dietary cues by changing its morphology and metabolic capacity. The ability of WAT to undergo a beige remodeling has become an appealing strategy to combat obesity and its comorbidities. Here, by using single-cell RNA sequencing, we provide a comprehensive atlas of the cellular dynamics during beige remodeling. We reveal drastic changes both in the overall cellular composition and transcriptional states of individual cell subtypes between Adrb3- and cold-induced beiging. Moreover, we demonstrate that cold induces a myeloid to lymphoid shift of the immune compartment compared to Adrb3 activation. Further analysis showed that, Adrb3 stimulation leads to activation of the interferon/Stat1 pathways favoring infiltration of myeloid immune cells, while repression of this pathway by cold promotes lymphoid immune cell recruitment. These findings highlight that pharmacological mimetics may not provide the same beneficial effects as physiological stimuli.
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Torres MJM, Peterson JM, Wolf SE. Detection of Infection and Sepsis in Burns. Surg Infect (Larchmt) 2020; 22:20-27. [PMID: 33021433 DOI: 10.1089/sur.2020.348] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Infection is the most frequent complication after severe burns and has a propensity to progress into sepsis then septic shock and multiple organ dysfunction syndrome (MODS). Improving outcomes in acute burn care depends on early detection of infection to allow prompt interventions. Diagnosis of sepsis in severe burns is uniquely challenging because otherwise-typical clinical signs are masked by the hypermetabolic state and systemic inflammation induced by the burn itself. For this reason, burns have historically been excluded from high-impact studies on the diagnosis and treatment of sepsis. Methods: This article provides a comprehensive three-fold review of current findings and guidelines pertinent to the early detection of infection and sepsis in severe burns. Results: First, evidence-based detection of the most common infections encountered in the burn intensive care unit is reviewed. Second, we analyze the evolution of the diagnostic criteria for sepsis and the evidence regarding their utility in severe burns. Last, we examine the development of biomarkers, from procalcitonin to molecular genomics, for the detection of sepsis. Conclusions: Although gold standard methods of early detection of sepsis in burn patients have yet to be identified, improved understanding and appropriate application of the available diagnostic criteria and assays are paramount to providing effective care of patients with severe burns.
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Affiliation(s)
- Mark Jason M Torres
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Joshua M Peterson
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA.,Shriners Hospitals for Children, Galveston, Texas, USA
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Abdullahi A, Barayan D, Vinaik R, Diao L, Yu N, Jeschke MG. Activation of ER stress signalling increases mortality after a major trauma. J Cell Mol Med 2020; 24:9764-9773. [PMID: 32810382 PMCID: PMC7520325 DOI: 10.1111/jcmm.15548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/14/2023] Open
Abstract
The endoplasmic reticulum (ER) adapts to stress by activating a signalling cascade known as the ER stress response. While ER stress signalling is a central component of the cellular defence against environmental insult, persistent activation is thought to contribute to the progression of various metabolic complications via loss of protein function and cell death. Despite its importance however, whether and how ER stress impacts morbidity and mortality in conditions of hypermetabolism remain unclear. In this study, we discovered that chronic ER stress response plays a role in mediating adverse outcomes that occur after major trauma. Using a murine model of thermal injury, we show that induction of ER stress with Tunicamycin not only increased mortality but also resulted in hepatic damage and hepatic steatosis. Importantly, post‐burn treatment with chaperone ER stress inhibitors attenuated hepatic ER stress and improved organ function following injury. Our study identifies ER stress as a potential hub of the signalling network affecting multiple aspects of metabolism after major trauma and as a novel potential molecular target to improve the clinical outcomes of severely burned patients.
