Acute Inflammation is Persistent Locally in Burn Wounds: A Pivotal Role for Complement and C-Reactive Protein

Abstract

Severe burns can cause major complications, such as infection and deforming scar formation. Burn wounds induce an excessive inflammatory response. Serum levels of complement and the acute phase reactant C-reactive protein (CRP) are upregulated in response to burn injury and have been shown to be related to the severity of burn trauma and to the clinical outcome. However, complement and CRP have not been investigated on a tissue level locally at the site of the burn trauma. Protein levels and localization of complement activation product C3d and CRP were determined semi-quantitatively in burn eschar between 2 and 46 days after injury, using immunohistochemistry. CD68 and myeloperoxidase (MPO), markers for macrophages and neutrophilic granulocytes, respectively, were also analyzed on these biopsies. Skin biopsies of very recent surgical wounds (seconds old) served as controls. C3d and CRP are present at high levels in the burn wound. Protein levels of both mediators are significantly elevated up to at least 46 days after injury in comparison with control wounds. In line with this, neutrophils and macrophages infiltrate the burn wound in high numbers up to at least 46 days after injury. The excessive presence of the inflammatory mediators, complement and CRP, and the increased infiltration of neutrophils and macrophages in burn woundsup to 46 days after injury implicate a persistent ongoing acute inflammation locally in the burn wound up to weeks after the initial trauma. (J Burn Care Res 2009;30:274 -280)

Adipose-Derived Regenerative Cell Therapy for Burn Wound Healing: A Comparison of Two Delivery Methods

“…Similarly, numerous preclinical and case study reports from our group and others have reported the angiogenic effect of ADRCs in several acute and chronic injury models. 11,26,27,33 Taken together, these data suggest that ADRCs promote tissue repair through their effect on modulating the inflammatory response and promoting angiogenesis and epithelialization.…”

A Review of the Local Pathophysiologic Bases of Burn Wound Progression

“…33,38,39,41,[43][44][45] Recent evidence from a clinical study points to the complement product C3d and C-reactive protein as having roles in skin leukocyte sequestration after burn injury. 46 A number of studies explore the utility of various inhibitors of postburn inflammatory cell infiltration ( Table 2).…”

Molecular mechanisms of trauma-induced acute kidney injury: Inflammatory and metabolic insights from animal models

“…The same group showed C1 inhibition reduced capillary leakage and tubular degeneration within the kidneys [94]. Alternatively, C3 has been shown to be increased in burn wounds [95]. Kidney function was not assessed in these studies.…”