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Dombrecht D, Van Daele U, Van Asbroeck B, Schieffelers D, Guns PJ, Gebruers N, Meirte J, van Breda E. Molecular mechanisms of post-burn muscle wasting and the therapeutic potential of physical exercise. J Cachexia Sarcopenia Muscle 2023; 14:758-770. [PMID: 36760077 PMCID: PMC10067483 DOI: 10.1002/jcsm.13188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
After a severe burn injury, a systemic stress response activates metabolic and inflammatory derangements that, among other, leads to muscle mass loss (muscle wasting). These negative effects on skeletal muscle continue for several months or years and are aggravated by short-term and long-term disuse. The dynamic balance between muscle protein synthesis and muscle protein breakdown (proteolysis) is regulated by complex signalling pathways that leads to an overall negative protein balance in skeletal muscle after a burn injury. Research concerning these molecular mechanisms is still scarce and inconclusive, understanding of which, if any, molecular mechanisms contribute to muscle wasting is of fundamental importance in designing of therapeutic interventions for burn patients as well. This review not only summarizes our present knowledge of the molecular mechanisms that underpin muscle protein balance but also summarizes the effects of exercise on muscle wasting post-burn as promising strategy to counteract the detrimental effects on skeletal muscle. Future research focusing on the pathways causing post-burn muscle wasting and the different effects of exercise on them is needed to confirm this hypothesis and to lay the foundation of therapeutic strategies.
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Affiliation(s)
- Dorien Dombrecht
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium
| | - Ulrike Van Daele
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium.,Oscare, Organisation for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Birgit Van Asbroeck
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium
| | - David Schieffelers
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium
| | - Pieter-Jan Guns
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium.,Multidisciplinary Edema Clinic, Antwerp University Hospital, Edegem, Belgium
| | - Jill Meirte
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium.,Oscare, Organisation for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Eric van Breda
- Department of Rehabilitation Sciences & Physiotherapy, Research group MOVANT, Multidisciplinary Metabolic Research Unit (M2RUN), University of Antwerp, Antwerp, Belgium
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Jaconelli M, Greenhaff PL, Atherton PJ, Lobo DN, Brook MS. The effects of elective abdominal surgery on protein turnover: A meta-analysis of stable isotope techniques to investigate postoperative catabolism. Clin Nutr 2022; 41:709-722. [PMID: 35168004 PMCID: PMC8902515 DOI: 10.1016/j.clnu.2022.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Elective surgery induces skeletal muscle wasting driven by an imbalance between muscle protein synthesis and breakdown. From examination of diverse stable isotope tracer techniques, the dynamic processes driving this imbalance are unclear. This meta-analysis aimed to elucidate the mechanistic driver(s) of postoperative protein catabolism through stable isotope assessment of protein turnover before and after abdominal surgery. METHODS Meta-analysis was performed of randomized controlled trials and cohort studies in patients undergoing elective abdominal surgery that contained measurements of whole-body or skeletal muscle protein turnover using stable isotope tracer methodologies pre- and postoperatively. Postoperative changes in protein synthesis and breakdown were assessed through subgroup analysis of tracer methodology and perioperative care. RESULTS Surgery elicited no overall change in protein synthesis [standardized mean difference (SMD) -0.47, 95% confidence interval (CI): -1.32, 0.39, p = 0.25]. However, subgroup analysis revealed significant suppressions via direct-incorporation methodology [SMD -1.53, 95%CI: -2.89, -0.17, p = 0.03] within skeletal muscle. Changes of this nature were not present among arterio-venous [SMD 0.61, 95%CI: -1.48, 2.70, p = 0.58] or end-product [SMD -0.09, 95%CI: -0.81, 0.64, p = 0.82] whole-body measures. Surgery resulted in no overall change in protein breakdown [SMD 0.63, 95%CI: -0.06, 1.32, p = 0.07]. Yet, separation by tracer methodology illustrated significant increases in urinary end-products (urea/ammonia) [SMD 0.70, 95%CI: 0.38, 1.02, p < 0.001] that were not present among arterio-venous measures [SMD 0.67, 95%CI: -1.05, 2.38, p = 0.45]. CONCLUSIONS Elective abdominal surgery elicits suppressions in skeletal muscle protein synthesis that are not reflected on a whole-body level. Lack of uniform changes across whole-body tracer techniques are likely due to contribution from tissues other than skeletal muscle.
