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Roos-Mattila M, Kaprio T, Mustonen H, Hagström J, Saharinen P, Haglund C, Seppänen H. The possible dual role of Ang-2 in the prognosis of pancreatic cancer. Sci Rep 2023; 13:18725. [PMID: 37907568 PMCID: PMC10618172 DOI: 10.1038/s41598-023-45194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) features a dense desmoplastic stroma, which raises the intratumoral interstitial pressure leading to vascular collapse and hypoxia, inducing angiogenesis. Vascular growth factors, such as vascular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2), increase in PDAC. A high VEGF and a high circulating Ang-2 associate with shorter survival in PDAC. In addition to the circulatory Ang-2, PDAC endothelial and epithelial cells express Ang-2. No correlation between tumor epithelial nor endothelial cell Ang-2 expression and survival has been published. We aimed to examine Ang-2 expression and survival. This study comprised PDAC surgical patients at Helsinki University Hospital in 2000-2013. Ang-2 immunohistochemistry staining was completed on 168 PDAC patient samples. Circulating Ang-2 levels were measured using ELISA in the sera of 196 patients. Ang-2 levels were assessed against clinical data and patient outcomes. A low tumor epithelial Ang-2 expression predicted shorter disease-specific survival (DSS) compared with a high expression (p = 0.003). A high serum Ang-2 associated with shorter DSS compared with a low circulating Ang-2 (p = 0.016). Ang-2 seemingly plays a dual role in PDAC survival. Further studies are needed to determine the mechanisms causing tumor cell Ang-2 expression and its positive association with survival.
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Affiliation(s)
- Matilda Roos-Mattila
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Kaprio
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland.
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Department of Pathology, Haartmaninkatu 3 (PB 21), University of Helsinki, 00014, Helsinki, Finland.
| | - Harri Mustonen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Oral Pathology and Radiology, University of Turku, Turku, Finland
| | - Pipsa Saharinen
- Wihuri Research Institute, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Seppänen
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
- Translational Cancer Medicine Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- iCAN, Digital Cancer Precision Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Jain V, Thomas T, Basak S, Sharma RK, Singh N. Sequential dysregulated plasma levels of angiopoietins (ANG-2 and ratios of ANG-2/ANG-1) are associated with malaria severity and mortality among hospital admitted cases in South Bastar Region of Chhattisgarh, Central India. Pathog Glob Health 2022; 116:47-58. [PMID: 34308785 PMCID: PMC8812749 DOI: 10.1080/20477724.2021.1953685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Cerebral malaria (CM) is one of the most severe forms of P. falciparum infection, with an associated high case-fatality rate. Angiopoietins (ANG-1 and ANG-2) are important biomarkers of endothelial activation and dysfunction. This study was carried out in Maharani Hospital and associated Medical College, Jagdalpur, CG, Central India from 2010 to 2014. Based on the treatment recovery patterns, cases (n = 65) were classified as mild malaria with rapid recovery (MM-RR), n= 14; non-cerebral severe malaria with moderately fast recovery (NCSM-MFR), n= 9; CM survivors with slow recovery (CMS-SR), n= 36 and deteriorated CM non-survivors (Det-CMNS), n= 6. Plasma levels (pg/ml) of ANG-1 and ANG-2 were measured by ELISA in all the samples at the time of hospital admission and 48 hours of treatment. Levels were also measured in available samples at the third time point (time of discharge for survivors or 72 hours post-treatment in fatal cases). Data analysis was done by appropriate statistical tests using Stata 11.0 and SPSS 25.0 software. At the time of admission, ANG-2 and ratios of ANG-2/ANG-1 significantly distinguished Det-CMNS cases from MM-RR and NCSM-MFR cases with good AUC scores (0.8-0.9). Further, Det-CMNS cases could also be distinguished from MM-RR, NCSM-MFR, and CMS-SR cases by ANG-2 (AUC scores 0.9) and ratios of ANG-2/ANG-1 (AUC: 0.8-0.9) at 48 hours of treatment. Paired analysis of sequential measurement of angiopoietins revealed that compared to admission levels, the ratios of ANG-2/ANG-1 significantly declined 48 hours after treatment in MM-RR (p= 0.041), NCSM-MFR (p= 0.050), and CMS-SR (p= 0.0002) cases but not in cases of Det-CMNS (p= 0.916). In conclusion, plasma levels of ANG-2 and ratios of ANG-2/ANG-1 may serve as good biomarkers to distinguish the malaria severity at the time of hospital admission and recovery patterns upon treatment in Central India.
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Affiliation(s)
- Vidhan Jain
- Department of Virology and Zoonotic Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, MP, India
| | - Trilok Thomas
- Department of Virology and Zoonotic Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, MP, India
| | - Sanjay Basak
- Former District Malaria Officer, Maharani Hospital and Associated Medical College Jagdalpur, Chhattisgarh, India
| | - Ravendra Kumar Sharma
- Department of Statistics, ICMR-National Institute of Medical Statistics, ICMR Campus, New Delhi, India
| | - Neeru Singh
- Department of Virology and Zoonotic Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, MP, India
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Wu J, Ma Z, Raman A, Beckerman P, Dhillon P, Mukhi D, Palmer M, Chen HC, Cohen CR, Dunn T, Reilly J, Meyer N, Shashaty M, Arany Z, Haskó G, Laudanski K, Hung A, Susztak K. APOL1 risk variants in individuals of African genetic ancestry drive endothelial cell defects that exacerbate sepsis. Immunity 2021; 54:2632-2649.e6. [PMID: 34715018 PMCID: PMC9338439 DOI: 10.1016/j.immuni.2021.10.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/18/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2022]
Abstract
The incidence and severity of sepsis is higher among individuals of African versus European ancestry. We found that genetic risk variants (RVs) in the trypanolytic factor apolipoprotein L1 (APOL1), present only in individuals of African ancestry, were associated with increased sepsis incidence and severity. Serum APOL1 levels correlated with sepsis and COVID-19 severity, and single-cell sequencing in human kidneys revealed high expression of APOL1 in endothelial cells. Analysis of mice with endothelial-specific expression of RV APOL1 and in vitro studies demonstrated that RV APOL1 interfered with mitophagy, leading to cytosolic release of mitochondrial DNA and activation of the inflammasome (NLRP3) and the cytosolic nucleotide sensing pathways (STING). Genetic deletion or pharmacological inhibition of NLRP3 and STING protected mice from RV APOL1-induced permeability defects and proinflammatory endothelial changes in sepsis. Our studies identify the inflammasome and STING pathways as potential targets to reduce APOL1-associated health disparities in sepsis and COVID-19.
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Affiliation(s)
- Junnan Wu
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ziyuan Ma
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Archana Raman
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Pazit Beckerman
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Poonam Dhillon
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Dhanunjay Mukhi
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Matthew Palmer
- Department of Pathology and Laboratory Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hua Chang Chen
- Division of Nephrology & Hypertension, Tennessee Valley Healthcare System, Nashville Campus and Vanderbilt University Medical Centre, Nashville, TN, USA; Division of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cassiane Robinson Cohen
- Division of Nephrology & Hypertension, Tennessee Valley Healthcare System, Nashville Campus and Vanderbilt University Medical Centre, Nashville, TN, USA; Division of Nephrology & Hypertension, Vanderbilt Precision Nephrology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas Dunn
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Translational Lung Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Reilly
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Translational Lung Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nuala Meyer
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Translational Lung Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael Shashaty
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Translational Lung Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zoltan Arany
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - György Haskó
- Department of Anesthesiology, Columbia University, New York, NY 10032, USA
| | - Krzysztof Laudanski
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Adriana Hung
- Division of Nephrology & Hypertension, Tennessee Valley Healthcare System, Nashville Campus and Vanderbilt University Medical Centre, Nashville, TN, USA; Division of Nephrology & Hypertension, Vanderbilt Precision Nephrology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katalin Susztak
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Diabetes, Obesity, and Metabolism, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Determining the Value of Angiopoietin-2 Biomarker in Predicting Complications of Leptospirosis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2020. [DOI: 10.5812/archcid.87162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Leptospirosis is a common zoonosis disease that is potentially life-threatening all around the world. Angiopoietin-2 can be used as an indicator to determine the severity of the disease in critically ill patients. Objectives: This study aimed to determine the value of angiopoietin-2 biomarker in predicting leptospirosis complications. Methods: In this prospective observational study, 90 participants, including 45 patients with leptospirosis and 45 participants in the control group, are studied. Three to five days after the onset of symptoms before starting treatment with antibiotics, 5 mL venous blood was taken to measuring the angiopoietin-2 level by enzyme-linked immunosorbent assay (ELISA). Results: In this study, 75 men (83.3%) and 15 women (16.7%) with an age distribution of 23 to 75 years participated. A total of 74 (82.3%) patients were employed in the agriculture sector, while 59 (65.6%) lived in rural areas. There was a significant relationship between patients with severe forms of leptospirosis and levels of angiopoietin-2 (P-value < 0.01). Also, there was a significant relationship between angiopoietin-2 biomarker level and markers of disease severity such as anemia (P-value < 0.01), oliguria (P-value < 0.01), severe thrombocytopenia (P-value < 0.01), length of stay (P-value < 0.01), and CRP more than 2+ (P-value < 0.001). Conclusions: This study demonstrated that angiopoietin-2 biomarker can be used in screening disease severity and predicting complications of leptospirosis.
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Evaluation of Angiopoietins 1 and 2 in Malaria-Infested Children. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020; 2020:2169763. [PMID: 32565839 PMCID: PMC7271246 DOI: 10.1155/2020/2169763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/09/2020] [Indexed: 11/17/2022]
Abstract
Background Malaria could affect people of all ages, most especially young children. The study evaluated the levels of serum angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) which are critical regulators of endothelial activation and integrity with some hematological parameters (total white blood cell counts (WBC), total red blood cell counts (RBC), platelet counts, and malaria parasite density) in malaria-infected children. Method A total of 92 blood samples from children between the ages of 6 months to 15 years were analyzed. The samples consisted of 30 cases of severe malaria, 40 cases of uncomplicated malaria, and 22 apparently healthy subjects served as control. Serum Ang-1 and -2 levels were determined using the enzyme-linked immunosorbent assay technique. The hematological parameters were determined using the WHO standard. Results There was significant decrease (p < 0.05) in serum Ang-1 of uncomplicated malaria and severe malaria compared with the control, while significant increase (p < 0.05) was observed in Ang-2 and Ang-2/Ang-1 ratio in uncomplicated malaria and severe malaria compared with the control. RBC and platelet showed significant decrease, while WBC showed significant increase in severe malaria compared with uncomplicated malaria and control. Conclusion This study showed that subjects with malaria infection had a significant increase of Ang-2 and Ang-2 : Ang-1 ratio but presented with a significant decrease of Ang-1. Ang-1 and Ang-2 may be used to determine the severity of malaria infection since their levels differ significantly in malaria subjects compared with the control.
