Melatonin as pharmacologic support in burn patients: a proposed solution to thermal injury-related lymphocytopenia and oxidative damage.
OBJECTIVE
To review the data that support the clinical use of melatonin in the treatment of burn patients, with special emphasis on the stimulation of the oxidative defense system, the immune system, circadian rhythm of sleep/wakefulness, and the reduction in the toxicity of therapeutic agents used in the treatment of burn victims.


METHODS
A MEDLINE/PubMed search from 1975 to July 2006 was conducted.


METHODS
The screening of the literature was examined using the key words: burn patients, lymphocytopenia, skin oxidative stress, antioxidant, melatonin, and free radicals.


METHODS
Thermal injury often causes damage to multiple organs remote from the original burn wound and may lead to multiple organ failure. Animal models and burn patients exhibit elevated free radical generation that may be causative in the local wound response and in the development of burn shock and distant organ injury. The suppression of nonspecific resistance and the disturbance in the adaptive immune system makes burn patients vulnerable to infections. Moreover, there is loss of sleep and the toxicity produced by drugs habitually used in the clinic for burn patients. Melatonin is a powerful antioxidant and is a potent protective agent against damage after experimental thermal injury. Some actions of melatonin as a potential supportive pharmacologic agent in burn patients include its: role as a scavenger of both oxygen and nitrogen-based reactants, stimulation of the activities of a variety of antioxidative enzymes, reduction in proinflammatory cytokines, inhibition of adhesion molecules, chronobiotic effects, and reduction in the toxicity of the drugs used in protocols to treat thermal injury patients.


CONCLUSIONS
These combined actions of melatonin, along with its low toxicity and its ability to penetrate all morphophysiologic membranes, could make it a ubiquitously acting and highly beneficial molecule in burn patients.
Maldonado
Maria-Dolores
MD
Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Murillo-Cabezas
Francisco
F
Calvo
Juan-Ramón
JR
Lardone
Patricia-Judith
PJ
Tan
Dun-Xian
DX
Guerrero
Juan-Miguel
JM
Reiter
Russell J
RJ
D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000009:adverse effects; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use*; D002056:Burns / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D002940:Circadian Rhythm; D003422:Critical Care / Q000379:methods; D005609:Free Radicals / Q000378:metabolism; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007107:Immune System / Q000503:physiopathology; D008231:Lymphopenia / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D008550:Melatonin / Q000009:adverse effects / Q000627:therapeutic use*; D018384:Oxidative Stress; D012867:Skin / Q000378:metabolism; D012893:Sleep Wake Disorders / Q000209:etiology
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D000975:Antioxidants; D005609:Free Radicals; D006993:Hypnotics and Sedatives; D008550:Melatonin