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Welsh N, Disano K, Linzey M, Pike SC, Smith AD, Pachner AR, Gilli F. CXCL10/IgG1 Axis in Multiple Sclerosis as a Potential Predictive Biomarker of Disease Activity. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200200. [PMID: 38346270 DOI: 10.1212/nxi.0000000000200200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is a heterogeneous disease, and its course is difficult to predict. Prediction models can be established by measuring intrathecally synthesized proteins involved in inflammation, glial activation, and CNS injury. METHODS To determine how these intrathecal proteins relate to the short-term, i.e., 12 months, disease activity in relapsing-remitting MS (RRMS), we measured the intrathecal synthesis of 46 inflammatory mediators and 14 CNS injury or glial activation markers in matched serum and CSF samples from 47 patients with MS (pwMS), i.e., 23 RRMS and 24 clinically isolated syndrome (CIS), undergoing diagnostic lumbar puncture. Subsequently, all pwMS were followed for ≥12 months in a retrospective follow-up study and ultimately classified into "active", i.e., developing clinical and/or radiologic disease activity, n = 18) or "nonactive", i.e., not having disease activity, n = 29. Disease activity in patients with CIS corresponded to conversion to RRMS. Thus, patients with CIS were subclassified as "converters" or "nonconverters" based on their conversion status at the end of a 12-month follow-up. Twenty-seven patients with noninflammatory neurologic diseases were included as negative controls. Data were subjected to differential expression analysis and modeling techniques to define the connectivity arrangement (network) between neuroinflammation and CNS injury relevant to short-term disease activity in RRMS. RESULTS Lower age and/or higher CXCL13 levels positively distinguished active/converting vs nonactive/nonconverting patients. Network analysis significantly improved the prediction of short-term disease activity because active/converting patients featured a stronger positive connection between IgG1 and CXCL10. Accordingly, analysis of disease activity-free survival demonstrated that pwMS, both RRMS and CIS, with a lower or negative IgG1-CXCL10 correlation, have a higher probability of activity-free survival than the patients with a significant correlation (p < 0.0001, HR ≥ 2.87). DISCUSSION Findings indicate that a significant IgG1-CXCL10 positive correlation predicts the risk of short-term disease activity in patients with RRMS and CIS. Thus, the present results can be used to develop a predictive model for MS activity and conversion to RRMS.
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Affiliation(s)
- Nora Welsh
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Krista Disano
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Michael Linzey
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Steven C Pike
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Andrew D Smith
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Andrew R Pachner
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Francesca Gilli
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
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Wise PM, Saiz AM, Haller J, Wenke JC, Schaer T, Schneider P, Morshed S, Bahney CS. Preclinical models of orthopaedic trauma: Orthopaedic Research Society (ORS) and Orthopaedic Trauma Association (OTA) symposium 2022. OTA Int 2024; 7:e303. [PMID: 38487400 PMCID: PMC10936151 DOI: 10.1097/oi9.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Orthopaedic trauma remains a leading cause of patient morbidity, mortality, and global health care burden. Although significant advances have been made in the diagnosis, treatment, and rehabilitation of these injuries, complications such as malunion, nonunion, infection, disuse muscle atrophy and osteopenia, and incomplete return to baseline function still occur. The significant inherent clinical variability in fracture care such as differing patient demographics, injury patterns, and treatment protocols make standardized and replicable study, especially of cellular and molecular based mechanisms, nearly impossible. Hence, the scientists dedicated to improving therapy and treatments for patients with orthopaedic trauma rely on preclinical models. Preclinical models have proven to be invaluable in understanding the timing between implant insertion and bacterial inoculation on the bioburden of infection. Posttraumatic arthritis (PTOA) can take years to develop clinically, but with a porcine pilon fracture model, posttraumatic arthritis can be reliably induced, so different surgical and therapeutic strategies can be tested in prevention. Conversely, the racehorse presents a well-accepted model of naturally occurring PTOA. With preclinical polytrauma models focusing on chest injury, abdominal injury, multiple fractures, and/or head injury, one can study how various injury patterns affect fracture healing can be systemically studied. Finally, these preclinical models serve as a translational bridge to for clinical application in human patients. With selection of the right preclinical model, studies can build a platform to decrease the risk of emerging technologies and provide foundational support for therapeutic clinical trials. In summary, orthopaedic trauma preclinical models allow scientists to simplify a complex clinical challenge, to understand the basic pathways starting with lower vertebrate models. Then, R&D efforts progress to higher vertebrate models to build in more complexity for translation of findings to the clinical practice.
