MCG Nurse Scientist Investigates Trauma-Induced Sepsis

An emergency room nurse’s curiosity about why some trauma patients develop sepsis while others don’t has led to an expanded career as a researcher studying the question.

Dr. Beth NeSmith, assistant professor of physiological and technological nursing in the Medical College of Georgia School of Nursing, has received a three-year, $281,000 National Institutes of Health grant to examine risk factors for sepsis and organ failure following trauma.

Trauma kills more than 13 million Americans annually. Sepsis, an uncontrolled systemic infection commonly known as blood poisoning, and associated organ failure are the leading causes of in-hospital trauma deaths, yet little data exist to explain differences in population vulnerability to these deadly outcomes.

NeSmith believes lifetime chronic stress may be the culprit and a simple test on hair may identify those at risk.

“My theory is that a person who grows up with chronic stress, such as socio-economic stress or abuse, will have a different response to trauma in terms of their inflammation profile,” NeSmith said. “Inflammation is a normal body response to trauma, but if it gets out of hand it’s dangerous. The only care for it is supportive until – if – the body gets better.”

As the trauma clinical nurse specialist at MCG Health System from 1997-2003, NeSmith was intrigued by the limited treatment options available for sepsis. “As members of the health care team, we knew there was no cure. I thought that was mysterious and we needed research to figure it out.”

It’s well known that chronic stress suppresses the immune response, NeSmith said. Her grant will allow her to test the theory that people with existing chronic stress respond differently physiologically to trauma than non-stressed individuals.

Chronic stress produces high levels of cortisol, a stress hormone that normally works in sync with the immune system but, when sustained, gradually interrupts the body’s carefully orchestrated checks and balances system. The result may suppress the immune response to trauma in much the same way as the body’s aging process.

“We know intuitively that older people are more vulnerable to complications following trauma, and therefore, we are as preventative as possible in treatment,” NeSmith said. “If a younger person who has lived a chronically stressed life has the same biological changes as a chronologically older person, and we can test for that susceptibility, we could support them as well and work to prevent a sepsis episode.”

Pre-trauma stress levels can be determined by testing for cortisol deposits in hair. That information, combined with screening results from a Life Events and Difficulties survey, could help determine changes in the inflammatory response to trauma and associated sepsis risk.

NeSmith also is studying the effect of heat shock protein 90 inhibitors, which show promise as anti-inflammatories in animal studies, on alleviating trauma-induced inflammation. The study, funded by a $125,000 grant from the MCG Cardiovascular Discovery Institute, examines whether a patient’s inflammation profile could be changed by the addition of an hsp90 inhibitor.

Heat shock proteins play a key role in the inflammatory response. Inhibitors of heat shock protein 90 have been used as chemotherapeutic agents and are being studied in cardiovascular disease. NeSmith will investigate their ability to prevent or reverse inflammation in humans.

Collaborating on both grants with mentor Dr. John Catravas, director of the MCG Vascular Biology Center, NeSmith spends three days a week in the lab working with basic science research techniques.

“This is translational research, breaking down the silos between basic science and clinical research,” said NeSmith, who received her Ph.D. from MCG in 2007. “As a nurse taking care of sepsis patients, I wanted to help, knowing the difficult road ahead of them. I had never imagined doing research like this; historically, it’s not something nurses have done. Yet we are perfect for it because nurses specialize in the patient’s environment.”

NeSmith’s grant from the National Institutes of Health is a career development grant designed for new investigators. In addition to research and mentoring components, she’ll be taking advanced coursework from MCG and the University of Pittsburgh.

Source: Medical College of Georgia

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