The long term impact of burns on the immune system

Mr. Blair Johnson1, Associate Professor Matthew Linden1, Dr Andrew Stevenson2, Dr. Thirthar  Vetrichevvel2, Professor Fiona Wood2, Associate Professor Mark Fear2

1Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia, 2Burn Injury Research Unit, University Of Western Australia, Crawley, Australia

Abstract:

Burns are a significant cause of morbidity and mortality worldwide (Brusselaers et al., 2010), and while the acute impact of severe burns has been thoroughly studied, the long-term impacts are only more recently coming to light. Epidemiological evidence of long term effects include increased overall mortality risk (Duke et al., 2015) , increased rates of diabetes (Duke et al., 2016), increased cancer risk (Duke et al., 2014) and many others. The mechanisms underpinning this long-term morbidity are yet to be elucidated. However, it is well known that burn injury causes significant acute immune dysfunction and we hypothesise that this disruption to immune function is sustained and is key to the long-term morbidity observed in burn patients.

To investigate the long-term changes in immune function we have investigated the immune profiles of pediatric patients at least 2 years after their burn injury for cellular and cytokine profile changes. We have identified significant changes in the levels of circulating cytokines in patients when compared to age and gender matched non-injured control samples. We have also identified significant changes in circulating antibodies to vaccination antigens in the burn patient cohort.

Together the data suggests that there are long-term changes to circulating immune markers and likely to immune function in the pediatric burn injured population. Further work to understand the functional impacts of these changes and potential links to long-term morbidity will be important to truly understand the impact of burn injury on the lifetime health trajectory of patients.

References
Brusselaers N, Monstrey S, Vogelaers D, et al. (2010) Severe burn injury in Europe: a systematic review of the incidence, etiology, morbidity, and mortality. Critical care 14: R188.
Duke JM, Bauer J, Fear MW, et al. (2014) Burn injury, gender and cancer risk: population-based cohort study using data from Scotland and Western Australia. BMJ open 4: e003845.
Duke JM, Randall SM, Fear MW, et al. (2016) Increased admissions for diabetes mellitus after burn. Burns 42: 1734-1739.
Duke JM, Rea S, Boyd JH, et al. (2015) Mortality after burn injury in children: a 33-year population-based study. Pediatrics 135: e903-e910.


Biography:

Andrew Stevenson is a junior postdoc working at the Burn Injury Research Unit at the University of Western Australia. He was awarded his PhD in 2016 titled “Investigating the role of epigenetics in scar maintenance” from UWA, and has been lucky to continue on this and other research focused on the mechanisms and treatment of fibrosis at the Burn Injury Research Unit.