Acute alcohol intoxication is clearly a risk for sustaining traumatic injury. Our recently completed epidemiologic study of trauma patients demonstrated that having a positive blood alcohol content is an independent risk factor for developing acute lung injury (ALI) in the first five days of hospitalization (Odds Ratio 1.40;95% Confidence Interval 1.22-1.60;p<0.0001). Our pilot study of ex vivo blood lymphocyte activation in human subjects that consumed alcohol to simulate binge drinking showed substantially increased PHA-induced interferon (IFN)-? and interleukin (IL)-2 secretion 20 minutes after alcohol ingestion and lasting for up to 5 hours. Our goal is to elucidate the mechanism by which acute alcohol intoxication increases the risk of organ injury in trauma patients. Our central hypothesis is that acute alcohol exposure potentiates leukocyte activation by increasing intracellular reactive oxygen intermediate (ROI) production, which amplifies expression of proinflammatory cytokines that can cause injury to tissues including lung. The following Specific Aims have been developed to address this hypothesis while providing me with valuable new research skills in basic and translational research techniques that will complement my previous training in clinical and epidemiologic investigation. We will test our hypothesis using a human alcohol binge-drinking model. Specifically we will (1) determine how acute alcohol ingestion modifies lymphocyte, monocyte, and neutrophil response to ex vivo activation and the potential role of intracellular ROI in mediating these effects;and (2) analyze how acute alcohol ingestion modifies cytokine expression, leukocyte activation, and ROI generation in response to intravenous endotoxin LPS infusion in normal human subjects. We anticipate that the proposed studies will increase our understanding of how alcohol intoxication can modify host response to increase risk of lung and other organ injury, determine if and how a follow-up Phase II Clinical Trial of antioxidants in intoxicated trauma patients should be conducted, provide me with an excellent framework on which to expand my translational research skills, and produce publications that will propel my career as a pulmonary and critical care physician scientist and translational investigator.

Public Health Relevance

While it is well known that having alcohol in your system can increase your risk of traumatic injury, our preliminary clinical study showed for the first time tht binge drinking can also increase the risk of complications of traumatic injury, such as acute lung injury. Our pilot study suggested that the negative effects of alcohol may occur by inducing a proinflammatory state. The present study will identify the mechanisms by which binge drinking predisposes to a proinflammatory state utilizing a human binge drinking model and studying responses of blood in vitro and response to endotoxin challenge in vivo. In particular the potential role of oxidant generation will be explored as a mechanism. If successful, these studies will not only demonstrate the mechanism of a common clinical problem, but also identify antioxidants as a potential treatment in such patients, which can be formally studied in a future Phase II clinical trial.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Postdoctoral Individual National Research Service Award (F32)
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Health Services Research Review Subcommittee (AA)
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Wang, Joe
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University of Maryland Baltimore
Internal Medicine/Medicine
Schools of Medicine
United States
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Afshar, Majid; Netzer, Giora; Salisbury-Afshar, Elizabeth et al. (2016) Injured patients with very high blood alcohol concentrations. Injury 47:83-8
Afshar, Majid; Smith, Gordon S; Cooper, Richard S et al. (2016) Trauma indices for prediction of acute respiratory distress syndrome. J Surg Res 201:394-401
Afshar, Majid; Netzer, Giora; Murthi, Sarah et al. (2015) Alcohol exposure, injury, and death in trauma patients. J Trauma Acute Care Surg 79:643-8
Mansoor, Sahar; Afshar, Majid; Barrett, Matthew et al. (2015) Acute respiratory distress syndrome and outcomes after near hanging. Am J Emerg Med 33:359-62
Afshar, Majid; Richards, Stephanie; Mann, Dean et al. (2015) Acute immunomodulatory effects of binge alcohol ingestion. Alcohol 49:57-64
Afshar, Majid; Smith, Gordon S; Terrin, Michael L et al. (2014) Blood alcohol content, injury severity, and adult respiratory distress syndrome. J Trauma Acute Care Surg 76:1447-55