Role of fat metabolism in burn trauma-induced skeletal muscle insulin resistance

OBJECTIVE: Review current evidence on the role of fat in posttrauma insulin resistance, in reference to new studies with peroxisome proliferating activating receptor-α agonists. DESIGN: Review. SETTING: University laboratory. PATIENTS: Thirty pediatric burn trauma patients. INTERVENTIONS: Fourteen days of peroxisome proliferating activating receptor-α agonist immediately following burn trauma. MEASUREMENTS AND MAIN RESULTS: We measured glucose metabolism and fat metabolism via tracer methodology and intracellular measurements. Insulin-stimulated glucose uptake is impaired following burn trauma, as is intracellular insulin signaling, palmitate oxidation, and mitochondrial oxidative capacity. Furthermore, levels of intracellular lipids are increased. Two weeks of peroxisome proliferating activating receptor-α treatment significantly reverses these pathologic changes incurred from burn injury. CONCLUSIONS: Severe burn injury seriously affects multiple aspects of glucose and fat metabolism within the muscle, which can adversely affect clinical outcomes. Treatment with a peroxisome proliferating activating receptor-α drug may be a potential new therapeutic option.