Shear Stress and Endothelial Mechanotransduction in Trauma Patients with Hemorrhagic Shock: Hidden Coagulopathy Pathways and Novel Therapeutic Strategies

Massive trauma remains a leading cause of death and a global public health burden. Post-traumatic coagulopathy may be present even before the onset of resuscitation, and correlates with severity of trauma. Several mechanisms have been proposed to explain the development of abnormal coagulation proce...

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Veröffentlicht in:International journal of molecular sciences 2023-12, Vol.24 (24), p.17522
1. Verfasser: Chalkias, Athanasios
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description Massive trauma remains a leading cause of death and a global public health burden. Post-traumatic coagulopathy may be present even before the onset of resuscitation, and correlates with severity of trauma. Several mechanisms have been proposed to explain the development of abnormal coagulation processes, but the heterogeneity in injuries and patient profiles makes it difficult to define a dominant mechanism. Regardless of the pattern of death, a significant role in the pathophysiology and pathogenesis of coagulopathy may be attributed to the exposure of endothelial cells to abnormal physical forces and mechanical stimuli in their local environment. In these conditions, the cellular responses are translated into biochemical signals that induce/aggravate oxidative stress, inflammation, and coagulopathy. Microvascular shear stress-induced alterations could be treated or prevented by the development and use of innovative pharmacologic strategies that effectively target shear-mediated endothelial dysfunction, including shear-responsive drug delivery systems and novel antioxidants, and by targeting the venous side of the circulation to exploit the beneficial antithrombogenic profile of venous endothelial cells.
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subjects Acidosis
Blood
Blood Coagulation Disorders - etiology
Blood Coagulation Disorders - metabolism
Blood Coagulation Disorders - therapy
Blood platelets
Cardiac arrhythmia
Edema
Endothelial Cells
Endothelium
Endothelium, Vascular - metabolism
Glycoproteins
Hemodynamics
Hemorrhage
Humans
Hypothermia
Inflammation
Mechanotransduction, Cellular
Permeability
Physiology
Polyethylene glycol
Proteins
Shear stress
Shock, Hemorrhagic - complications
Shock, Hemorrhagic - therapy
Trauma
title Shear Stress and Endothelial Mechanotransduction in Trauma Patients with Hemorrhagic Shock: Hidden Coagulopathy Pathways and Novel Therapeutic Strategies
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