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Affiliation(s)
- Abdikarim Abdullahi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Dalia Barayan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Roohi Vinaik
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Li Diao
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Nancy Yu
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Marc G Jeschke
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.,Ross Tilley Burn Centre, Sunnybrook Hospital, Toronto, ON, Canada.,Department of Surgery, Division of Plastic Surgery and Department of Immunology, University of Toronto, Toronto, ON, Canada
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Nguyen LN, Phan KQ, Nguyen AH. Changing of serum metabolic hormone and liver size during acute phase of severe adult burn patients. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:107-112. [PMID: 32934864 PMCID: PMC7486563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
The aims of this study were to determine characteristics and factors influencing metabolic hormones including serum catecholamines, cortisol level and liver size in severe adult burn patients. A prospective study was conducted on 44 adult burn patients with burn extent from and over 20% TBSA admitted during 72 h after burn to burn intensive care unit, National Burn Hospital, Vietnam. Serum levels of epinephrine, norepinephrine and cortisol were measured on admission and 7th day after burn. Liver size was measured by ultrasound on admission and 21st day after burn. The results indicated that norepinephrine level did not significantly change along the time meanwhile epinephrine concentration significantly increased after 1 week (P < 0.01). Serum cortisol level was higher than normal physiological value and then significantly reduced at 7th day post burn (P < 0.05). Significantly increased liver size was seen at the 21st day postburn (P < 0.01). Age, gender, burn severity, inhalation injury and death did not affect concentration of catecholamines and liver size. Meanwhile, cortisol level was significantly higher in patients with deep burn area ≥ 20% TBSA at 7th day after burn and in non-survivors (P < 0.05). Further studies are necessary to understand clearly metabolic state in severe adult burn patients.
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Affiliation(s)
- Lam N Nguyen
- National Burn HospitalHanoi, Viet Nam
- Medical Military UniversityViet Nam
| | | | - An H Nguyen
- National Burn HospitalHanoi, Viet Nam
- Medical Military UniversityViet Nam
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36
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Silver serum levels in burned patients treated with silver sulfadiazine and its toxicity on inflammatory cells. Burns 2020; 46:1120-1127. [DOI: 10.1016/j.burns.2019.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022]
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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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Zhang J, Li W, Ying Z, Zhao D, Yi G, Li H, Liu X. Soybean protein-derived peptide nutriment increases negative nitrogen balance in burn injury-induced inflammatory stress response in aged rats through the modulation of white blood cells and immune factors. Food Nutr Res 2020; 64:3677. [PMID: 32694965 PMCID: PMC7346896 DOI: 10.29219/fnr.v64.3677] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND As an important nutrient, soybean protein-derived peptides (SPP) affect the immune function of animals. OBJECTIVE This study describes the effects of nutrient supplementation with SPP on the negative nitrogen balance in the burn injury-induced inflammatory response of aged rats. DESIGN Soybean protein isolate (SPI) was hydrolyzed to obtain SPP. A negative nitrogen-balance aged rat model and a major full-thickness 30% total body surface area (TBSA) burn-injury rat model were utilized. RESULTS The results show that SPP can increase the speed and ability of inflammatory stress by adjusting white blood cell counts. Soybean protein-derived peptides significantly increased serum immunoglobulin M (IgM), immunoglobulin G (IgG) and immunoglobulin A (IgA) levels; significantly decreased serum interleukin-1 beta (IL-β), tumor necrosis factor-alpha (TNF-α) and regulated upon activation normal T-cell expressed and secreted (RANTES) levels. These results give conclusive evidence that SPP has a significantly positive effect in improving the immune function on the condition of negative nitrogen balance with burn-injury, and reducing excessive inflammation. CONCLUSIONS Nutrient supplementation of SPP can, therefore, be used as an adjuvant treatment to inhibit the development and severity of inflammatory reactions caused by burns, providing a novel therapy for the treatment and positive prognosis of burn patients.
