Background/Aims: Skin biopsies allow for direct phenotyping of the endothelium in clinical settings. Objectives: We hypothesize that in murine sepsis endothelial activation is manifested by changes in protein and mRNA expression in skin biopsies, and that such alterations differ from other organs. Methods: In two mouse models of sepsis [endotoxemia and cecal ligation puncture (CLP)], we measured circulating levels of endothelial biomarkers, quantitated mRNA expression of activation markers and assayed for protein expression using immunohistochemistry. Results: Endotoxemic mice demonstrated increased circulating levels of sE-selectin, sICAM-1, sVCAM-1 and sP-selectin at 24 h, while CLP was associated with increased levels of sE-selectin alone. In real-time PCR, mRNA levels for P-selectin, ICAM-1 and PAI-1 were increased in skin from endotoxemic mice. In CLP, mRNA levels for P-selectin, ICAM-1, E-selectin and PAI-1 were elevated, while VCAM-1 expression was reduced in skin. Most, but not all of these changes correlated with alterations in immunohistochemical staining. Expression patterns in skin differed from those in brain, heart, and lung. Conclusions: Skin biopsies demonstrated endothelial cell activation during sepsis. The expression patterns differed by type of sepsis model and between vascular beds of skin, brain, heart, and lung, providing a foundation for identifying skin microvascular-bed-specific molecule signatures.

1.
Aird WC: The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003;101:3765–3777.
2.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303–1310.
3.
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP: The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 1995;273:117–123.
4.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–1377.
5.
Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;344:699–709.
6.
Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW: Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med 2003;31: 670–675.
7.
Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA: A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987;317:653–658.
8.
Friedman G, Silva E, Vincent JL: Has the mortality of septic shock changed with time. Crit Care Med 1998;26:2078–2086.
9.
Matsuda N, Hattori Y, Jesmin S, Gando S: Nuclear factor-kappaB decoy oligodeoxynucleotides prevent acute lung injury in mice with cecal ligation and puncture-induced sepsis. Mol Pharmacol 2005;67:1018–1025.
10.
Boldt J, Papsdorf M, Rothe A, Kumle B, Piper S: Changes of the hemostatic network in critically ill patients – is there a difference between sepsis, trauma, and neurosurgery patients? Crit Care Med 2000;28:445–450.
11.
Sessler CN: Steroids for septic shock: back from the dead? (Con). Chest 2003;123:482S–489S.
12.
Krafte-Jacobs B, Brilli R: Increased circulating thrombomodulin in children with septic shock. Crit Care Med 1998;26:933–938.
13.
Shapiro NI, Yano K, Okada H, Fischer C, Howell M, Spokes KC, Ngo L, Angus DC, Aird WC: A prospective, observational study of soluble Flt-1 and vascular endothelial growth factor in sepsis. Shock 2008;29:452–457.
14.
Aird WC: Endothelial Cell Heterogeneity. Stuttgart, Schattauer Verlag, 1997.
15.
Aird WC: Spatial and temporal dynamics of the endothelium. J Thromb Haemost 2005;3:1392–1406.
16.
Aird WC: Phenotypic heterogeneity of the endothelium. II. Representative vascular beds. Circ Res 2007;100:174–190.
17.
Aird WC: Phenotypic heterogeneity of the endothelium. I. Structure, function, and mechanisms. Circ Res 2007;100:158–173.
18.
Yano K, Liaw PC, Mullington JM, Shih SC, Okada H, Bodyak N, Kang PM, Toltl L, Belikoff B, Buras J, Simms BT, Mizgerd JP, Carmeliet P, Karumanchi SA, Aird WC: Vascular endothelial growth factor is an important determinant of sepsis morbidity and mortality. J Exp Med 2006;203:1447–1458.
19.
Gando S, Kameue T, Matsuda N, Hayakawa M, Hoshino H, Kato H: Serial changes in neutrophil-endothelial activation markers during the course of sepsis associated with disseminated intravascular coagulation. Thromb Res 2005;116:91–100.
20.
Briassoulis G, Papassotiriou I, Mavrikiou M, Lazaropoulou C, Margeli A: Longitudinal course and clinical significance of TGF-beta1, sL- and sE-selectins and sICAM-1 levels during severe acute stress in children. Clin Biochem 2007;40:299–304.
21.
Faust SN, Levin M, Harrison OB, Goldin RD, Lockhart MS, Kondaveeti S, Laszik Z, Esmon CT, Heyderman RS: Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 2001;345:408–416.
22.
Leone M, Boutiere B, Camoin-Jau L, Albanese J, Horschowsky N, Mege JL, Martin C, Dignat-George F: Systemic endothelial activation is greater in septic than in traumatic-hemorrhagic shock but does not correlate with endothelial activation in skin biopsies. Crit Care Med 2002;30:808–814.
23.
Turner GD, Ly VC, Nguyen TH, Tran TH, Nguyen HP, Bethell D, Wyllie S, Louwrier K, Fox SB, Gatter KC, Day NP, Tran TH, White NJ, Berendt AR: Systemic endothelial activation occurs in both mild and severe malaria. Correlating dermal microvascular endothelial cell phenotype and soluble cell adhesion molecules with disease severity. Am J Pathol 1998;152:1477–1487.
24.
Komatsu S, Flores S, Gerritsen ME, Anderson DC, Granger DN: Differential up-regulation of circulating soluble and endothelial cell intercellular adhesion molecule-1 in mice. Am J Pathol 1997;151:205–214.
25.
Henninger DD, Panes J, Eppihimer M, Russell J, Gerritsen M, Anderson DC, Granger DN: Cytokine-induced VCAM-1 and ICAM-1 expression in different organs of the mouse. J Immunol 1997;158:1825–1832.
26.
Eppihimer MJ, Wolitzky B, Anderson DC, Labow MA, Granger DN: Heterogeneity of expression of E- and P-selectins in vivo. Circ Res 1996;79:560–569.
27.
Lush CW, Cepinskas G, Sibbald WJ, Kvietys PR: Endothelial E- and P-selectin expression in iNOS-deficient mice exposed to polymicrobial sepsis. Am J Physiol Gastrointest Liver Physiol 2001;280:G291–G297.
28.
Bauer P, Lush CW, Kvietys PR, Russell JM, Granger DN: Role of endotoxin in the expression of endothelial selectins after cecal ligation and perforation. Am J Physiol Regul Integr Comp Physiol 2000;278:R1140–R1147.
29.
Rittirsch D, Hoesel LM, Ward PA: The disconnect between animal models of sepsis and human sepsis. J Leukoc Biol 2007;81:137–143.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.