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The ratio of plasma angiopoietin-2 to angiopoietin-1 as a prognostic biomarker in patients with sepsis. Cytokine 2020; 129:155029. [DOI: 10.1016/j.cyto.2020.155029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/01/2023]
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7
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Attia EF, Bhatraju PK, Triplette M, Kosamo S, Maleche-Obimbo E, West TE, Richardson B, Zifodya JS, Eskander S, Njiru CD, Warui D, Kicska GA, Chung MH, Crothers K, Liles WC, Graham SM. Endothelial Activation, Innate Immune Activation, and Inflammation Are Associated With Postbronchodilator Airflow Limitation and Obstruction Among Adolescents Living With HIV. J Acquir Immune Defic Syndr 2020; 83:267-277. [PMID: 32032277 PMCID: PMC7735385 DOI: 10.1097/qai.0000000000002255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic inflammation, innate immune activation, T-cell imbalance and endothelial activation have been linked with lung diseases. We sought to determine whether markers of these pathophysiologic pathways were associated with spirometry and chest computed tomography (CT) abnormalities among adolescents living with HIV (ALWH). SETTING Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. METHODS We performed a cross-sectional study of ALWH (10-19 years old). Participants underwent chest CT, spirometry, and venipuncture for serum biomarkers. We also collected demographic, anthropometric, T-cell subset, antiretroviral therapy, and exposure data. We compared characteristics and biomarkers by airflow obstruction [postbronchodilator FEV1/FVC z-score (zFEV1/FVC) < -1.64]. We used multivariable linear regression to determine associations of log10-transformed biomarkers and chest CT abnormalities with lower postbronchodilator zFEV1/FVC (airflow limitation). We performed exploratory principal components analysis on biomarkers, and determined associations of factors with postbronchodilator zFEV1/FVC and chest CT abnormalities. RESULTS Of 47 participants with acceptable quality spirometry, 21 (45%) were female, median age was 13 years and 96% had perinatally-acquired HIV. Median CD4 was 672 cells/µL. Overall, 28% had airflow obstruction and 78% had a chest CT abnormality; airflow obstruction was associated with mosaic attenuation (P = 0.001). Higher endothelial activation (sVCAM-1, sICAM-1), inflammation and innate immune activation (serum amyloid-A, sTREM-1, sCD163), and T-cell imbalance (lower CD4/CD8) markers were associated with airflow limitation. Factors comprising endothelial and innate immune activation were associated with airflow limitation. CONCLUSIONS Endothelial activation, innate immune activation, T-cell imbalance, and chronic inflammation are associated with airflow limitation and obstruction, providing insights into chronic lung disease pathophysiology among ALWH.
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Affiliation(s)
- Engi F. Attia
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
- University of Washington, International Respiratory and Severe Illness Center, Seattle, WA
| | - Pavan K. Bhatraju
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
| | - Matthew Triplette
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
- Fred Hutchinson Cancer Research Center, Clinical Research Center, Seattle, WA
| | - Susanna Kosamo
- University of Washington, Department of Medicine, Seattle, WA
| | | | - T. Eoin West
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
- University of Washington, International Respiratory and Severe Illness Center, Seattle, WA
- University of Washington, Department of Global Health, Seattle, WA
| | | | - Jerry S. Zifodya
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
| | | | | | - Danson Warui
- Coptic Hope Center for Infectious Diseases, Nairobi, Kenya
| | - Gregory A. Kicska
- University of Washington, Department of Radiology and Cardiothoracic Imaging, Seattle, WA
| | - Michael H. Chung
- University of Washington, Department of Medicine, Seattle, WA
- University of Washington, Department of Global Health, Seattle, WA
- University of Washington, Department of Epidemiology, Seattle, WA
| | - Kristina Crothers
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
- VA Puget Sound Health Care System, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA
| | - W. Conrad Liles
- University of Washington, Department of Medicine, Seattle, WA
- University of Washington, Department of Global Health, Seattle, WA
- University of Washington, Department of Pathology, Seattle, WA
- University of Washington, Department of Pharmacology, Seattle, WA
| | - Susan M. Graham
- University of Washington, Department of Medicine, Seattle, WA
- University of Washington, Department of Global Health, Seattle, WA
- University of Washington, Department of Epidemiology, Seattle, WA
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Shirali AS, Lluri G, Guihard PJ, Conrad MB, Kim H, Pawlikowska L, Boström KI, Iruela-Arispe ML, Aboulhosn JA. Angiopoietin-2 predicts morbidity in adults with Fontan physiology. Sci Rep 2019; 9:18328. [PMID: 31797976 PMCID: PMC6892891 DOI: 10.1038/s41598-019-54776-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/14/2019] [Indexed: 12/14/2022] Open
Abstract
Morbidity in patients with single-ventricle Fontan circulation is common and includes arrhythmias, edema, and pulmonary arteriovenous malformations (PAVM) among others. We sought to identify biomarkers that may predict such complications. Twenty-five patients with Fontan physiology and 12 control patients with atrial septal defects (ASD) that underwent cardiac catheterization were included. Plasma was collected from the hepatic vein and superior vena cava and underwent protein profiling for a panel of 20 analytes involved in angiogenesis and endothelial dysfunction. Ten (40%) of Fontan patients had evidence of PAVM, eighteen (72%) had a history of arrhythmia, and five (20%) were actively in arrhythmia or had a recent arrhythmia. Angiopoietin-2 (Ang-2) was higher in Fontan patients (8,875.4 ± 3,336.9 pg/mL) versus the ASD group (1,663.6 ± 587.3 pg/mL, p < 0.0001). Ang-2 was higher in Fontan patients with active or recent arrhythmia (11,396.0 ± 3,457.7 vs 8,118.2 ± 2,795.1 pg/mL, p < 0.05). A threshold of 8,500 pg/mL gives Ang-2 a negative predictive value of 100% and positive predictive value of 42% in diagnosing recent arrhythmia. Ang-2 is elevated among adults with Fontan physiology. Ang-2 level is associated with active or recent arrhythmia, but was not found to be associated with PAVM.
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Affiliation(s)
- Aditya S Shirali
- Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Pierre J Guihard
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Miles B Conrad
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Helen Kim
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.,Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Ludmila Pawlikowska
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.,Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Kristina I Boström
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - M Luisa Iruela-Arispe
- Department of Molecular, Cell & Developmental Biology, Molecular Biology Institute and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, USA.
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König M, Nentwig A, Marti E, Mirkovitch J, Adamik KN, Schuller S. Evaluation of plasma angiopoietin-2 and vascular endothelial growth factor in healthy dogs and dogs with systemic inflammatory response syndrome or sepsis. J Vet Intern Med 2018; 33:569-577. [PMID: 30575998 PMCID: PMC6430886 DOI: 10.1111/jvim.15369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background Angiopoietin‐2 (Ang‐2) and vascular endothelial growth factor (VEGF) are regulators of endothelial permeability. Objective Plasma concentrations of Ang‐2 and VEGF are increased in dogs with systemic inflammatory response syndrome (SIRS) and sepsis and are correlated with disease severity and outcome. Animals Healthy dogs (n = 18) and client‐owned dogs with SIRS (n = 34) or sepsis (n = 25). Methods Prospective observational study. Ang‐2 and VEGF concentrations in admission plasma samples were compared between healthy dogs and dogs with SIRS or sepsis, and between survivors and non‐survivors. Correlations with the acute patient physiologic and laboratory evaluation (APPLEfast) disease severity score were examined. Results Median Ang‐2 was significantly higher in dogs with SIRS (19.3; interquartile range [IQR]: 8.6‐25.7 ng/mL) and sepsis (21.2; IQR: 10.3‐30.1 ng/mL) compared to healthy dogs (7.6; IQR: 6.7‐9.8 ng/mL). Ang‐2 was significantly higher in non‐survivors (24.1; IQR: 11.9‐50.0 ng/mL) than survivors (10.2; IQR: 7.2‐21.5 ng/mL) but did not correlate with the APPLEfast score. Admission Ang‐2 predicted negative outcome in dogs with SIRS and sepsis with reasonable accuracy (area under the curve [AUC]: 0.75, confidence interval [CI]: 0.59‐0.85; sensitivity: 0.5, CI: 0.29‐0.71; specificity: 0.87, CI: 0.75‐0.95); differentiation between sepsis and SIRS was poor (AUC: 0.58). Plasma VEGF was significantly higher in dogs with sepsis (45; IQR: 14‐107.5 pg/mL) than in dogs with SIRS (3.3; IQR: 0‐35.6 pg/mL) or healthy dogs (0; IQR: 0 pg/mL; P = 0.008). VEGF was significantly (P = .0004) higher in non‐survivors (34.5; IQR: 0‐105.7 pg/mL) than in survivors (0; IQR: 0‐55.2 pg/mL). The ability of VEGF to predict a negative outcome was poor. Conclusions and Clinical Importance Ang‐2 may represent a useful additional prognostic marker in dogs with SIRS.
