Persistent Elevation of TNF-α in Burn Patients May Contribute to Compromised Wound Healing
Tumor Necrosis Factor-α (TNF-α)/cachectin has been implicated as a mediator of many of the adverse host responses to injury and infection. We evaluated elevated levels of this mediator that persists in burn patients, leading to compromised wound healing. Serum samples taken from 36 pediatric burn patients were collected over a period of six years and stored at ― 70°C until analyzed by an ELISA for TNF-α. All patients who were less than 3 months post-burn with greater than 50% total body surface area (TBSA) burns had elevated TNF-α levels (95±10 pg/ml). Patients more than 6 months post-burn with greater than 30% TBSA burns also had elevated TNF-α levels (with 30-50% TBSA burns, the levels were 60± 11 pg/ml, and with >50% TBSA burns, the levels were 83±8 pg/ml). In the present study, we have demonstrated that serum TNF-α is detectable with greater frequency and in higher concentrations in patients with major burns, up to five years after the injury. This may be a factor contributing to the increased rate of infections and delayed wound healing seen in these patients. Studies also suggest a yin-yang relationship between TNF-α and scarring. These investigations support the implication that TNF-α in low concentrations helps wound healing, whereas higher concentrations may be detrimental.