Cited by 527Respiratory Support and MechanismsSepsis Diagnosis and TreatmentAngiogenesis and VEGF in Cancer

Excess Circulating Angiopoietin-2 May Contribute to Pulmonary Vascular Leak in Sepsis in Humans

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Parikh, Samir M, Mammoto, Tadanori, Schultz, Aylit, Yuan, Hai-Tao, Christiani, David, Karumanchi, S. Ananth, Sukhatme, Vikas P·2006·PLoS Medicine

Abstract

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a devastating complication of numerous underlying conditions, most notably sepsis. Although pathologic vascular leak has been implicated in the pathogenesis of ARDS and sepsis-associated lung injury, the mechanisms promoting leak are incompletely understood. Angiopoietin-2 (Ang-2), a known antagonist of the endothelial Tie-2 receptor, was originally described as a naturally occurring disruptor of normal embryonic vascular development otherwise mediated by the Tie-2 agonist angiopoietin-1 (Ang-1). We hypothesized that Ang-2 contributes to endothelial barrier disruption in sepsis-associated lung injury, a condition involving the mature vasculature. METHODS AND FINDINGS: We describe complementary human, murine, and in vitro investigations that implicate Ang-2 as a mediator of this process. We show that circulating Ang-2 is significantly elevated in humans with sepsis who have impaired oxygenation. We then show that serum from these patients disrupts endothelial architecture. This effect of sepsis serum from humans correlates with measured Ang-2, abates with clinical improvement, and is reversed by Ang-1. Next, we found that endothelial barrier disruption can be provoked by Ang-2 alone. This signal is transduced through myosin light chain phosphorylation. Last, we show that excess systemic Ang-2 provokes pulmonary leak and congestion in otherwise healthy adult mice. CONCLUSIONS: Our results identify a critical role for Ang-2 in disrupting normal pulmonary endothelial function.

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Crossref · 10.1371/journal.pmed.0030046

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  • ANG2, which is up-regulated in diseases associated with inflammation and vascular leakage, synergizes with multiple inflammatory agents, promoting endothelial permeability.

    “Furthermore, the EC-derived growth factor angiopoietin-2 (ANG2, ANGPT2), which is up-regulated in diseases associated with inflammation and vascular leakage, synergizes with multiple inflammatory agents, promoting endothelial permeability (6, 7).”

    From Targeting β1-integrin inhibits vascular leakage in endotoxemia (2018) · cites this paper as [6]

    The Results report elevated circulating Ang-2 in severe sepsis and show that Ang-2 alone increased endothelial-monolayer permeability by approximately 20%. The Discussion mentions inflammatory ligands and other causes of vascular leak, but does not establish that Ang-2 synergizes with multiple inflammatory agents; the disease finding is also specific to severe sepsis rather than diseases generally. The indexed passages provide section labels but no page numbers. (LLM, conf=0.86)

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  • Increased capillary leakage leading to hypovolemic shock and multiorgan failure is a key event in the pathobiology of several difficult-to-treat conditions, such as sepsis.

    “Increased capillary leakage leading to hypovolemic shock and multiorgan failure is a key event in the pathobiology of several difficult-to-treat conditions, such as sepsis (2, 3, 6).”

    From Targeting β1-integrin inhibits vascular leakage in endotoxemia (2018) · cites this paper as [6]

    The Introduction says capillary permeability is altered in sepsis, causing fluid to leave the vascular space, and notes that patients who develop shock and multi-organ dysfunction face the greatest risk of death. The Discussion identifies vascular leak as an early contributor to lung injury. Neither passage establishes that capillary leakage leads specifically to hypovolemic shock or multi-organ failure. (LLM, conf=0.85)

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Authors
Parikh, S. M., Mammoto, T., Schultz, A., Yuan, H.-T., Christiani, D., Karumanchi, S. A., & Sukhatme, V. P.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • Harvard University (US)
Corresponding author
Sukhatme, Vikas P
Venue
PLoS Medicine
Published
2006-01-24
Volume
3
Issue
3
Pages
e46
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
OpenAlex
W2157225099
Cited by
527
References
63
Citations by year
2026: 9 · 2025: 19 · 2024: 23 · 2023: 27 · 2022: 18 · 2021: 26 · 2020: 29 · 2019: 24 · 2018: 33 · 2017: 30 · 2016: 38 · 2015: 30 · 2014: 33 · 2013: 36 · 2012: 30
FWCI
21.22
Type
journal article
Language
en
Open access
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Angiogenesis and VEGF in Cancer
Keywords
angiopoietin-2, sepsis, acute respiratory distress syndrome, sepsis-associated lung injury, endothelial barrier disruption, Tie2 receptor, angiopoietin-1, myosin light chain phosphorylation, pulmonary congestion
MeSH terms
Aged, Animals, Blood Vessels, Capillary Permeability, Convalescence, Female, Humans, Lung, Male, Pulmonary Gas Exchange, Up-Regulation, Protein Serine-Threonine Kinases, Sepsis, Angiopoietin-1, Angiopoietin-2, Endothelial Cells, Receptor, TIE-2, Intracellular Signaling Peptides and Proteins, Mice, rho-Associated Kinases

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