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Bentley C, Hazeldine J, Greig C, et al. Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient. Burns Trauma. 2019;7:26doi: 10.1186/s41038-019-0158-z.
Bentley, C., Hazeldine, J., Greig, C., Lord, J., & Foster, M. (2019). Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient. Burns & trauma, 726. https://doi.org/10.1186/s41038-019-0158-z
Bentley, Conor, et al. "Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient." Burns & trauma vol. 7 (2019): 26. doi: https://doi.org/10.1186/s41038-019-0158-z
Bentley C, Hazeldine J, Greig C, Lord J, Foster M. Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient. Burns Trauma. 2019 Aug 02;7:26. doi: 10.1186/s41038-019-0158-z. eCollection 2019. PMID: 31388512; PMCID: PMC6676517.
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Burns Trauma. 2019 Aug 02;7:26. doi: 10.1186/s41038-019-0158-z. eCollection 2019.

Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient.

Burns & trauma

Conor Bentley, Jon Hazeldine, Carolyn Greig, Janet Lord, Mark Foster

Affiliations

  1. 1NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, B15 2WB UK.
  2. 2School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
  3. 3MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK.
  4. 4NIHR Biomedical Research Centre, University Hospital Birmingham, Birmingham, UK.
  5. 5Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham, B15 2SQ UK.

PMID: 31388512 PMCID: PMC6676517 DOI: 10.1186/s41038-019-0158-z

Abstract

Severe injuries are the major cause of death in those aged under 40, mainly due to road traffic collisions. Endocrine, metabolic and immune pathways respond to limit the tissue damage sustained and initiate wound healing, repair and regeneration mechanisms. However, depending on age and sex, the response to injury and patient prognosis differ significantly. Glucocorticoids are catabolic and immunosuppressive and are produced as part of the stress response to injury leading to an intra-adrenal shift in steroid biosynthesis at the expense of the anabolic and immune enhancing steroid hormone dehydroepiandrosterone (DHEA) and its sulphated metabolite dehydroepiandrosterone sulphate (DHEAS). The balance of these steroids after injury appears to influence outcomes in injured humans, with high cortisol: DHEAS ratio associated with increased morbidity and mortality. Animal models of trauma, sepsis, wound healing, neuroprotection and burns have all shown a reduction in pro-inflammatory cytokines, improved survival and increased resistance to pathological challenges with DHEA supplementation. Human supplementation studies, which have focused on post-menopausal females, older adults, or adrenal insufficiency have shown that restoring the cortisol: DHEAS ratio improves wound healing, mood, bone remodelling and psychological well-being. Currently, there are no DHEA or DHEAS supplementation studies in trauma patients, but we review here the evidence for this potential therapeutic agent in the treatment and rehabilitation of the severely injured patient.

Keywords: Dehydroepiandrosterone; Dehydroepiandrosterone sulphate; Immune; Intensive care; Rehabilitation; Traumatic injury

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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