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Affiliation(s)
- Jian Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
| | - Wenhui Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
| | - Zhiwei Ying
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
| | - Di Zhao
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
| | - Guofu Yi
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
| | - He Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
| | - Xinqi Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Technology and Business University, Beijing, China
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Phan KQ, Nguyen LN, Nguyen AH. Profile and factors influencing resting energy expenditure in adult burn patients. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:55-59. [PMID: 32714628 PMCID: PMC7364417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
The aims of this study are to determine characteristics and factors influencing REE in adult severe burn patients. A prospective study was conducted on 62 adult burn patients admitted during 72 h after burn to burn intensive care unit, National Burn Hospital, Vietnam. REE measurements and REE/BMR calculations were obtained on the 3rd, 7th, 14th, 21st and 28th day after burn. Collected data was analyzed to find out the influence of age, gender, burn extent, inhalation injury to REE. The results indicated that all measured REE was significantly higher than BMR at all time points (REE/BMR ratio > 1) with a peak value on the 7th day then steady decreased but still around 200% in compared with BMR on the 28th day after burn. In compared with females, REE of male patients were significantly higher during the first three weeks after burn. In addition, significantly greater REE were seen in the patients with burn surface area ≥ 60% TBSA or deep burn area ≥ 20% TBSA. Moreover, REE of nonsurvivors was significantly higher in compared with survivor group on the 7th and 14th day after burning. Meanwhile, increased age and presence of inhalation injury did not affect REE. In conclusion, in adult burn patients, increased REE is prolonged, burn size dependent and significantly higher in male and in nonsurvivor. This finding should be considered in nutritional caring for adult burn patients.
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Affiliation(s)
| | - Lam N Nguyen
- National Burn HospitalHanoi, Viet Nam
- Medical Military UniversityViet Nam
| | - An H Nguyen
- National Burn HospitalHanoi, Viet Nam
- Medical Military UniversityViet Nam
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40
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Blears E, Sommerhalder C, Toliver-Kinsky T, Finnerty CC, Herndon DN. Current problems in burn immunology. Curr Probl Surg 2020; 57:100779. [PMID: 32507131 DOI: 10.1016/j.cpsurg.2020.100779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/22/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Elizabeth Blears
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - Tracy Toliver-Kinsky
- Department of Anesthesiology, Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX.
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Galveston, TX
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41
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Jo YG, Kim JC, Jin HM, Cho YN, Kee SJ, Park YW. Natural Killer T Cells Are Numerically and Functionally Deficient in Patients with Trauma. J Innate Immun 2020; 12:344-354. [PMID: 32450553 DOI: 10.1159/000504324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/22/2019] [Indexed: 01/23/2023] Open
Abstract
Natural killer T (NKT) cells rapidly produce Th1 and Th2 cytokines such as interferon-γ (IFN-γ) and interleukin (IL)-4. This study examined the frequency and function of NKT cells in trauma patients. Frequencies, proliferative responses to α-galactosylceramide (α-GalCer), and Th1/Th2 cytokine secretion levels of NKT cells in peripheral blood mononuclear cells from trauma patients and healthy controls (HC) were measured by flow cytometry. Circulating NKT cell levels were significantly reduced in trauma patients. Proliferation and IFN-γ production of circulating NKT cells in response to α-GalCer were markedly decreased in trauma patients. CD69 expression levels produced by NKT cells were significantly upregulated in trauma patients compared to those in HC. In addition, annexin V+ NKT cells were profoundly increased in trauma patients after α-GalCer stimulation. Trauma patients had higher plasma levels of IL-6, IL-8, and TNF-α compared to HC. In particular, the proliferative response of NKT cells to α-GalCer was significantly decreased in the presence of these cytokines. Such decrease was partially recovered after treatment with blocking antibodies against these cytokines. This study demonstrates that circulating NKT cells are numerically deficient and functionally impaired in IFN-γ production in trauma patients. These findings provide an important insight into the trauma-related innate immune response.
