Center for Clinical and Translation Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH 43205, USA.
J Burn Care Res. 2024 Nov 14;45(6):1607-1616. doi: 10.1093/jbcr/irae111.
Pediatric burn injuries are a leading cause of morbidity with infections being the most common acute complication. Thermal injuries elicit a heightened cytokine response while suppressing immune function; however, the mechanisms leading to this dysfunction are still unknown. Our aim was to identify extracellular proteins and circulating phosphoprotein expression in the plasma after burn injury to predict the development of nosocomial infection (NI). Plasma was collected within 72 hours after injury from 64 pediatric burn subjects; of these, 18 went on to develop an NI. Extracellular damage-associated molecular proteins, FAS(APO), and protein kinase b (AKT) signaling phosphoproteins were analyzed. Subjects who went on to develop an NI had elevated high-mobility group box 1, heat shock protein 90 (HSP90), and FAS expression than those who did not develop an NI after injury (NoNI). Concurrently, phosphorylated (p-)AKT and mammalian target of rapamycin (p-mTOR) were elevated in those subjects who went on to develop an NI. Quadratic discriminant analysis revealed distinct differential profiles between NI and NoNI burn subjects using HSP90, FAS, and p-mTOR. The area under the receiver-operator characteristic curves displayed significant ability to distinguish between these 2 burn subject cohorts. These findings provide insight into predicting the signaling proteins involved in the development of NI in pediatric burn patients. Further, these proteins show promise as a diagnostic tool for pediatric burn patients at risk of developing infection while additional investigation may lead to potential therapeutics to prevent NI.
儿科烧伤是发病率的主要原因,感染是最常见的急性并发症。热损伤会引起细胞因子反应增强,同时抑制免疫功能;然而,导致这种功能障碍的机制尚不清楚。我们的目的是确定烧伤后血浆中外泌体蛋白和循环磷酸化蛋白的表达,以预测医院获得性感染(NI)的发生。在损伤后 72 小时内从 64 名儿科烧伤患者中采集血浆;其中 18 例发生了 NI。分析了细胞外损伤相关分子蛋白、FAS(APO)和蛋白激酶 b(AKT)信号转导磷酸化蛋白。发生 NI 的患者的高迁移率族蛋白 1(HMGB1)、热休克蛋白 90(HSP90)和 FAS 的表达水平高于未发生 NI 的患者(NoNI)。同时,发生 NI 的患者中磷酸化(p-)AKT 和雷帕霉素靶蛋白(p-mTOR)升高。二次判别分析显示,NI 和 NoNI 烧伤患者之间存在 HSP90、FAS 和 p-mTOR 的明显差异特征。受试者工作特征曲线下的面积显示出区分这 2 组烧伤患者的显著能力。这些发现为预测儿科烧伤患者中与 NI 发展相关的信号蛋白提供了深入了解。此外,这些蛋白质有望成为儿科烧伤患者感染风险的诊断工具,进一步的研究可能会导致预防 NI 的潜在治疗方法。