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Pre-empting pressure ulcers in individuals with spinal cord injury

PLOS

Pressure ulcers affect more than 2.5 million Americans annually and patients who have spinal cord injuries that impair movement are more vulnerable to ulcer development. Researchers at the University of Pittsburgh School of Medicine have devised a computational model that could enhance understanding, diagnosis and treatment of pressure ulcers related to spinal cord injury. The research publishing this week in PLOS Computational Biology, shows the results of virtual clinical trials that demonstrated that in order to effectively treat the lesions, anti-inflammatory measures had to be applied well before the earliest clinical signs of ulcer formation.

To address the complexity of the biologic pathways that create and respond to pressure sore development, the researchers designed a computational, or "in silico," model of the process based on serial photographs of developing ulcers from spinal cord-injured patients enrolled in studies at the Pitt's Rehabilitation Engineering Research Center on Spinal Cord Injury. Photos were taken when the ulcer was initially diagnosed, three times per week in the acute stage and once a week as it resolved.

The scientists validated the model, finding that if they started with a single small round area over a virtual bony protuberance and altered factors such as inflammatory mediators and tissue oxygenation, they could recreate a variety of irregularly shaped ulcers that mimic what is seen in reality. They conducted two virtual trials of potential interventions, finding that anti-inflammatory interventions could not prevent ulcers unless applied very early in their development.

"Computational models like this one might one day be able to predict the clinical course of a disease or injury, as well as make it possible to do less expensive testing of experimental drugs and interventions to see whether they are worth pursuing with human trials," Dr. Vodovotz said. "They hold great potential as a diagnostic and research tool."

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All works published in PLOS Computational Biology are Open Access, which means that all content is immediately and freely available. Use this URL in your coverage to provide readers access to the paper upon publication: http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1004309

Press-only preview: https://www.plos.org/wp-content/uploads/2015/06/pcbi.1004309.pdf

Contact: Anita Srikameswaran
Address: Senior Manager, Media Relations
UPMC and University of Pittsburgh
Schools of the Health Sciences
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600 Grant Street
Pittsburgh, PA 15219
Phone: 412-720-2058
Email: srikamav@upmc.edu

Citation: Ziraldo C, Solovyev A, Allegretti A, Krishnan S, Henzel MK, Sowa GA, et al. (2015) A

Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury. PLoS Comput Biol 11(6): e1004309. doi:10.1371/journal.pcbi.1004309

Funding: This work was made possible by a grant from the US Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR grant # H133E070024) and an IBM Shared University Research Award to YV. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: YV and GA are inventors on U.S. Patent No. 8,165,819 "Modeling Wound Healing".

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