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Affiliation(s)
- Young-Goun Jo
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Jung-Chul Kim
- Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Hye-Mi Jin
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Young-Nan Cho
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Seung-Jung Kee
- Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea,
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Yin HN, Hao JW, Chen Q, Li F, Yin S, Zhou M, Zhang QH, Yao YM, Chai JK. Plasma glucagon-like peptide 1 was associated with hospital-acquired infections and long-term mortality in burn patients. Surgery 2020; 167:1016-1022. [PMID: 32295709 DOI: 10.1016/j.surg.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/19/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although glucagon-like peptide 1 levels have been closely associated with inflammation and mortality in septic patients, the clinical importance of glucagon-like peptide 1 on hospital-acquired infections and long-term mortality after burn injury remains unexplored. METHODS Plasma samples from 144 burn patients were collected on admission to determine total glucagon-like peptide 1, interleukin 6, and monocyte chemotactic protein-1 levels. Hospital-acquired infections were determined by positive microbial culture. One-year mortality was assessed by telephone interview. Factors associated with glucagon-like peptide 1 were determined by multivariable linear logistic regression. Predicting the clinical importance of glucagon-like peptide 1 on the development of hospital-acquired infections and mortality were determined by Cox proportional hazards models and further by receiver operating characteristic curve analysis. Kaplan-Meier analyses were performed to examine whether the mean glucagon-like peptide 1 level of the cohort could discriminate the hospital-acquired infections-free survival. RESULTS Median burn size was 41% (19%-70%) of total body surface area. Hospital-acquired infections developed in 36 (25%) patients after a mean of 10 ± 1 days after injury. Interleukin 6, monocyte chemotactic protein-1, and blood urea nitrogen levels and thrombin time were independently associated with increased glucagon-like peptide 1 levels. Levels of glucagon-like peptide 1 (median, interquartile range) were greater in patients who developed hospital-acquired infections than in those who did not (237 pmol/L, 76-524 vs 80 pmol/L, 51-158; P < .001) and in patients who died (536 pmol/L, interquartile range: 336-891 pmol vs 98 pmol/L, 47-189; P < .001). Although the glucagon-like peptide 1 level could not predict hospital-acquired infections-free survival in individual patients, it could predict 1-year mortality independently (P = .021). Moreover, a glucagon-like peptide 1 level of 200 pmol/L could discriminate hospital-acquired infections-free survival (P < .001). CONCLUSION Admission glucagon-like peptide 1 level can discriminate hospital-acquired infections-free survival and predict long-term mortality in a group of patients with burn injury. Our data suggests that glucagon-like peptide 1 may be a predictive biomarker for hospital-acquired infections and mortality in burn patients.
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Affiliation(s)
- Hui-Nan Yin
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Ji-Wei Hao
- Trauma Repairment and Tissue Regeneration Center, Department of Medical Innovation Study, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Qi Chen
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Feng Li
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Song Yin
- Department of Outpatient Service, Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Min Zhou
- Neurocritical Care Unit, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, Hefei, Anhui, People's Republic of China
| | - Qing-Hong Zhang
- Trauma Repairment and Tissue Regeneration Center, Department of Medical Innovation Study, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
| | - Yong-Ming Yao
- Trauma Repairment and Tissue Regeneration Center, Department of Medical Innovation Study, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Jia-Ke Chai
- Department of Burn and Plastic Surgery, Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China
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Soluble Suppression Of Tumorigenicity-2 Predicts Hospital Mortality in Burn Patients: An Observational Prospective Cohort Pilot Study. Shock 2020; 51:194-199. [PMID: 29642231 DOI: 10.1097/shk.0000000000001155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The IL33/ST2 pathway has been implicated in the pathogenesis of different inflammatory diseases. Our aim was to analyze whether plasma levels of biomarkers involved in the IL33/ST2 axis might help to predict mortality in burn patients. METHODS Single-center prospective observational cohort pilot study performed at the Burns Unit of the Plastic and Reconstructive Surgery Department of the Vall d'Hebron University Hospital (Barcelona). All patients aged ≥18 years old with second or third-degree burns requiring admission to the Burns Unit were considered for inclusion. Blood samples were taken to measure levels of interleukins (IL)6, IL8, IL33, and soluble suppression of tumorigenicity-2 (sST2) within 24 h of admission to the Burns Unit and at day 3. Results are expressed as medians and interquartile ranges or as frequencies and percentages. RESULTS Sixty-nine patients (58 [84.1%] male, mean age 52 [35-63] years, total body surface area burned 21% [13%-30%], Abbreviated Burn Severity Index 6 [4-8]) were included. Thirteen (18.8%) finally died in the Burns Unit. Plasma levels of sST2 measured at day 3 after admission demonstrated the best prediction accuracy for survival (area under the receiver-operating curve 0.85 [0.71-0.99]; P < 0.001). The best cutoff point for the area under the receiver-operating curve index was estimated to be 2,561. In the Cox proportional hazards model, after adjusting for potential confounding, a plasma sST2 level ≥2,561 measured at day 3 was significantly associated with mortality (hazard ratio 6.94 [1.73-27.74]; P = 0.006). CONCLUSIONS Plasma sST2 at day 3 predicts hospital mortality in burn patients.
