Pathophysiological mechanisms and exercise counter measures of hypermetabolism and muscle wasting in severe burns 01/10/2020 - 30/09/2022

Abstract

Severe burns cause a cascade of unwanted effects such as an overdrive in metabolism, loss of muscle tissue, and loss of the body's ability to effectively handle glucose as an energy source and an enhanced inflammatory state. Against common belief, these side effects have shown to persist for years, and cause long-term consequences such as a reduced physical fitness and a higher risk of developing diabetes. Despite many research efforts, much of these persistent side effects that occur in burns are not well understood. Efforts to counteract the negative effects on metabolism, the loss of muscle tissue and to prevent or lessen the amount of the inflammation have not yet been successful. Exercise rehabilitation has the potential to, at least partly, prevent and/or restore the negative consequences as has been shown in other critically ill hospitalised patients. This project will, therefore, shed more light onto 1) the short- and long-term effects of severe burns on energy metabolism, loss of muscle tissue, and inflammation in adults, and 2) the effect of an 8-week exercise rehabilitation programme during the initial period of hospitalization on these parameters. In order to successfully execute this project, we will study patients from Belgium and Chinese burn centres to get a better understanding of the bodily derangements, which will lay a foundation for better future care of burn patients.

Researcher(s)

Research team(s)

Cellular and molecular aspects of skeletal muscle wasting in a rat model of severe burns. 01/10/2019 - 30/09/2023

Abstract

Severe burned patients undergo rapid increases in metabolism (hypermetabolism) and increased energy expenditure caused by the initial inflammatory and humoral responses. These responses also elicit, on top of the bed rest period, a cascade of negative reactions leading to additional muscle wasting. Muscle wasting itself leads to insulin resistance and may have long-term health consequences. Some of these effects persist from the first few days following severe burn injury to as long as three years later after wound closing. Although insulin resistance is assumed to be triggered by several catabolic factors, an important contributor to insulin resistance is muscle wasting itself. Insulin-resistance, may eventually lead to diabetes mellitus and is a long-term complication of severe burn patients which has major implications for future morbidity and mortality. Muscle wasting is a hallmark of burns but the underlying pathophysiological pathways are not well understood. The main aim of this project is to investigate the underlying mechanisms of muscle wasting (atrophy) in a rat model of severe burns (>40% TBSA). The first part of the study will focus on the effects of severe burn trauma in rats on the metabolomic profile of skeletal muscle, liver and blood. Secondly, we will focus on the same outcome measures during muscle disuse by means of rat hindlimb suspension with or without exercise. Thirdly, immune-histochemical, Western-blotting and biochemical analysis of the skeletal muscle activation and content of satellite cells, muscle capillarisation, autophagy and/or associated metabolic signalling pathways will be done. Finally, chemical blocking of myostatin as muscle wasting regulator will be investigated. The results of this project will be linked to the results of our ongoing clinical FWO project on exercise therapy in severely burned patients.

Researcher(s)

Research team(s)

Pathophysiological mechanisms and exercise counter measures of hypermetabolism and muscle wasting in severe burns. 01/10/2018 - 30/09/2020

Abstract

Severe burns cause a cascade of unwanted effects such as an overdrive in metabolism, loss of muscle tissue, and loss of the body's ability to effectively handle glucose as an energy source and an enhanced inflammatory state. Against common belief, these side effects have shown to persist for years, and cause long-term consequences such as a reduced physical fitness and a higher risk of developing diabetes. Despite many research efforts, much of these persistent side effects that occur in burns are not well understood. Efforts to counteract the negative effects on metabolism, the loss of muscle tissue and to prevent or lessen the amount of the inflammation have not yet been successful. Exercise rehabilitation has the potential to, at least partly, prevent and/or restore the negative consequences as has been shown in other critically ill hospitalised patients. This project will, therefore, shed more light onto 1) the short- and long-term effects of severe burns on energy metabolism, loss of muscle tissue, and inflammation in adults, and 2) the effect of an 8-week exercise rehabilitation programme during the initial period of hospitalization on these parameters. In order to successfully execute this project, we will study patients from Belgium and Chinese burn centres to get a better understanding of the bodily derangements, which will lay a foundation for better future care of burn patients.

