A Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury

Authored by Gary An, Alexey Solovyev, David Brienza, Qi Mi, Yoram Vodovotz, Cordelia Ziraldo, Ana Allegretti, Shilpa Krishnan, M Kristi Henzel, Gwendolyn A Sowa

Date Published: 2015

DOI: 10.1371/journal.pcbi.1004309

Sponsors: No sponsors listed

Platforms: SPARK

Model Documentation: Other Narrative Flow charts Pseudocode

Model Code URLs: http://www.plosone.org/article/fetchSingleRepresentation.action?uri=info:doi/10.1371/journal.pcbi.1004309.s002

Abstract

People with spinal cord injury (SCI) are predisposed to pressure ulcers (PU). PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM) of ischemia/reperfusion-induced inflammation and PU (the PUABM) was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to ``better{''} vs. ``worse{''} outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs) suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU.

Tags

inflammation systems biology Mycobacterium-tuberculosis infection Clinical-trials Ischemia-reperfusion injury Therapeutic target Xanthine-oxidase Acute-care Cytokine Age