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de Amorim JSC, Torres KCL, Carvalho AT, Martins-Filho OA, Lima-Costa MF, Peixoto SV. Inflammatory markers associated with fall recurrence and severity: The Bambuí Cohort Study of Aging. Exp Gerontol 2020; 132:110837. [PMID: 31935439 DOI: 10.1016/j.exger.2020.110837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/21/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to analyze the association between inflammatory markers and recurrent and severe falls in 1304 community-dwelling older adults from the Bambuí Cohort Study of Aging. METHODS Information about falls in the previous 12 months was collected, and classified based on recurrence (two or more falls) and severity (requirement of medical attention). The screened biomarkers included interleukins (IL-1β, IL-6, IL-10, and IL-12, TNF), chemokines (CXCL8, CXCL9, CXCL10, CCL2, and CCL5), and high-sensitive C-reactive protein (hs-PCR). Potential confounders included sociodemographic, behavioral, and health indicators. Associations were evaluated through logistic regression, using odds ratios (OR) and 95% confidence intervals (95% CI), with Stata 13.1. RESULTS The prevalence of recurrent and severe falls was 10.7% and 9.0%, respectively. After adjustments, elevated levels of IL-12 (OR: 1.92; 95% CI: 1.09-3.37) and CXCL9 (OR: 1.67; 95% CI: 1.05-2.66) were found to be associated with recurrent falls, while elevated levels of TNF (OR: 1.58; 95% CI: 1.01-2.50), IL-12 (OR: 2.04; 95% CI: 1.13-3.70), CXCL10 (OR: 1.75; 95% CI: 1.04-2.92), and CCL5 (OR: 1.90; 95% CI: 1.18-3.07) were associated with severe falls. CONCLUSIONS The results highlight a wide range of biomarkers not yet explored in the literature and suggest that inflammation may be an important component of recurrent and severe falls.
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Affiliation(s)
- Juleimar Soares Coelho de Amorim
- Postgraduate Program in Public Health, René Rachou Research Institute, Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil.
| | - Karen Cecília Lima Torres
- Laboratory of Diagnostic and Monitoring Biomarkers, René Rachou Research Institute, Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil; Faculty of Medicine, University José do Rosário Vellano, UNIFENAS, Belo Horizonte, Brazil
| | - Andréa Teixeira Carvalho
- Laboratory of Diagnostic and Monitoring Biomarkers, René Rachou Research Institute, Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil
| | - Olindo Assis Martins-Filho
- Laboratory of Diagnostic and Monitoring Biomarkers, René Rachou Research Institute, Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Fernanda Lima-Costa
- Center of Studies in Public Health and Aging, René Rachou René Rachou Research Institute, Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil
| | - Sérgio Viana Peixoto
- Laboratory of Diagnostic and Monitoring Biomarkers, René Rachou Research Institute, Oswaldo Cruz Foundation in the State of Minas Gerais, Belo Horizonte, Brazil; Federal University of Minas Gerais, Nursing School, Belo Horizonte, Brazil
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Chao T, Gomez BI, Heard TC, Dubick MA, Burmeister DM. Increased oxidative phosphorylation in lymphocytes does not atone for decreased cell numbers after burn injury. Innate Immun 2020; 26:403-412. [PMID: 31906760 PMCID: PMC7903530 DOI: 10.1177/1753425918805544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The acute systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction (MOD) that occur in large burn injuries may be attributed, in part, to immunosuppressive responses such as decreased lymphocytes. However, the mitochondrial bioenergetics of lymphocytes after severe burn injury are poorly understood. The purpose of this study was to examine mitochondrial function of lymphocytes following severe burns in a swine model. Anesthetized Yorkshire swine (n = 17) sustained 40% total body surface area full-thickness contact burns. Blood was collected at pre-injury (Baseline; BL) and at 24 and 48 h after injury for complete blood cell analysis, flow cytometry, cytokine analysis, and ficoll separation of intact lymphocytes for high-resolution mitochondrial respirometry analysis. While neutrophil numbers increased, a concomitant decrease was found in lymphocytes (P < 0.001) after burn injury, which was not specific to CD4+ or CD8+ lymphocytes. No changes in immune cell population were observed from 24 h to 48 h post-injury. IL 12-23 decreased while a transient increase in IL 4 was found from BL to 24h (P < 0.05). CRP progressively increased from BL to 24h (P < 0.05) and 48h (P < 0.001) post-injury. Routine and maximal mitochondrial respiration progressively increased from BL to 24h (P < 0.05) and 48 h post-injury (P < 0.001). No changes were found in leak respiration or residual oxygen consumption. When considering the reduction in lymphocyte number, the total peripheral lymphocyte bioenergetics per volume of blood significantly decreased from BL to 24h and 48h (P < 0.05). For the first time, we were able to measure mitochondrial activity in intact lymphocyte mitochondria through high-resolution respirometry in a severely burned swine model. Our data showed that the non-specific reduction in peripheral T cells after injury was larger than the increased mitochondrial activity in those cells, which may be a compensatory mechanism for the total reduction in lymphocytes. Additional studies in the metabolic activation of T cell subpopulations may provide diagnostic or therapeutic targets after severe burn injury.