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Affiliation(s)
- Patrick M. Wise
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA
| | - Augustine M. Saiz
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA
| | - Justin Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Joseph C. Wenke
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch at Galveston, Galveston, TX
- Shriners Children's Texas, Galveston, TX
| | - Thomas Schaer
- Department of Clinical Studies, New Bolton Center University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Saam Morshed
- Orthopaedic Trauma Institute, University of California, San Francisco (UCSF), San Francisco, CA
| | - Chelsea S. Bahney
- Orthopaedic Trauma Institute, University of California, San Francisco (UCSF), San Francisco, CA
- Center for Regenerative and Personalized Medicine, The Steadman Clinic & Steadman Philippon Research Institute, Vail, CO
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Keller LE, Fortier LA, Lattermann C, Hunt ER, Zhang S, Fu Q, Jacobs CA. Complement system dysregulation in synovial fluid from patients with persistent inflammation following anterior cruciate ligament reconstruction surgery. THE JOURNAL OF CARTILAGE & JOINT PRESERVATION 2023; 3:100114. [PMID: 38343688 PMCID: PMC10853944 DOI: 10.1016/j.jcjp.2023.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Introduction Patients with anterior cruciate ligament injury are at high risk of posttraumatic osteoarthritis and their response to reconstructive surgery and rehabilitation vary. Proteins identified in the orchestration of the acute inflammatory response may be predictive of patient outcomes. Objective An unbiased, bottom-up proteomics approach was used to discover novel targets for therapeutics in relation to dysregulation in the orchestration of inflammatory pathways implicated in persistent joint inflammation subsequent to joint trauma. Methods Synovial fluid was aspirated from patients at 1 week and 4 weeks after anterior cruciate ligament reconstruction (ACLR) and interleukin 6 (IL-6) concentrations were quantified by enzyme-linked immunosorbent assay. Patients were segregated into IL-6low and IL-6high groups based on IL-6 concentrations in synovial fluid at 4-weeks postoperation and proteins in synovial fluid were analyzed using qualitative, bottom-up proteomics. Abundance ratios were calculated for IL-6high and IL-6low groups as 4 weeks postoperation:1 week postoperation. Results A total of 291 proteins were detected in synovial fluid, 34 of which were significantly (P < .05) differentially regulated between groups. Proteins associated with the classical and alternative complement cascade pathways were increased in the IL-6high compared to IL-6low group. Insulin-like growth factor-binding protein 6 (IGFBP-6) was increased by nearly 60-fold in the IL-6low group. Conclusions Patients segregated by IL-6 concentration in synovial fluid at 4 weeks post-ACLR demonstrated differential regulation of multiple pathways, providing opportunities to investigate novel targets, such as IGFBP-6, and to take advantage of therapeutics already approved for clinical use in other diseases that target inflammatory pathways, including the complement system.
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Affiliation(s)
- Laura E. Keller
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Lisa A. Fortier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily R. Hunt
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sheng Zhang
- Biological Resource Center, Cornell University, Ithaca, NY, USA
| | - Qin Fu
- Biological Resource Center, Cornell University, Ithaca, NY, USA
| | - Cale A. Jacobs
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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Bonaroti J, Billiar I, Moheimani H, Wu J, Namas R, Li S, Kar UK, Vodovotz Y, Neal MD, Sperry JL, Billiar TR. Plasma proteomics reveals early, broad release of chemokine, cytokine, TNF, and interferon mediators following trauma with delayed increases in a subset of chemokines and cytokines in patients that remain critically ill. Front Immunol 2022; 13:1038086. [PMID: 36532045 PMCID: PMC9750757 DOI: 10.3389/fimmu.2022.1038086] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Severe injury is known to cause a systemic cytokine storm that is associated with adverse outcomes. However, a comprehensive assessment of the time-dependent changes in circulating levels of a broad spectrum of protein immune mediators and soluble immune mediator receptors in severely injured trauma patients remains uncharacterized. To address this knowledge gap, we defined the temporal and outcome-based patterns of 184 known immune mediators and soluble cytokine receptors in the circulation of severely injured patients. Proteomics (aptamer-based assay, SomaLogic, Inc) was performed on plasma samples drawn at 0, 24, and 72 hours (h) from time of admission from 150 trauma patients, a representative subset from the Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock (PAMPer) trial. Patients were categorized into outcome groups including Early Non-Survivors (died within 72 h; ENS; n=38), Non-Resolvers (died after 72 h or required ≥7 days of intensive care; NR; n=78), and Resolvers (survivors that required < 7 days of intensive care; R; n=34), with low Injury Severity Score (ISS) patients from the Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury (STAAMP) trial as controls. The major findings include an extensive release of immune mediators and cytokine receptors at time 0h that is more pronounced in ENS and NR patients. There was a selective subset of mediators elevated at 24 and 72 h to a greater degree in NR patients, including multiple cytokines and chemokines not previously described in trauma patients. These findings were validated in a quantitative fashion using mesoscale discovery immunoassays (MSD) from an external validation cohort (VC) of samples from 58 trauma patients matched for R and NR status. This comprehensive longitudinal description of immune mediator patterns associated with trauma outcomes provides a new level of characterization of the immune response that follows severe injury.