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Affiliation(s)
- Maya König
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | | | - Eliane Marti
- Division of Experimental Clinical Research, Department of Clinical Research and Veterinary Public Health (DCR-VPH), Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Jelena Mirkovitch
- Division of Experimental Clinical Research, Department of Clinical Research and Veterinary Public Health (DCR-VPH), Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Katja-Nicole Adamik
- Emergency and Critical Care Group, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
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Xing LY, Yin J, Shao M, Yang YL, Li KY, Xue MM, Mu SC, Sun Z, Zhang YP, Yao CL, Chu X, Tong CY, Song ZJ. Clinical characteristics and prognosis of serous body cavity effusions in patients with sepsis: a retrospective observational study. BMC Anesthesiol 2018; 18:169. [PMID: 30428838 PMCID: PMC6237031 DOI: 10.1186/s12871-018-0621-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background Cavity effusion is common in patients with infectious diseases. However, the incidence rate and characteristics of serous cavity effusions (SCE) in septic patients are not clear to date. The objective of this study was to investigate the incidence and characteristics of SCE in septic patients and to explore the correlations between the bloody effusions and the illness severity/prognosis in septic patients. Methods From January 2010 to January 2015, a total of 214 patients with severe sepsis and septic shock were enrolled in this retrospective observational study. Thoracentesis or abdominal paracentesis was performed in 45 septic patients because of massive pleural effusions or ascites. The serum concentrations of VEGF, VEGFR, Ang, sICAM-1, sVCAM-1, E-selectin, Serpine1 and VE-cadherin in 45 septic patients underwent paracentesis were measured by enzyme-linked immunosorbent assay (ELISA). Results Of the 214 septic patients, 155 (72.4%) had SCE according to imaging or ultrasound manifestations. 45 subjects with SCE underwent therapeutic thoracentesis or abdominal paracentesis. Effusion laboratory analysis showed that exudates were predominant when compared with transudates (95.6% vs. 4.4%), and 16 (35.6%) patients suffered bloody effusions. Compared with patients with non-bloody effusions, those with bloody effusions showed higher critical illness scores (13 vs. 17 for APACHE II; 7 vs. 9 for SOFA), and higher mortality (6.9% vs. 62.5%). Moreover, patients with bloody effusions had delayed TT and APTT, increased D-dimer concentration, and higher serum levels of CRP and PCT (P < 0.05). In addition, the serum levels of Ang2, sVCAM-1 and E-selectin were significantly higher in patients with bloody effusions than in those with non-bloody effusions (P < 0.05). However, the serum level of VEGFR2 was lower in patients with bloody fluids (P = 0.025). Conclusions The incidence of serous cavity effusion is high in patients with sepsis. The septic patients with bloody effusions suffer a more inflammatory burden and a worse prognosis compared to septic patients with non-bloody effusions.
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Affiliation(s)
- Ling-Yu Xing
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Jun Yin
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Mian Shao
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yi-Lin Yang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ke-Yong Li
- Department of Pharmacology, University of Virginia School of Medicine Charlottesville, Virginia, 22908, USA
| | - Ming-Ming Xue
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Su-Cheng Mu
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Zhan Sun
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Ya-Ping Zhang
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Chen-Ling Yao
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xun Chu
- Xinhua Hospital, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.
| | - Chao-Yang Tong
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Zhen-Ju Song
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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König ML, Lettry SC, Marti E, Mirkovitch J, Wyder M, Giger U, Schuller S. Validation of a human angiopoietin-2 ELISA for measurement of angiopoietin-2 concentrations in canine plasma samples and supernatant of primary canine aortic endothelial cell cultures. Am J Vet Res 2018; 79:803-810. [PMID: 30058854 DOI: 10.2460/ajvr.79.8.803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess 2 human ELISA kits for measurement of angiopoietin-1 and -2 concentrations in canine plasma samples, determine whether plasma angiopoeitin-2 concentration differed between septic and healthy dogs, and determine the effect of tumor necrosis factor-α (TNF-α) stimulation on angiopoeitin-2 release from primary canine aortic endothelial cells (pCAECs) in vitro. ANIMALS 10 healthy dogs and 10 septic dogs. PROCEDURES Human angiopoietin-1 and -2 ELISAs were used to detect recombinant canine angiopoietins-1 and -2 in canine plasma samples. The angiopoietin-2 ELISA was further validated by use of plasma samples from healthy and septic dogs and supernatants of pCAEC cultures. Associations between plasma angiopoeitin-2 and C-reactive protein (CRP) concentrations were examined. RESULTS Angiopoeitin-2 but not angiopoeitin-1 was detected in canine plasma samples by the respective ELISAs. The angiopoeitin-2 ELISA had excellent dilutional linearity, parallelism, accuracy, precision, and reproducibility for measurements in canine plasma samples and pCAEC supernatants. Plasma angiopoeitin-2 concentration was significantly higher in septic dogs (median, 25.5 ng/mL) than in healthy dogs (median, 6.7 ng/mL) and was positively correlated with plasma CRP concentration (R2 = 0.60). Stimulation of pCAECs with TNF-α resulted in a significant increase in supernatant angiopoietin-2 concentration. CONCLUSIONS AND CLINICAL RELEVANCE The tested human angiopoietin-2 ELISA kit was useful for measuring angiopoietin-2 concentrations in canine plasma samples and pCAEC supernatants. Sepsis appeared to increase angiopoietin-2 concentration in dogs in vivo, whereas TNF-α stimulation caused release of angiopoietin-2 from pCAECs in vitro. These findings support the use of angiopoietin-2 as a marker of endothelial cell activation and inflammation in dogs.
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12
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Statz S, Sabal G, Walborn A, Williams M, Hoppensteadt D, Mosier M, Rondina M, Fareed J. Angiopoietin 2 Levels in the Risk Stratification and Mortality Outcome Prediction of Sepsis-Associated Coagulopathy. Clin Appl Thromb Hemost 2018; 24:1223-1233. [PMID: 29996658 PMCID: PMC6714761 DOI: 10.1177/1076029618786029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
It has been well established that angiopoietin 2 (Ang-2), a glycoprotein involved in activation of the endothelium, plays an integral role in the pathophysiology of sepsis and many other inflammatory conditions. However, the role of Ang-2 in sepsis-associated coagulopathy (SAC) specifically has not been defined. The aim of this study was to measure Ang-2 plasma levels in patients with sepsis and suspected disseminated intravascular coagulation (DIC) in order to demonstrate its predictive value in SAC severity determination and 28-day mortality outcome. Plasma samples were collected from 102 patients with sepsis and suspected DIC at intensive care unit (ICU) admission. The Ang-2 plasma levels were quantified using a sandwich enzyme-linked immunosorbent assay method. The International Society on Thrombosis and Haemostasis DIC scoring system was used to compare the accuracy of Ang-2 levels versus clinical illness severity scores in predicting SAC severity. Mean Ang-2 levels in patients with sepsis and DIC were significantly higher in comparison to healthy controls (P < 0.0001), and median Ang-2 levels showed a downward trend over time (P = 0.0008). Baseline Ang-2 levels and clinical illness severity scores were higher with increasing severity of disease, and Ang-2 was a better predictor of DIC severity than clinical illness scores. This study demonstrates that Ang-2 levels are significantly upregulated in SAC, and this biomarker can be used to risk stratify patients with sepsis into non-overt DIC and overt DIC. Furthermore, the Ang-2 level at ICU admission in a patient with sepsis and suspected DIC may provide a predictive biomarker for mortality outcome.
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Affiliation(s)
- Stephen Statz
- 1 Hemostasis and Thrombosis Laboratories, Health Sciences Division, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Giselle Sabal
- 1 Hemostasis and Thrombosis Laboratories, Health Sciences Division, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Amanda Walborn
- 1 Hemostasis and Thrombosis Laboratories, Health Sciences Division, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | | | - Michael Mosier
- 4 Department of General Surgery, Surgical and Burn Specialists at Emanuel, Portland, OR, USA
| | - Matthew Rondina
- 5 Department of Internal Medicine, University of Utah Hospital, Salt Lake City, UT, USA
| | - Jawed Fareed
- 3 Department of Pathology, Loyola University Chicago, Maywood, IL, USA
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Kümpers P, Lukasz A. The curse of angiopoietin-2 in ARDS: on stranger TI(E)des. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:44. [PMID: 29477144 PMCID: PMC6389145 DOI: 10.1186/s13054-018-1978-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/07/2018] [Indexed: 12/15/2022]
Abstract
Pulmonary inflammation and vascular leakage are hallmarks of acute respiratory distress syndrome (ARDS), a life-threatening condition, for which there is no specific pharmacologic treatment. Recent literature suggests that leaky vessels in pulmonary infection and ARDS may be mediated through dysregulation of a non-redundant endothelial control pathway, the Tie2 receptor and its ligands, the angiopoietins. This Viewpoint summarizes results from cell-based experiments, animal models and clinical studies underlining the potential of Tie2 targeted interventions in reducing infection-mediated pulmonary hyperpermeability.
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Affiliation(s)
- Philipp Kümpers
- Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Alexander Lukasz
- Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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14
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Brettner F, Chappell D, Schwartz L, Lukasz A, Kümpers P, Becker BF, Reichart B, Rehm M, Bruegger D. Vascular Endothelial Dysfunction during Cardiac Surgery: On-Pump versus Off-Pump Coronary Surgery. Eur Surg Res 2017; 58:354-368. [PMID: 29073603 DOI: 10.1159/000480431] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/16/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiac surgery often causes ischemia and development of a systemic inflammatory response syndrome, which impairs vascular barrier function, normally maintained by the endothelial cell line and the endothelial glycocalyx (EG). The EG normally covers and protects healthy endothelial cells throughout the vasculature. The aim of the present study was to assess the disruption of the cellular part of the microvascular barrier by determining parameters of endothelial cell activation known to influence and reflect cell-cell junctional integrity. Particular attention was placed on angiopoietins and their important effects on endothelial gap junctions. Furthermore, comparative measurements were undertaken in patients undergoing on- and off-pump cardiac surgery, the latter group presumably experiencing less ischemic stress. METHODS 30 patients undergoing elective coronary artery bypass surgery were assigned to the conventional coronary artery bypass (CCAB) group (n = 15) or the off-pump coronary artery bypass grafting (OPCAB) group (n = 15). Blood samples were obtained for measuring angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), vascular endothelial (VE)-cadherin, and endocan at various time points. RESULTS There were significant increases in all measured parameters in both study groups versus the respective basal values. Maximal increases were as follows: Ang-1: CCAB +220%, OPCAB +166%, p < 0.05 each; Ang-2: CCAB +150%, OPCAB +20%, p < 0.05 each; VE-cadherin: CCAB +87%, OPCAB +66%, p < 0.05 each; endocan: CCAB +323%, OPCAB +72%, p < 0.05 each. CONCLUSION The present study demonstrates the activation of endothelial cells, shedding of cell-cell contacts and a potential intrinsic counterregulation by Ang-1 and endocan in patients undergoing major cardiac surgery. Quantitatively greater deviations of parameters in the CCAB than in the OPCAB group suggest a relation between the occurrence of ischemia/reperfusion and the extent of endothelial activation.
