DEHYDROEPIANDROSTERONE, AN ENDOGENOUS IMMUNE MODULATOR, AFTER TRAUMATIC SHOCK

Dehydroepiandrosterone (DHEA), an endogenous immune modulator, reduces mortality after endotoxin (lipopolysaccharide (LPS)) administration i n rodents, However, there have been no studies in clinically relevant large-animal models. A unique experimental model is used to study the effects of DHEA in resuscitated trauma and to evaluate the protective effect of DHEA on the systemic inflammatory response induced by a dela yed LPS challenge, Anesthetized, ventilated pigs were instrumented and then subjected to local hind-limb trauma and 35% hemorrhage. After 1 h, animals were resuscitated with shed blood, supplemental Ringers sol ution, and in a randomized, blinded fashion, 4 mg/kg of DHEA or vehicl e. Two additional groups received 10 mg/kg or 20 mg/kg of DHEA. Animal s were dosed again at 24, 48, and 72 h. After 75 h, Escherichia coli L PS was administered. LPS caused a fall in DHEA levels (0.23 +/- .05 ng /mL (60 min post-LPS) versus .94 +/- 35 ng/mL (72 h), p = .01). DHEA l evels 60 min post-LPS were significantly higher in treated animals (p < .002). After LPS, all groups manifested progressive septic symptoms with a hyperdynamic state and pulmonary failure. These symptoms were n ot blunted by the administration of DHEA. DHEA levels are suppressed b y LPS in this two-stage model of trauma and delayed sepsis; however, e xogenous DHEA administration fails to blunt the associated systemic in flammatory response and pulmonary failure.