drtbear1967
Musclechemistry Board Certified Member
[h=1]The Effect of Oxandrolone on the Endocrinologic, Inflammatory, and Hypermetabolic Responses During the Acute Phase Postburn[/h]Marc G. Jeschke, MD, PhD,[SUP]*†[/SUP] Celeste C. Finnerty, PhD,[SUP]*†[/SUP] Oscar E. Suman, PhD,[SUP]*†[/SUP] Gabriela Kulp, MS,[SUP]*[/SUP] Ronald P. Mlcak, PhD,[SUP]*[/SUP] and David N. Herndon, MD, FACS[SUP]*†[/SUP]
[h=3]Marc G. Jeschke[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Marc G. Jeschke
[h=3]Celeste C. Finnerty[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Celeste C. Finnerty
[h=3]Oscar E. Suman[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Oscar E. Suman
[h=3]Gabriela Kulp[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Gabriela Kulp
[h=3]Ronald P. Mlcak[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Ronald P. Mlcak
[h=3]David N. Herndon[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by David N. Herndon
From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Author information ► Copyright and License information ► Disclaimer
Copyright © 2007 Lippincott Williams & Wilkins, Inc.
Go to:
[h=2]Abstract[/h][h=2]Objective and Summary Background Data:[/h]Postburn long-term oxandrolone treatment improves hypermetabolism and body composition. The effects of oxandrolone on clinical outcome, body composition, endocrine system, and inflammation during the acute phase postburn in a large prospective randomized single-center trial have not been studied.
[h=2]Methods:[/h]Burned children (n = 235) with >40% total body surface area burn were randomized (block randomization 4:1) to receive standard burn care (control, n = 190) or standard burn care plus oxandrolone for at least 7 days (oxandrolone 0.1 mg/kg body weight q.12 hours p.o, n = 45). Clinical parameters, body composition, serum hormones, and cytokine expression profiles were measured throughout acute hospitalization. Statistical analysis was performed by Student t test, or ANOVA followed by Bonferroni correction with significance accepted at P < 0.05.
[h=2]Results:[/h]Demographics and clinical data were similar in both groups. Length of intensive care unit stay was significantly decreased in oxandrolone-treated patients (0.48 ± 0.02 days/% burn) compared with controls (0.56 ± 0.02 days/% burn), (P < 0.05). Control patients lost 8 ± 1% of their lean body mass (LBM), whereas oxandrolone-treated patients had preserved LBM (+9 ± 4%), P < 0.05. Oxandrolone significantly increased serum prealbumin, total protein, testosterone, and AST/ALT, whereas it significantly decreased α2-macroglobulin and complement C3, P < 0.05. Oxandrolone did not adversely affect the endocrine and inflammatory response as we found no significant differences in the hormone panels and cytokine expression profiles.
[h=2]Conclusions:[/h]In this large prospective, double-blinded, randomized single-center study, oxandrolone shortened length of acute hospital stay, maintained LBM, improved body composition and hepatic protein synthesis while having no adverse effects on the endocrine axis postburn, but was associated with an increase in AST and ALT.
Severe burn injuries induce a hypermetabolic response, which leads to endocrinologic dysfunction, immune compromise, catabolism, and hyper inflammation.[SUP]1–4[/SUP] Stress-related hormones such as catecholamines, cortisol, and glucagons drive this response and are markedly elevated postburn.[SUP]2–6[/SUP] These changes result in a hypercatabolic state, which is characterized by a significant loss of lean body mass (LBM), even in the fed state, persistent muscle weakness, tachycardia, early fatigue with normal activity, and growth arrest.[SUP]2–4,7–11[/SUP] The loss of total nitrogen from the skeletal muscle may be as much as 10- to 15-fold greater in the burned patient than in a healthy-fasted volunteer.[SUP]11[/SUP] These drastic changes are most pronounced immediately postburn and up to 6 to 8 weeks postburn until the patient is discharged from the unit.[SUP]1,12–15[/SUP] Hypermetabolism, however, has been shown to persist over 2 years leaving the patient disabled and preventing them from reintegration into society.[SUP]14,15[/SUP] Attenuation of these responses has been investigated and shown to be beneficial in terms of improved rehabilitation and accelerated reintegration of the patient into society.[SUP]2,6,16[/SUP]
One of the agents that have been shown to be effective is oxandrolone.[SUP]17–20[/SUP] Oxandrolone, an oral synthetic testosterone analogue, has been successfully used in children with Turner syndrome and other pathologic delays in growth, cachexia, alcoholic hepatitis, and in patients with AIDS-associated wasting myopathy.[SUP]21–24[/SUP] Compared with testosterone, oxandrolone has minimal virilizing activity.[SUP]25,26[/SUP] In burned children and adults, oxandrolone has shown promising results in terms of weight gain and urinary nitrogen balance during the acute phase postburn.[SUP]18,20[/SUP] oxandrolone further improved body composition and strength in severely burned children during the 12 months of treatment.[SUP]15,18[/SUP] Recently, a multicenter study showed that oxandrolone significantly shortened length of hospital stay in 81 severely burned adults.[SUP]27[/SUP] Taking these data together, it appears that oxandrolone is a beneficial treatment option for severely burned patients; however, there is no large prospective single center trial on the effect of oxandrolone on clinical outcome. Furthermore, the underlying mechanisms responsible for the improved clinical outcome are not fully understood. As the peak of the hypermetabolic and inflammatory responses occurs immediately after burn,[SUP]1,2,6,12[/SUP] the current study was designed to investigate the effect of oxandrolone on clinical, metabolic, endocrinologic, and inflammatory markers during the immediate acute phase postburn.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959346/
[h=3]Marc G. Jeschke[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Marc G. Jeschke
[h=3]Celeste C. Finnerty[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Celeste C. Finnerty
[h=3]Oscar E. Suman[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Oscar E. Suman
[h=3]Gabriela Kulp[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Gabriela Kulp
[h=3]Ronald P. Mlcak[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by Ronald P. Mlcak
[h=3]David N. Herndon[/h]From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Find articles by David N. Herndon
From the *Shriners Hospital for Children, and †Department of Surgery, University Texas Medical Branch, Galveston, Texas.
