Public Health’s Epidemiology Data Center to Coordinate Study of Mysterious Trauma Hemorrhaging

The Epidemiology Data Center at the University of Pittsburgh Graduate School of Public Health will coordinate a new multicenter, multidisciplinary study about a deadly bleeding syndrome called coagulopathy, which occurs without warning in some trauma patients. The research will be supported by a five-year, $23.8 million National Institutes of Health grant.

Stephen Wisniewski, senior associate dean and codirector of the Epidemiology Data Center, will oversee coordination of the study, which will be led by University of Vermont Professor Emeritus of Biochemistry Kenneth Mann. Known as the Trans-Agency Consortium for Trauma-Induced Coagulopathy, the study is a cooperative effort funded by the National Heart, Lung, and Blood Institute, part of the federal National Institutes of Health. The research will establish a unique collaboration between the National Institutes of Health and the federal Department of Defense.

“Multiple, parallel research projects will each explore a different side of coagulopathic syndromes in an effort to discover why they occur and, ultimately, to explore ways to treat and prevent them,” said Wisniewski, who also is a professor of epidemiology. “Those projects will produce a massive amount of data, something we in Public Health at Pitt are well-equipped to collect, analyze, and organize into useful information.”

Trauma is the major cause of death in people younger than 34 years old and the third-leading cause of mortality in the United States, with uncontrollable hemorrhage representing the major cause of preventable deaths, according to the National Institutes of Health. Each year, nearly 50 million traumatic injuries in the United States result in 170,000 deaths.

Little is known about biological phenomena that lead to coagulopathy. When a person sustains a traumatic injury, some, regardless of proper treatment, can suddenly suffer from uncontrolled bleeding and die. It is believed that the shock from the trauma induces a “storm” of coagulation and inflammatory problems that can prevent a trauma patient’s blood from clotting.

“There are no analytical tools that allow emergency department staff to conclude that coagulopathy is occurring in trauma victims. We’re starting from ‘ground zero,’” explained the University of Vermont’s Mann. “The physicians and staff are left without resources to guide an effective therapeutic approach.”

Study coleader Charles Esmon, the Lloyd Noble Chair in Cardiovascular Biology at the Oklahoma Medical Research Foundation, will study the role played by DNA and a type of small protein in initiating the inflammatory and coagulation abnormalities that occur in trauma.

“We’ve gathered the leading minds in the field to attack a problem that has a serious and immediate impact on patients,” Esmon said. “To understand and address the issue of severe trauma, we need a multidisciplinary approach. This project requires experts in clinical science, basic biology, laboratory science, and animal research.”

This trans-agency endeavor links two programs: the National Heart, Lung, and Blood Institute’s Trans-Agency Consortium for Trauma-Induced Coagulopathy and the Department of Defense’s clinical trauma research centers.

Additional institutions involved in the research include the Massachusetts Institute of Technology, Mayo Clinic, Scripps Research Institute, University of California-San Francisco, University of Illinois and University of Pennsylvania. Department of Defense-supported institutions participating in the clinical component of the grant include Pitt, the University of Colorado, and Virginia Commonwealth University.