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The use of beta-adrenergic blockade in preventing trauma-induced hepatomegaly
Robert E Barrow1, Robert R Wolfe, Mohan R Dasu
1Department of Surgery, University of Texas Medical Branch, and Shriners Hospitals for Children, Galveston, TX 77550, USA. rbarrow@utmb.edu
Insights
Beta-adrenergic blockade significantly reduced liver enlargement in burned children by inhibiting lipolysis and decreasing fatty acid delivery to the liver. This treatment offers a potential therapeutic strategy for managing hepatomegaly in pediatric burn survivors.
Area of Science:
- Pediatric critical care
- Burn medicine
- Metabolic disorders
Background:
- Severely burned children often develop hepatomegaly (enlarged liver), frequently exceeding twice normal size.
- Accelerated lipolysis and subsequent free fatty acid (FFA) delivery to the liver contribute to triglyceride accumulation and hepatic enlargement.
Purpose of the Study:
- To investigate if blocking lipolysis can reduce or reverse hepatomegaly in pediatric burn patients.
- To test the efficacy of beta-adrenergic blockade in managing hepatic complications post-burn.
Main Methods:
- A study involving 98 children (2-18 years) with >40% Total Body Surface Area burns.
- Treatment groups received either propranolol (beta-blocker) or placebo, with liver size assessed by ultrasound.
- Body composition and adipose tissue gene expression (lipid metabolism) were analyzed.
Main Results:
- 80% of children not receiving propranolol experienced ≥100% liver size increase; 86% receiving propranolol showed decreased or stable liver size.
- Propranolol treatment led to down-regulation of genes involved in lipid metabolism in adipose tissue.
- Reduced FFA delivery to the liver and decreased hepatic blood flow were observed.
Conclusions:
- Beta-adrenergic blockade effectively inhibits lipolysis, reducing FFA delivery to the liver.
- This blockade attenuates or reverses hepatomegaly and hepatic congestion in severely burned children.
- The findings support propranolol as a therapeutic option for managing burn-related liver complications.
Objective:
The objective of this study was to test the hypothesis that hepatomegaly in burned children can be attenuated or reversed by blocking lipolysis and reducing free fatty acids delivered to the liver.
Summary Background Data:
Accelerated lipolysis in severely burned children has been shown to play an important role in the accumulation of hepatic TGs. Severely burned children who survive 10 days or more after injury commonly have enlarged livers often twice or more normal size for their sex, age, and weight.
Methods:
Ninety-eight children, 2 to 18 years of age, with burns covering more than 40% of their body surface and who received either propranolol (beta-adrenergic blockade) or placebo were studied. Liver weights were measured by ultrasonic scanning. Body composition changes were identified by dual-image x-ray absorptiometry and validated by whole-body potassium-40 scintillation counting. Discarded abdominal cutaneous adipose tissue was collected before and after propranolol or placebo for microarray analysis.
Results:
In 80% of severely burned children studied not receiving propranolol, liver sizes increased by 100% or more while 86% of burned children receiving propranolol showed a decrease or no change in liver size over the same period of time after injury. Gene expression patterns of adipose tissue after propranolol treatment showed that all of the identified genes related to lipid metabolism were down-regulated.
Conclusions:
Data reported here support the hypothesis that beta-adrenergic blockade can reduce delivery of fatty acids to the liver and hepatic congestion commonly found in severely burned children by inhibiting lipolysis and reducing hepatic blood flow.
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