A genomic storm in critically injured humans

Wenzhong Xiao, Michael N. Mindrinos, Junhee Seok, Joseph Cuschieri, Alex G. Cuenca, Hong Gao, Douglas L. Hayden, Laura Hennessy, Ernest E. Moore, Joseph P. Minei, Paul E. Bankey, Jeffrey L. Johnson, Jason Sperry, Avery B. Nathens, Timothy R. Billiar, Michael A. West, B. Brownstein, Philip H. Mason, Henry V. Baker, Celeste C. FinnertyMarc G. Jeschke, M. Cecilia López, Matthew B. Klein, Richard L. Gamelli, Nicole S. Gibran, Brett Arnoldo, Weihong Xu, Yuping Zhang, Steven E. Calvano, Grace P. Mcdonald-Smith, David A. Schoenfeld, John D. Storey, J. Perren Cobb, H. Shaw Warren, Lyle L. Moldawer, David N. Herndon, Stephen F. Lowry, Ronald V. Maier, Ronald W. Davis, Ronald G. Tompkins*, M. Lopez, Lily Altstein, Ulysses G.J. Balis, David G. Camp, K. De Asit, Brian G. Harbrecht, Shari E. Honari, Bruce A. McKinley, Carol L. Miller-Graziano, Frederick A. Moore, Grant E. O'Keefe, Laurence G. Rahme, Daniel G. Remick, Michael B. Shapiro, Richard D. Smith, Robert Tibshirani, Mehmet Toner, Bram Wispelwey, Wing H. Wong

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

884 Scopus citations


Human survival from injury requires an appropriate inflammatory and immune response. We describe the circulating leukocyte transcriptome after severe trauma and burn injury, as well as in healthy subjects receiving low-dose bacterial endotoxin, and show that these severe stresses produce a global reprioritization affecting >80% of the cellular functions and pathways, a truly unexpected "genomic storm." In severe blunt trauma, the early leukocyte genomic response is consistent with simultaneously increased expression of genes involved in the systemic inflammatory, innate immune, and compensatory antiinflammatory responses, as well as in the suppression of genes involved in adaptive immunity. Furthermore, complications like nosocomial infections and organ failure are not associated with any genomic evidence of a second hit and differ only in the magnitude and duration of this genomic reprioritization. The similarities in gene expression patterns between different injuries reveal an apparently fundamental human response to severe inflammatory stress, with genomic signatures that are surprisingly far more common than different. Based on these transcriptional data, we propose a new paradigm for the human immunological response to severe injury.

Original languageEnglish
Pages (from-to)2581-2590
Number of pages10
JournalJournal of Experimental Medicine
Issue number13
StatePublished - 1 Dec 2011
Externally publishedYes


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