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Affiliation(s)
- Florian Brettner
- Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany.,Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Daniel Chappell
- Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany
| | - Lisa Schwartz
- Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany
| | - Alexander Lukasz
- Department of Medicine, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Philipp Kümpers
- Department of Medicine, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany
| | - Bernhard F Becker
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bruno Reichart
- Department of Cardiac Surgery, University Hospital of Munich (LMU), Munich, Germany
| | - Markus Rehm
- Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany
| | - Dirk Bruegger
- Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany
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15
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The role of laser Doppler flowmetry tests, serum angiopoietin-2, asymmetric and symmetric dimethylarginine to predict outcome in chronic kidney disease. J Hypertens 2017; 35:1109-1118. [DOI: 10.1097/hjh.0000000000001256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Elevated Plasma Angiopoietin-2 Levels Are Associated With Fluid Overload, Organ Dysfunction, and Mortality in Human Septic Shock. Crit Care Med 2016; 44:2018-2027. [DOI: 10.1097/ccm.0000000000001853] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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17
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Lee JY, Linge HM, Ochani K, Lin K, Miller EJ. Regulation of angiopoietin-2 secretion from human pulmonary microvascular endothelial cells. Exp Lung Res 2016; 42:335-345. [PMID: 27585839 DOI: 10.1080/01902148.2016.1218977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Sepsis is characterized by dysregulated systemic inflammation and cytokine storm. Angiopoietin-2 (Ang-2) is known to closely correlate with severity of sepsis-related acute lung injury and mortality. The aim of this study was to clarify the mechanisms involved in Ang-2 secretion to better understand the pathophysiology of sepsis. MATERIALS AND METHODS The concentration of Ang-2 was assessed in culture medium of pulmonary microvascular endothelial cells in the presence or absence of Gram-positive bacteria cell wall components [lipoteichoic acid (LTA) and peptidoglycan (PGN)] stimulation at different time points ranging from 15 minutes to 24 hours. Constitutive and LTA-PGN-stimulated Ang-2 level changes were also assessed after cells were pretreated with different pathway inhibitors for 1 hour. RESULTS Two distinctive mechanisms of Ang-2 secretion, constitutive and stimulated secretion, were identified. Constitutive secretion resulted in slow but continuous increase in Ang-2 in culture medium over time. It was regulated by 3'5'-cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA)-Ca2+ and nitric oxide (NO)-3'5'-cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG)-Ca2+ pathways and partially regulated by N-ethyl-maleimide-sensitive factor-Ca2+ pathways. LTA-PGN stimulation caused rapid and potent increase followed by gradual decrease of Ang-2. It was partially regulated by both Ral A-phospholipase D and NSF-Ca2+ pathways. CONCLUSIONS We demonstrated characteristics and involved pathways for two distinctive secretory mechanisms, constitutive and stimulated, of Ang-2 in pulmonary microvascular endothelial cells. Considering the close correlation of Ang-2 with sepsis outcomes, our findings provide a better understanding of an important mechanism associated with sepsis pathophysiology and identify possible therapeutic targets to improve outcomes in the potentially lethal disease.
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Affiliation(s)
- Ji Young Lee
- a The Elmezzi Graduate School of Molecular Medicine , Manhasset , New York , USA.,b Department of Pulmonary and Critical Care Medicine , University of South Alabama , Mobile , Alabama , USA
| | - Helena M Linge
- c The Center for Heart and Lung Research , The Feinstein Institute for Medical Research , Manhasset , New York , USA
| | - Kanta Ochani
- c The Center for Heart and Lung Research , The Feinstein Institute for Medical Research , Manhasset , New York , USA
| | - Ke Lin
- c The Center for Heart and Lung Research , The Feinstein Institute for Medical Research , Manhasset , New York , USA
| | - Edmund J Miller
- a The Elmezzi Graduate School of Molecular Medicine , Manhasset , New York , USA.,c The Center for Heart and Lung Research , The Feinstein Institute for Medical Research , Manhasset , New York , USA.,d Hofstra North Shore-LIJ Medical School , Hempstead , New York , USA
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18
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Thamm K, David S. Role of angiopoietin-2 in infection - A double-edged sword? Cytokine 2016; 83:61-63. [PMID: 27038015 DOI: 10.1016/j.cyto.2016.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
The endothelial angiopoietin (Angpt)/Tie2 ligand receptor system maintains vascular quiescence and modulates the response to injury. Angpt-1 is considered the natural Tie2 agonist and receptor ligation leads to its phosphorylation inducing various protective downstream pathways. The natural antagonist - Angpt-2 - appears to inhibit these protective effects. In sepsis, the balance between both ligands is shifted in favor for Angpt-2 and the vasculature is highly dysfunctional, activated and leaky. Circulating levels of Angpt-2 strongly predict mortality in septic patients. Consistently, experimental strategies that target Angpt-2 (e.g. antibody, RNAi, etc.) can protect the vascular barrier and improve survival. However, in vitro is has also been shown that Angpt-2 can act as a dose-dependent Tie2 agonist/antagonist. Based on this, people have wondered if Angpt-2 is per se injurious or if it might have protective effects dependent on the scenario. A recent paper by Safioleas and colleagues showed survival benefits after a therapeutic injection of recombinant Angpt-2 in experimental pyelonephritis. Here, we discuss their counter-intuitive but interesting findings and put them into a global context with respect to the existent literature in the angiopoietin/Tie2 sepsis field.
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Affiliation(s)
- Kristina Thamm
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Sascha David
- Division of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
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Hilbert T, Duerr GD, Hamiko M, Frede S, Rogers L, Baumgarten G, Hoeft A, Velten M. Endothelial permeability following coronary artery bypass grafting: an observational study on the possible role of angiopoietin imbalance. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:51. [PMID: 26951111 PMCID: PMC4782352 DOI: 10.1186/s13054-016-1238-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/15/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Unresolved inflammation resulting in capillary leakage with endothelial barrier dysfunction is a major contributor to postoperative morbidity and mortality after coronary artery bypass graft (CABG). Angiopoietins (ANGs) are vascular growth factors, also mediating inflammation and disruption of the endothelium, thus inducing capillary leakage. We hypothesized that changes in the relative serum levels of ANG1 and ANG2 influence endothelial barrier function and perioperative morbidity after CABG. METHODS After approval and informed consent, serum samples (n = 28) were collected pre CABG surgery, 1, 6, and 24 h after aortic de-clamping. ANG1, ANG2, soluble ANG receptor TIE2 (sTIE2), and IL-6 serum concentrations were analyzed by ELISA. Human pulmonary microvascular endothelial cells (HPMECs) were incubated with patient serum and FITC-dextran permeability was assessed. Furthermore, ANG2 secretion of HPMECs was analyzed after incubation with IL-6-containing patient serum. RESULTS CABG induced an early and sustained increase of ANG2/ANG1 ratio (5-fold after 24 h compared to pre-surgery). These changes correlated with elevated serum lactate levels, fluid balance, as well as the duration of mechanical ventilation. Permeability of HPMECs significantly increased after incubation with post-surgery serum showing a marked shift of ANG2/ANG1 balance (18-fold) compared to serum with a less pronounced increase (6-fold). Furthermore, CABG resulted in increased IL-6 serum content. Pre-incubation with serum containing high levels of IL-6 amplified the ANG2 secretion by HPMECs; however, this was not influenced by blocking IL-6. CONCLUSIONS CABG affects the balance between ANG1 and ANG2 towards a dominance of the barrier-disruptive ANG2. Our data suggest that this ANG2/ANG1 imbalance contributes to an increased postoperative endothelial permeability, likewise being reflected by the clinical course. The results strongly suggest a biological effect of altered angiopoietin balance during cardiac surgery on endothelial permeability.
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Affiliation(s)
- Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Marwan Hamiko
- Department of Cardiovascular Surgery, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Stilla Frede
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Lynette Rogers
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Georg Baumgarten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Andreas Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany.
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Shimizu M, Inoue N, Kuroda M, Mizuta M, Sugimoto N, Kaneda H, Ohta K, Yachie A. Angiopoietin-1 and -2 as markers for disease severity in hemolytic uremic syndrome induced by enterohemorrhagic Escherichia coli. Clin Exp Nephrol 2016; 21:76-82. [PMID: 26945868 DOI: 10.1007/s10157-016-1254-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Angiopoietin (Ang)-1 and -2 play important roles in maintaining vascular homeostasis. This study aimed to assess the roles of angiopoietin (Ang)-1 and -2 and to investigate the clinical significance of their serum levels in patients with hemolytic uremic syndrome (HUS) induced by enterohemorrhagic Escherichia coli (EHEC). METHODS Twenty patients with HUS and 15 healthy controls were studied. Serum Ang-1 and Ang-2 levels were quantified using enzyme-linked immunosorbent assay. The results were compared with the clinical features of HUS. RESULTS During the HUS phase, serum Ang-1 levels were significantly decreased, whereas serum Ang-2 levels and the Ang-2/Ang-1 ratio were significantly elevated. Compared with patients without encephalopathy, serum Ang-2 levels and Ang-2/Ang-1 ratio were significantly elevated in patients with encephalopathy. Patients with HUS and serum Ang-2 levels of >7061 pg/mL or Ang2/Ang1 ratios of >2.29 were at high risk of encephalopathy. Serum Ang-1 levels were significantly decreased in patients in the pre-HUS phase compared with those in healthy controls. CONCLUSION Disruption of homeostasis of vascular endothelial function by Ang-1 and -2 may be closely associated with the development of HUS. Serum Ang-1 and -2 levels and the Ang-2/Ang-1 ratio may be promising indicators of disease activity in HUS and the development of encephalopathy.
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Affiliation(s)
- Masaki Shimizu
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Natsumi Inoue
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Mondo Kuroda
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Mao Mizuta
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Naotoshi Sugimoto
- Department of Physiology, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hisashi Kaneda
- Department of Pediatrics, Toyama City Hospital, Toyama, Japan
| | - Kazuhide Ohta
- Department of Pediatrics, Kanazawa Medical Center, Kanazawa, Japan
| | - Akihiro Yachie
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Involvement of Angiopoietin-2 and Tie2 Receptor Phosphorylation in STEC-HUS Mediated by Escherichia coli O104:H4. Mediators Inflamm 2015; 2015:670248. [PMID: 26858516 PMCID: PMC4706916 DOI: 10.1155/2015/670248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/04/2015] [Accepted: 11/29/2015] [Indexed: 01/13/2023] Open
Abstract
Escherichia coli O104:H4-associated hemolytic uremic syndrome (HUS) is characterized by Shiga toxin-induced vascular damage. As indicated by recent studies, dysregulation of the angiopoietin (Angpt)/Tie2 ligand receptor system may be crucial for endothelial dysfunction in HUS. Early Angpt-2 levels quantified in 48 adult HUS patients were predictive for a complicated clinical course, in particular for need of hemodialysis and mechanical ventilation as well as occurrence of seizures. In vitro challenge of human umbilical vein endothelial cells with patients' sera indicated an injurious mediator role of Angpt-2 opening future perspectives for mitigating endothelial activation in HUS.
