title: Dehydroepiandrosterone, an endogenous immune modulator, after traumatic shock.
abstract: Dehydroepiandrosterone (DHEA), an endogenous immune modulator, reduces mortality after endotoxin (lipopolysaccharide (LPS)) administration in rodents. However, there have been no studies in clinically relevant large-animal models. A unique experimental model is used to study the effects of DHEA in resuscitated trauma and to evaluate the protective effect of DHEA on the systemic inflammatory response induced by a delayed LPS challenge. Anesthetized, ventilated pigs were instrumented and then subjected to local hind-limb trauma and 35% hemorrhage. After 1 h, animals were resuscitated with shed blood, supplemental Ringers solution, and in a randomized, blinded fashion, 4 mg/kg of DHEA or vehicle. Two additional groups received 10 mg/kg or 20 mg/kg of DHEA. Animals were dosed again at 24, 48, and 72 h. After 75 h, Escherichia coli LPS was administered. LPS caused a fall in DHEA levels (0.23 +/- .05 ng/mL (60 min post-LPS) versus .94 +/- 35 ng/mL (72 h), p = .01). DHEA levels 60 min post-LPS were significantly higher in treated animals (p < .002). After LPS, all groups manifested progressive septic symptoms with a hyperdynamic state and pulmonary failure. These symptoms were not blunted by the administration of DHEA. DHEA levels are suppressed by LPS in this two-stage model of trauma and delayed sepsis; however, exogenous DHEA administration fails to blunt the associated systemic inflammatory response and pulmonary failure.
authors.affiliation: Department of Surgery, Presley Regional Trauma Center, University of Tennessee Health Science Center, Memphis 38163, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Schurr
authors.forename: T C
authors.initials: TC
authors.lastname: Fabian
authors.forename: M A
authors.initials: MA
authors.lastname: Croce
authors.forename: L E
authors.initials: LE
authors.lastname: Varnavas
authors.forename: K G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D003687:Dehydroepiandrosterone / Q000378:metabolism* / Q000494:pharmacology; D008070:Lipopolysaccharides / Q000494:pharmacology; D008168:Lung / Q000503:physiopathology*; D013552:Swine; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology*; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D008070:Lipopolysaccharides; D003687:Dehydroepiandrosterone