Burn Unit, Department of Surgery, MGH
Ronald G. Tompkinis, MD, Sc.D. Program Director Trauma And Burn Center, Program Director, Glue Grant
Summary of Research
Severe injury and sepsis cause profound metabolic disorders in critically ill patients, featured by accelerated protein breakdown and hypermetabolism. The extent of these disorders is closely related to the morbidity and mortality of these patients. The disease course and the outcome of these patients were closely related to their nutritional status of these patients under the local social-economic condition. Based on the education and training received in the subsequent 20 years, The major interest of this investigator is further exploring the nature of the metabolic-immune response in critical illness, especially the in vivo metabolic disorders of protein (nitrogen) and amino acids, occurring in whole body and individual tissues / organs. Stable isotope tracer techniques, combined with positron emission tomorgraph (PET) imaging have proved to be the least invasive and most powerful approach in exploring the in vivo metabolic alterations in the burn and other major trauma patients. The research activities in the past years have been: (1) exploring the metabolic relationship between essential and non-essential amino acids in healthy subjects and burn patients, quantifying the de novo synthesis rates and the consumption rates of "non-essential" amino acids, after trauma and under different nutritional status. Burn injury reduced the de novo synthesis and increased the metabolic demand of certain "non-essential" amino acids, rendering them as conditionally essential nutrients (e.g. tyrosine, cysteine and arginine). These results serve a basis for improving the amino acid composition nutritional support. (2) Exploring the quantitative in vivo aspects of amino acid and nitrogen metabolism in individual organ / tissues using stable isotopes combined with PET. Substantial efforts were made in contribution to the development of PET-metabolism study with department of nuclear medicine at Massachusetts General Hospital. Further studies are being carried out to refine this non-invasive PET imaging technique in exploring the nature of muscle wasting in severely burned patients and the potential effects of anabolic agents in metabolic care of these patients. (3) Exploring the non-protein pathways of amino acid metabolism, especially the effects of inflammatory mediators in modulating metabolic response to trauma and sepsis. These mediators include nitric oxide formed from arginine, the detrimental effect of peroxynitrite in relation to organ failure (especially lung injury), the in vivo kinetics of glutathione and its metabolic regulation in ameliorating the oxidative tissue damage in these patients. (4) Developing new approaches accurately estimating the rate of specific protein synthesis with a combined mass isotopomer analysis (MIA) and proteomic analysis. (5) Exploring the genomic - proteomic basis of inflammatory response in critically ill patients in relation to metabolic response.
These investigations aim at providing new information to help improve the metabolic care of surgical patients, through nutritional-pharmacological modulation. Information about clinical research on amino acid and protein metabolism in burn patients, using stable isotope and Positron Emission Tomograph technique.
Contact Information
Phone: 617-371-4864
E-mail: yyu@partners.org