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Affiliation(s)
- Jillian Bonaroti
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Isabel Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hamed Moheimani
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Junru Wu
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Xiangya School of Medicine, Central South University, Changsha, China
| | - Rami Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shimena Li
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Upendra K. Kar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew D. Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jason L. Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Timothy R. Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States,*Correspondence: Timothy R. Billiar,
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5
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Shah AM, Zamora R, Korff S, Barclay D, Yin J, El-Dehaibi F, Billiar TR, Vodovotz Y. Inferring Tissue-Specific, TLR4-Dependent Type 17 Immune Interactions in Experimental Trauma/Hemorrhagic Shock and Resuscitation Using Computational Modeling. Front Immunol 2022; 13:908618. [PMID: 35663944 PMCID: PMC9160183 DOI: 10.3389/fimmu.2022.908618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Trauma/hemorrhagic shock followed by resuscitation (T/HS-R) results in multi-system inflammation and organ dysfunction, in part driven by binding of damage-associated molecular pattern molecules to Toll-like Receptor 4 (TLR4). We carried out experimental T/HS-R (pseudo-fracture plus 2 h of shock followed by 0-22 h of resuscitation) in C57BL/6 (wild type [WT]) and TLR4-null (TLR4-/-) mice, and then defined the dynamics of 20 protein-level inflammatory mediators in the heart, gut, lung, liver, spleen, kidney, and systemic circulation. Cross-correlation and Principal Component Analysis (PCA) on data from the 7 tissues sampled suggested that TLR4-/- samples express multiple inflammatory mediators in a small subset of tissue compartments as compared to the WT samples, in which many inflammatory mediators were localized non-specifically to nearly all compartments. We and others have previously defined a central role for type 17 immune cells in human trauma. Accordingly, correlations between IL-17A and GM-CSF (indicative of pathogenic Th17 cells); between IL-17A and IL-10 (indicative of non-pathogenic Th17 cells); and IL-17A and TNF (indicative of memory/effector T cells) were assessed across all tissues studied. In both WT and TLR4-/- mice, positive correlations were observed between IL-17A and GM-CSF, IL-10, and TNF in the kidney and gut. In contrast, the variable and dynamic presence of both pathogenic and non-pathogenic Th17 cells was inferred in the systemic circulation of TLR4-/- mice over time, suggesting a role for TLR4 in efflux of these cells into peripheral tissues. Hypergraph analysis - used to define dynamic, cross compartment networks - in concert with PCA-suggested that IL-17A was present persistently in all tissues at all sampled time points except for its absence in the plasma at 0.5h in the WT group, supporting the hypothesis that T/HS-R induces efflux of Th17 cells from the circulation and into specific tissues. These analyses suggest a complex, context-specific role for TLR4 and type 17 immunity following T/HS-R.
