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Korkmaz HI, Sheraton VM, Bumbuc RV, Li M, Pijpe A, Mulder PPG, Boekema BKHL, de Jong E, Papendorp SGF, Brands R, Middelkoop E, Sloot PMA, van Zuijlen PPM. An in silico modeling approach to understanding the dynamics of the post-burn immune response. Front Immunol 2024; 15:1303776. [PMID: 38348032 PMCID: PMC10859697 DOI: 10.3389/fimmu.2024.1303776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Burns are characterized by a massive and prolonged acute inflammation, which persists for up to months after the initial trauma. Due to the complexity of the inflammatory process, Predicting the dynamics of wound healing process can be challenging for burn injuries. The aim of this study was to develop simulation models for the post-burn immune response based on (pre)clinical data. Methods The simulation domain was separated into blood and tissue compartments. Each of these compartments contained solutes and cell agents. Solutes comprise pro-inflammatory cytokines, anti-inflammatory cytokines and inflammation triggering factors. The solutes diffuse around the domain based on their concentration profiles. The cells include mast cells, neutrophils, and macrophages, and were modeled as independent agents. The cells are motile and exhibit chemotaxis based on concentrations gradients of the solutes. In addition, the cells secrete various solutes that in turn alter the dynamics and responses of the burn wound system. Results We developed an Glazier-Graner-Hogeweg method-based model (GGH) to capture the complexities associated with the dynamics of inflammation after burn injuries, including changes in cell counts and cytokine levels. Through simulations from day 0 - 4 post-burn, we successfully identified key factors influencing the acute inflammatory response, i.e., the initial number of endothelial cells, the chemotaxis threshold, and the level of chemoattractants. Conclusion Our findings highlight the pivotal role of the initial endothelial cell count as a key parameter for intensity of inflammation and progression of acute inflammation, 0 - 4 days post-burn.
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Affiliation(s)
- H. Ibrahim Korkmaz
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
| | - Vivek M. Sheraton
- Computational Science Lab, Informatics Institute, University of Amsterdam, UvA - LAB42, Amsterdam, Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Laboratory for Experimental Oncology and Radiobiology, ONCODE, Amsterdam University Medical Center (UMC), Location AMC, Amsterdam, Netherlands
| | - Roland V. Bumbuc
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity (AII) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Computational Science Lab, Informatics Institute, University of Amsterdam, UvA - LAB42, Amsterdam, Netherlands
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Laboratory for Experimental Oncology and Radiobiology, ONCODE, Amsterdam University Medical Center (UMC), Location AMC, Amsterdam, Netherlands
| | - Meifang Li
- Computational Science Lab, Informatics Institute, University of Amsterdam, UvA - LAB42, Amsterdam, Netherlands
| | - Anouk Pijpe
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
| | - Patrick P. G. Mulder
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bouke K. H. L. Boekema
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
| | - Evelien de Jong
- Department of Intensive Care, Red Cross Hospital, Beverwijk, Netherlands
| | | | - Ruud Brands
- Complexity Institute, Nanyang Technological University, Singapore, Singapore
- Alloksys Life Sciences BV, Wageningen, Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
| | - Peter M. A. Sloot
- Computational Science Lab, Informatics Institute, University of Amsterdam, UvA - LAB42, Amsterdam, Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam University Medical Center (UMC), Location VUmc, Amsterdam, Netherlands
- Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
- Preclinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
- Paediatric Surgical Centre, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), Location AMC, Amsterdam, Netherlands
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van de Warenburg MS, Munk EFL, Davies A, McBride CA, Edgar DW, Vehmeijer-Heeman MLAW, Young AE. Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care. J Burn Care Res 2024; 45:112-119. [PMID: 37310702 PMCID: PMC10768758 DOI: 10.1093/jbcr/irad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.
