Blood and Shock Resuscitation, USA Army Institute of Surgical Research, 3698 Chambers Pass, Bldg 3610, JBSA Fort Sam Houston, TX, 78234-7767, USA.
Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA.
Sci Rep. 2024 Feb 16;14(1):3874. doi: 10.1038/s41598-024-53945-w.
Pre-hospital potentially preventable trauma related deaths are mainly due to hypoperfusion-induced tissue hypoxia leading to irreversible organ dysfunction at or near the point of injury or during transportation prior to receiving definitive therapy. The prolyl hydroxylase domain (PHD) is an oxygen sensor that regulates tissue adaptation to hypoxia by stabilizing hypoxia inducible factor (HIF). The benefit of PHD inhibitors (PHDi) in the treatment of anemia and lactatemia arises from HIF stabilization, which stimulates endogenous production of erythropoietin and activates lactate recycling through gluconeogenesis. The results of this study provide insight into the therapeutic roles of MK-8617, a pan-inhibitor of PHD-1, 2, and 3, in the mitigation of lactatemia in anesthetized rats with polytrauma and hemorrhagic shock. Additionally, in an anesthetized rat model of lethal decompensated hemorrhagic shock, acute administration of MK-8617 significantly improves one-hour survival and maintains survival at least until 4 h following limited resuscitation with whole blood (20% EBV) at one hour after hemorrhage. This study suggests that pharmaceutical interventions to inhibit prolyl hydroxylase activity can be used as a potential pre-hospital countermeasure for trauma and hemorrhage at or near the point of injury.
创伤发生在现场或转运途中的潜在可预防的院前相关死亡主要是由于低灌注引起的组织缺氧,导致损伤部位或在接受确定性治疗之前发生不可逆转的器官功能障碍。脯氨酰羟化酶结构域(PHD)是一种氧传感器,通过稳定缺氧诱导因子(HIF)来调节组织对缺氧的适应。PHD 抑制剂(PHDi)在治疗贫血和乳酸性血症中的益处源于 HIF 的稳定,这刺激了内源性促红细胞生成素的产生,并通过糖异生激活乳酸循环。这项研究的结果提供了关于 MK-8617 的治疗作用的深入了解,MK-8617 是 PHD-1、2 和 3 的泛抑制剂,可减轻创伤和失血性休克麻醉大鼠的乳酸性血症。此外,在麻醉大鼠失代偿性出血性休克模型中,急性给予 MK-8617 可显著提高 1 小时生存率,并在出血后 1 小时给予全血(20% EBV)进行有限复苏后至少维持 4 小时的存活。这项研究表明,抑制脯氨酰羟化酶活性的药物干预可以作为创伤和出血的潜在院前治疗对策,在现场或在损伤部位附近使用。