Burns cause physical and psychological trauma. Patients often experience prolonged treatment to enable their wounds to heal, and may experience scarring and repeated operations. Patients often experience distress related to the initial injury and ongoing management, and are at risk of developing PTSD. The patients who are more likely to develop heightened trauma reactions, long-term psychological sequelae and wound healing with scarring and surgery, need to be identified early in the treatment pathway, for improved management. It is also important to understand how psychological factors affect trauma and burn wound healing responses and to identify the biological basis for psychosocial outcomes. Dysregulation in the hypothalamus-pituitary-adrenal (HPA) axis has been reported in people who have experienced traumatic events or developed post-traumatic stress disorder (PTSD). Epigenetic changes in the HPA axis can occur as a result of childhood trauma, and excessive stimulation of this axis may result in adaptive changes that alter the function of this stress response system and lead to development of stress-related psychiatric disorders, including depressive and anxiety disorders. However, changes in the HPA axis and other stress-responsive systems have previously not been assessed in children with burns.
Aims and Hypotheses
Overall Hypothesis: Burn patients who are experiencing heightened psychological trauma reactions have predisposing altered genetic mutations in their stress response pathways.
Aim 1: Extract DNA from buccal swabs collected from children with burns and control children
Aim 2: Identify epigenetic modifications associated with burns, using a methylation array (EPIC) and pyrosequencing, and bioinformatic analyses
Aim 3: Examine the relationship between any identified epigenetic modifications and the trauma status of the burned children and their physical wound healing and recovery.
Approaches/skills and techniques
Methylation array, DNA sequencing, bioinformatics, trauma
If interesting targets are identified, these will be investigated further for potential development into diagnostic tools for the clinic. The researchers regularly interact with the burn unit at Queensland Children’s Hospital.