North Trent Critical Care Network

Written by Critical Care Endothelial injury has emerged as a crucial early event in the pathogenesis of microcirculatory dysfunction, capillary leakage and multi-organ dysfunction syndrome (MODS). Recently, the endothelial-specific Angiopoietin (Ang)/Tie2 ligand-receptor system has been identified as a non-redundant regulator of endothelial responsiveness. Ang-1 is a Tie-2 agonist and promotes endothelial stabilization and quiescence, whereas Ang-2 is a Tie-2 antagonist and promotes endothelial activation, destabilization, and inflammation. While the mediator function of both, Ang-1 and Ang-2 has been well established in preclinical research, only Ang-2 has been identified as a clinically useful biomarker in the critical care arena. In this issue of Critical Care, Mankhamo et al. report on angiogenic factors in Malawian children with severe bacterial infection. Among those, diminished levels of the vessel-protective factor Angiopoietin-1 remained a significant predictor of outcome after multivariate adjustment. It remains to be seen whether low Ang-1 represents an important risk factor of adverse outcome in critically ill adults.

Authors: Sascha David

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