Plasma supplemented with glycine is superior to standard plasma in reducing vascular permeability and organ injury via reduction of inflammation in an experimental traumatic shock model.

Abstract

BACKGROUND: While plasma transfusion is a key resuscitation strategy, its mechanisms of benefit beyond coagulopathy correction remain unclear. Solvent detergent plasma, which contains high glycine levels and lacks inflammatory mediators, may offer advantages over fresh frozen plasma by preserving endothelial integrity and reducing inflammation. This study aimed to test whether plasma containing a high dose of glycine is superior to standard plasma in improving outcomes after traumatic shock by mitigating endothelial damage and inflammation. STUDY DESIGN AND METHODS: Anesthetized, fully instrumented Wistar rats (n&#x2009;=&#x2009;11 per group) were randomly assigned to receive plasma, glycine-supplemented plasma, or crystalloid following polytraumatic injury and shock. The primary outcome was endothelial leakage of the lung. Inflammation and organ failure, as determined by biochemistry and histopathology, were secondary outcomes. RESULTS: Glycine-supplemented plasma, but not plasma, prevented an increase in pulmonary vascular leakage in comparison to crystalloid. Glycine-supplemented plasma resulted in lower systemic levels of syndecan-1 than crystalloid (p&#x2009;<&#x2009;.05). Glycine-supplemented plasma caused less lung injury compared with standard plasma (p&#x2009;<&#x2009;.001) and crystalloids (p&#x2009;<&#x2009;.001). Preservation of the endothelial barrier was associated with lower IL-6 levels and less acidosis in the glycine-supplemented plasma group than in the crystalloid group (p&#x2009;<&#x2009;.05). DISCUSSION: Glycine-supplemented plasma is superior to standard plasma in preventing endothelial permeability, glycocalyx shedding, and lung injury, which may be mediated via inhibition of IL-6 or improvement of acid-base balance. The use of solvent detergent plasma for trauma resuscitation may be more beneficial than standard plasma, partly due to glycine content.