Role of the PPAR-α agonist fenofibrate in severe pediatric burn.
Fenofibrate is a peroxisome proliferator activated receptor alpha agonist that contains both pro and anti-inflammatory properties, and has been used in the treatment of dyslipidemia and diabetes for decades. Its receptors are expressed in the liver, skeletal muscle, cardiac, enteric, and renal cells, which allow it to provide systemic regulation of lipoprotein metabolism, fatty acid oxidation, and fatty acid transport. Hyperglycemia is a common complication found in the burn population because hepatic glucose production and catecholamine-mediated hepatic glycogenolysis are augmented. Insulin resistance occurs often in these patients and is associated with poor outcomes. In the pediatric burn population, fenofibrate has been found to ameliorate or decrease the number of hypoglycemic episodes when compared to management with insulin alone. Its mechanism of action is thought to involve an improvement in insulin signaling in skeletal muscle, as well as improvements in mitochondrial function, glucose oxidation, and insulin sensitivity. The long term use of fenofibrate in severely burned patients may improve hyperglycemia and insulin resistance, as well as improve wound healing, and reduce apoptosis, and oxidative stress.
Department of Surgery, The University of Texas Medical Branch and Shriners Burns Hospital for Children at Galveston, TX 77555-0591, USA.
Itoro E
IE
Elijah
Elisabet
E
Børsheim
Dirk M
DM
Maybauer
Celeste C
CC
Finnerty
David N
DN
Herndon
Marc O
MO
Maybauer
D002056:Burns / Q000150:complications*; D011345:Fenofibrate / Q000627:therapeutic use*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D050356:Lipid Metabolism / Q000187:drug effects*; D008066:Lipolysis / Q000187:drug effects; D047493:PPAR alpha / Q000819:agonists* / Q000502:physiology; D047492:Peroxisome Proliferator-Activated Receptors / Q000502:physiology
D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D047493:PPAR alpha; D047492:Peroxisome Proliferator-Activated Receptors; D011345:Fenofibrate