Understanding the long-term impacts of burn on the cardiovascular system

Duke, Janine M.; Randall, Sean; Fear, Mark W.; Boyd, James H.; Rea, Suzanne; Wood, Fiona

doi:10.1016/j.burns.2015.08.020

Cited by 79 publications

(63 citation statements)

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“…The project was approved by the Human Research Ethics Committees of the University of Western Australia and the Western Australian Department of Health and project methods and analyses have been previously published [7, 23]. …”

Section: Methodsmentioning

confidence: 99%

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Burn Injury Leads to Increased Long-Term Susceptibility to Respiratory Infection in both Mouse Models and Population Studies

et al. 2017

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BackgroundBurn injury initiates an acute inflammatory response that subsequently drives wound repair. However, acute disruption to the immune response is also common, leading to susceptibility to sepsis and increased morbidity and mortality. Despite increased understanding of the impact of burn injury on the immune system in the acute phase, little is known about long-term consequences of burn injury on immune function. This study was established to determine whether burn injury has long-term clinical impacts on patients’ immune responses.MethodsUsing a population-based retrospective longitudinal study and linked hospital morbidity and death data from Western Australia, comparative rates of hospitalisation for respiratory infections in burn patients and a non-injured comparator cohort were assessed. In addition, a mouse model of non-severe burn injury was also used in which viral respiratory infection was induced at 4 weeks post-injury using a mouse modified version of the Influenza A virus (H3NN; A/mem/71-a).Results and conclusionsThe burn injured cohort contained 14893 adult patients from 1980–2012 after removal of those patients with evidence of smoke inhalation or injury to the respiratory tract. During the study follow-up study a total of 2,884 and 2,625 respiratory infection hospital admissions for the burn and uninjured cohorts, respectively, were identified. After adjusting for covariates, the burn cohort experienced significantly elevated admission rates for influenza and viral pneumonia (IRR, 95%CI: 1.73, 1.27–2.36), bacterial pneumonia (IRR, 95%CI: 2.05, 1.85–2.27) and for other types of upper and lower respiratory infections (IRR, 95% CI: 2.38, 2.09–2.71). In the mouse study an increased viral titre was observed after burn injury, accompanied by a reduced CD8 response and increased NK and NKT cells in the draining lymph nodes. This data suggests burn patients are at long-term increased risk of infection due to sustained modulation of the immune response.

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Section: Methodsmentioning

confidence: 99%

“…Our previous population-based research has identified long-term cardiovascular [23] and musculoskeletal morbidity [24] as well as increased incidence of cancer [25] after both severe and minor burn injury. These results, together with animal data [11] suggests potential long-term effects of the burn on the immune system.…”

Section: Introductionmentioning

confidence: 99%

Burn Injury Leads to Increased Long-Term Susceptibility to Respiratory Infection in both Mouse Models and Population Studies

et al. 2017

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“…Cardiac ischemia, characterized by inadequate supply of oxygen and nutrients, often leads to irreversible damage to the myocardium, which is manifested as contractile tissue loss and compensatory cardiac hypertrophy. Many pathological conditions, such as coronary heart disease, and heart diseases caused by other factors, including long residence in plateau regions, severe burns, traumatic hemorrhage and organ transplantation, lead to ischemic injury (Edtinger et al, 2014;Duke et al, 2016). Therefore, a better understanding of the mechanisms underlying cardiac loss could yield new therapeutic targets against these pathological conditions.…”

Section: Introductionmentioning

confidence: 99%

The Lysosomal Membrane Protein Lamp2 Alleviates Lysosomal Cell Death by Promoting Autophagic Flux in Ischemic Cardiomyocytes

Cui

Zhao

et al. 2020

Front. Cell Dev. Biol.

