Immune response of severely injured patients – influence of surgical intervention and therapeutic impact

Flohé, Sascha; Schade, F. U.; Waydhas, Christian

doi:10.1007/s00423-007-0203-4

Cited by 29 publications

(23 citation statements)

References 99 publications

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“…[1][2][3][4][5][6][7][8][9] Many studies have begun to assess these changes in the reactivity of the immune system following trauma. [10][11][12][13][14][15] Immunologic studies are greatly supported through the wide variety of transgenic and knockout mice available for in vivo modeling; these strains aid in detailed investigations to assess the molecular pathways involved in the immunologic responses.…”

mentioning

confidence: 99%

Pseudofracture: An Acute Peripheral Tissue Trauma Model

Darwiche

Kobbe²,

Pfeifer³

et al. 2011

JoVE

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Following trauma there is an early hyper-reactive inflammatory response that can lead to multiple organ dysfunction and high mortality in trauma patients; this response is often accompanied by a delayed immunosuppression that adds the clinical complications of infection and can also increase mortality. [1][2][3][4][5][6][7][8][9] Many studies have begun to assess these changes in the reactivity of the immune system following trauma. [10][11][12][13][14][15] Immunologic studies are greatly supported through the wide variety of transgenic and knockout mice available for in vivo modeling; these strains aid in detailed investigations to assess the molecular pathways involved in the immunologic responses. [16][17][18][19][20][21] The challenge in experimental murine trauma modeling is long term investigation, as fracture fixation techniques in mice, can be complex and not easily reproducible. [22][23][24][25][26][27][28][29][30] This pseudofracture model, an easily reproduced trauma model, overcomes these difficulties by immunologically mimicking an extremity fracture environment, while allowing freedom of movement in the animals and long term survival without the continual, prolonged use of anaesthesia. The intent is to recreate the features of long bone fracture; injured muscle and soft tissue are exposed to damaged bone and bone marrow without breaking the native bone.The pseudofracture model consists of two parts: a bilateral muscle crush injury to the hindlimbs, followed by injection of a bone solution into these injured muscles. The bone solution is prepared by harvesting the long bones from both hindlimbs of an age-and weight-matched syngeneic donor. These bones are then crushed and resuspended in phosphate buffered saline to create the bone solution.Bilateral femur fracture is a commonly used and well-established model of extremity trauma, and was the comparative model during the development of the pseudofracture model. Among the variety of available fracture models, we chose to use a closed method of fracture with soft tissue injury as our comparison to the pseudofracture, as we wanted a sterile yet proportionally severe peripheral tissue trauma model. 31 Hemorrhagic shock is a common finding in the setting of severe trauma, and the global hypoperfusion adds a very relevant element to a trauma model. [32][33][34][35][36] The pseudofracture model can be easily combined with a hemorrhagic shock model for a multiple trauma model of high severity. 37 Protocol

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confidence: 99%

Pseudofracture: An Acute Peripheral Tissue Trauma Model

Darwiche

Kobbe²,

Pfeifer³

et al. 2011

JoVE

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“…Gouel-Chéron et al [53] 2012 P-cc 100 37 (37%) N [IL-10] is not related to the development of sepsis Lausevic et al [33] 2010 Giamarellos-Bourboulis et al [55] 2008 P-cc 69 43 (62%) N [IFN-γ] below detection limit Livingston et al [44] 1988 P-coh 20 6 (30%) Y [IFN-γ] is markedly lower in sepsis after 14 d G-CSF Cook et al [58] 2013 P-cc 83 6 (7%) Y [G-CSF] > 500 pg/mL is significantly associated with sepsis IL- 18 Mommsen et al [30] 2009 P-coh 55 -18] is significantly higher in sepsis on days 3-6 post injury IL- 1 Menges et al [50] 1999 P-coh …”

Section: Il-10mentioning

confidence: 99%

“…Further, cytokine secretion patterns may pose an indication for the appropriate prophylactic treatment, as well as optimal timing of surgical interventions, thereby reducing the risk of sepsis and multiorgan failure. The aim of the current review was: (1) to summarize the available knowledge on specific cytokines that are involved in the posttraumatic immune alterations; and (2) to assess the value of cytokines for predicting the development of acute respiratory distress syndrome, sepsis, muliorgan dysfunction syndrome, multi-organ failure and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Polytraumatized patients that survive the initial impact of trauma, are confronted with an enor mous host defence reaction, which is associated with morbidity and mortality. Trauma initiates a local proinflammatory response, encompassing the activation of effector cells, complement cascade, coagulation system, cytokines, acute phase proteins and neuroendocrine mediators [1,2] . This sequence of events is part of the physiologic response to trauma, as it serves to initiate the healing process, prevents the host from additional injury and acts as a barrier against infection [3] .…”