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Affiliation(s)
- Tony Chao
- United States Army Institute of Surgical Research, TX, USA
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Abdullahi A, Auger C, Stanojcic M, Patsouris D, Parousis A, Epelman S, Jeschke MG. Alternatively Activated Macrophages Drive Browning of White Adipose Tissue in Burns. Ann Surg 2019; 269:554-563. [PMID: 28817438 DOI: 10.1097/sla.0000000000002465] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to uncover the mediators and mechanistic events that facilitate the browning of white adipose tissue (WAT) in response to burns. BACKGROUND In hypermetabolic patients (eg, burns, cancer), the browning of WAT has presented substantial clinical challenges related to cachexia, atherosclerosis, and poor clinical outcomes. Browning of the adipose tissue has recently been found to induce and sustain hypermetabolism. Although browning appears central in trauma-, burn-, or cancer-induced hypermetabolic catabolism, the mediators are essentially unknown. METHODS WAT and blood samples were collected from patients admitted to the Ross Tilley Burn Centre at Sunnybrook Hospital. Wild type, CCR2 KO, and interleukin (IL)-6 KO male mice were purchased from Jax laboratories and subjected to a 30% total body surface area burn injury. WAT and serum collected were analyzed for browning markers, macrophages, and metabolic state via histology, gene expression, and mitochondrial respiration. RESULTS In the present study, we show that burn-induced browning is associated with an increased macrophage infiltration, with a greater type 2 macrophage profile in the fat of burn patients. Similar to our clinical findings in burn patients, both an increase in macrophage recruitment and a type 2 macrophage profile were also observed in post burn mice. Genetic loss of the chemokine CCR2 responsible for macrophage migration to the adipose impairs burn-induced browning. Mechanistically, we show that macrophages recruited to burn-stressed subcutaneous WAT (sWAT) undergo alternative activation to induce tyrosine hydroxylase expression and catecholamine production mediated by IL-6, factors required for browning of sWAT. CONCLUSION Together, our findings uncover macrophages as the key instigators and missing link in trauma-induced browning.