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Schilder L, Nurmohamed SA, ter Wee PM, Paauw NJ, Girbes ARJ, Beishuizen A, Beelen RHJ, Groeneveld ABJ. Putative novel mediators of acute kidney injury in critically ill patients: handling by continuous venovenous hemofiltration and effect of anticoagulation modalities. BMC Nephrol 2015; 16:178. [PMID: 26519056 PMCID: PMC4628303 DOI: 10.1186/s12882-015-0167-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Novel putative mediators of acute kidney injury (AKI) include immune-cell derived tumour necrosis factor-like weak inducer of apoptosis (TWEAK), angiopoietin-2 (Ang-2) and protein pentraxin-3 (PTX3). The effect of continuous venovenous hemofiltration (CVVH) and different anticoagulation regimens on plasma levels were studied. METHODS At 0, 10, 60, 180 and 720 min of CVVH, samples were collected from pre- and postfilter blood and ultrafiltrate. No anticoagulation (n = 13), unfractionated heparin (n = 8) or trisodium citrate (n = 21) were compared. RESULTS Concentrations of TWEAK, Ang-2 and PTX3 were hardly affected by CVVH since the mediators were not (TWEAK, PTX3) or hardly (Ang-2) detectable in ultrafiltrate, indicating negligible clearance by the filter in spite of molecular sizes (TWEAK, PTX3) at or below the cutoff of the membrane. Heparin use, however, was associated with an increase in in- and outlet plasma TWEAK. CONCLUSION Novel AKI mediators are not cleared nor produced by CVVH. However, heparin anticoagulation increased TWEAK levels in patient's plasma whereas citrate did not, favouring the latter as anticoagulant in CVVH for AKI.
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Affiliation(s)
- Louise Schilder
- Department of Nephrology, VU University medical center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - S Azam Nurmohamed
- Department of Nephrology, VU University medical center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Pieter M ter Wee
- Department of Nephrology, VU University medical center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Nanne J Paauw
- Department of Molecular Cell Biology and Immunology, Netherlands, The Netherlands.
| | - Armand R J Girbes
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.
| | - Albertus Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Robert H J Beelen
- Department of Molecular Cell Biology and Immunology, Netherlands, The Netherlands.
| | - A B Johan Groeneveld
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
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Pöss J, Fuernau G, Denks D, Desch S, Eitel I, de Waha S, Link A, Schuler G, Adams V, Böhm M, Thiele H. Angiopoietin-2 in acute myocardial infarction complicated by cardiogenic shock-a biomarker substudy of the IABP-SHOCK II-Trial. Eur J Heart Fail 2015; 17:1152-60. [DOI: 10.1002/ejhf.342] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/29/2015] [Accepted: 07/06/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Janine Pöss
- Medical Clinic II/Cardiology/Angiology/Intensive Care Medicine; University Heart Centre Lübeck, University Hospital Schleswig-Holstein (UKSH); Ratzeburger Allee 160 23538 Lübeck Germany
| | - Georg Fuernau
- Medical Clinic II/Cardiology/Angiology/Intensive Care Medicine; University Heart Centre Lübeck, University Hospital Schleswig-Holstein (UKSH); Ratzeburger Allee 160 23538 Lübeck Germany
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
| | - Daniel Denks
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
| | - Steffen Desch
- Medical Clinic II/Cardiology/Angiology/Intensive Care Medicine; University Heart Centre Lübeck, University Hospital Schleswig-Holstein (UKSH); Ratzeburger Allee 160 23538 Lübeck Germany
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
| | - Ingo Eitel
- Medical Clinic II/Cardiology/Angiology/Intensive Care Medicine; University Heart Centre Lübeck, University Hospital Schleswig-Holstein (UKSH); Ratzeburger Allee 160 23538 Lübeck Germany
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
| | - Suzanne de Waha
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
- Herzzentrum, Segeberger Kliniken GmbH; Bad Segeberg Germany
| | - Andreas Link
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
| | - Gerhard Schuler
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
| | - Volker Adams
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
| | - Holger Thiele
- Medical Clinic II/Cardiology/Angiology/Intensive Care Medicine; University Heart Centre Lübeck, University Hospital Schleswig-Holstein (UKSH); Ratzeburger Allee 160 23538 Lübeck Germany
- Clinic for Internal Medicine/Cardiology; University of Leipzig - Heart Centre; Leipzig Germany
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24
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Lin SM, Chung FT, Kuo CH, Chou PC, Wang TY, Chang PJ, Lo YL, Huang CD, Lin HC, Wang CH, Kuo HP. Circulating angiopopietin-1 correlates with the clinical course of multiple organ dysfunction syndrome and mortality in patients with severe sepsis. Medicine (Baltimore) 2015; 94:e878. [PMID: 25997069 PMCID: PMC4602874 DOI: 10.1097/md.0000000000000878] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To determine plasma concentrations of angiopoietin (Ang)-1, Ang-2, Tie-2, and vascular endothelial growth factor (VEGF) in patients with sepsis-induced multiple organ dysfunction syndrome (MODS) and determine their association with mortality.The study prospectively recruited 96 consecutive patients with severe sepsis in a l intensive care unit of a tertiary hospital. Plasma Ang-1, Ang-2, Tie-2, and VEGF levels and MODS were determined in patients on days 1, 3, and 7 of sepsis. Univariate and Cox proportional hazards analysis were performed to develop a prognostic model.Days 1, 3, and 7 plasma Ang-1 concentrations were persistently decreased in MODS patients than in non-MODS patients (day1: 4.0 ± 0.5 vs 8.0 ± 0.5 ng/mL, P < 0.0001; day 3, 3.2 ± 0.6 vs 7.3 ± 0.5 ng/mL, P < 0.0001, day 7, 2.8 ± 0.6 vs 10.4 ± 0.7 ng/mL, P < 0.0001). In patients with resolved MODS on day 7 of sepsis, Ang-1 levels were increased from day 1 (4.7 ± 0.6 ng/mL vs 9.1 ± 1.4 ng/mL, n = 43, P = 0.004). Plasma Ang-1 levels were lower in nonsurvivors than in survivors on days 1 (4.0 ± 0.5 vs 7.1 ± 0.5 ng/mL, P < 0.0001), 3 (3.8 ± 0.6 vs 7.1 ± 0.5 ng/mL, P < 0.0001), and 7 (4.7 ± 0.7 vs 11.0 ± 0.8 ng/mL, P < 0.0001) of severe sepsis. In contrast, plasma Ang-2 levels were higher in nonsurvivors than in survivors only on day 1 (15.8 ± 2.0 vs 9.5 ± 1.2 ng/mL, P = 0.035). VEGF and Tie-2 levels were not associated with MODS and mortality. Ang-1 level less than the median value was the only independent predictor of mortality (hazard ratio, 2.57; 95% CI 1.12-5.90, P = 0.025).Persistently decreased Ang-1 levels are associated with MODS and subsequently, mortality in patients with sepsis.
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Affiliation(s)
- Shu-Min Lin
- From the Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan
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25
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Pauta M, Ribera J, Melgar-Lesmes P, Casals G, Rodríguez-Vita J, Reichenbach V, Fernandez-Varo G, Morales-Romero B, Bataller R, Michelena J, Altamirano J, Jiménez W, Morales-Ruiz M. Overexpression of angiopoietin-2 in rats and patients with liver fibrosis. Therapeutic consequences of its inhibition. Liver Int 2015; 35:1383-92. [PMID: 24612347 DOI: 10.1111/liv.12505] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 02/12/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Studies in experimental models of cirrhosis showed that anti-angiogenic treatments may be effective for the treatment of liver fibrosis. In this context, angiopoietins are potential therapeutic targets as they are involved in the maintenance and stabilization of newly formed blood vessels. In addition, angiopoietin-2 is expressed in fibrotic livers and its inhibition in tumours results in vessel stability. Therefore, our study was aimed to assess the therapeutic utility of inhibiting angiopoietin-2. METHODS Circulating levels of angiopoietin-1 and angiopoietin-2 were quantified by ELISA in CCl4 -treated rats and in patients with cirrhosis. In vivo blockade of angiopoietin-2 in rats with liver fibrosis was performed with a chemically programmed antibody, CVX-060. RESULTS High levels of angiopoietin-2 were found in the systemic and suprahepatic circulation of cirrhotic patients and the ratio angiopoietin-1/angiopoietin-2 inversely correlated with prognostic models for alcoholic liver disease. Chronic treatment of CCl4 -treated rats with CVX-060 was associated with a significant decrease in inflammatory infiltrate, normalization of the hepatic microvasculature and reduction in VCAM-1 vascular expression. The anti-angiopoietin-2 treatment was also associated with less liver fibrosis and with lower levels of circulating transaminases. CVX-060 treatment was not associated with either vascular pruning in healthy tissue or compensatory overexpression of VEGF. CONCLUSIONS Inhibition of angiopoietin-2 is an effective and safe treatment for liver fibrosis in CCl4 -treated rats, acting mainly through the induction of vessel normalization and the attenuation of hepatic inflammatory infiltrate. Therefore, inhibition of angiopoietin-2 offers a therapeutic alternative for liver fibrosis.
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Affiliation(s)
- Montse Pauta
- Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS) and CIBERehd, Barcelona, Spain
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26
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Scholz A, Plate KH, Reiss Y. Angiopoietin-2: a multifaceted cytokine that functions in both angiogenesis and inflammation. Ann N Y Acad Sci 2015; 1347:45-51. [PMID: 25773744 DOI: 10.1111/nyas.12726] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/19/2015] [Accepted: 01/23/2015] [Indexed: 12/12/2022]
Abstract
Angiogenesis and inflammation are two highly linked processes. In the last decade, several factors with dual function in both of these major pathways have been identified. This review focuses on angiopoietin-2 (Ang-2), an important proangiogenic factor that has more recently been implicated in mediating inflammatory processes as well. Ang-2 is upregulated in multiple inflammatory diseases and has been implicated in the direct control of inflammation-related signaling pathways. As a consequence of its multiple roles, designs for therapeutic targeting of Ang-2 should consider the dual function of this factor in regulating angiogenesis and inflammation.