Author information ► Copyright and License information ► Disclaimer
Copyright © 2007 Lippincott Williams & Wilkins, Inc.
Go to:
[h=2]Abstract[/h][h=2]Objective and Summary Background Data:[/h]Postburn long-term oxandrolone treatment improves hypermetabolism and body composition. The effects of oxandrolone on clinical outcome, body composition, endocrine system, and inflammation during the acute phase postburn in a large prospective randomized single-center trial have not been studied.
[h=2]Methods:[/h]Burned children (n = 235) with >40% total body surface area burn were randomized (block randomization 4:1) to receive standard burn care (control, n = 190) or standard burn care plus oxandrolone for at least 7 days (oxandrolone 0.1 mg/kg body weight q.12 hours p.o, n = 45). Clinical parameters, body composition, serum hormones, and cytokine expression profiles were measured throughout acute hospitalization. Statistical analysis was performed by Student t test, or ANOVA followed by Bonferroni correction with significance accepted at P < 0.05.
[h=2]Results:[/h]Demographics and clinical data were similar in both groups. Length of intensive care unit stay was significantly decreased in oxandrolone-treated patients (0.48 ± 0.02 days/% burn) compared with controls (0.56 ± 0.02 days/% burn), (P < 0.05). Control patients lost 8 ± 1% of their lean body mass (LBM), whereas oxandrolone-treated patients had preserved LBM (+9 ± 4%), P < 0.05. Oxandrolone significantly increased serum prealbumin, total protein, testosterone, and AST/ALT, whereas it significantly decreased α2-macroglobulin and complement C3, P < 0.05. Oxandrolone did not adversely affect the endocrine and inflammatory response as we found no significant differences in the hormone panels and cytokine expression profiles.
[h=2]Conclusions:[/h]In this large prospective, double-blinded, randomized single-center study, oxandrolone shortened length of acute hospital stay, maintained LBM, improved body composition and hepatic protein synthesis while having no adverse effects on the endocrine axis postburn, but was associated with an increase in AST and ALT.
Severe burn injuries induce a hypermetabolic response, which leads to endocrinologic dysfunction, immune compromise, catabolism, and hyper inflammation.[SUP]1–4[/SUP] Stress-related hormones such as catecholamines, cortisol, and glucagons drive this response and are markedly elevated postburn.[SUP]2–6[/SUP] These changes result in a hypercatabolic state, which is characterized by a significant loss of lean body mass (LBM), even in the fed state, persistent muscle weakness, tachycardia, early fatigue with normal activity, and growth arrest.[SUP]2–4,7–11[/SUP] The loss of total nitrogen from the skeletal muscle may be as much as 10- to 15-fold greater in the burned patient than in a healthy-fasted volunteer.[SUP]11[/SUP] These drastic changes are most pronounced immediately postburn and up to 6 to 8 weeks postburn until the patient is discharged from the unit.[SUP]1,12–15[/SUP] Hypermetabolism, however, has been shown to persist over 2 years leaving the patient disabled and preventing them from reintegration into society.[SUP]14,15[/SUP] Attenuation of these responses has been investigated and shown to be beneficial in terms of improved rehabilitation and accelerated reintegration of the patient into society.[SUP]2,6,16[/SUP]
One of the agents that have been shown to be effective is oxandrolone.[SUP]17–20[/SUP] Oxandrolone, an oral synthetic testosterone analogue, has been successfully used in children with Turner syndrome and other pathologic delays in growth, cachexia, alcoholic hepatitis, and in patients with AIDS-associated wasting myopathy.[SUP]21–24[/SUP] Compared with testosterone, oxandrolone has minimal virilizing activity.[SUP]25,26[/SUP] In burned children and adults, oxandrolone has shown promising results in terms of weight gain and urinary nitrogen balance during the acute phase postburn.[SUP]18,20[/SUP] oxandrolone further improved body composition and strength in severely burned children during the 12 months of treatment.[SUP]15,18[/SUP] Recently, a multicenter study showed that oxandrolone significantly shortened length of hospital stay in 81 severely burned adults.[SUP]27[/SUP] Taking these data together, it appears that oxandrolone is a beneficial treatment option for severely burned patients; however, there is no large prospective single center trial on the effect of oxandrolone on clinical outcome. Furthermore, the underlying mechanisms responsible for the improved clinical outcome are not fully understood. As the peak of the hypermetabolic and inflammatory responses occurs immediately after burn,[SUP]1,2,6,12[/SUP] the current study was designed to investigate the effect of oxandrolone on clinical, metabolic, endocrinologic, and inflammatory markers during the immediate acute phase postburn.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959346/
