Dynamics of acute-phase protein levels and circulating immune complexes during soft tissue reconstruction in the course of multiple trauma

Abstract

The aim of the work: to determine the dynamics of acute-phase protein levels and circulating immune complexes in the context of soft tissue regeneration during the development of multiple trauma.

Materials and Methods. The experiments involved 199 mature male Wistar-line white rats. Under thiopental-sodium anesthesia, polytrauma (combined traumatic brain and skeletal injury) and soft tissue reconstruction (STR) were simulated in separate groups of rats (a 4 × 8 cm skin flap was excised on the leg) (series 1), which were taken out of the experiment after 14 days. Intact rats served as controls. In Series 2, rats in the first subgroup underwent simulated multiple trauma, while in the second subgroup, STR was performed against a background of multiple trauma at 1, 3, 7, and 14 days of the post-traumatic period. Rats with polytrauma from the first series of experiments served as controls. Rats were taken out of the experiment at a time corresponding to 14 days after STR, which corresponded to 15, 17, 21, and 28 days from the time of polytrauma simulation. The intensity of the body’s systemic inflammatory response was assessed based on serum levels of acute-phase proteins: C-reactive protein (CRP) and ceruloplasmin (CP); immune responses were assessed based on levels of circulating immune complexes (CIC).

Results. It was established that modeling of multiple trauma 14 days after post-traumatic period was accompanied by a significant increase in systemic inflammatory and immune responses, as evidenced by elevated serum levels of C-reactive protein (CRP), ceruloplasmin (CP), and circulated immune complexes (CIC). It was demonstrated for the first time that performing only STR is also sufficient to cause an increase in these parameters, and their values under experimental conditions did not differ statistically from the results of polytrauma. When only multiple trauma was simulated, the levels reached their maximum 14 days after the post-traumatic period and gradually decreased by the 28th day, without reaching the levels observed in uninjured rats. Performing STR at various time points after modeling polytrauma was accompanied by a significant increase in serum levels of CRP, CP, and CIC compared to rats that had only undergone polytrauma. Depending on the timing of STR administration during the post-traumatic period, it was found that STR performed 1 day after simulated multiple trauma was associated with the highest serum levels of CRP, CP, and CIC compared to the control group. Performing STR 3 and 7 days after polytrauma caused fewer disturbances. Moreover, under conditions of STR performed 7 days after the post-traumatic period, the lowest accumulation of the studied indicators in the blood was observed. At the same time, the STR, performed 14 days after the modeling of multiple trauma–at the peak of post-traumatic disorders–was accompanied by a repeated increase in serum levels of CRP, CP, and CIC.

Conclusions. Thus, soft tissue reconstruction has a significant impact on the development of systemic reactions in the body in the context of multiple trauma; this impact depends on the timing of skin reconstruction during the post-traumatic period and opens up prospects for optimizing soft tissue reconstruction procedures, taking into account the body’s overall resistance, which changes as the traumatic condition progresses.