Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient.
Dehydroepiandrosterone
Dehydroepiandrosterone sulphate
Immune
Intensive care
Rehabilitation
Traumatic injury
Journal
Burns & trauma
ISSN: 2321-3868
Titre abrégé: Burns Trauma
Pays: England
ID NLM: 101651457
Informations de publication
Date de publication:
2019
2019
Historique:
received:
17
01
2019
accepted:
03
05
2019
entrez:
8
8
2019
pubmed:
8
8
2019
medline:
8
8
2019
Statut:
epublish
Résumé
Severe injuries are the major cause of death in those aged under 40, mainly due to road traffic collisions. Endocrine, metabolic and immune pathways respond to limit the tissue damage sustained and initiate wound healing, repair and regeneration mechanisms. However, depending on age and sex, the response to injury and patient prognosis differ significantly. Glucocorticoids are catabolic and immunosuppressive and are produced as part of the stress response to injury leading to an intra-adrenal shift in steroid biosynthesis at the expense of the anabolic and immune enhancing steroid hormone dehydroepiandrosterone (DHEA) and its sulphated metabolite dehydroepiandrosterone sulphate (DHEAS). The balance of these steroids after injury appears to influence outcomes in injured humans, with high cortisol: DHEAS ratio associated with increased morbidity and mortality. Animal models of trauma, sepsis, wound healing, neuroprotection and burns have all shown a reduction in pro-inflammatory cytokines, improved survival and increased resistance to pathological challenges with DHEA supplementation. Human supplementation studies, which have focused on post-menopausal females, older adults, or adrenal insufficiency have shown that restoring the cortisol: DHEAS ratio improves wound healing, mood, bone remodelling and psychological well-being. Currently, there are no DHEA or DHEAS supplementation studies in trauma patients, but we review here the evidence for this potential therapeutic agent in the treatment and rehabilitation of the severely injured patient.
Identifiants
pubmed: 31388512
doi: 10.1186/s41038-019-0158-z
pii: 158
pmc: PMC6676517
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
26Subventions
Organisme : Medical Research Council
ID : MR/K00414X/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/P021220/1
Pays : United Kingdom
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
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