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Affiliation(s)
- Alexander Scholz
- Department of Pathology, Laboratory of Immunology and Vascular Biology, Stanford University School of Medicine, Stanford, California
| | - Karl H Plate
- Edinger Institute/Institute of Neurology, Frankfurt University Medical School, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yvonne Reiss
- Edinger Institute/Institute of Neurology, Frankfurt University Medical School, Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Frankfurt, Germany.,German Cancer Consortium (DKTK), Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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27
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Plasma angiopoietin-1 level, left ventricular ejection fraction, and multivessel disease predict development of 1-year major adverse cardiovascular events in patients with acute ST elevation myocardial infarction — A pilot study. Int J Cardiol 2015; 182:155-60. [DOI: 10.1016/j.ijcard.2014.12.172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 11/27/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022]
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28
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Lung-Targeted RNA Interference Against Angiopoietin-2 Ameliorates Multiple Organ Dysfunction and Death in Sepsis. Crit Care Med 2014; 42:e654-62. [DOI: 10.1097/ccm.0000000000000524] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Padberg JS, Wiesinger A, di Marco GS, Reuter S, Grabner A, Kentrup D, Lukasz A, Oberleithner H, Pavenstädt H, Brand M, Kümpers P. Damage of the endothelial glycocalyx in chronic kidney disease. Atherosclerosis 2014; 234:335-43. [DOI: 10.1016/j.atherosclerosis.2014.03.016] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/24/2014] [Accepted: 03/17/2014] [Indexed: 01/22/2023]
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30
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Molnar MZ, Kümpers P, Kielstein JT, Schiffer M, Czira ME, Ujszaszi A, Kovesdy CP, Mucsi I. Circulating Angiopoietin-2 levels predict mortality in kidney transplant recipients: a 4-year prospective case-cohort study. Transpl Int 2014; 27:541-52. [PMID: 24628855 DOI: 10.1111/tri.12293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/31/2013] [Accepted: 02/24/2014] [Indexed: 12/16/2022]
Abstract
Angiopoietin 2 (Angpt2) impairs endothelial function by preventing angiopoietin 1 from binding to their common endothelial-specific receptor Tie2. Here, we examined whether circulating Angpt2 predicts outcome in kidney transplant recipients. For this case-cohort study, we selected 130 kidney transplant recipients who had died or returned to dialysis within the first 2 years of follow-up of our cohort study, as well as 130 age- and gender-matched kidney transplant recipients without an event (controls) from a total of 993 kidney transplant recipients. The total of 260 selected patients were followed in median 4 years. Serum Angpt2 at baseline was measured using an in-house immunoluminometric assay. Median Angpt2 concentrations were significantly higher in patients who died [median (interquartile range--IQR) 3.6 (2.8-5.9) ng/ml] as compared to patients who did not die during the study period [2.8 (2.1-4.1) ng/ml; P < 0.001]. Ln (natural log) Angpt2 levels correlated positively with C-reactive protein levels (r = 0.315, P < 0.001) and the Charlson Comorbidity Index (r = 0.188, P = 0.002) and were inversely associated with eGFR (r = -0.301, P < 0.001) hemoglobin (r = -0.269, P < 0.001), and serum albumin concentrations (r = -0.382, P < 0.001). On multivariate analyses, baseline Angpt2 levels independently predicted all-cause mortality (multivariable-adjusted hazard ratio associated with one natural log unit higher Angpt2 level: 1.70 (95% confidence interval: 1.10-2.61)). In our analysis, circulating Angpt2 was an independent predictor of all-cause mortality in stable, prevalent kidney transplant recipients.
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Affiliation(s)
- Miklos Z Molnar
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA; Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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31
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Lukasz A, Hoffmeister B, Graf B, Wölk B, Noeckler K, Bode-Böger SM, Hadem J, Pischke S, Kielstein JT. Association of angiopoietin-2 and dimethylarginines with complicated course in patients with leptospirosis. PLoS One 2014; 9:e87490. [PMID: 24498116 PMCID: PMC3907516 DOI: 10.1371/journal.pone.0087490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 12/23/2013] [Indexed: 11/22/2022] Open
Abstract
Leptospirosis is one of the most relevant zoonosis worldwide and a potentially life-threatening infectious disease. While it is frequent in tropic regions, it is uncommon in European industrialized countries. Angiopoietin-2 (Angpt-2) and asymmetric and symmetric dimethylarginine (ADMA and SDMA) are markers of endothelial activation and systemic inflammation. These parameters have been studied recently in the context of sepsis and MODS showing potential to determine disease severity and outcome specific parameters like acute kidney injury (AKI) and survival. These biomarkers were measured in 13 patients with leptospirosis. High levels of Angpt-2 were statistically significant associated with a complicated clinical course with occurrence of AKI, Sepsis and intensive care unit treatment. ADMA was significantly associated with occurrence of AKI and ICU treatment whereas SDMA was associated with AKI. Therefore these endothelial markers may serve as additional tools for risk stratification in these patients.
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Affiliation(s)
- Alexander Lukasz
- Department of Nephrology & Hypertension, Hannover Medical School, Hannover, Germany
- Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany
- * E-mail:
| | - Bodo Hoffmeister
- Department of Infectious Diseases and Pulmonology, Charité University Medicine, Berlin, Germany
| | - Barbara Graf
- Department of Microbiology and Hygiene, Charité University Medicine, Berlin, Germany
| | - Benno Wölk
- Institute for Virology, Hannover Medical School, Hannover, Germany
| | - Karsten Noeckler
- Bundesinstitut für Risikobewertung, Abteilung für Biologische Sicherheit, Berlin, Germany
| | | | - Johannes Hadem
- Department of Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - Sven Pischke
- Department of Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - Jan T. Kielstein
- Department of Nephrology & Hypertension, Hannover Medical School, Hannover, Germany
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32
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Ong SP, Ng ML, Chu JJH. Differential regulation of angiopoietin 1 and angiopoietin 2 during dengue virus infection of human umbilical vein endothelial cells: implications for endothelial hyperpermeability. Med Microbiol Immunol 2013; 202:437-52. [DOI: 10.1007/s00430-013-0310-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 08/19/2013] [Indexed: 12/17/2022]
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A high angiopoietin-2/angiopoietin-1 ratio is associated with a high risk of septic shock in patients with febrile neutropenia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R169. [PMID: 23915833 PMCID: PMC4056795 DOI: 10.1186/cc12848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/05/2013] [Indexed: 12/18/2022]
Abstract
Introduction Endothelial barrier breakdown is a hallmark of septic shock, and proteins that physiologically regulate endothelial barrier integrity are emerging as promising biomarkers of septic shock development. Patients with cancer and febrile neutropenia (FN) present a higher risk of sepsis complications, such as septic shock. Nonetheless, these patients are normally excluded or under-represented in sepsis biomarker studies. The aim of our study was to validate the measurement of a panel of microvascular permeability modulators as biomarkers of septic shock development in cancer patients with chemotherapy-associated FN. Methods This was a prospective study of diagnostic accuracy, performed in two distinct in-patient units of a university hospital. Levels of vascular endothelial growth factor A (VEGF-A), soluble fms-like tyrosine kinase-1 (sFlt-1) and angiopoietin (Ang) 1 and 2 were measured after the onset of neutropenic fever, in conditions designed to mimic the real-world use of a sepsis biomarker, based on our local practice. Patients were categorized based on the development of septic shock by 28 days as an outcome. Results A total of 99 consecutive patients were evaluated in the study, of which 20 developed septic shock and 79 were classified as non-complicated FN. VEGF-A and sFlt-1 levels were similar between both outcome groups. In contrast, Ang-2 concentrations were increased in patients with septic shock, whereas an inverse finding was observed for Ang-1, resulting in a higher Ang-2/Ang-1 ratio in patients with septic shock (5.29, range 0.58 to 57.14) compared to non-complicated FN (1.99, range 0.06 to 64.62; P = 0.01). After multivariate analysis, the Ang-2/Ang-1 ratio remained an independent factor for septic shock development and 28-day mortality. Conclusions A high Ang-2/Ang-1 ratio can predict the development of septic shock in cancer patients with febrile neutropenia.
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The angiopoietin:Tie 2 interaction: a potential target for future therapies in human vascular disease. Cytokine Growth Factor Rev 2013; 24:579-92. [PMID: 23838360 DOI: 10.1016/j.cytogfr.2013.05.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/22/2013] [Accepted: 05/24/2013] [Indexed: 01/06/2023]
Abstract
Angiopoietin-1 and -2 are endogenous ligands for the vascular endothelial receptor tyrosine kinase Tie2. Signalling by angiopoietin-1 promotes vascular endothelial cell survival and the sprouting and reorganisation of blood vessels, as well as inhibiting activation of the vascular endothelial barrier to reduce leakage and leucocyte migration into tissues. Angiopoietin-2 generally has an opposing action, and is released naturally at times of vascular growth and inflammation. There is a significant body of emerging evidence that promoting the actions of angiopoietin-1 through Tie2 is of benefit in pathologies of vascular activation, such as sepsis, stroke, diabetic retinopathy and asthma. Similarly, methods to inhibit the actions of angiopoietin-2 are emerging and have been demonstrated to be of preclinical and clinical benefit in reducing tumour angiogenesis. Here the author reviews the evidence for potential benefits of modulation of the interaction of angiopoietins with Tie2, and the potential applications. Additionally, methods for delivery of the complex protein angiopoietin-1 are discussed, as well as potentially deleterious consequences of administering angiopoietin-1.
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35
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Lukasz A, Beutel G, Kümpers P, Denecke A, Westhoff-Bleck M, Schieffer B, Bauersachs J, Kielstein JT, Tutarel O. Angiopoietin-2 in adults with congenital heart disease and heart failure. PLoS One 2013; 8:e66861. [PMID: 23826161 PMCID: PMC3691231 DOI: 10.1371/journal.pone.0066861] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/10/2013] [Indexed: 11/25/2022] Open
Abstract
Background Chronic heart failure is an important cause for morbidity and mortality in adults with congenital heart disease (ACHD). While NT-proBNP is an established biomarker for heart failure of non-congenital origin, its application in ACHD has limitations. The angiogenic factors Angiopoietin-1 and -2 (Ang-1, Ang-2), vascular endothelial growth factor (VEGF), and soluble receptor tyrosine kinase of the Tie family (sTie2) correlate with disease severity in heart failure of non-congenital origin. Their role in ACHD has not been studied. Methods In 91 patients Ang-2 and NT-proBNP were measured and related to New York Heart Association class, systemic ventricular function and parameters of cardiopulmonary exercise testing. Ang-1, VEGF, and sTie2 were also measured. Results Ang-2 correlates with NYHA class and ventricular dysfunction comparable to NT-proBNP. Further, Ang-2 showed a good correlation with parameters of cardiopulmonary exercise testing. Both, Ang-2 and NT-proBNP identified patients with severely limited cardiopulmonary exercise capacity. Additionally, Ang-2 is elevated in patients with a single ventricle physiology in contrast to NT-proBNP. VEGF, Ang-1, and sTie2 were not correlated with any clinical parameter. Conclusion The performance of Ang-2 as a biomarker for heart failure in ACHD is comparable to NT-proBNP. Its significant elevation in patients with single ventricle physiology indicates potential in this patient group and warrants further studies.