Researcher(s)

Research team(s)

The effects of exercise on energy expenditure and muscle function in severe burned patients. 01/10/2017 - 30/09/2018

Abstract

Severe burned patients undergo rapid increases in metabolism (hypermetabolism) and increased energy expenditure caused by the initial inflammatory and humoral responses. These responses also elicit, on top of the bed rest period, a cascade of negative reactions leading to additional muscle wasting. Muscle wasting itself leads to insulin resistance and may have long-term health consequences. Some of these effects persist from the first few days following severe burn injury to as long as three years later after wound closing. Although insulin resistance is assumed to be triggered by several catabolic factors, an important contributor to insulin resistance is muscle wasting itself. Insulin-resistance, may eventually lead to diabetes mellitus and is a long-term complication of severe burn patients which has major implications for future morbidity and mortality. Physical exercise has been shown to affects both the metabolism as well as skeletal muscle function in oncology, cardiac patients, obstructive lung diseases and diabetic patients. In addition, physical exercise in critically-ill patients has also been shown to have beneficial effects on general health outcome parameters. Therefore, in the present study we will investigate the effects of severe burns [≥ 30 % total body surface area (TBSA)] on energy expenditure, hypermetabolism (especially insulin and glucose homeostasis) and muscle function (strength). Besides the fundamental research questions we will investigate the effect of an 8 week (3 times/week) rehabilitative exercise strength training on energy expenditure, hyper metabolism and muscle function. For the long-term effects we will investigate the Quality of Life (QoL) in patients undergoing such an additional rehabilitative program on top of standard-care. For this purpose we will use both general as well as burn specific questionnaires regarding QoL.

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Research team(s)

Tension reducing taping as a mechanotherapy for hypertrophic burn scars. 01/07/2017 - 31/12/2018

Abstract

Background: Hypertrophic scarring following burn injuries remains a real concern and clinical challenge. The prevalence of hypertrophic scarring following burns reaches up to 70%. There is increasing acknowledgement that mechanical forces can regulate inflammation and fibrosis and therefore may be used therapeutically to stimulate tissue repair and remodeling. This mechanism is referred to as "mechanotherapy". Specific objectives : A STIMPRO financing allows us to confirm the hypothesis that mechanotherapy can remodel hypertrophic scarring by use of a newly developed taping technique that reduces tension on pathological burn scars. We will also investigate whether this is related to the phases of wound healing (proliferation/ maturation). Assessment of scar variables will provide fundamental knowledge needed for further development of mechanotherapy. Novelty: This is the first study that attempts to confirm the mechanotherapy hypothesis in reducing tension, by the use of elastic therapeutic tape, to improve hypertrophic scarring. Method: A prospective cohort study will be performed. Scar sites will be treated with "standard of care" (pressure garments, silicone and moisturisers as prescribed by the treating physician) + mechanotherapy (newly developed specific taping technique with kinesio tape). A six months enrolment and intervention period followed by a 12 month follow-up period and completion period will be anticipated totalling 18 months. Link to previous and future research: This project is a continuation of the work that has been done by our consortium (REVAKI & Oscare). Our collaboration has led to the PhD. of Jill Meirte in 2016, six joint publications in peer reviewed journals and numerous presentations at international conferences. Prior to this project we have already conducted a pilot study. The confirmation of the effectiveness of the taping technique on reducing mechanical tension in the pilot study was a prerequisite for the current project. Financing and finalizing the project, as proposed here, will significantly increase our success in finding additional funding of, for example, a randomized control trial (e.g. FWO-TBM).

Researcher(s)

Research team(s)

Scientific advisor at Oscare 01/01/2017 - 31/12/2020

Abstract

Oscare is an after-care and research center for burns and scars in Antwerp. The multi-disciplinary after-care team and the research group of Oscare are experienced in the treatment of scars since 2001 and developed expertise in the domain of scientific research for innovative treatment methods for scars since 2008. The past years the research group Revaki - Movant had a successful collaboration with Oscare which has led to a first PhD. During this period Oscare has grown in all fields (prevention - treatment - research). To support further development of research within this field our research group Revaki –Movant, more particularly Ulrike Van Daele, will take active role in the research group of Oscare.

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Research team(s)

Scar tissue as a barrier in physiotherapy. 01/07/2014 - 31/12/2015

Abstract

Despite the widespread use of physical applications in physiotherapy there is lack of evidence based practice. The skin is an important barrier for topical applications. In scars, often present in patients receiving physiotherapy, the histology of the skin has changed, being an important factor of influence. The goal of this project is to investigate the bioavailability of scarred skin for vaso-active topical applications.

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Research team(s)

Manual and mechanical defibrosing techniques in scars after burns and major trauma. 01/10/2013 - 08/02/2017

Abstract

This project represents a formal research agreement between UA and on the other hand Oscare. UA provides Oscare research results mentioned in the title of the project under the conditions as stipulated in this contract.

Researcher(s)

Research team(s)