Section: Introductionmentioning

confidence: 99%

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Predictive value of cytokines for developing complications after polytrauma

Dekker

Krijnen

Schipper

2016

WJCCM

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AIM:To investigate posttraumatic cytokine alterations and their value for predicting complications and mortality in polytraumatized patients. METHODS:Studies on the use of specific cytokines to predict the development of complications and mortality were identified in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Of included studies, relevant data were extracted and study quality was scored. RESULTS:Forty-two studies published between 1988 and 2015 were identified, including 28 cohort studies and 14 "nested" case-control studies. Most studies investigated the cytokines interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor (TNF-a). IL-6 seems related to muliorgan dysfunction syndrome, multiorgan failure (MOF) and mortality; IL-8 appears altered in acute respiratory distress syndrome, MOF and mortality; IL-10 alterations seem to precede sepsis and MOF; and TNF-a seems related to MOF. CONCLUSION:Cytokine secretion patterns appear to be different for patients developing complications when compared to patients with uneventful posttraumatic course. More research is needed to strengthen the evidence for clinical relevance of these cytokines.

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“…Increasing of fibroblast as a result of lymphokine induced which secreted by CD4 + lymphocytes [20]. CD4 + lymphocytes have a role as healing promotor to cellular imunrespon [21]. CD4 + lymphocytes depletion can decrease skin tension and extracellular matrix component [22].…”

Section: Cd4mentioning

confidence: 99%

Effects of Aloe vera Cream On Skin Wound Healing In Sprague Dawley Rats: The Role of CD4+ And CD8+ Lymphocytes

Prakoso¹,

Kurniasih²

2018

Proceedings of the 1st International Conference in One Health (ICOH 2017)

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Wound is defined as a damage of the normal anatomical structure and function of tissues. Aloe verais one of potential herbal on wound healing. The aim of this study is to explore the effect of topical Aloe vera on skin wound healing in Sprague Dawley rats. Thirty six male Sprague Dawley rats 150-200 grams were divided into four groups. All groups were anaesthetised, shaved, and exposed two round full-thickness punch biopsy on the back. Group I as control group; group II treated with topical application of Aloe vera cream 1%; group III treated with topical application of Aloe vera cream 2%; and group IV treated with topical application of madecassol®. The treatments were given once a day, for 15 days. Macroscopic and microscopic examination were observed at 5, 10 and 15 days post skin biopsy. Skin specimens were prepared for histopatological study using Hematoxillin and Eosin (HE) and immunohistochemistry (IHC) staining. HE were used to analysed epidermal thickness, leucocytes infiltration, fibroblast, and angiogenesis. IHC using antibody anti-CD4 + and CD8 + were used to analysed the expression of CD4 + and CD8 + lymphocytes. All the microscopical data collection were performed by ImageJ software, and then all data were analysed by Statistical Package for the Social Sciences 16(SPSS.16). Result of this research shows that topical application of Aloe vera cream 1% and 2% significantly reduced the percentage of wound, leucocytes infiltration, angiogenesis, expression of CD8 + lymphocytes. However, epidermal thickness and the expression of CD4 + lymphocytes increased (p ≤ 0,05). There were no significant different in the number of fibroblast in all groups. Topical application of Aloe vera 1% and 2% have wound healing potential via its ability to increase the ratio of CD4 + /CD8 + lymphocytes in the wound area.

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Immune response of severely injured patients – influence of surgical intervention and therapeutic impact

Abstract: Immunomodulating therapies in trauma patients exist on an experimental level with inconsistent results. The general management of trauma patients includes strategies that have been developed also on the basis of immunological considerations.

Cited by 29 publications

References 99 publications

Pseudofracture: An Acute Peripheral Tissue Trauma Model

Pseudofracture: An Acute Peripheral Tissue Trauma Model

Predictive value of cytokines for developing complications after polytrauma

Effects of Aloe vera Cream On Skin Wound Healing In Sprague Dawley Rats: The Role of CD4+ And CD8+ Lymphocytes

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