Ethanol and burn injury: estrogen modulation of immunity

Kovacs, Elizabeth J.; Faunce, Douglas E.; Messingham, Kelly A.N.

doi:10.1016/j.alcohol.2004.05.005

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Volume 33, Issue 3 , Pages 209-216, July 2004

Ethanol and burn injury: estrogen modulation of immunity

Elizabeth J. Kovacs
- Department of Cell Biology, Neurobiology and Anatomy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Alcohol Research Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Corresponding author. Departments of Cell Biology, Neurobiology & Anatomy and Surgery, Loyola University Medical Center, Building 110, Room 4237, 2160 South First Avenue, Maywood, IL 60153, USA. Tel.: +1-708-327-2477; fax: +1-708-327-2813.
Douglas E. Faunce
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Alcohol Research Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
Kelly A.N. Messingham
- Department of Cell Biology, Neurobiology and Anatomy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Department of Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Burn and Shock Trauma Institute, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Alcohol Research Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
- Present address: Department of Microbiology, University of Iowa, Iowa City, IA 52242, USA.

Received 9 March 2004; received in revised form 18 May 2004; accepted 19 May 2004.

Editor: T.R. Jerrells

Abstract

A good deal of clinical evidence supports the idea that ethanol exposure is a causative factor in the occurrence of burn or other traumatic injury. In addition, more recent evidence reveals that individuals who sustain injury while under the influence of ethanol suffer from increased morbidity and mortality compared with those with comparable injuries who did not consume ethanol. Many of the complications seen in ethanol-exposed, burn-injured subjects result from depressed immune responses, which render the host unable to fight off infectious organisms. Both injury and ethanol exposure independently affect cellular immune responses, including delayed-type hypersensitivity and splenocyte proliferative responses, and the combined insult of ethanol exposure and injury acts in conjunction to increase further the magnitude and duration of immunosuppression. It is interesting that these immune responses can be restored experimentally in male, but not in female, mice by administration of low, proestrous levels of estrogen. The complexity of the responses after injury in ethanol-exposed subjects is multiplied when the sex of the subjects is added to the equation. This is due, in part, to the effect of the combined insult of injury and ethanol on the production of gonadal steroid hormones in males and females and the direct effects of those hormones on cytokine gene expression in sensitive cell types such as the macrophage. Evidence seems to indicate that cellular immune responses after ethanol exposure and burn injury differ in kinetics and magnitude for male and female subjects, and, hence, the therapeutic interventions to treat burn-injured patients should take into account both sex and ethanol exposure.

Keywords: Traumatic injury, Cytokines, Inflammation, Immunosuppression, Macrophage, Sex, Gender, Steroid hormone, Estrogen, Testosterone