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Affiliation(s)
- Abdikarim Abdullahi
- University of Toronto, Toronto, ON, Canada.,Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Christopher Auger
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mile Stanojcic
- University of Toronto, Toronto, ON, Canada.,Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - David Patsouris
- Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Slava Epelman
- University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - Marc G Jeschke
- University of Toronto, Toronto, ON, Canada.,Ross Tilley Burn Centre, Sunnybrook Hospital, Toronto, ON, Canada.,Department of Surgery, Division of Plastic Surgery and Department of Immunology, University of Toronto, Toronto, ON, Canada
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Yu W, Guo Z, Liang P, Jiang B, Guo L, Duan M, Huang X, Zhang P, Zhang M, Ren L, Zeng J, Huang X. Expression changes in protein-coding genes and long non-coding RNAs in denatured dermis following thermal injury. Burns 2019; 46:1128-1135. [PMID: 31852616 DOI: 10.1016/j.burns.2019.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/26/2019] [Accepted: 11/23/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Thermal injury repair is a complex process during which maintaining the proliferation of human dermis fibroblasts (HDFs) and synthesis of extracellular matrix (ECM) plays a critical role. In the present study, we analyzed potential molecular markers and the probable association between differentially-expressed lncRNAs and protein-coding genes within denatured dermis following thermal injury, attempting to provide further insights to thermal injury repair pathogenesis. METHODS AND MAIN RESULTS We found that the expression of 3940 lncRNAs was increased, while that of 1438 lncRNAs was reduced in the denatured dermis following thermal injury when compared to normal tissue. Of them, 338 were upregulated and 154 were downregulated by more than 128 times. Via cross-check with another microarray profile analysis on differentially-expressed lncRNAs after thermal injury, LINC00302 was found to be downregulated after thermal injury; more importantly, this skin-specially expressed lncRNA is located near a series of genes related to multiple skin inflammation and skin barrier-associated genomes. LINC00302 overexpression promoted the cell viability and the protein levels of α-SMA and Collagen I in HDFs. CONCLUSIONS In conclusion, mRNAs and lncRNAs could be differentially expressed in the denatured dermis following thermal injury. mRNA and lncRNA regulatory signaling pathways could participate in thermal injury repair pathogenesis. More importantly, LINC00302 may play a critical role in thermal injury repair.
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Affiliation(s)
- Wenchang Yu
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Zaiwen Guo
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China; Department of Burn and Plastic Surgery, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu 215002, PR China
| | - Pengfei Liang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
| | - Bimei Jiang
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan 410008, PR China
| | - Le Guo
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Mengting Duan
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Xu Huang
- Department of Hyperbaric Oxygen, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Pihong Zhang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Minghua Zhang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Licheng Ren
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Jizhang Zeng
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China
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Vinaik R, Barayan D, Abdullahi A, Jeschke MG. NLRP3 inflammasome mediates white adipose tissue browning after burn. Am J Physiol Endocrinol Metab 2019; 317:E751-E759. [PMID: 31453709 PMCID: PMC6879867 DOI: 10.1152/ajpendo.00180.2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A hallmark after burn is the stress and inflammatory-induced hypermetabolic response. Recently, we and others found that browning of white adipose tissue (WAT) is a critical component of this complex detrimental response. Although browning and inflammation have been independently delineated to occur after injury, their interaction is currently not well defined. One of the master regulators of inflammation and adipose tissue remodeling after burns is nucleotide-binding and oligomerization domain, leucine rich repeat and pyrin domain containing 3 (NLRP3) inflammasome. The aim of this this study was to determine whether NLRP3 modulates and activates WAT browning after burn. To obtain molecular and mechanistic insights, we used an NLRP3 knockout (NLRP3-/-) murine burn model. We demonstrated that genetic deletion of NLRP3 promoted persistent and augmented browning in adipocytes, evidenced by increased gene expression of peroxisome proliferator-activated receptor γ and CIDEA at 3 days (5.74 vs. 0.29, P < 0.05; 26.0 vs. 0.71, P < 0.05) and uncoupling protein 1 (UCP1) and PGC1α at 7 days (7,406 vs. 3,894, P < 0.05; 20.6 vs. 2.52, P < 0.01) and enhanced UCP1 staining and multilocularity. Additionally, the main regulator of postburn WAT browning, IL-6, was elevated in the plasma acutely after burn in NLRP3-/- compared with wild-type counterparts (478.9 vs. 67.1 pg/mL, P < 0.05 at 3 days). These results suggest that NLRP3 has antibrowning effects and that blocking NLRP3 increases thermogenesis and augments browning via increased levels of IL-6. Our findings provide insights into targeting innate inflammatory systems for regulation of adaptive thermogenesis, a critical response after burns and other hypermetabolic conditions.
