The chances of surviving massive blood loss from a traumatic injury such as a gunshot wound are around 50 percent. To survive, a patient needs two things to happen quickly: a large infusion of blood and coagulation at the wound to stop the bleeding. The problem is one of these solutions prevents the other (
).
Coagulopathy of trauma is a major contributor to mortality, but no treatment is fully effective. Researchers were getting 60 percent mortality with animal models. With dimethyl malonate, they got zero percent mortality, and the coagulopathy completely went away.
Perfume Ingredient Could Keep Gunshot Victims from Bleeding to Death
Trauma is a leading cause of death in the United States especially for children and young adults as a result of gun violence (2✔ ✔Trusted Source
Mortality rates following trauma The difference is night and day
Go to source
). Recent studies have shown that coagulopathy during massive hemorrhage treatment is most likely caused by the shedding of the glycocalyx, a barrier of sugars that surrounds and protects cells.
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In blood vessels, the glycocalyx lines the vessel walls and prevents blood from clotting. However, this is the first study to identify the cellular events that cause the glycocalyx to be ripped apart.
The study found that, during blood loss, a person’s cells lack the oxygen to metabolize succinate, a key part of the cell’s energy-generating cycle. Unable to be metabolized, the succinate builds up. When a large amount of blood is infused into a trauma victim – the succinate is metabolized too quickly, which leads to a change in the structure of the plasma membrane lipids (3✔ ✔Trusted Source
Succinate metabolism and membrane reorganization drives the endotheliopathy and coagulopathy of traumatic hemorrhage
Go to source).
This exposes the glycocalyx, allows it to be chewed up by enzymes, and mixes the shreds into the bloodstream, where it prevents clotting. People have been trying to figure out ways to move the needle a little bit on the death rate from a massive hemorrhage for the last 20 or so years and nothing has worked.
Researchers are hopeful that understanding these cellular-level events can help to develop something that does make a big difference. In animal models, dimethyl malonate was effective at inhibiting excessive cellular metabolism, which prevented the glycocalyx from shedding and causing coagulopathy.
But more research needs to be done to determine if dimethyl malonate is safe for humans or if an equivalent drug that targets cellular metabolism can be developed. Researchers have established this pathway that causes coagulopathy, so if they can target it therapeutically with a pre-hospital drug or injection, they can hopefully save some lives.
References :
- Trauma-induced coagulopathy – (https://www.nature.com/articles/s41572-021-00264-3)
- Mortality rates following trauma The difference is night and day – (https://journals.lww.com/onlinejets/Fulltext/2011/04020/Mortality_rates_following_trauma__The_difference.6.aspx)
- Succinate metabolism and membrane reorganization drives the endotheliopathy and coagulopathy of traumatic hemorrhage – (https://www.science.org/doi/10.1126/sciadv.adf6600)
Source: Eurekalert
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