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Affiliation(s)
- Milly S van de Warenburg
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Elleke F L Munk
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anna Davies
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Craig A McBride
- Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Node, The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Mariëlle L A W Vehmeijer-Heeman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
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Keshri VR, Peden M, Singh P, Norton R, Abimbola S, Jagnoor J. Health systems research in burn care: an evidence gap map. Inj Prev 2023; 29:446-453. [PMID: 37532304 DOI: 10.1136/ip-2023-044963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Burn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent of health systems research (HSR) in burn care is unknown. This review aimed to systematically map the global HSR related to burn care. METHODS An evidence gap map (EGM) was developed based on the World Health Organization health systems framework. All major medical, health and injury databases were searched. A standard method was used to develop the EGM. RESULTS A total of 6586 articles were screened, and the full text of 206 articles was reviewed, of which 106 met the inclusion criteria. Most included studies were cross-sectional (61%) and were conducted in hospitals (71%) with patients (48%) or healthcare providers (29%) as participants. Most studies were conducted in high-income countries, while only 13% were conducted in low-and middle-income countries, accounting for 60% of burns mortality burden globally. The most common health systems areas of focus were service delivery (53%), health workforce (33%) and technology (19%). Studies on health policy, governance and leadership were absent, and there were only 14 qualitative studies. CONCLUSIONS Major evidence gaps exist for an integrated health systems response to burns care. There is an inequity between the burden of burn injuries and HSR. Strengthening research capacity will facilitate evidence-informed health systems and policy reforms to sustainably improve access to affordable, equitable and optimal burn care and outcomes.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Margaret Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Pratishtha Singh
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
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Mulder PP, Vlig M, Fasse E, Stoop MM, Pijpe A, van Zuijlen PP, Joosten I, Boekema BK, Koenen HJ. Burn-injured skin is marked by a prolonged local acute inflammatory response of innate immune cells and pro-inflammatory cytokines. Front Immunol 2022; 13:1034420. [PMID: 36451819 PMCID: PMC9703075 DOI: 10.3389/fimmu.2022.1034420] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/28/2022] [Indexed: 10/10/2023] Open
Abstract
The systemic and local immune response in burn patients is often extreme and derailed. As excessive inflammation can damage healthy tissues and slow down the healing process, modulation of inflammatory responses could limit complications and improve recovery. Due to its complexity, more detailed information on the immune effects of thermal injury is needed to improve patient outcomes. We therefore characterized and quantified subsets of immune cells and mediators present in human burn wound tissue (eschar), sampled at various time points. This study shows that after burn injury, the number of immune cells were persistently increased, unlike the normal wound healing process. There was an immediate, strong increase in neutrophils and a moderate increase in monocytes/macrophages and lymphocytes, especially in the second and third week post burn. The percentage of classical (CD14highCD16-) monocytes/macrophages demonstrated a steady decrease over time, whereas the proportion of intermediate (CD14highCD16+) monocytes/macrophages slowly increased. The absolute numbers of T cells, NK cells and B cells increased up to week 3, while the fraction of γδ T cells was increased only in week 1. Secretome profiling revealed high levels of chemokines and an overall pro-inflammatory cytokine milieu in burn tissue. The local burn immune response shows similarities to the systemic immune reaction, but differs in neutrophil maturity and lymphocyte composition. Altogether, the neutrophil surges, high levels of pro-inflammatory cytokines and limited immunosuppression might be key factors that prolong the inflammation phase and delay the wound healing process in burns.
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Affiliation(s)
- Patrick P.G. Mulder
- Preclinical & Clinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel Vlig
- Preclinical & Clinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
| | - Esther Fasse
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Matthea M. Stoop
- Burn Center & Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
| | - Anouk Pijpe
- Preclinical & Clinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
- Burn Center & Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Paul P.M. van Zuijlen
- Burn Center & Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, Netherlands
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
- Paediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC University of Amsterdam, Amsterdam, Netherlands
| | - Irma Joosten
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bouke K.H.L. Boekema
- Preclinical & Clinical Research, Association of Dutch Burn Centres (ADBC), Beverwijk, Netherlands
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hans J.P.M. Koenen
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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