title: C1 Inhibitor Limits Organ Injury and Prolongs Survival in Swine Subjected to Battlefield Simulated Injury.
abstract: Complement system activation is recognized as a deleterious component of the mammalian physiological response to traumatic injury with severe hemorrhage (TH). Female Yorkshire swine were subjected to a simulated austere prehospital battlefield scenario. Each animal underwent controlled hemorrhage of 22 mL/kg at 100 mL/min rate for approximately 10 min followed by soft tissue injury, femur fracture, and spleen injury. Subsequent blood loss was uncontrolled. Twenty-eight minutes postinjury the animals were randomized into treatment or no treatment with recombinant human C1 esterase inhibitor (C1INH) (500 IU/kg, n = 11) and into receiving or not permissive hypotensive resuscitation (n = 14) with infusion of 45 mL/kg lactated Ringer's solution (2× blood lost). Observation and animal maintenance continued for 6 h at which time the animals had either expired or were euthanized. Heart, lung, and small intestine tissue samples were collected. Pharmacokinetic, hemodynamic, and metabolic parameters as well as survival time, plasma complement activity and tissue deposition, cytokine levels, and tissue injury were determined. We found that administration of C1INH protected tissues from damage, reduced the levels of inflammatory cytokines, and improved blood chemistry. Immunohistochemical analyses revealed that C1INH administration following TH markedly reduced complement activation and deposition in tissues. Importantly, C1INH administration prolonged survival of animals particularly in those which received resuscitation fluid infusion. Our data urge early administration of C1INH to limit organ damage and prolong survival of those injured in the battlefield.
authors.affiliation: *Chief Scientist Office, 59MDW/ST, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas †Damage Control Resuscitation, U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, Texas ‡Pharming Technologies BV, Leiden, The Netherlands §Navel Medical Research Unit, Joint Base San Antonio-Fort Sam Houston, Texas ¶Combat Casualty Care Research Program, U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland ||Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts #Chemical and Biological Technologies Department, Defense Threat Reduction Agency, Fort Belvoir, Virginia.
authors.forename: James C
authors.initials: JC
authors.lastname: Campbell
authors.forename: Yansong
authors.initials: Y
authors.lastname: Li
authors.forename: Edwin
authors.initials: E
authors.lastname: van Amersfoort
authors.forename: Anurag
authors.initials: A
authors.lastname: Relan
authors.forename: Michael
authors.initials: M
authors.lastname: Dubick
authors.forename: Forest
authors.initials: F
authors.lastname: Sheppard
authors.forename: Anthony
authors.initials: A
authors.lastname: Pusateri
authors.forename: Debra
authors.initials: D
authors.lastname: Niemeyer
authors.forename: George C
authors.initials: GC
authors.lastname: Tsokos
authors.forename: Jurandir J
authors.initials: JJ
authors.lastname: Dalle Lucca
mesh_terms: D000818:Animals; D003167:Complement Activation / Q000187:drug effects; D050718:Complement C1 Inhibitor Protein / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005260:Female; D005265:Femoral Neck Fractures / Q000188:drug therapy / Q000628:therapy; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000188:drug therapy / Q000628:therapy; D007552:Isotonic Solutions / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000188:drug therapy / Q000628:therapy; D017695:Soft Tissue Injuries / Q000188:drug therapy / Q000628:therapy; D013154:Spleen / Q000187:drug effects / Q000293:injuries; D013552:Swine; D014857:Warfare
chemical_list: D050718:Complement C1 Inhibitor Protein; D007552:Isotonic Solutions; D000077325:Ringer's Lactate