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Affiliation(s)
- Matthew Jaconelli
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Metabolic and Molecular Physiology, University of Nottingham, Queen's Medical Centre, Nottingham, UK; School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Paul L Greenhaff
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Metabolic and Molecular Physiology, University of Nottingham, Queen's Medical Centre, Nottingham, UK; School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Philip J Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Metabolic and Molecular Physiology, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK
| | - Dileep N Lobo
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Metabolic and Molecular Physiology, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | - Matthew S Brook
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Metabolic and Molecular Physiology, University of Nottingham, Queen's Medical Centre, Nottingham, UK; School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
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3
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Ackland GL, Walker SLM, Jones TF. The Inflammatory Response to Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00002-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sobhy E, Kader RA, Aboulfotouh A, Eshra M, Sayed M. Associations of measured resting energy expenditure with predictive equations, NUTRIC score, and patient outcomes. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021; 33:35. [PMID: 34690491 PMCID: PMC8520770 DOI: 10.1186/s43162-021-00060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background Indirect calorimetry is the reference method for measuring resting energy expenditure (REE), but the necessary equipment and technical expertise are not always available. Meanwhile, the NUTrition Risk in the Critically ill (NUTRIC) scale is designed to identify patients who would benefit from nutrition therapy, but no data are available regarding the association of NUTRIC scores with REE. Several predictive formulas are available as alternatives to indirect calorimetry for calculation of energy requirements, but they have not been compared in a homogeneous group of critically ill patients. The purpose of the study is to examine the correlations between energy expenditure and NUTRIC scores or patient outcomes, and to compare measured REE with estimations of energy expenditure. Methods In this observational, prospective study, indirect calorimetry was performed on 50 mechanically ventilated patients. Energy expenditure was also estimated with the bodyweight-based, Faisy–Fagon, and Penn-State PSUm equations. Results REE was higher in patients who survived treatment than in those who died, and was positively correlated with length of stay and duration of ventilation. NUTRIC scores did not correlate with REE. The Faisy–Fagon equation overestimated expenditure, whereas PSUm was unbiased and accurate. Calculations based on 25 kcal/kg bodyweight/day overestimated expenditure, whereas 23 kcal/kg/day produced unbiased estimates with greater accuracy than PSUm. Conclusion REE was positively associated with patient outcomes. Energy expenditure was accurately predicted by calculations of 23 kcal/kg bodyweight/day.
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Affiliation(s)
- Elham Sobhy
- Internal Medicine Department, KasrAlainy Cairo University, Cairo, Egypt
| | - Radwa Abdel Kader
- Internal Medicine Department, KasrAlainy Cairo University, Cairo, Egypt
| | | | - Mohammed Eshra
- Physiology Department, KasrAlainy Cairo University, Cairo, Egypt
| | - Mohamed Sayed
- Internal Medicine Department, KasrAlainy Cairo University, Cairo, Egypt.,Giza, Egypt
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Ndahimana D, Kim EK. Energy Requirements in Critically Ill Patients. Clin Nutr Res 2018; 7:81-90. [PMID: 29713616 PMCID: PMC5921333 DOI: 10.7762/cnr.2018.7.2.81] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 11/19/2022] Open
Abstract
During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.