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Affiliation(s)
- Ashti M Shah
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States
| | - Sebastian Korff
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Derek Barclay
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jinling Yin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fayten El-Dehaibi
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, Pittsburgh, PA, United States.,Center for Systems Immunology, University of Pittsburgh, Pittsburgh, PA, United States
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McKinley TO, Gaski GE, Billiar TR, Vodovotz Y, Brown KM, Elster EA, Constantine GM, Schobel SA, Robertson HT, Meagher AD, Firoozabadi R, Gary JL, O'Toole RV, Aneja A, Trochez KM, Kempton LB, Steenburg SD, Collins SC, Frey KP, Castillo RC. Patient-Specific Precision Injury Signatures to Optimize Orthopaedic Interventions in Multiply Injured Patients (PRECISE STUDY). J Orthop Trauma 2022; 36:S14-S20. [PMID: 34924514 DOI: 10.1097/bot.0000000000002289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
SUMMARY Optimal timing and procedure selection that define staged treatment strategies can affect outcomes dramatically and remain an area of major debate in the treatment of multiply injured orthopaedic trauma patients. Decisions regarding timing and choice of orthopaedic procedure(s) are currently based on the physiologic condition of the patient, resource availability, and the expected magnitude of the intervention. Surgical decision-making algorithms rarely rely on precision-type data that account for demographics, magnitude of injury, and the physiologic/immunologic response to injury on a patient-specific basis. This study is a multicenter prospective investigation that will work toward developing a precision medicine approach to managing multiply injured patients by incorporating patient-specific indices that quantify (1) mechanical tissue damage volume; (2) cumulative hypoperfusion; (3) immunologic response; and (4) demographics. These indices will formulate a precision injury signature, unique to each patient, which will be explored for correspondence to outcomes and response to surgical interventions. The impact of the timing and magnitude of initial and staged surgical interventions on patient-specific physiologic and immunologic responses will be evaluated and described. The primary goal of the study will be the development of data-driven models that will inform clinical decision-making tools that can be used to predict outcomes and guide intervention decisions.
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Affiliation(s)
- Todd O McKinley
- Department of Orthopedic Surgery, Indiana University Health Methodist Hospital, Indianapolis, IN
| | - Greg E Gaski
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, VA
| | | | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Krista M Brown
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Greg M Constantine
- Department of Mathematics and Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Seth A Schobel
- Department of Surgery, Uniformed Services University of the Health Sciences, Surgical Critical Care Initiative, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Henry T Robertson
- Department of Surgery, Uniformed Services University of the Health Sciences, Surgical Critical Care Initiative, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Reza Firoozabadi
- Department of Orthopaedics and Sports Medicine, University of Washington Harborview Medical Center, Seattle, WA
| | - Joshua L Gary
- Department of Orthopedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX (now at Keck School of Medicine of University of Southern California, Los Angeles, CA)
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD
| | - Arun Aneja
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Karen M Trochez
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Laurence B Kempton
- Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Health Methodist Hospital, Indianapolis, IN; and
| | - Susan C Collins
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Katherine P Frey
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Bonaroti J, Abdelhamid S, Kar U, Sperry J, Zamora R, Namas RA, McKinley T, Vodovotz Y, Billiar T. The Use of Multiplexing to Identify Cytokine and Chemokine Networks in the Immune-Inflammatory Response to Trauma. Antioxid Redox Signal 2021; 35:1393-1406. [PMID: 33860683 PMCID: PMC8905234 DOI: 10.1089/ars.2021.0054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Significance: The immunoinflammatory responses that follow trauma contribute to clinical trajectory and patient outcomes. While remarkable advances have been made in trauma services and injury management, clarity on how the immune system in humans responds to trauma is lagging. Recent Advances: Multiplexing platforms have transformed our ability to analyze comprehensive immune mediator responses in human trauma. In parallel, with the establishment of large data sets, computational methods have been adapted to yield new insights based on mediator patterns. These efforts have added an important data layer to the emerging multiomic characterization of the human response to injury. Critical Issues: Outcome after trauma is greatly affected by the host immunoinflammatory response. Excessive or sustained responses can contribute to organ damage. Hence, understanding the pathophysiology behind traumatic injury is of vital importance. Future Directions: This review summarizes our work in the study of circulating immune mediators in trauma patients. Our foundational studies into dynamic patterns of inflammatory mediators represent an important contribution to the concepts and computational challenges that these large data sets present. We hope to see further integration and understanding of multiomics strategies in the field of trauma that can aid in patient endotyping and in potentially identifiying certain therapeutic targets in the future. Antioxid. Redox Signal. 35, 1393-1406.
