Current views on the mechanisms of immune responses to trauma and infection

Abstract

According to the World Health Organization, post-traumatic mortality rates are still very high and show an increasing tendency. Disorders of innate immune response that may increase the risk of serious complications play a key role in the immunological system response to trauma and infection. The mechanism of these disorders is multifactorial and is still poorly understood. The changing concepts of systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS) early inflammatory response, presented in this work, have been extended to genetic studies. Overexpression of genes and increased production of immune response mediators are among the main causes of multiple organ dysfunction syndrome (MODS). Changes in gene expression detected early after injury precede the occurrence of subsequent complications with a typical clinical picture. Rapid depletion of energy resources leads to immunosuppression and persistent inflammation and immune suppression catabolism syndrome (PICS). Early diagnosis of immune disorders and appropriate nutritional therapy can significantly reduce the incidence of complications, length of hospital stay, and mortality. The study presents the development of knowledge and current views explaining the mechanisms of the immune response to trauma and infection.

Keywords: CARS; MODS; PICS; SIRS; innate immune response; sepsis.

Fig. 1

The hypothetical model of pro-inflammatory (SIRS) and anti-inflammatory response (CARS) to trauma and infection, which can lead to multiple organ failure (according to Bone et al.) [19]

Fig. 2

Cascade inflammatory response to trauma and infection, including immunological indicators and “diagnostic window”

Fig. 3

Dynamics of changes in SIRS and CARS response to trauma and infection, including the physiological and pathological reactions (according to Moore et al.) [36]

Fig. 4

Changes in the inflammatory response to trauma and infection, including the parallel course of SIRS and CARS response (according to Murphy et al.) [37]

Fig. 5

An example of changes in the pro- and anti-inflammatory response to injury and infection (according to Brochner et al.) [46]

Fig. 6

Dynamics of changes in SIRS and CARS response in trauma patients based on genetic studies (according to Xiao et al.) [47]

Fig. 7

A new concept of the immune response to trauma and infection, involving PICS and disorders of cell-mediated immunity (according to Gentile et al.) [49]