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Affiliation(s)
- Didace Ndahimana
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Eun-Kyung Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
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Metabolomics of trauma-associated death: shared and fluid-specific features of human plasma vs lymph. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:185-94. [PMID: 27177401 DOI: 10.2450/2016.0208-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/17/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Water-soluble components in mesenteric lymph have been implicated in the pathophysiology of acute lung injury and distal organ failure following trauma and haemorrhagic shock. Proteomics analyses have recently shown similarities and specificities of post-trauma/haemorrhagic shock lymph and plasma. We hypothesise that the metabolic phenotype of post-trauma/haemorrhagic shock mesenteric lymph and plasma share common metabolites, but are also characterised by unique features that differentiate these two fluids. MATERIALS AND METHODS Matched samples were collected from 5 brain-dead organ donors who had suffered extreme trauma/haemorrhagic shock. Metabolomics analyses were performed through ultra-high performance liquid chromatography mass spectrometry. RESULTS Overall, 269 metabolites were identified in either fluid. Despite significant overlapping, metabolic phenotypes of matched lymph or plasma from the same patients could be used to discriminate sample fluid or biological patient/traumatic-injury origin. Metabolites showing relatively high levels in both fluids included markers of haemolysis and cell lysis secondary to tissue injury. DISCUSSION High positive correlations were observed between the quantitative levels of markers of systemic metabolic derangement following traumatic/haemorrhagic hypoxaemia, such as succinate, oxoproline, urate and fatty acids. These metabolites might contribute to coagulopathies of trauma and neutrophil priming driving acute lung injury. Future studies will investigate whether the observed compositional specificities mirror functional or pathological adaptations after trauma and haemorrhage.
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Ljungqvist O, Fearon K. Nutrition in Surgery and Trauma. Clin Nutr 2015. [DOI: 10.1002/9781119211945.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Metabolic changes after surgery, trauma, or serious illness have a complex pathophysiology. The early posttraumatic stress response is physiologic and associated with a state of hyperinflammation, increased oxygen consumption, and increased energy expenditure. These are part of a systemic reaction that encompasses a wide range of endocrinological, immunologic, and hematological effects. Surgery initiates changes in metabolism that can affect virtually all organs and tissues; the metabolic response results in hormone-mediated mobilization of endogenous substrates that leads to stress catabolism. Hypercatabolism has been associated with severe complications related to hyperglycemia, hypoproteinemia, and immunosuppression. Proper metabolic support is essential to restore homeostasis and ensure survival.
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Affiliation(s)
- George L Blackburn
- Center for the Study of Nutrition Medicine, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Feldberg 880 East Campus, 330 Brookline Avenue, Boston, MA 02215, USA.
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Stahel PF, Flierl MA, Moore EE. "Metabolic staging" after major trauma - a guide for clinical decision making? Scand J Trauma Resusc Emerg Med 2010; 18:34. [PMID: 20565752 PMCID: PMC2894005 DOI: 10.1186/1757-7241-18-34] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/17/2010] [Indexed: 11/16/2022] Open
Abstract
Metabolic changes after major trauma have a complex underlying pathophysiology. The early posttraumatic stress response is associated with a state of hyperinflammation, with increased oxygen consumption and energy expenditure. This hypercatabolic state must be recognized early and mandates an early nutritional management strategy. A proactive concept of early enteral "immunonutrition" in severely injured patients, is aimed at counterbalancing the negative aspects of hyperinflammation and hypercatabolism in order to reduce the risk of late complications, including infections and posttraumatic organ failure. Recently, the concept of "metabolic staging" has been advocated, which takes into account the distinct inflammatory phases and metabolic phenotypes after major trauma, including the "ischemia/reperfusion phenotype", the "leukocytic phenotype", and the "angiogenic phenotype". The potential clinical impact of metabolic staging, and of an appropriately adapted "metabolic control" and nutritional support, remains to be determined.