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Affiliation(s)
- Jillian Bonaroti
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sultan Abdelhamid
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Upendra Kar
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rami Ahmd Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Todd McKinley
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Trauma Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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8
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McKinley TO, Gaski GE, Zamora R, Shen L, Sun Q, Namas RA, Billiar TR, Vodovotz Y. Early dynamic orchestration of immunologic mediators identifies multiply injured patients who are tolerant or sensitive to hemorrhage. J Trauma Acute Care Surg 2021; 90:441-450. [PMID: 33093290 DOI: 10.1097/ta.0000000000002998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiply injured patients (MIPs) are at risk of complications including infections, and acute and prolonged organ dysfunction. The immunologic response to injury has been shown to affect outcomes. Recent advances in computational capabilities have shown that early dynamic coordination of the immunologic response is associated with improved outcomes after trauma. We hypothesized that patients who were sensitive or tolerant of hemorrhage would demonstrate differences in dynamic immunologic orchestration within hours of injury. METHODS We identified two groups of MIPs who demonstrated distinct clinical tolerance to hemorrhage (n = 10) or distinct clinical sensitivity to hemorrhage (n = 9) from a consecutive cohort of 100 MIPs. Hemorrhage was quantified by integrating elevated shock index values for 24 hours after injury (shock volume). Clinical outcomes were quantified by average Marshall Organ Dysfunction Scores from days 2 to 5 after injury. Shock-sensitive patients had high cumulative organ dysfunction after lower magnitude hemorrhage. Shock-tolerant (ST) patients had low cumulative organ dysfunction after higher magnitude hemorrhage. Computational methods were used to analyze a panel of 20 immunologic mediators collected serially over the initial 72 hours after injury. RESULTS Dynamic network analysis demonstrated the ST patients had increased orchestration of cytokines that are reparative and protective including interleukins 9, 17E/25, 21, 22, 23, and 33 during the initial 0- to 8-hour and 8- to 24-hour intervals after injury. Shock-sensitive patients had delayed immunologic orchestration of a network of largely proinflammatory and anti-inflammatory mediators. Elastic net linear regression demonstrated that a group of five mediators could discriminate between shock-sensitive and ST patients. CONCLUSIONS Preliminary evidence from this study suggests that early immunologic orchestration discriminates between patients who are notably tolerant or sensitive to hemorrhage. Early orchestration of a group of reparative/protective mediators was amplified in shock-tolerant patients. LEVEL OF EVIDENCE Prospective clinical outcomes study, level III.
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Affiliation(s)
- Todd O McKinley
- From the Department of Orthopaedic Surgery, (T.O.M.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Orthopaedic Surgery, INOVA Health System (G.E.G.), Fairfax, Virginia; Department of Surgery, (R.Z., R.A.N., T.R.B., Y.V.), University of Pittsburgh School of Medicine, Pittsburgh; Department of Biostatistics, Epidemiology and Informatics, School of Medicine (L.S.), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Preventive Medicine, Keck School of Medicine, (Q.S.), University of Southern California, Los Angeles, California
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9
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Abstract
The management of multiply injured or severely injured patients is a complex and dynamic process. Timely and safe fracture fixation is a critical component of the multidisciplinary care that these patients require. Effective management of these patients, and their orthopaedic injuries, requires a strong understanding of the pathophysiology of the response to trauma and indicators of patient status, as well as an appreciation for the dynamic nature of these parameters. Substantial progress in both clinical and basic science research in this area has advanced our understanding of these concepts and our approach to management of the polytraumatized patient. This article summarizes a symposium on this topic that was presented by an international panel of experts at the 2020 Virtual Annual Meeting of the Orthopaedic Trauma Association.
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10
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Schimunek L, Lindberg H, Cohen M, Namas RA, Mi Q, Yin J, Barclay D, El-Dehaibi F, Abboud A, Zamora R, Billiar TR, Vodovotz Y. Computational Derivation of Core, Dynamic Human Blunt Trauma Inflammatory Endotypes. Front Immunol 2021; 11:589304. [PMID: 33537029 PMCID: PMC7848165 DOI: 10.3389/fimmu.2020.589304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/30/2020] [Indexed: 02/03/2023] Open
Abstract
Systemic inflammation ensues following traumatic injury, driving immune dysregulation and multiple organ dysfunction (MOD). While a balanced immune/inflammatory response is ideal for promoting tissue regeneration, most trauma patients exhibit variable and either overly exuberant or overly damped responses that likely drive adverse clinical outcomes. We hypothesized that these inflammatory phenotypes occur in the context of severe injury, and therefore sought to define clinically distinct endotypes of trauma patients based on their systemic inflammatory responses. Using Patient-Specific Principal Component Analysis followed by unsupervised hierarchical clustering of circulating inflammatory mediators obtained in the first 24 h after injury, we segregated a cohort of 227 blunt trauma survivors into three core endotypes exhibiting significant differences in requirement for mechanical ventilation, duration of ventilation, and MOD over 7 days. Nine non-survivors co-segregated with survivors. Dynamic network inference, Fisher Score analysis, and correlations of IL-17A with GM-CSF, IL-10, and IL-22 in the three survivor sub-groups suggested a role for type 3 immunity, in part regulated by Th17 and γδ 17 cells, and related tissue-protective cytokines as a key feature of systemic inflammation following injury. These endotypes may represent archetypal adaptive, over-exuberant, and overly damped inflammatory responses.