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Affiliation(s)
- Alexander Lukasz
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Gernot Beutel
- Department of Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Philipp Kümpers
- Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Muenster, Muenster, Germany
| | - Agnieszka Denecke
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Bernhard Schieffer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan T. Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Oktay Tutarel
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- * E-mail:
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36
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Graham SM, Rajwans N, Tapia KA, Jaoko W, Estambale BBA, McClelland RS, Overbaugh J, Liles WC. A prospective study of endothelial activation biomarkers, including plasma angiopoietin-1 and angiopoietin-2, in Kenyan women initiating antiretroviral therapy. BMC Infect Dis 2013; 13:263. [PMID: 23734875 PMCID: PMC3679794 DOI: 10.1186/1471-2334-13-263] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/01/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV-1-related inflammation is associated with increased levels of biomarkers of vascular adhesion and endothelial activation, and may increase production of the inflammatory protein angiopoietin-2 (ANG-2), an adverse prognostic biomarker in severe systemic infection. We hypothesized that antiretroviral therapy (ART) initiation would decrease endothelial activation, reducing plasma levels of ANG-2. METHODS Antiretroviral-naïve Kenyan women with advanced HIV infection were followed prospectively. Endothelial activation biomarkers including soluble intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and E-selectin, and plasma ANG-2 and angiopoietin-1 (ANG-1) were tested in stored plasma samples from 0, 6, and 12 months after ART initiation. We used Wilcoxon matched-pairs signed rank tests to compare endothelial activation biomarkers across time-points, generalized estimating equations to analyze associations with change in log10-transformed biomarkers after ART initiation, and Cox proportional-hazards regression to analyze associations with mortality. RESULTS The 102 HIV-1-seropositive women studied had advanced infection (median CD4 count, 124 cells/μL). Soluble ICAM-1 and plasma ANG-2 levels decreased at both time-points after ART initiation, with concomitant increases in the beneficial protein ANG-1. Higher ANG-2 levels after ART initiation were associated with higher plasma HIV-1 RNA, oral contraceptive pill use, pregnancy, severe malnutrition, and tuberculosis. Baseline ANG-2 levels were higher among five women who died after ART initiation than among women who did not (median 2.85 ng/mL [inter-quartile range (IQR) 2.47-5.74 ng/mL] versus median 1.32 ng/mL [IQR 0.35-2.18 ng/mL], p = 0.01). Both soluble ICAM-1 and plasma ANG-2 levels predicted mortality after ART initiation. CONCLUSIONS Biomarkers of endothelial activation decreased after ART initiation in women with advanced HIV-1 infection. Changes in plasma ANG-2 were associated with HIV-1 RNA levels over 12 months of follow-up. Soluble ICAM-1 and plasma ANG-2 levels represent potential biomarkers for adverse outcomes in advanced HIV-1 infection.
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Abstract
Endothelial dysfunction contributes to the pathogenesis of a variety of potentially serious infectious diseases and syndromes, including sepsis and septic shock, hemolytic-uremic syndrome, severe malaria, and dengue hemorrhagic fever. Because endothelial activation often precedes overt endothelial dysfunction, biomarkers of the activated endothelium in serum and/or plasma may be detectable before classically recognized markers of disease, and therefore, may be clinically useful as biomarkers of disease severity or prognosis in systemic infectious diseases. In this review, the current status of mediators of endothelial cell function (angiopoietins-1 and -2), components of the coagulation pathway (von Willebrand Factor, ADAMTS13, and thrombomodulin), soluble cell-surface adhesion molecules (soluble E-selectin, sICAM-1, and sVCAM-1), and regulators of vascular tone and permeability (VEGF and sFlt-1) as biomarkers in severe infectious diseases is discussed in the context of sepsis, E. coli O157:H7 infection, malaria, and dengue virus infection.
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Affiliation(s)
- Andrea V Page
- Mount Sinai Hospital-University Health Network, Toronto, ON, Canada.
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Shroff RC, Price KL, Kolatsi-Joannou M, Todd AF, Wells D, Deanfield J, Johnson RJ, Rees L, Woolf AS, Long DA. Circulating angiopoietin-2 is a marker for early cardiovascular disease in children on chronic dialysis. PLoS One 2013; 8:e56273. [PMID: 23409162 PMCID: PMC3568077 DOI: 10.1371/journal.pone.0056273] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/08/2013] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular disease (CVD) is increasingly recognised as a complication of childhood chronic kidney disease (CKD) even in the absence of diabetes and hypertension. We hypothesized that an alteration in angiopoietin-1 and -2, growth factors which regulate endothelial and vascular function could be involved. We report that the endothelial survival factor, angiopoietin-1 is low in children with pre-dialysis CKD whereas the pro-inflammatory angiopoietin-2 is elevated in children on dialysis. In dialysis patients, angiopoietin-2 positively correlated with time on dialysis, systolic blood pressure, and carotid artery intima media thickness. Elevated angiopoietin-2 levels in dialysis versus pre-dialysis CKD patients were also associated with an anti-angiogenic (high soluble VEGFR-1 and low VEGF-A) and pro-inflammatory (high urate, E-selectin, P-selectin and VCAM-1) milieu. Ang-2 was immunodetected in arterial biopsy samples whilst the expression of VEGF-A was significantly downregulated in dialysis patients. Serum urate correlated with angiopoietin-2 levels in dialysis patients and addition of uric acid was able to induce rapid release of angiopoietin-2 from cultured endothelial cells. Thus, angiopoietin-2 is a marker for cardiovascular disease in children on chronic dialysis and may act as an anti-angiogenic and pro-inflammatory effector in this context. The possibility that the release of angiopoietin-2 from endothelia is mediated by urate should be explored further.
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Affiliation(s)
- Rukshana C. Shroff
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Karen L. Price
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Maria Kolatsi-Joannou
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Alexandra F. Todd
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - David Wells
- Department of Chemical Pathology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - John Deanfield
- National Centre for Cardiovascular Disease Prevention and Outcomes, University College London, London, United Kingdom
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado, Denver, Colorado, United States of America
| | - Lesley Rees
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Adrian S. Woolf
- Institute of Human Development, University of Manchester and the Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - David A. Long
- Nephro-Urology Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- * E-mail:
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Makki FM, Taylor SM, Shahnavaz A, Leslie A, Gallant J, Douglas S, Teh E, Trites J, Bullock M, Inglis K, Pinto DM, Hart RD. Serum biomarkers of papillary thyroid cancer. J Otolaryngol Head Neck Surg 2013; 42:16. [PMID: 23663694 PMCID: PMC3651213 DOI: 10.1186/1916-0216-42-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/06/2013] [Indexed: 02/07/2023] Open
Abstract
Objective To identify serum biomarkers of papillary thyroid cancer. Methods Prospective analysis was performed of banked tumor and serum specimens from 99 patients with thyroid masses. Enzyme-linked immunosorbent assay (ELISA) was employed to measure levels of five serum proteins previously demonstrated to be up-regulated in papillary thyroid cancer (PTC): angiopoietin-1 (Ang-1), cytokeratin 19 (CK-19), tissue inhibitor of metalloproteinase-1 (TIMP-1), chitinase 3 like-1 (YKL-40), and galectin-3 (GAL-3). Serum levels were compared between patients with PTC and those with benign tumors. Results A total of 99 patients were enrolled in the study (27 men, 72 women), with a median age of 54 years. Forty-three patients had PTC and 58 cases were benign tumors. There were no statistically significant differences when comparing all five different biomarkers between PTC and other benign thyroid tumors. The p-values were 0.94, 0.48, 0.72, 0.48, and 0.90 for YKL-40, Gal-3, CK19, TIMP-1, and Ang-1, respectively. Conclusion Serum levels of four of the five proteins were elevated in patients with thyroid masses relative to normal values. However, the difference between benign and PTC was not significant. Two of the markers (Gal-3 & TIMP-1) displayed a greater potential difference, which may warrant further investigation. This study suggests that other serum markers should be sought. This is the first study to investigate potential serum biomarkers based on over-expressed proteins in thyroid cancer versus benign pathology.
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Affiliation(s)
- Fawaz M Makki
- Department of Surgery, Division of Otolaryngology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1278 Tower Rd,, B3H 2Y9, Halifax, N, S,, Canada.
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David S, Kümpers P, van Slyke P, Parikh SM. Mending leaky blood vessels: the angiopoietin-Tie2 pathway in sepsis. J Pharmacol Exp Ther 2013; 345:2-6. [PMID: 23378191 DOI: 10.1124/jpet.112.201061] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Sepsis is a systemic inflammatory response to infection. A common end-feature, these patients regularly suffer from is the so-called multiple organ dysfunction syndrome, an often fatal consequence of organ hypoperfusion, coagulopathy, immune dysregulation,and mitochondrial dysfunction. Microvascular dysfunction critically contributes to the morbidity and mortality of this disease. The angiopoietin (Angpt)/Tie2 system consists of the transmembrane endothelial tyrosine kinase Tie2 and its circulating ligands (Angpt-1,-2, and -3/4). The balance between the canonical agonist Angpt-1 and its competitive inhibitor, Angpt-2, regulates basal endothelial barrier function and the leakage and vascular inflammation that develop in response to pathogens and cytokines. Here we summarize recent work in mice and men to highlight the therapeutic potential in this pathway to prevent or even reverse microvascular dysfunction in this deadly disease.
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Affiliation(s)
- Sascha David
- Department of Nephrology & Hypertension, Medical School Hannover, Hannover, Germany.
