Metabolic Reprogramming in Renal Tubular Cells in Acute Kidney Injury Following Severe Trauma
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 80
- 试验地点
- 1
- 主要终点
- Profile of urinary metabolite concentrations measured by mass spectometry
研究概览
简要总结
Severe trauma remains the leading cause of death in people under 50, and is associated with high morbidity, including severe disability, with a substantial socio-economic impact. Secondary to trauma, multiple mechanisms (inflammatory, ischemic, oxidative, etc.) setting in rapidly, leads to organ failure, one of the three first cause of death. Vascular damage, with vasoplegia, renal damage, with acute kidney injury (AKI), and pulmonary damage, with acute respiratory distress syndrome (ARDS), are the most frequently observed but all organs can be affected whatever the type of trauma. For these reasons, identifying the pathophysiological pathways involved in organ failure induced by severe trauma is a major step towards limiting the morbidity and mortality induced by trauma, and proposing therapies to prevent them.
Because of the variability of lesions in these patients, and the multiplicity of pathways activated, the mechanisms involved and their causality with organ failure following severe trauma, are still poorly understood. Given their frequency and importance in terms of morbidity and mortality, the investigators decided to take a particular interest in the mechanisms leading to renal and pulmonary injury. The investigators' hypothesis is that the study of urinary and blood markers not performed as part of clinical routine would provide a better understanding of the pathophysiological mechanisms leading to organ failure secondary to severe trauma, and more specifically to renal and pulmonary injuries. With TRAUMATEC study, the investigators will explore mechanisms leading to AKI and ARDS through blood and urine samples of 60 severe trauma patients sampled over the first 48 hours after ICU admission and a reference of 20 healthy volunteers.
详细描述
The investigators plan to include 60 patients over 18 years old with severe trauma, defined with an ISS≥9 and 20 healthy volunteers 18 years old as a reference group.
Blood and urine samples will be collected at ICU arrival, 12-, 24- and 48- hours after ICU admission. Specific dosages will then be realized on blood and urines to study metabolic and hormonal pathway leading to AKI and ARDS.
The primary objective of the study is to explore the association between renal metabolic changes and renal function impairment following severe trauma.
Secondary objectives are (1) to explore mitochondrial changes observed at the renal cellular level, on in vitro renal culture cells after exposure to trauma patient serum (2) to explore the association between plasma metabolic changes and renal and pulmonary function impairment following severe trauma (3) to explore the association between hormonal metabolic changes and renal and pulmonary function impairment following severe trauma (4) to explore the association between red blood cell-induced oxidative stress and renal function impairment following severe trauma (5) to explore the association between changes in the hemoglobin recycling (chelation) system and impaired renal function following severe trauma (6) to explore renal tubular damage secondary to severe trauma (7) to explore the pathophysiological mechanisms associated with pulmonary damage following severe trauma (8) to describe mortality at day 30.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Trauma patients :
- •Adult patients (age ≥ 18 years)
- •Patient admitted for suspected severe trauma (1 Vittel criteria)
- •Injury Severity Score ≥ 9
- •Health insurance
- •Written consent obtained from the patient or trusted support person / family member / close friend, or inclusion in an emergency situation and written consent obtained from the patient (trusted support person / family member / close friend if necessary) as soon as possible (article L1122-1-2 of the CSP).
- •Healthy volunteers :
- •Adult patients (≥ 18 years)
- •Affiliated with health insurance
- •Written informed consent́
- •Patient respecting matching
排除标准
- •Trauma patients :
- •Pregnant patient
- •Minor patient
- •Adult under guardianship, curatorship or safeguard of justice
- •Patient under Aide Médicale d'État
- •Chronic renal failure on dialysis
- •Chronic respiratory disease
- •Patient with chronic cardiac insufficiency
- •Systemic inflammatory disease
- •Healthy volunteers :
- •Pregnant patient
- •Minor patient
- •Adult under guardianship, curatorship or safeguard of justice
- •Patient under Aide Médicale d'État
- •Patient with chronic renal failure on dialysis
- •Chronic respiratory disease
- •Patient with chronic cardiac insufficiency
- •Systemic inflammatory disease
结局指标
主要结局
Profile of urinary metabolite concentrations measured by mass spectometry
时间窗: On admission, at 12 hours, 24 hours and 48 hours of hospital admission
Metabolomic study of patients urine according to AKI and compared to healthy volunteers measured by mass spectometry
次要结局
- erythrocyte NO production produced by red blood cells(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- Antidiuretic hormone (ADH) profile(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- mitochondrial enzymatic activities of cultured Human Kidney 2 (HK2) kidney cells exposed to patient serum and exposed to serum from healthy volunteers(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- advanced glycation end products (AGEs) produced by red blood cells(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- mitochondrial Adenosine TriPhosphate (ATP) content of cultured Human Kidney 2 (HK2) kidney cells exposed to patient serum and exposed to serum from healthy volunteers(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- Plasma metabolite concentration profile measured by mass spectrometry(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- reactive oxygen derivatives produced by red blood cells(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- monocyte CD163 receptor from peripheral blood mononuclear cell (PBMC) isolation level(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- mitochondrial membrane potential of cultured Human Kidney 2 (HK2) kidney cells exposed to patient serum and exposed to serum from healthy volunteers(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- haptoglobin level(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- leptine profile(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- Radiographic Assessment of Lung Edema (RALE) score(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- alveolar epithelial lesions(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- expression levels of mitochondrial of cultured Human Kidney 2 (HK2) kidney cells exposed to patient serum and exposed to serum from healthy volunteers(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- renin-angiotensin-aldosterone (RASS) profile(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- cortisol profile(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- hypoxemia level(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- use of mechanical ventilation(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- Death(Day 30)
- haptoglobin-hemoglobin complexes level(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- free hemoglobin level(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- Intensity of renal tubular injury(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)
- Heme oxygenase-1 (HO-1) enzyme catabolizing heme level(On admission, at 12 hours, 24 hours and 48 hours of hospital admission)