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Affiliation(s)
- Lukas Schimunek
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Haley Lindberg
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria Cohen
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rami A Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Qi Mi
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
| | - Jinling Yin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Derek Barclay
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fayten El-Dehaibi
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew Abboud
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
| | - Timothy Robert Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regeneration Medicine, University of Pittsburgh, Pittsburgh, PA, United State
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11
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Cyr A, Zhong Y, Reis SE, Namas RA, Amoscato A, Zuckerbraun B, Sperry J, Zamora R, Vodovotz Y, Billiar TR. Analysis of the Plasma Metabolome after Trauma, Novel Circulating Sphingolipid Signatures, and In-Hospital Outcomes. J Am Coll Surg 2021; 232:276-287.e1. [PMID: 33453380 DOI: 10.1016/j.jamcollsurg.2020.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trauma is the leading cause of death and disability for individuals under age 55. Many severely injured trauma patients experience complicated clinical courses despite appropriate initial therapy. We sought to identify novel circulating metabolomic signatures associated with clinical outcomes following trauma. STUDY DESIGN Untargeted metabolomics and circulating plasma immune mediator analysis was performed on plasma collected during 3 post-injury time periods (<6 hours [h], 6 h-24h, day 2-day 5) in critically ill trauma patients enrolled between April 2004 and May 2013 at UPMC Presbyterian Hospital in Pittsburgh, PA. Inclusion criteria were age ≥ 18 years, blunt mechanism, ICU admission, and expected survival ≥ 24 h. Exclusion criteria were isolated head injury, spinal cord injury, and pregnancy. Exploratory endpoints included length of stay (overall and ICU), ventilator requirements, nosocomial infection, and Marshall organ dysfunction (MOD) score. The top 50 metabolites were isolated using repeated measures ANOVA and multivariate empirical Bayesian analysis for further study. RESULTS Eighty-six patients were included for analysis. Sphingolipids were enriched significantly (chi-square, p < 10-6) among the top 50 metabolites. Clustering of sphingolipid patterns identified 3 patient subclasses: nonresponders (no time-dependent change in sphingolipids, n = 41), sphingosine/sphinganine-enhanced (n = 24), and glycosphingolipid-enhanced (n = 21). Compared with the sphingolipid-enhanced subclasses, nonresponders had longer mean length of stay, more ventilator days, higher MOD scores, and higher circulating levels of proinflammatory immune mediators IL-6, IL-8, IL-10, MCP1/CCL2, IP10/CXCL10, and MIG/CXCL9 (all p < 0.05), despite similar Injury Severity Scores (p = 0.12). CONCLUSIONS Metabolomic analysis identified broad alterations in circulating plasma sphingolipids after blunt trauma. Circulating sphingolipid signatures and their association with both clinical outcomes and circulating inflammatory mediators suggest a possible link between sphingolipid metabolism and the immune response to trauma.