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Affiliation(s)
- Philip F Stahel
- Department of Orthopaedic Surgery Denver Health Medical Center University of Colorado School of Medicine 777 Bannock Street Denver, CO 80204 USA
| | - Michael A Flierl
- Department of Orthopaedic Surgery Denver Health Medical Center University of Colorado School of Medicine 777 Bannock Street Denver, CO 80204 USA
| | - Ernest E Moore
- Department of Surgery Denver Health Medical Center University of Colorado School of Medicine 777 Bannock Street Denver, CO 80204 USA
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Aller MA, Arias JI, Alonso-Poza A, Arias J. A review of metabolic staging in severely injured patients. Scand J Trauma Resusc Emerg Med 2010; 18:27. [PMID: 20478066 PMCID: PMC2883961 DOI: 10.1186/1757-7241-18-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 05/17/2010] [Indexed: 02/07/2023] Open
Abstract
An interpretation of the metabolic response to injury in patients with severe accidental or surgical trauma is made. In the last century, various authors attributed a meaning to the post-traumatic inflammatory response by using teleological arguments. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research. The goal of the current review is to correlate the metabolic changes with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic- that the patients express during the evolution of the systemic inflammatory response. The sequence in the expression of multiple metabolic systems that becomes progressively more elaborate and complex in severe injured patients urges for more detailed knowledge in order to establish the most adequate metabolic support according to the evolutive phase. Thus, clinicians must employ different treatment strategies based on the different metabolic phases when caring for this challenging patient population. Perhaps, the best therapeutic option would be to favor early hypometabolism during the ischemia-reperfusion phase, to boost the antienzymatic metabolism and to reduce hypermetabolism during the leukocytic phase through the early administration of enteral nutrition and the modulation of the acute phase response. Lastly, the early epithelial regeneration of the injured organs and tissues by means of an oxidative metabolism would reduce the fibrotic sequelae in these severely injured patients.
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Affiliation(s)
- Maria-Angeles Aller
- Surgery I Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
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Gedeon GS, Goll C, Shenkin A, Al-Shamma G, Richards JR, Fleck A, Cuthbertson DP, Fell GS. The effect of environmental temperature on protein and energy changes following burn injury in the rat. Clin Nutr 2008; 2:13-24. [PMID: 16829402 DOI: 10.1016/0261-5614(83)90024-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/1982] [Accepted: 12/06/1982] [Indexed: 10/26/2022]
Abstract
The metabolic response to a standard burn injury in rats (25% of body surface area) was investigated at environmental temperature 20 degrees C and 30 degrees C. With an intake of 15 g diet (20% w/w protein) per day, burned rats at 20 degrees C were found to be in negative energy balance mainly due to increased insensible (evaporative) losses, and they lost weight. Fat was the main endogenous source of energy, although protein was also catabolised from both carcass and pelt. At 30 degrees C, insensible losses of burned rats were still high, but they had lower sensible (mainly radiative) losses leading to a positive energy balance and a gain in weight. This consisted mainly of carcass water, fat and protein. Urine catecholamines were higher in burned rats at 20 degrees C than at 30 degrees C and correlated with heat loss, urine nitrogen and urine 3-methylhistidine, supporting the hypothesis that catecholamines play a central role in mediating the protein and energy changes following burn injury. For the first 4-6 days, urine nitrogen and 3-methylhistidine excretion increased in rats at 30 degrees C, suggesting that this early part of the metabolic response is obligatory. These findings support the use of raised environmental temperatures to reduce the metabolic response to burns.
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Affiliation(s)
- G S Gedeon
- Department of Biochemistry and Department of Surgery, Royal Infirmary, Glasgow, UK; Institute of Physiology, University of Glasgow, Scotland
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Frayn KN. Integration of substrate flow in vivo: some insights into metabolic control. Clin Nutr 2007; 16:277-82. [PMID: 16844609 DOI: 10.1016/s0261-5614(97)80012-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/1997] [Accepted: 09/16/1997] [Indexed: 11/16/2022]
Affiliation(s)
- K N Frayn
- Oxford Lipid Metabolism Group, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX2 6HE, UK
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