Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
Front Immunol. 2023 Aug 18;14:1196241. doi: 10.3389/fimmu.2023.1196241. eCollection 2023.
Hemorrhagic shock (HS) is responsible for approximately 2 million deaths per year worldwide and is caused in 80% by polytrauma. These patients need a precise and quick diagnostic, which should be based on a combination of laboratory markers and radiological data. Extracellular vesicles (EVs) were described as potential new markers and mediators in trauma. The aim of the present study was to analyze, whether the surface epitopes of plasma-EVs reflect HS in polytraumatized patients and whether cell-specific EV subpopulations are useful diagnostic tools.
Plasma samples from polytraumatized patients (ISS ≥16) with HS (n=10) and without (n=15), were collected at emergency room (ER) and 24h after trauma. Plasma-EVs were isolated via size exclusion chromatography and EV-concentrations were detected by Coomassie Plus (Bradford) Assay. The EVs subpopulations were investigated by a bead-based multiplex flow cytometry measurement of surface epitopes and were compared with healthy controls (n=10). To investigate the diagnostic and prognostic potential of EVs subpopulations, results were correlated with clinical outcome parameters documented in the electronical patients' record.
We observed a significant reduction of the total amount of plasma EVs in polytrauma patients with HS, as compared to polytrauma patients without HS and healthy controls. We found significant reduction of CD42a+ and CD41b+ (platelet-derived) EVs in all polytrauma patients, as well as a reduction of CD29+ EVs compared to healthy volunteers (*p<0.05). CD44+ and CD31+ EVs were specifically altered in patients with HS (*p<0.05). Both EV populations showed a moderate correlation (r² = 0.42) with the transfusion of erythrocyte concentrate, were associated with non-survival and the need for catecholamines (*p<0.05).
Our data reveal that polytrauma patients with a hemorrhagic shock are characterized by a reduction of CD44+ and CD31+ plasma-EVs. Both EV populations showed a moderate correlation with the need of erythrocyte transfusion, were associated with non-survival and the need for catecholamines.
全球每年约有 200 万人死于失血性休克（HS），其中 80%是由多发伤引起的。这些患者需要准确和快速的诊断，这应该基于实验室标志物和放射学数据的结合。细胞外囊泡（EVs）被描述为创伤中潜在的新标志物和介质。本研究旨在分析多创伤患者的血浆-EVs 表面表位是否反映 HS，以及细胞特异性 EV 亚群是否是有用的诊断工具。
在急诊室（ER）和创伤后 24 小时，采集多发伤患者（ISS≥16）的 HS（n=10）和非 HS（n=15）的血浆样本。通过分子筛色谱法分离血浆-EVs，并通过考马斯亮蓝 Plus（Bradford）法检测 EV 浓度。通过基于珠子的多重流式细胞术测量表面表位来研究 EV 亚群，并与健康对照组（n=10）进行比较。为了研究 EV 亚群的诊断和预后潜力，将结果与电子患者记录中记录的临床结果参数相关联。
与非 HS 多发伤患者和健康对照组相比，HS 多发伤患者的血浆 EV 总量明显减少。我们发现所有多发伤患者的 CD42a+和 CD41b+（血小板衍生）EV 明显减少，与健康志愿者相比，CD29+EV 减少（*p<0.05）。HS 患者的 CD44+和 CD31+EV 特异性改变（*p<0.05）。这两种 EV 群体与红细胞浓缩物的输血呈中度相关（r²=0.42），与非生存和儿茶酚胺的需求相关（*p<0.05）。
我们的数据表明，患有失血性休克的多发伤患者的 CD44+和 CD31+血浆-EVs 减少。这两种 EV 群体与红细胞输血的需求呈中度相关，与非生存和儿茶酚胺的需求相关。
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