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Affiliation(s)
- Anthony Cyr
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Yanjun Zhong
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Critical Care, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Steven E Reis
- Clinical and Translational Science Institute and Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rami A Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Andrew Amoscato
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Jason Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Clinical and Translational Science Institute and Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA; Clinical and Translational Science Institute and Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
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12
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Huang GS, Dunham CM, Chance EA, Hileman BM, DelloStritto DJ. Body mass index interaction effects with hyperglycemia and hypocholesterolemia modify blunt traumatic brain injury outcomes: a retrospective study. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:314-323. [PMID: 33500843 PMCID: PMC7811935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION There is controversy regarding obesity or body mass index (BMI) effects on postinjury mortality and mechanical ventilation. The aim was to assess outcome associations with BMI and postinjury blood glucose and cholesterol. METHOD Adult blunt traumatic brain injury patients admitted to a level I trauma center and requiring ≥ 3 days of intensive care were investigated. Admission blood glucose and day-4 total cholesterol were captured from the medical records. Cholesterol ratio was calculated by dividing day-4 values by published national normative levels according to sex, age, and injury date. RESULTS The parent cohort included 588 patients. The ventilator days ≥ 10 or died group, when compared to the ventilator days < 10 and lived group, had higher Injury Severity Score (ISS) (29.2±9.9 versus [vs.] 23.7±9.7, P < 0.0001), BMI (27.9±6.8 vs. 26.0±5.5, P = 0.0002), and admission glucose (182.6±79 vs. 155.4±59 mg/dl, P < 0.0001, n = 476) and lower emergency department Glasgow Coma Scale score (ED GCS) (6.9±4.7 vs. 10.3±5.0, P < 0.0001) and cholesterol ratio (0.64±0.2 vs. 0.70±0.2, P = 0.0018, n = 364). The ventilator days ≥ 10 or died group had independent associations with increased ISS (P = 0.0709), decreased ED GCS (P = 0.0078), and increased BMI÷cholesterol ratio (P = 0.0003). The ventilator days ≥ 10 or died group had independent associations with increased ISS (P = 0.0013), decreased ED GCS (P < 0.0001), and increased BMI × glucose (P < 0.0001). Ventilator days were increased with higher ISS (P < 0.0001), BMI (P = 0.0014) and glucose (P = 0.0031) and with lower ED GCS (P < 0.0001) and cholesterol ratio (P = 0.0004). Ventilator days had independent associations with increased ISS (P < 0.0001), decreased ED GCS (P = 0.0041), and increased BMI÷cholesterol ratio (P = 0.0010). Ventilator days had independent associations with increased ISS (P < 0.0001), decreased ED GCS (P < 0.0001), and increased BMI × glucose (P = 0.0041). CONCLUSION For TBI patients, valid risk assessment measurements include ISS (anatomic injury burden), ED GCS (brain function), BMI (preinjury weight status), admission glucose (postinjury metabolism), and day-4 cholesterol ratio (postinjury inflammation).
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Affiliation(s)
- Gregory S Huang
- Trauma, Critical Care, General Surgery, St. Elizabeth Youngstown Hospital1044 Belmont Ave, Youngstown, OH 44501, USA
| | - Carl M Dunham
- Trauma, Critical Care, General Surgery, St. Elizabeth Youngstown Hospital1044 Belmont Ave, Youngstown, OH 44501, USA
| | - Elisha A Chance
- Trauma/Neuroscience Research, St. Elizabeth Youngstown Hospital1044 Belmont Ave, Youngstown, OH 44501, USA
| | - Barbara M Hileman
- Trauma/Neuroscience Research, St. Elizabeth Youngstown Hospital1044 Belmont Ave, Youngstown, OH 44501, USA
| | - Daniel J DelloStritto
- Department of Surgery, St. Elizabeth Youngstown Hospital1044 Belmont Ave, Youngstown, OH 44501, USA
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13
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Guo W, Bläsius FM, Greven J, Luo P, Wang W, Lübke C, Simon TP, Kobbe P, Tolba R, Hildebrand F, Horst K. Hematological and Chemical Profiles in a Porcine Model of Severe Multiple Trauma. Eur Surg Res 2020; 61:83-94. [PMID: 33022680 DOI: 10.1159/000510267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clinical chemistry and hematological tests are widely used to monitor the clinical course of several diseases. However, these parameters are sparse in large-animal models of multiple trauma (MT). Thus, we aimed to provide these missing data to improve future experimental setups in trauma research. METHODS Male pigs (German Landrace pigs) were randomized into either an MT group (n = 8) including blunt thoracic trauma, tibial fracture, and controlled hemorrhage or a sham group (n = 8) without any trauma. After trauma induction, all animals received intensive care treatment for 72 h under anesthesia, including mechanical ventilation and volume resuscitation. Blood and urine samples were obtained to measure common hematological and chemical parameters before trauma (0 h), after trauma (1.5 h), during resuscitation (2.5 h), after fracture stabilization (3.5 h), and at 12, 24, 48, and 72 h. Statistical analyses were performed using a linear mixed model (group × time) and Welch's ANOVA. RESULTS MT led to a perceptible immunological reaction. Between groups, significantly different time courses of leukocyte counts (p = 0.034) and lymphocyte proportions (p = 0.001) were observed. Moreover, MT changed the time course of total protein (p = 0.006). Significantly lower concentrations compared to sham were found in MT at each single time point starting at 1.5 h to the end of the observation period (all p < 0.05). CONCLUSIONS Our results indicate that a traumatic insult leads to significant alterations in the immune system already shortly after trauma. Together with the additional catabolic reactions observed, these alterations might contribute to the occurrence of later complications. The presented data provide valid references for further experimental setups with prolonged observation times, especially in similar porcine models of MT.
