Omics Signatures of Tissue Injury and Hemorrhagic Shock in Swine

Objective: Advanced mass spectrometry methods were leveraged to analyze both proteomics and metabolomics signatures in plasma upon controlled tissue injury and hemorrhagic shock – isolated or combined - in a swine model, followed by correlation to viscoelastic measurements of coagulopathy via thrombelastography. Summary Background Data: TI and HS cause distinct molecular changes in plasma in both animal models and trauma patients. However, the contribution to coagulopathy of trauma, the leading cause of preventable mortality in this patient population remains unclear. The recent development of a swine model for isolated or combined TI + HS facilitated the current study. Methods: Male swine (n=17) were randomized to either isolated or combined tissue injury and hemorrhagic shock. Coagulation status was analyzed by thrombelastography during the monitored time course. The plasma fractions of the blood draws (at baseline, end of shock and at 30 min, 1, 2 and 4h after shock) were analyzed by mass spectrometry-based proteomics and metabolomics workflows. Results: HS– isolated or combined with TI - caused the most severe omic alterations during the monitored time course. While isolated TI delayed the activation of coagulation cascades. Correlation to TEG parameters of clot strength (MA) and breakdown (LY30) revealed signatures of coagulopathy which were supported by analysis of gene ontology enriched biological pathways. Conclusion: The current study provides a comprehensive characterization of proteomic and metabolomic alterations to combined or isolated TI and HS in a swine model, and identifies early and late omics correlates to viscoelastic measurements in this system.