BACKGROUND: Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of "uremic microangiopathy", we have measured microvascular density in biopsies of the omentum of children with CKD. PATIENTS AND METHODS: Omental tissue was collected from 32 healthy children (0-18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2. RESULTS: Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01). CONCLUSIONS: Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease.

• MeSH
• angiopoetin-1 krev   MeSH
• angiopoetin-2 krev   MeSH
• apoptóza genetika   MeSH
• autofagie genetika   MeSH
• biologické markery krev   MeSH
• biopsie MeSH
• chronická renální insuficience krev   genetika   patologie   MeSH
• dítě MeSH
• kardiovaskulární nemoci krev   genetika   patologie   MeSH
• kojenec MeSH
• lidé MeSH
• mikrocévy patologie   MeSH
• mikrocirkulace genetika   MeSH
• mladiství MeSH
• novorozenec MeSH
• peritoneální dialýza MeSH
• předškolní dítě MeSH
• receptor 2 pro vaskulární endoteliální růstový faktor krev   MeSH
• regulace genové exprese MeSH
• vaskulární endoteliální růstový faktor A krev   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• angiopoetin-1 MeSH
• angiopoetin-2 MeSH
• ANGPT1 protein, human MeSH Prohlížeč
• ANGPT2 protein, human MeSH Prohlížeč
• biologické markery MeSH
• KDR protein, human MeSH Prohlížeč
• receptor 2 pro vaskulární endoteliální růstový faktor MeSH
• vaskulární endoteliální růstový faktor A MeSH
• VEGFA protein, human MeSH Prohlížeč

Deletion of the cellular inhibitor of apoptosis protein 2 (cIAP2) is capable of rendering lipopolysaccharide (LPS)-activated macrophages highly susceptible to apoptotic triggers, thereby quickly eliminating the resident macrophage population soon after the initiation of a systemic inflammatory response. The aim of our study was to evaluate the impact of cIAP2 deletion on leukocyte recruitment and capillary perfusion in experimental endotoxemia and polybacterial sepsis using intravital microscopy of the intestinal microcirculation, which is crucial in the pathogenesis of septic multiple organ failure. We studied six groups of animals: wild-type (WT) control mice, cIAP2 knockout mice, endotoxemic WT mice (5 mg/kg LPS), endotoxemic cIAP2 knockouts (5 or 50 mg/kg LPS, respectively), and WT as well as knockout mice with polybacterial sepsis (colon ascendens stent peritonitis [CASP]). Intravital microscopy of the intestinal microcirculation was performed after 1 h of endotoxemia or 12 h of CASP-induced sepsis, respectively. Intestinal microvascular blood flow was measured using laser Doppler flowmetry. After 1 h of endotoxemia (5 mg/kg LPS), we observed a significant increase of leukocyte adhesion in intestinal submucosal venules of WT mice in comparison with control animals. The cIAP2 knockout mice showed a significant reduction in leukocyte recruitment within the intestinal submucosal microvasculature after 5 or 50 mg/kg LPS challenge, respectively. Lipopolysaccharide-induced decrease in intestinal microvascular blood flow was not affected by cIAP2 inhibition. In CASP-induced sepsis, cIAP2 deletion had no effect on intestinal leukocyte recruitment. Deletion of cIAP2 resulted in reduced microvascular leukocyte recruitment within the intestinal microcirculation in endotoxemia but not in polybacterial sepsis.

• MeSH
• endotoxemie genetika   metabolismus   patofyziologie   MeSH
• inhibitory apoptózy genetika   metabolismus   MeSH
• mikrocirkulace genetika   fyziologie   MeSH
• modely nemocí na zvířatech MeSH
• myši inbrední C57BL MeSH
• myši knockoutované MeSH
• myši MeSH
• sepse genetika   metabolismus   patofyziologie   MeSH
• střeva krevní zásobení   MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• inhibitory apoptózy MeSH