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Thursday 23 August 2007

Restoration of hormonal action and muscle protein.

By: Ferrando AA, Wolfe RR.

Crit Care Med 2007 Sep;35(9 Suppl):S630-4

This review focuses on the effects of restoring hormonal levels and/or influence on muscle protein metabolism in the stressed state. We have highlighted our clinical experience in the administration of anabolic and anticatabolic agents in stressed clinical populations, primarily adult and pediatric burn injury, as well as patients undergoing elective hip arthroplasty. Our previous experience entails the administration of anabolic hormones, such as testosterone and its derivatives, growth hormone, insulin-like growth factor-1 combined with its binding protein 3, and insulin. Current efforts focus on the administration of anticatabolic agents to reduce the effects of hypercortisolemia. Muscle protein metabolism was determined by stable isotope methodology. Our results indicate that normalization of anabolic hormone concentrations or amelioration of hormonal resistance restores the effects of feeding on skeletal muscle protein metabolism. Anabolic hormone administration results in a more favorable muscle protein balance in severely burned patients. Amelioration of hypercortisolemia in the stressed state leads to an improvement in protein kinetics. To summarize, alterations in hormonal influence that accompany stress states favor the loss of muscle protein. Restoration or normalization of hormonal influence improves muscle protein kinetics and ameliorates the loss of muscle nitrogen. To restore hormonal influence, clinicians should consider reestablishing anabolic stimuli and reducing catabolic stimuli.

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