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Circulating endothelial cells in patients with septic shock.
M Mutunga1, B Fulton, R Bullock
1Department of Anaesthesia and Intensive Care Medicine, Newcastle-upon-Tyne National Health Service Trust, Newcastle-upon-Tyne, United Kingdom.
American Journal of Respiratory and Critical Care Medicine
|February 24, 2001
Summary
Detecting circulating endothelial cells (EC) in sepsis reveals significant endothelial damage. This finding supports the hypothesis that EC shedding contributes to multiorgan failure in septic shock.
Area of Science:
- Vascular Biology
- Critical Care Medicine
- Immunology
Background:
- The vascular endothelium regulates microvascular tone.
- Endothelial damage is implicated in multiorgan failure during septic shock.
- Direct evidence of endothelial cell (EC) shedding in human sepsis was lacking.
Purpose of the Study:
- To develop and validate a method for detecting circulating endothelial cells (EC) in human sepsis.
- To investigate EC shedding as a marker of endothelial damage in sepsis and septic shock.
Main Methods:
- Developed a technique using isopycnic centrifugation to recover ECs from whole blood.
- Validated the method by seeding and recovering human umbilical vein endothelial cells (HUVEC).
- Identified ECs via indirect immunofluorescence using antibodies against von Willebrand factor (vWf) and KDR.
Main Results:
- EC counts were significantly higher in sepsis and septic shock patients compared to healthy and ICU controls (p < 0.0001).
- KDR-positive EC counts were significantly higher in non-survivors of septic shock than in survivors (p = 0.026).
- High correlation (r² = 0.93) observed between vWf-positive and KDR-positive EC counts.
Conclusions:
- An increase in circulating ECs can be identified in sepsis and septic shock.
- This supports the hypothesis of endothelial damage occurring in human sepsis.
- Circulating EC detection offers a direct measure of endothelial injury in sepsis.