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Kümpers P, David S. Angiopoietin-2 in sepsis: lost in translation? Nephrol Dial Transplant 2012; 28:487-9. [PMID: 23136212 DOI: 10.1093/ndt/gfs443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Philipp Kümpers
- Department of Nephrology and Hypertension, Hannover Medical School, Münster, Germany
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Woolnough C, Wang Y, Kan C, Morris J, Tasevski V, Ashton A. Source of angiopoietin-2 in the sera of women during pregnancy. Microvasc Res 2012; 84:367-74. [DOI: 10.1016/j.mvr.2012.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 08/15/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
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Salama MK, Taha FM, Safwat M, Darweesh HEA, Basel ME. The Tie2 receptor antagonist angiopoietin-2 in systemic lupus erythematosus: its correlation with various disease activity parameters. Immunol Invest 2012; 41:864-75. [PMID: 22989097 DOI: 10.3109/08820139.2012.711407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Systemic lupus erythematosus is one of the autoimmune diseases characterized by multisystem involvement associated with autoantibody and immune complex vasculitis along with endothelial cell damage. OBJECTIVE to study the possible role of Angiopoietin- 2 (Ang-2) as a recently highlighted inflammatory and angiogenic mediator in the pathogenesis of SLE and its correlation with the state of another inflammatory marker, P-Selectin, as well as with various markers of the disease activity. PATIENTS AND METHODS The present study included 3 main groups: active SLE patients (group I), inactive SLE patients (group II) and healthy normal control subjects (group III). Groups I and II were subjected to disease activity assessment using the SLEDAI scoring system and measurement of plasma Ang-2 and P-Selectin by ELISA in addition to various laboratory investigations to assess disease activity as: Complete blood count, ESR, serum creatinine, C3, C4 and 24-h urinary proteins. RESULTS The mean level of Plasma Ang-2 and P-selectin showed a high significant increase in active group compared to inactive SLE patients and control subjects (p < 0.001).There was a significant positive correlation between Ang-2, P-Selectin, and each of SLEDAI score and 24-h urinary proteins in all SLE patients as well as in the active group, and Ang-2 was a significant independent marker for proteinuria. A significant negative correlation was found between Ang-2, P-Selectin and each of C3, C4. Ang-2 and P-Selectin showed a high sensitivity and specificity in the patients with SLE. CONCLUSION Our study suggests that Ang-2 may be a more useful marker than P-Selectin, C3 and C4 in the assessment of disease activity.
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Affiliation(s)
- Maysa K Salama
- Medical Biochemistry and Molecular Biology, Cairo University , Cairo , Egypt
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Lukasz A, Kümpers P, David S. Role of angiopoietin/tie2 in critical illness: promising biomarker, disease mediator, and therapeutic target? SCIENTIFICA 2012; 2012:160174. [PMID: 24278675 PMCID: PMC3820656 DOI: 10.6064/2012/160174] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 07/30/2012] [Indexed: 06/02/2023]
Abstract
Critical illness is a descriptive, broad term for a serious clinical condition that can result from enormously heterogeneous etiologies. A common end feature these patients regularly suffer from is the so-called multiple organ dysfunction syndrome (MODS), often a consequence of organ hypoperfusion and ischemia, coagulopathies, overwhelming inflammatory responses, immune paralysis and mitochondrial dysfunction. Mechanistically, endothelial injury and particularly microvascular leakage is a major step in the pathophysiology of MODS and contributes to its mortality. The angiopoietin (Angpt)/Tie2 system consists of the endothelial tyrosine kinase Tie2 and its 4 circulating ligands (Angpt1-4). The balance between the agonistic ligand "Angpt-1" and the antagonistic one "Angpt-2" regulates baseline endothelial barrier function and its response to injury and is therefore considered a gatekeeper of endothelial activation. This paper provides a systematic overview of the Angpt/Tie2 system with respect to (1) its role as a global biomarker of endothelial activation in critical ill patients, (2) its contribution to MODS pathophysiology as a disease mediator, and last but not least (3) putative therapeutic applications to modify the activation state of Tie2 in mice and men.
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Affiliation(s)
- Alexander Lukasz
- Department of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Philipp Kümpers
- Department of Internal Medicine, Rheumatology and Nephrology, University Hospital Münster, 48149 Münster, Germany
| | - Sascha David
- Department of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
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Angiopoietin-2 is a potential mediator of endothelial barrier dysfunction following cardiopulmonary bypass. Cytokine 2012; 60:352-9. [PMID: 22770562 DOI: 10.1016/j.cyto.2012.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 02/23/2012] [Accepted: 04/04/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Endothelial activation leading to vascular barrier dysfunction and organ failure is a well-recognized complication of cardiovascular surgery with cardiopulmonary bypass (CPB). The endothelial-specific angiopoietin-Tie2 ligand-receptor system has been identified as a non-redundant regulator of endothelial activation. Binding of angiopoietin-2 (Ang-2) to the Tie2 receptor antagonizes Tie2 signaling and renders the endothelial barrier responsive to pro-inflammatory cytokines. We aimed to study the time course and potential triggering factors of Ang-2 release after CPB, as well as the association of Ang-2 changes with surrogates of increased vascular permeability, organ dysfunction, and outcome. METHODS Serum levels of Ang-2 from 25 adult patients (140 screened) were measured before and at 0, 12, and 24h following CPB procedure by in-house immuno-luminometric assay (ILMA), and compared with indices of organ dysfunction, duration of mechanical ventilation (MV), length of stay (LOS) in the intensive care unit (ICU), and hospital mortality. The effect of Ang-2 was studied in vitro by incubating high Ang-2 patient serum with endothelial cells (EC). RESULTS Ang-2 levels steadily increased from 2.6 ± 2.4 ng/mL at 0 h up to 7.3 ± 4.6 ng/mL at 24h following CPB (P<0.001). The release of Ang-2 correlated with the duration of CPB, aortic cross-clamp time, and post-CPB lactate levels. Changes in Ang-2 during follow-up correlated with partial pressure of oxygen in arterial blood (PaO(2))/fraction of inspired oxygen (FiO(2)) ratio, alveolar-arterial oxygen tension difference (AaDO(2)), hemodynamics, fluid balance, and disease severity measures. Ang-2 levels at 12h predicted the duration of MV, ICU-LOS, and hospital mortality. High Ang-2 patient sera disrupted EC architecture in vitro, an effect reversed by treatment with the competitive Tie2 ligand angiopoietin-1 (Ang-1). CONCLUSIONS Collectively, our results suggest that Ang-2 is a putative mediator of endothelial barrier dysfunction after CPB. These findings suggest that targeting the Ang/Tie2 pathway may mitigate organ dysfunction and improve outcome in patients undergoing CPB.
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Chittiboina P, Ganta V, Monceaux CP, Scott LK, Nanda A, Alexander JS. Angiopoietins as promising biomarkers and potential therapeutic targets in brain injury. ACTA ACUST UNITED AC 2012; 20:15-21. [PMID: 22633746 DOI: 10.1016/j.pathophys.2012.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Traumatic brain injury (TBI) and sub-arachnoid hemorrhage (SAH) are major causes of long-term disability, mortality, and enormous economic costs to society. The full spectrum of neurological damage created by TBI or SAH is not usually manifested at the time of injury, but evolves gradually over the course of hours to days (or weeks) following these injuries. Angiopoietins, important regulators of vascular structure and function, are hallmark indicators of vascular injury and may therefore represent promising targets in the treatment of SAH and TBI. In animal models and human tissues, normal intracerebral and pial vessels show strong expression of Angiopoietin-1 (Ang-1), but only minimal expression or presentation of Angiopoietin-2 (Ang-2). After several types of neurotrauma, the ratios of Ang-1 and Ang-2 expression in brain microvessel are disturbed and appear to contribute to the remarkable loss of blood-brain barrier (BBB) in these injuries. Angiopoietins levels, and perhaps more importantly, Angiopoietin ratios (1:2) may have novel and important diagnostic and prognostic uses in TBI and SAH brain injury. Ang-1/2 evaluation in plasma, serum and cerebrospinal fluid may provide new therapeutic modalities which can modify 'secondary' forms of brain injury after TBI and SAH.
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Affiliation(s)
- Prashant Chittiboina
- Department of Neurosurgery, LSUHSC-Shreveport, Shreveport, LA 71130, United States
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Utility of soluble angiogenic factors as biomarker for disease severity and prognosis. J Clin Gastroenterol 2012; 46:172. [PMID: 22064555 DOI: 10.1097/mcg.0b013e318236effa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Circulating angiopoietin-2 as a biomarker in ANCA-associated vasculitis. PLoS One 2012; 7:e30197. [PMID: 22279570 PMCID: PMC3261176 DOI: 10.1371/journal.pone.0030197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 12/11/2011] [Indexed: 01/12/2023] Open
Abstract
The endothelial-specific Angiopoietin-Tie2 ligand-receptor system is an important regulator of endothelial activation. Binding of angiopoietin-2 (Ang-2) to Tie2 receptor renders the endothelial barrier responsive to pro-inflammatory cytokines. We previously showed that circulating Ang-2 correlated with disease severity in a small cohort of critically ill patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. The current study reassessed Ang-2 as a biomarker of disease activity and relapse in AAV. Circulating Ang-2 was measured in 162 patients with severe AAV (BVAS/WG≥3, with or without glomerulonephritis) in a clinical trial. Ang-2 levels during active AAV were compared to levels in the same patients during remission (BVAS/WG = 0). Levels in clinical subsets of AAV were compared, and association with future disease course was assessed. Ang-2 levels were elevated in severe disease (median 3.0 ng/ml, interquartile range 1.9–4.4) compared to healthy controls (1.2, 0.9–1.5). However, they did not reliably decline with successful treatment (median 2.6 ng/ml, interquartile range 1.9–3.8, median change −0.1). Ang-2 correlated weakly with BVAS/WG score (r = 0.17), moderately with markers of systemic inflammation (r = 0.25–0.41), and inversely with renal function (r = −0.36). Levels were higher in patients with glomerulonephritis, but levels adjusted for renal dysfunction were no different in patients with or without glomerulonephritis. Levels were higher in patients with newly diagnosed AAV and lower in patients in whom treatment had recently been started. Ang-2 levels during active disease did not predict response to treatment, and Ang-2 levels in remission did not predict time to flare. Thus, Ang-2 appears to have limited practical value in AAV as a biomarker of disease activity at time of measurement or for predicting future activity.
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Platelet activation accounts for excessive angiopoietin-1 levels in patients' sera. ACTA ACUST UNITED AC 2011; 71:1480-1. [PMID: 22071944 DOI: 10.1097/ta.0b013e3182331fd2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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David S, John SG, Jefferies HJ, Sigrist MK, Kümpers P, Kielstein JT, Haller H, McIntyre CW. Angiopoietin-2 levels predict mortality in CKD patients. Nephrol Dial Transplant 2011; 27:1867-72. [DOI: 10.1093/ndt/gfr551] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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