Maraviroc-Mediated Lung Protection following Trauma-Hemorrhagic Shock

Establishment and evaluation of rat trauma hemorrhagic liver injury model

Trauma hemorrhagic shock is a common and critical disease, which induces multiple organ failure, especially of the liver, when combined with fracture. However, no effective trauma hemorrhagic liver injury model that mimics the real-life condition has been developed so far. This study aims to develop an effective trauma hemorrhagic liver injury model based on a fracture and hemorrhage approach. The levels of the following proteins were determined by the enzyme-linked immunosorbent assay (ELISA) in our fracture and hemorrhage-based model system: serum alanine transaminase (ALT), aspartate aminotransferase (AST), inflammatory cytokines such as interleukin-1β, interleukin-6, and tumor necrosis factor-α, chemokines such as C-C motif ligand 2, C-C motif ligand 5, C-C motif ligand 13, and C-X-C motif ligand 2. Pathological changes in the liver and the numbers of CD45⁺ cells and polymorphic nuclear neutrophils (PMNs) in the liver parenchyma were analyzed by hematoxylin-eosin staining, periodic acid-Schiff staining, and flow cytometry, respectively. As expected, the serum levels of ALT and AST increased significantly with trauma time and peaked at 16 hrs post-trauma. Similarly, the levels of the inflammatory cytokines also increased significantly with trauma time, and peaked after 8 hrs or 16 hrs of trauma. Analysis of hepatic morphology at the time-point when the trauma was inflicted and at later time-points post-trauma, revealed invasion of inflammatory cells, formation of hyperchromatic nuclei, and presence of loose and irregular acinus and vacuolus; the phenotype was most severe at 16 hrs post-trauma. The number of CD45⁺ cells and PMNs increased significantly with trauma time and peaked after 16 hrs of trauma. These observations indicated that the trauma hemorrhagic liver injury model was successfully established and that it could provide an effective system to study the mechanisms of trauma hemorrhagic liver injury.

IL33-mediated ILC2 activation and neutrophil IL5 production in the lung response after severe trauma: A reverse translation study from a human cohort to a mouse trauma model

BACKGROUND

The immunosuppression and immune dysregulation that follows severe injury includes type 2 immune responses manifested by elevations in interleukin (IL) 4, IL5, and IL13 early after injury. We hypothesized that IL33, an alarmin released early after tissue injury and a known regulator of type 2 immunity, contributes to the early type 2 immune responses after systemic injury.

METHODS AND FINDINGS

Blunt trauma patients admitted to the trauma intensive care unit of a level I trauma center were enrolled in an observational study that included frequent blood sampling. Dynamic changes in IL33 and soluble suppression of tumorigenicity 2 (sST2) levels were measured in the plasma and correlated with levels of the type 2 cytokines and nosocomial infection. Based on the observations in humans, mechanistic experiments were designed in a mouse model of resuscitated hemorrhagic shock and tissue trauma (HS/T). These experiments utilized wild-type C57BL/6 mice, IL33-/- mice, B6.C3(Cg)-Rorasg/sg mice deficient in group 2 innate lymphoid cells (ILC2), and C57BL/6 wild-type mice treated with anti-IL5 antibody. Severely injured human blunt trauma patients (n = 472, average injury severity score [ISS] = 20.2) exhibited elevations in plasma IL33 levels upon admission and over time that correlated positively with increases in IL4, IL5, and IL13 (P < 0.0001). sST2 levels also increased after injury but in a delayed manner compared with IL33. The increases in IL33 and sST2 were significantly greater in patients that developed nosocomial infection and organ dysfunction than similarly injured patients that did not (P < 0.05). Mechanistic studies were carried out in a mouse model of HS/T that recapitulated the early increase in IL33 and delayed increase in sST2 in the plasma (P < 0.005). These studies identified a pathway where IL33 induces ILC2 activation in the lung within hours of HS/T. ILC2 IL5 up-regulation induces further IL5 expression by CXCR2+ lung neutrophils, culminating in early lung injury. The major limitations of this study are the descriptive nature of the human study component and the impact of the potential differences between human and mouse immune responses to polytrauma. Also, the studies performed did not permit us to make conclusions about the impact of IL33 on pulmonary function.

CONCLUSIONS

These results suggest that IL33 may initiate early detrimental type 2 immune responses after trauma through ILC2 regulation of neutrophil IL5 production. This IL33-ILC2-IL5-neutrophil axis defines a novel regulatory role for ILC2 in acute lung injury that could be targeted in trauma patients prone to early lung dysfunction.