Glysin som en del av det akutte resusciteringsregimet etter skuddskader hos gris - modulering av den tidlige inflammatoriske responsen

As part of a training course in Traumatology and War Surgery organised by the Norwegian Defence Medical Headquarter at Lahaugmoen camp we have used glycine as part of the immediate resuscitation regime after gunshot injuries in the pig. Effects on the early inflammatory response, using the synthesis of reactive oxygen species (ROS) as immune function marker, were investigated. 22 animals (45-55 kg) were used for the experiments. In general anaesthesia the femoral artery was exposed and catheterised for blood analysis and monitoring purposes. The animals suffered a standardised trauma: one rifle shot hitting the right femur from a distance of 25 m, and one pistol shot to the left upper abdomen from close range. Immediate first aid treatment was instituted before transportation to a nearby field hospital for surgery. The animals were randomised into two groups. Group 1 (n=13) received an iv infusion of Glycine 7.5 g over 30 min, group 2 (n=9) a similar infusion of normal saline. The infusions were started 5 min after the last shot. Blood samples were drawn before trauma and 75 min after shooting. Circulating granulocytes were isolated and the production of ROS measured. The granulocytes were in vitro treated with SB203580, U0126, FK506, or Wortmannin. Glycine moderately depressed ROS production. U-0126 and Wortmannin further reduced the synthesis of ROS, and to about the same extent. SB203580 was least effective. No positive synergy appeared to exist between glycine and the individual inhibitors. We conclude that glycine inhibits ROS synthesis after trauma. Wortmannin and U0126 proved to be the most potent inhibitors. The p38 branch of the MAPK cascade appears to be less important as a signalling pathway after trauma than the ERK branch.