Proteases involved in distant posttraumatic lesions: a review of literature

Abstract

Introduction. Inflammation is a state driven by pathogenic stimuli. Trauma is one of the causes of acute onset of the inflammatory pathway. Multiple proteases are capable of inducing distant multiple organ lesions (lungs, brain or spinal cord, heart, kidney, liver and systemic vessel endothelium). The onset of corresponding syndromes will complicate the clinical course of that particular patient. These molecules are potential biomarkers in trauma patients. Material and methods. There were reviewed the PubMed, Elsevier, ResearchGate, Google Scholar, Cochrane Library, medRxiv databases using the keywords “proteases”, “antiproteases” and “trauma”. A total of 114 relevant sources were included. An additional74 papers were selected. Overall there 188 literature sources were reviewed. Results and discussions. There are six classes of proteases: aspartic, glutamic, metalloproteases, cysteine, serine, and threonine proteases of which the glutamic ones are not found in mammals. Multiple processes that involve protein degradation are the fundamental mechanisms through which they mediate tissue and organ destruction after trauma-mediated inflammation. Certain inhibitors of the aforementioned proteases are of importance in these processes – they are vital in the prevention of pathophysiological processes such as fibrosis, although in the case of trauma due to their depletion there is high activity of the proteases system. The release of the protease/antiprotease system is mediated through by leukocytes, thrombocytes, myocytes and endothelium. Conclusions. In this literature review there was described a high variety of protease and antiproteases. There is an increased complexity for the potential treatment of the distant lesions, thus the necessity for symptomatic treatment is foremost in order to diminish the lesions of the acute phase.