• Traumatology

Clinical studies have characterized the early changes in plasma concentrations of Gc-globulin and gelsolin after severe injury: 1. The circulating levels of both proteins are significantly reduced shortly after trauma compared to normal controls. Furthermore the complex formation between Gc-globulin and actin is increased indicating a specific load on the Extracellular Actin Scavenger System. 2. The changes of Gc-globulin resemble that of an acute phase reactant, with an initial decrease followed by supra-normal levels the first week after injury and major surgery. 3. Admission plasma levels of Gc-globulin correlates with the subsequent development of organ dysfunction and survival. 4. The plasma levels of Gc-globulin and gelsolin in an animal burn injury model, resembles those seen after severe injury. Conclusions and futures studies In conclusion, significant new knowledge about the proteins of the EASS in the pathophysiological processes taking place after severe trauma, has been established. Initially, changes in circulating levels of Gc-globulin and gelsolin have been described in patients with fulminant hepatic failure, but within the last five years a number of studies have documented that early changes in the concentration of the proteins are predictive of prognosis after severe injury, both regarding survival and development of organ dysfunction. Experimental studies have supported the clinical findings, and indicated the possibility of a therapeutic use of gelsolin to attenuate the degree of pulmonary injury, but further experimental studies are needed to produce more detailed information about the kinetics of the two proteins after severe injury. In the near future experimental studies with infusion of Gc-globulin are realistic.

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