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Lysosomal membrane permeabilization (LMP) has recently been recognized as an important cell death pathway in various cell types. However, studies regarding the correlation between LMP and cardiomyocyte death are scarce. Lysosomal membraneassociated protein 2 (Lamp2) is an important component of lysosomal membranes and is involved in both autophagy and LMP. In the present study, we found that the protein content of Lamp2 gradually decreased in response to oxygen, glucose and serum deprivation (OGD) treatment in vitro. To further elucidate its role in ischemic cardiomyocytes, particularly with respect to autophagy and LMP, we infected cardiomyocytes with adenovirus carrying full-length Lamp2 to restore its protein level in cells. We found that OGD treatment resulted in the occurrence of LMP and a decline in the viability of cardiomyocytes, which were remarkably reversed by Lamp2 restoration. Exogenous expression of Lamp2 also significantly alleviated the autophagic flux blockade induced by OGD treatment by promoting the trafficking of cathepsin B (Cat B) and cathepsin D (Cat D). Through drug intervention and gene regulation to alleviate and exacerbate autophagic flux blockade respectively, we found that impaired autophagic flux in response to ischemic injury contributed to the occurrence of LMP in cardiomyocytes. In conclusion, our present data suggest that Lamp2 overexpression can improve autophagic flux blockade probably by promoting the trafficking of cathepsins and consequently conferring cardiomyocyte resistance against lysosomal cell death (LCD) that is induced by ischemic injury. These results may indicate a new therapeutic target for ischemic heart damage.

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“…Much of the research on burn injury over the last 20+ years has centered oncharacterizing the hyper metabolic response and has greatly improved burn care (14, 27). In fact, due to these medical advances, patients with 90% total body surface area burns now survive these injuries; however, these improvements in burn care have resulted in children and adults with long-term metabolic and cardiovascular complications that persist for up to 3 years postburn (11, 14, 16, 40)and that are thought to be risk factors for long-term cardiovascular disease (9). …”

Section: Introductionmentioning

confidence: 99%

Children with Burn Injury Have Impaired Cardiac Output during Submaximal Exercise

Rivas

Herndon

Beck³

et al. 2017

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction Burn trauma damages resting cardiac function; however, it is currently unknown if the cardiovascular response to exercise is likewise impaired. We tested the hypothesis that, in children, burn injury lowers cardiac output (Q) and stroke volume (SV) during submaximal exercise. Methods Five children with 49±4% total body surface area (BSA) burned (2 female, 11.7±1 y, 40.4±18 kg, 141.1±9 cm) and eight similar non-burned controls (5 female, 12.5±2 y, 58.0±17 kg, 147.3±12 cm) with comparable exercise capacity (peak oxygen consumption [peak VO2]: 31.9±11 vs. 36.8±8 ml O2·kg·min-1, P=0.39) participated. The exercise protocol entailed a pre-exercise (pre-EX) rest period followed by 3-minute exercise stages at 20 W and 50 W. VO2, heart rate (HR), Q (via non-rebreathing), SV (Q/HR), and arteriovenous O2 difference ([a-v] O2 dif, Q/VO2) were the primary outcome variables. Results Using a 2-way factorial ANOVA (group [G] × exercise [EX]), we found that Q was ∼27% lower in the burned than the non-burned group at 20 W of exercise (burned 5.7±1.0 vs. nonburned: 7.9±1.8 L·min-1) and 50 W of exercise (burned 6.9±1.6 vs. nonburned 9.2 ±3.2 L·min-1) (G × EX interaction, P=0.012). SV did not change from rest to exercise in burned children but increased by ∼24% in the non-burned group (main effect for EX, P=0.046). Neither [a-v] O2 dif nor VO2 differed between groups at rest or exercise, but HR response to exercise was reduced in the burn group (G × EX interaction, P=0.004). When normalized to BSA, SV (index) was similar between groups; however, Q (index) remained attenuated in the burned group (G × EX interaction, P<0.008). Conclusions Burned children have an attenuated cardiovascular response to submaximal exercise. Further investigation of hemodynamic function during exercise will provide insights important for cardiovascular rehabilitation in burned children.

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Understanding the long-term impacts of burn on the cardiovascular system

Abstract: Findings of increased hospital admission rates, prolonged length of hospital stay and increased long-term mortality related to circulatory system diseases in the burn cohort provide evidence to support that burn has long-lasting systemic impacts on the heart and circulation.

Cited by 79 publications

References 32 publications

Burn Injury Leads to Increased Long-Term Susceptibility to Respiratory Infection in both Mouse Models and Population Studies

Burn Injury Leads to Increased Long-Term Susceptibility to Respiratory Infection in both Mouse Models and Population Studies

The Lysosomal Membrane Protein Lamp2 Alleviates Lysosomal Cell Death by Promoting Autophagic Flux in Ischemic Cardiomyocytes

Children with Burn Injury Have Impaired Cardiac Output during Submaximal Exercise

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