Alicia Mohr, MD, discusses impacts of chronic stress on trauma recovery

Alicia Mohr, M.D., Acute care surgeon, UF Dept of SurgeryAlicia Mohr, MD, received the 2020 clinical science faculty research award from the UF College of Medicine for her outstanding achievement, productivity, and clinical research discovery.

Currently, she is examining the impact of chronic stress following injury and shock on the production of red blood cells“It’s translational research,” said Mohr, a professor in the department of surgery’s division of general surgery and chief of the division of acute care surgery. “My work examines the persistence of anemia after trauma. It’s not just blood loss—it’s about the lack of anemia recovery for months after severe injury or critical illness.”

Mohr uses an animal model of chronic stress to model the stress of being in the ICU, in addition, she enrolls severely injured trauma patients by collecting bone marrow and blood samples to examine erythropoiesis.

One of her current areas of focus now involves looking at bone marrow recovery –and why it takes so long for the anemia to resolve. The answer is multifactorial. Following severe trauma, there is reduced growth of erythroid progenitors, loss of hematopoietic progenitor cells into the blood stress, myelo-erythroid reprioritization and an abnormal response to erythropoietin which all contribute to persistent anemia.

“There’s a persistent inflammatory state which doesn’t allow the body to recover normally at the expense of erythropoiesis,” Mohr said. “We want to know if we can really reduce bone marrow progenitor cell loss and allow those progenitor cells to mature into normal red blood cells.”

The impact of trauma on the body results in a colorful variety of chaos, one of which also involves the dysregulation of iron trafficking that leads to a relative iron deficiency.

“I think some of the future areas of research involves molecular epigenetic changes to inflammatory states,” Mohr said. The ability to regulate inflammation and stress can lead to rapid recovery.

“Sepsis research has shown that being chronically critically ill in the ICU can impact your underlying physiology,” Mohr said. “Even on a young trauma patient, chronic critical illness has a profound impact on the body and the body’s ability to recover—that’s why we uniquely developed a chronic stress model that can be added to any injury model.”

Learning more about the stress the body experiences while recovering in critical care can lead to a better understanding of how it slows down patient recovery. The longer a patient is in the ICU, the more likely it is their recovery process will be affected, Mohr said. Profound changes can be seen after 10 days in the ICU.

“We see delirium, sleep deprivation and the lack of mobility that occurs along with the traumatic injuries,” Mohr said. “It is important that we reduce patients’ stress by encouraging mobility and restoring the sleep-wake cycle.”

Due to the neurological links between muscle and inflammation, stress reduction and mobility are small ways patients can help themselves feel better.

For further information, read the selected publications below.

Apple CG, Miller ES, Kannan KB, Stortz JA, Cox M, Loftus TJ, Parvataneni HK, Patrick M, Hagen JE, Brakenridge S, Efron PA, Mohr AM.Apple CG, et al. Among authors: mohr am. J Trauma Acute Care Surg. 2020 Jul 28. doi: 10.1097/TA.0000000000002895. Online ahead of print.J Trauma Acute Care Surg. 2020. PMID: 32769953
The effects of selective beta-adrenergic blockade on bone marrow dysfunction following severe trauma and chronic stress.
Miller ES, Apple CG, Kannan KB, Funk ZM, Efron PA, Mohr AM.Miller ES, et al. Among authors: mohr am. Am J Surg. 2020 Jul 25:S0002-9610(20)30413-X. doi: 10.1016/j.amjsurg.2020.06.058. Online ahead of print.Am J Surg. 2020. PMID: 32741547
Modulation of the HGF/c-Met axis impacts prolonged hematopoietic progenitor mobilization following trauma and chronic stress.
Loftus TJ, Kannan KB, Mira JC, Brakenridge SC, Efron PA, Mohr AM.Loftus TJ, et al. Among authors: mohr am. Shock. 2020 Jan 3:10.1097/SHK.0000000000001506. doi: 10.1097/SHK.0000000000001506. Online ahead of print.Shock. 2020. PMID: 31904616
The Postinjury Inflammatory State and the Bone Marrow Response to Anemia.
Loftus TJ, Mira JC, Miller ES, Kannan KB, Plazas JM, Delitto D, Stortz JA, Hagen JE, Parvataneni HK, Sadasivan KK, Brakenridge SC, Moore FA, Moldawer LL, Efron PA, Mohr AM.Loftus TJ, et al. Among authors: mohr am. Am J Respir Crit Care Med. 2018 Sep 1;198(5):629-638. doi: 10.1164/rccm.201712-2536OC.Am J Respir Crit Care Med. 2018. PMID: 29768025
Effect of Beta-Blockade on the Expression of Regulatory MicroRNA after Severe Trauma and Chronic Stress.
Apple CG, Miller ES, Loftus TJ, Kannan KB, Thompson CW, Lopez MC, Baker HV, Moldawer LL, Efron PA, Mohr AM.Apple CG, et al. Among authors: mohr am. J Am Coll Surg. 2020 Jan;230(1):121-129. doi: 10.1016/j.jamcollsurg.2019.09.011. Epub 2019 Oct 28.J Am Coll Surg. 2020. PMID: 31672639