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损伤相关分子模式、病原体相关分子模式及模式识别受体在创伤性炎症中的转化及临床意义

Translational and Clinical Significance of DAMPs, PAMPs, and PRRs in Trauma-induced Inflammation.

作者信息

Rai Vikrant, Mathews Gillian, Agrawal Devendra K

机构信息

Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA.

出版信息

Arch Clin Biomed Res. 2022;6(5):673-685. doi: 10.26502/acbr.50170279. Epub 2022 Aug 26.

Abstract

Increased morbidity and mortality after polytrauma due to multiple organ failure (MOF) is a major concern for clinicians. Systemic inflammatory response syndrome (SIRS) and sepsis are the major underlying causes. Damage-associated molecular proteins (DAMPs) released after polytrauma induce an inflammatory immune response to repair the tissue, however, persistent inflammation finally results in immunosuppression and MOF. During immunosuppression, additional exposure of the traumatized tissue to pattern-associated molecular patterns (PAMPs) further adds to the continuum of inflammatory cascade causing sepsis. These two hits worsen the condition of the patient and increase morbidity and mortality. Thus, it is critical to stratify the patient based on trauma severity and inflammatory biomarkers levels and design treatment accordingly for a better clinical outcome. Although some of the molecular mechanisms involved in SIRS and MOF after polytrauma have been reported, there is limited information on the critical factors related to the study of DAMPs and PAMPs, including the timing of sampling (time elapsed after trauma), source of sampling (blood, urine, saliva), proteomics and metabolomics, multiplex plasma assay, comparative interpretation of the results from various sources and diagnostic value, and interpretation on the translational and clinical significance. Additionally, there is limited literature on DAMPs like heat shock proteins, mitochondrial DNA, neutrophil extracellular traps, and their role in SIRS and MOF. Further, it is also important to distinguish between the biomarkers of SIRS and sepsis in a time-bound window to have a better clinical outcome. This critical review focuses on these aspects to provide comprehensive information and thought-provoking discussion to design future investigation and clinical trials.

摘要

多发伤后因多器官功能衰竭(MOF)导致的发病率和死亡率增加是临床医生主要关注的问题。全身炎症反应综合征(SIRS)和脓毒症是主要的潜在原因。多发伤后释放的损伤相关分子蛋白(DAMPs)诱导炎症免疫反应以修复组织,然而,持续的炎症最终导致免疫抑制和MOF。在免疫抑制期间,创伤组织再次暴露于模式相关分子模式(PAMPs)会进一步加剧炎症级联反应,导致脓毒症。这两次打击会使患者病情恶化,增加发病率和死亡率。因此,根据创伤严重程度和炎症生物标志物水平对患者进行分层,并据此设计治疗方案以获得更好的临床结果至关重要。尽管已经报道了一些多发伤后SIRS和MOF所涉及的分子机制,但关于与DAMPs和PAMPs研究相关的关键因素的信息有限,包括采样时间(创伤后经过的时间)、采样来源(血液、尿液、唾液)、蛋白质组学和代谢组学、多重血浆检测、不同来源结果的比较解读及其诊断价值,以及对转化和临床意义的解读。此外,关于热休克蛋白、线粒体DNA、中性粒细胞胞外陷阱等DAMPs及其在SIRS和MOF中的作用的文献也有限。此外,在有时间限制的窗口内区分SIRS和脓毒症的生物标志物对于获得更好的临床结果也很重要。这篇综述聚焦于这些方面,以提供全面信息并引发有启发性的讨论,从而设计未来的研究和临床试验。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6899/9491702/dd8c20652908/nihms-1834870-f0001.jpg

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