title: Trace element supplementation after major burns increases burned skin trace element concentrations and modulates local protein metabolism but not whole-body substrate metabolism.
abstract: BACKGROUND
  After major burns, patients exhibit an intense catabolism, and the wounds require surgery and grafting for closure. Complications, such as weight loss and delayed wound healing, are worsened by trace element (TE) deficiencies.
  
  
  OBJECTIVE
  We aimed to assess the effects of TE supplements on systemic substrate turnover and local protein metabolism during wound healing after major burns.
  
  
  METHODS
  This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y with burns on 45 +/- 16% of their body surface area; 12 had skin biopsies performed on days 3, 10, and 20, and 10 patients underwent a stable-isotope investigation on day 10. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. On day 10, [(13)C]phenylalanine (600-microg/kg bolus followed by 12 microg x kg(-1) x min(-1)) plus 6-[(2)H(2)]glucose and [(2)H(5)]glycerol were infused for 6 h to determine skin protein turnover. Biopsies were performed 1 and 6 h after the start of infusion to determine [(13)C]phenylalanine enrichment.
  
  
  RESULTS
  The patients' mean age and burn severity did not differ significantly between the groups nor between the skin investigations subgroups. Plasma TE concentrations were significantly higher in the TE group. In the burned areas, the skin contents of selenium (P=0.02) and zinc (P=0.03) increased by day 20. The supernatant-to-plasma (13)C enrichment ratio in burned skin was 0.363 +/- 0.094 (TE group) and 0.286 +/- 0.130 (V group) after 1 h (NS) and 0.592 +/- 0.153 (TE group) and 0.262 +/- 0.171 (V group) after 6 h, which reflected lower catabolism in the TE group (P=0.03). No significant differences in whole-body substrate turnover were found between the groups.
  
  
  CONCLUSIONS
  TE supplementation was associated with an increased skin tissue content of selenium and zinc and with a reduction in skin protein catabolism.
authors.affiliation: Department of Adult Intensive Care Medicine & Burns Centre, Lausanne, Switzerland. mette.berger@chuv.ch
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Christophe
authors.initials: C
authors.lastname: Binnert
authors.forename: René L
authors.initials: RL
authors.lastname: Chiolero
authors.forename: William
authors.initials: W
authors.lastname: Taylor
authors.forename: Wassim
authors.initials: W
authors.lastname: Raffoul
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Cayeux
authors.forename: Messod
authors.initials: M
authors.lastname: Benathan
authors.forename: Alan
authors.initials: A
authors.lastname: Shenkin
authors.forename: Luc
authors.initials: L
authors.lastname: Tappy
mesh_terms: D000328:Adult; D002056:Burns / Q000378:metabolism* / Q000601:surgery / Q000628:therapy; D002247:Carbon Isotopes; D003300:Copper / Q000032:analysis / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D003903:Deuterium; D019587:Dietary Supplements; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D009751:Nutritional Requirements; D011446:Prospective Studies; D014176:Protein Biosynthesis / Q000187:drug effects; D011506:Proteins / Q000378:metabolism*; D012643:Selenium / Q000032:analysis / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use; D012867:Skin / Q000378:metabolism*; D016038:Skin Transplantation; D014131:Trace Elements / Q000032:analysis / Q000172:deficiency / Q000378:metabolism* / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology; D015032:Zinc / Q000032:analysis / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D002247:Carbon Isotopes; D011506:Proteins; D014131:Trace Elements; D003300:Copper; D003903:Deuterium; D012643:Selenium; D015032:Zinc