Artikel
L-arginine improves wound healing after trauma-hemorrhage
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Autoren
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Stefan Nitsch
- Universitätsklinikum Schleswig Holstein, Campus Lübeck, Klinik für HNO
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Florian Wittmann
- LMU München, Klinikum Großhadern, Klinik für Chirurgie
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Barbara Wollenberg
- Universitätsklinikum Schleswig Holstein, Campus Lübeck, Klinik für HNO
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Martin Angele
- LMU München, Klinikum Großhadern, Klinik für Chirurgie
| Veröffentlicht: | 22. September 2005 |
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Gliederung
Text
Several studies indicate that the process of wound healing is impaired in the presence of concurrent trauma and shock (Hem). Wound immune cell dysfunction appears to be responsible for altered wound healing following Hem. In this respect, the amino acid L-arginine normalized wound immune cell function following Hem. Our objective is to determine whether L-arginine improves impaired wound healing following Hem.
To study this, male C3H/HeN mice were subjected to a midline laparotomy and polyvinyl sponges were implanted subcutaneously at the wound site prior to Hem (355 mmHg for 90 min) or sham operation. During resuscitation mice received 300 mg/kg body weight L-arginine or saline (vehicle). After 24 hrs wound immune cells were harvested, stimulated with 10 g/ml LPS for 24 hrs and Interleukin 6 (IL-6) was determined in the supernatants using ELISA technique. 7 days thereafter, Hydroxyproline (OHP) (mg/g protein), a metabolite of collagen synthesis, was measured in the wound fluid using high performance liquid chromatography. Collagen type I and III
were determined in the wound by western blot analysis after 7 days. On the 10th Postoperative day wound specimen were harvested and wound breaking strength was determined.
The results indicate that the capacity of wound immune cells to release IL-6 was significantly depressed in Hem mice. L-arginine, however, resulted in a normal IL-6 release capacity of wound immune cells in hemorrhaged mice. Furthermore levels of OHP in wound fluid were significantly decreased in Hem mice. Administration of L-arginine increased these levels of OHP in the wound fluid in hemorrhaged mice. Similarly, L-arginine treatment prevented a significant depression of collagen I synthesis following Hem. Collagen III was not significantly affected by Hem or L-arginine. Since collagen I is responsible for wound strength we although investigated whether L-arginine in fact improved wound healing. Wound breaking strength was impaired following severe blood loss. This decrease was prevented by administration of L-arginine and restored to control levels.
Therefore the administration of L-arginine after Hem might represent a novel and useful adjunct to fluid resuscitation for decreasing wound complications following severe blood loss.
Table 1 [Tab. 1]
(Supported by DFG AN 357/1-1)
