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Ziegler T, Horstkotte J, Schwab C, Pfetsch V, Weinmann K, Dietzel S, Rohwedder I, Hinkel R, Gross L, Lee S, Hu J, Soehnlein O, Franz WM, Sperandio M, Pohl U, Thomas M, Weber C, Augustin HG, Fässler R, Deutsch U, Kupatt C. Angiopoietin 2 mediates microvascular and hemodynamic alterations in sepsis. J Clin Invest 2013; 123:66549. [PMID: 23863629 PMCID: PMC3726157 DOI: 10.1172/jci66549] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 05/06/2013] [Indexed: 01/22/2023] Open
Abstract
Septic shock is characterized by increased vascular permeability and hypotension despite increased cardiac output. Numerous vasoactive cytokines are upregulated during sepsis, including angiopoietin 2 (ANG2), which increases vascular permeability. Here we report that mice engineered to inducibly overexpress ANG2 in the endothelium developed sepsis-like hemodynamic alterations, including systemic hypotension, increased cardiac output, and dilatory cardiomyopathy. Conversely, mice with cardiomyocyte-restricted ANG2 overexpression failed to develop hemodynamic alterations. Interestingly, the hemodynamic alterations associated with endothelial-specific overexpression of ANG2 and the loss of capillary-associated pericytes were reversed by intravenous injections of adeno-associated viruses (AAVs) transducing cDNA for angiopoietin 1, a TIE2 ligand that antagonizes ANG2, or AAVs encoding PDGFB, a chemoattractant for pericytes. To confirm the role of ANG2 in sepsis, we i.p. injected LPS into C57BL/6J mice, which rapidly developed hypotension, acute pericyte loss, and increased vascular permeability. Importantly, ANG2 antibody treatment attenuated LPS-induced hemodynamic alterations and reduced the mortality rate at 36 hours from 95% to 61%. These data indicate that ANG2-mediated microvascular disintegration contributes to septic shock and that inhibition of the ANG2/TIE2 interaction during sepsis is a potential therapeutic target.
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Affiliation(s)
- Tilman Ziegler
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Jan Horstkotte
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Claudia Schwab
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Vanessa Pfetsch
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Karolina Weinmann
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Steffen Dietzel
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Ina Rohwedder
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Rabea Hinkel
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Lisa Gross
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Seungmin Lee
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Junhao Hu
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Oliver Soehnlein
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Wolfgang M. Franz
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Markus Sperandio
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Ulrich Pohl
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Markus Thomas
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Christian Weber
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Hellmut G. Augustin
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Reinhard Fässler
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Urban Deutsch
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
| | - Christian Kupatt
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, Ludwig Maximilians University, Munich, Germany.
Theodor Kocher Institute, Bern, Switzerland.
Walter Brendel Centre of Experimental Medicine, Ludwig Maximilians University, Munich, Germany.
Department for Molecular Medicine, Max-Planck Institute for Biochemistry, Martinsried, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Joint Research Division Vascular Biology, Medical Faculty Mannheim (Centre for Biomedicine and Medical Technology Mannheim) and German Cancer Research Center (DKFZ–Zentrum für Molekulare Biologie der Universität Heidelberg Alliance), Heidelberg, Germany.
Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany.
Discovery Oncology, Pharma Research and Early Development, Roche Diagnostics GmbH, Penzberg, Germany
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