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Affiliation(s)
- Weijun Guo
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany.,Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Felix Marius Bläsius
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Johannes Greven
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany,
| | - Peng Luo
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany.,Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weikang Wang
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Cavan Lübke
- Department of Intensive Care and Intermediate Care, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive Care and Intermediate Care, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Philipp Kobbe
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - René Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Klemens Horst
- Department of Trauma and Reconstructive Surgery, Faculty of Medicine, RWTH Aachen University Hospital, Aachen, Germany
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14
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Zaaqoq AM, Namas RA, Abdul-Malak O, Almahmoud K, Barclay D, Yin J, Zamora R, Rosengart MR, Billiar TR, Vodovotz Y. Diurnal Variation in Systemic Acute Inflammation and Clinical Outcomes Following Severe Blunt Trauma. Front Immunol 2019; 10:2699. [PMID: 31824494 PMCID: PMC6879654 DOI: 10.3389/fimmu.2019.02699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/04/2019] [Indexed: 12/26/2022] Open
Abstract
Animal studies suggest that the time of day is a determinant of the immunological response to both injury and infection. We hypothesized that due to this diurnal variation, time of injury could affect the systemic inflammatory response and outcomes post-trauma and tested this hypothesis by examining the dynamics of circulating inflammatory mediators in blunt trauma patients injured during daytime vs. nighttime. From a cohort of 472 blunt trauma survivors, two stringently matched sub-cohorts of moderately/severely injured patients [injury severity score (ISS) >20] were identified. Fifteen propensity-matched, daytime-inured (“mDay”) patients (age 43.6 ± 5.2, M/F 11/4, ISS 22.9 ± 0.7) presented during the shortest local annual period (8:00 am−5:00 pm), and 15 propensity-matched “mNight” patients (age 43 ± 4.3, M/F 11/4, ISS 24.5 ± 2.5) presented during the shortest night period (10:00 pm−5:00 am). Serial blood samples were obtained (3 samples within the first 24 h and daily from days 1–7) from all patients. Thirty-two plasma inflammatory mediators were assayed. Two-way Analysis of Variance (ANOVA) was used to compare groups. Dynamic Network Analysis (DyNA) and Dynamic Bayesian Network (DyBN) inference were utilized to infer dynamic interrelationships among inflammatory mediators. Both total hospital and intensive care unit length of stay were significantly prolonged in the mNight group. Circulating IL-17A was elevated significantly in the mNight group from 24 h to 7 days post-injury. Circulating MIP-1α, IL-7, IL-15, GM-CSF, and sST2 were elevated in the mDay group. DyNA demonstrated elevated network complexity in the mNight vs. the mDay group. DyBN suggested that cortisol and sST2 were central nodes upstream of TGF-β1, chemokines, and Th17/protective mediators in both groups, with IL-6 being an additional downstream node in the mNight group only. Our results suggest that time of injury affects clinical outcomes in severely injured patients in a manner associated with an altered systemic inflammation program, possibly implying a role for diurnal or circadian variation in the response to traumatic injury.
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Affiliation(s)
- Akram M Zaaqoq
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, United States
| | - Rami A Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Othman Abdul-Malak
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Khalid Almahmoud
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Derek Barclay
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jinling Yin
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ruben Zamora
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, United States
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States.,Center for Inflammation and Regeneration Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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15
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SCIENTIFIC SUBSTANTIATION OF THE OSTEOSYNTHESIS METHOD CONVERSION IN LONG BONES GUNSHOT FRACTURES IN THE ARMED FORCES MEDICAL SYSTEM OF UKRAINE. WORLD OF MEDICINE AND BIOLOGY 2019. [DOI: 10.26724/2079-8334-2019-4-70-177-182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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