HMGB1 Inhibition to Ameliorate Organ Failure and Increase Survival in Trauma.

Zhangsheng Yang,Bin Liu,Peter R Edsall,Tomas S Cancio,Milomir O Simovic,Yansong Li,Leopoldo C Cancio,Andriy I Batchinsky

doi:10.3390/biom12010101

Abstract

Several preclinical and clinical reports have demonstrated that levels of circulating high mobility group box 1 protein (HMGB1) are increased early after trauma and are associated with systemic inflammation and clinical outcomes. However, the mechanisms of the interaction between HMGB1 and inflammatory mediators that lead to the development of remote organ damage after trauma remain obscure. HMGB1 and inflammatory mediators were analyzed in plasma from 54 combat casualties, collected on admission to a military hospital in Iraq, and at 8 and 24 h after admission. In total, 45 (83%) of these patients had traumatic brain injury (TBI). Nine healthy volunteers were enrolled as controls. HMGB1 plasma levels were significantly increased in the first 8 h after admission, and were found to be associated with systemic inflammatory responses, injury severity score, and presence of TBI. These data provided the rationale for designing experiments in rats subjected to blast injury and hemorrhage, to explore the effect of HMGB1 inhibition by CX-01 (2-O, 3-O desulfated heparin). Animals were cannulated, then recovered for 5–7 days before blast injury in a shock tube and volume-controlled hemorrhage. Blast injury and hemorrhage induced an early increase in HMGB1 plasma levels along with severe tissue damage and high mortality. CX-01 inhibited systemic HMGB1 activity, decreased local and systemic inflammatory responses, significantly reduced tissue and organ damage, and tended to increase survival. These data suggest that CX-01 has potential as an adjuvant treatment for traumatic hemorrhage.

Highlights

Trauma/hemorrhage (TH) is the leading cause of death on the battlefield, and, for those under the age of 45, in the civilian world as well [1]
In experiments with rats exposed to TH, we have recently shown that the inhibition of the complement terminal pathway (CTP) reduced extracellular HMGB1 (eHMGB1) levels in the blood, and coincided with beneficial treatment
We assessed the efficacy of CX-01 on morbidity and mortality in rats subjected to blast injury and hemorrhagic shock

Summary

Introduction

Trauma/hemorrhage (TH) is the leading cause of death on the battlefield, and, for those under the age of 45, in the civilian world as well [1]. Trauma immediately induces release of damage-associated molecular patterns (DAMPs), such as high mobility group box 1 protein (HMGB1, known as amphoterin) [7,8,9], IL-1, IL-33, calgranulins, histones, heat-shock proteins, nucleic acids, adenosine triphosphate (ATP) [9,10,11], matricryptins [12], free heme [9,13], cold-inducible RNA-binding protein [14], and mitochondrial DNA [15]. DAMPs in conjunction with pathogen-associated molecular patterns (PAMPs) promptly activate the complement [16], coagulation [17], and kallikreinkinin systems, [18], leading to trauma-induced immune dysfunction, infectious

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Results

Conclusion