Abstract
OBJECTIVES: Polytrauma is characterized by high mortality and morbidity rates, partly due to the post-traumatic immune response. This follow-up study investigated the effect of combined inhibition of complement factor 5 (C5) and CD14 on systemic (plasma) and local (fracture hematoma) protein levels in a porcine polytrauma model. METHODS: 18 male pigs (sus scrofa) were used for this study: a control group (n=6), and two groups that were subjected to standardized polytrauma, followed by standard treatment (intramedullary nailing; n=8) or standard treatment with C5/CD14 inhibition therapy (n=4). Plasma and fracture hematoma samples were collected at specified time points and the expression levels of proteins related to the post-traumatic immune response and fracture healing were determined using enzyme-linked immunosorbent assays. RESULTS: Pro-inflammatory proteins such as IL-1β, IL-6, and IFN-α were significantly reduced in both plasma and fracture hematoma samples at 72 h after trauma in the treated vs. the non-treated group. Soluble TLR4, a possible inhibitor of cell membrane TLR4, was increased in both the plasma and the fracture hematoma following therapy, suggesting that TLR4 was released from the cell membrane to the fluid phase. CONCLUSIONS: These findings show that systemic C5/CD14 inhibition effectively reduced the concentration of several pro-inflammatory proteins in the systemic circulation and locally, at the fracture site, in the fracture hematoma. The levels in the plasma were in line with those in the fracture hematoma, albeit that they were markedly lower in the plasma compared to the fracture hematoma.