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Affiliation(s)
- Roohi Vinaik
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Dalia Barayan
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Chao T, Gómez BI, Heard TC, Smith BW, Dubick MA, Burmeister DM. Burn-induced reductions in mitochondrial abundance and efficiency are more pronounced with small volumes of colloids in swine. Am J Physiol Cell Physiol 2019; 317:C1229-C1238. [PMID: 31532719 DOI: 10.1152/ajpcell.00224.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Severe burn injury results in systemic disruption of metabolic regulations and impaired cardiac function. Restoration of hemodynamic homeostasis utilizing intravenous (IV) fluids is critical for acute care of the burn victim. However, the effects of burns and resuscitation on cardiomyocyte mitochondria are currently unknown. The purpose of this study is to determine cardiac mitochondrial function in a swine burn model with subsequent resuscitation using either crystalloids or colloids. Anesthetized Yorkshire swine (n = 23) sustained 40% total body surface area burns and received IV crystalloids (n = 11) or colloids (n = 12) after recovery from anesthesia. Non-burned swine served as controls (n = 9). After euthanasia at 48 h, heart tissues were harvested, permeabilized, and analyzed by high-resolution respirometry. Citrate synthase (CS) activity was measured, and Western blots were performed to quantify proteins associated with mitochondrial fusion (OPA1), fission (FIS1), and mitophagy (PINK1). There were no differences in state 2 respiration or maximal oxidative phosphorylation. Coupled complex 1 respiration decreased, while uncoupled state 4O and complex II increased significantly due to burn injury, particularly in animals receiving colloids (P < 0.05). CS activity and electron transfer coupling efficiency were significantly lower in burned animals, particularly with colloid treatment (P < 0.05). Protein analysis revealed increased FIS1 but no differences in mitophagy in cardiac tissue from colloid-treated compared with crystalloid-treated swine. Taken together, severe burns alter mitochondrial respiration in heart tissue, which may be exacerbated by early IV resuscitation with colloids. Early IV burn resuscitation with colloids may require close hemodynamic observation. Mitochondrial stabilizing agents incorporated into resuscitation fluids may help the hemodynamic response to burn injury.
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Affiliation(s)
- Tony Chao
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Belinda I Gómez
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Tiffany C Heard
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Brian W Smith
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - Michael A Dubick
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
| | - David M Burmeister
- Damage Control Resuscitation Task Area, United States Army Institute of Surgical Research, San Antonio, Texas
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50
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Feng CJ, Lin CH, Tsai CH, Yang IC, Ma H. Adipose-derived stem cells-induced burn wound healing and regeneration of skin appendages in a novel skin island rat model. J Chin Med Assoc 2019; 82:635-642. [PMID: 31259836 DOI: 10.1097/jcma.0000000000000134] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The study of effectiveness of adipose-derived stem cells (ASCs) in treating burn wounds is still a developing field. The process of wound contraction in areas of loose skin is a major confounding factor in the evaluation and study of burn wound healing in animal models. METHODS To evaluate the effect of local ASCs administration, deep partial thickness burn wounds were induced by 30 s application of hot copper plates in a novel skin island burn wound rat model to avoid interference from primary wound contraction. Skin islands were divided into two treatment groups-control group (n = 9) injected with PBS and ASCs-treated group (n = 9) injected with 5 × 10 ASCs intradermally. Progress in wound healing was checked at regular intervals after injury (on 1st, 2nd, 3rd, and 4th week) by measuring the mean wound area and analyzing the wound histologically and immunohistochemically, after unstitching the overlaying skin to expose the skin island. RESULTS It was found that local intradermal injection of ASCs improved burn wound healing at all given time points when compared with control groups, especially in the first 2 weeks (p < 0.05). The percentage of live follicles increased gradually in the ASCs-treated groups compared with control groups between the 3rd and 4th weeks (p < 0.05). The vascular density and proliferating cell nuclear antigen index were also significantly increased in the ASCs-treated groups. CONCLUSION Thus, in this study, a novel burn wound rat model with reduced interference from wound contraction has been put forth to investigate the therapeutic effects of local administration of ASCs on burn wound healing. Local injection of ASCs not only improved burn wound recovery but also enhanced angiogenesis and skin appendage regeneration.
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Affiliation(s)
- Chin-Jung Feng
- Division of Plastic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Hsun Lin
- Division of Plastic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chi-Han Tsai
- Division of Plastic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-Chen Yang
- Division of Plastic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsu Ma
- Division of Plastic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
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