Department of Pediatrics I, University Children's Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.
Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.
PLoS One. 2020 Jan 27;15(1):e0227460. doi: 10.1371/journal.pone.0227460. eCollection 2020.
The acute respiratory distress syndrome (ARDS) is characterized by pulmonary epithelial and endothelial barrier dysfunction and injury. In severe forms of ARDS, extracorporeal membrane oxygenation (ECMO) is often the last option for life support. Endothelial progenitor (EPC) and mesenchymal stem cells (MSC) can regenerate damaged endothelium and thereby improve pulmonary endothelial dysfunction. However, we still lack sufficient knowledge about how ECMO might affect EPC- and MSC-mediated regenerative pathways in ARDS. Therefore, we investigated if ECMO impacts EPC and MSC numbers in ARDS patients.
Peripheral blood mononuclear cells from ARDS patients undergoing ECMO (n = 16) and without ECMO support (n = 12) and from healthy volunteers (n = 16) were isolated. The number and presence of circulating EPC and MSC was detected by flow cytometry. Serum concentrations of vascular endothelial growth factor (VEGF) and angiopoietin 2 (Ang2) were determined.
In the ECMO group, MSC subpopulations were higher by 71% compared to the non-ECMO group. Numbers of circulating EPC were not significantly altered. During ECMO, VEGF and Ang2 serum levels remained unchanged compared to the non-ECMO group (p = 0.16), but Ang2 serum levels in non-survivors of ARDS were significantly increased by 100% (p = 0.02) compared to survivors.
ECMO support in ARDS is specifically associated with an increased number of circulating MSC, most likely due to enhanced mobilization, but not with a higher numbers of EPC or serum concentrations of VEGF and Ang2.
急性呼吸窘迫综合征（ARDS）的特征是肺上皮和内皮屏障功能障碍和损伤。在严重的 ARDS 中，体外膜氧合（ECMO）通常是生命支持的最后选择。内皮祖细胞（EPC）和间充质干细胞（MSC）可以再生受损的内皮，从而改善肺内皮功能障碍。然而，我们仍然缺乏足够的知识，了解 ECMO 如何影响 ARDS 中的 EPC 和 MSC 介导的再生途径。因此，我们研究了 ECMO 是否会影响 ARDS 患者的 EPC 和 MSC 数量。
从接受 ECMO（n = 16）和未接受 ECMO 支持（n = 12）的 ARDS 患者以及健康志愿者（n = 16）中分离外周血单核细胞。通过流式细胞术检测循环 EPC 和 MSC 的数量和存在。测定血清血管内皮生长因子（VEGF）和血管生成素 2（Ang2）的浓度。
在 ECMO 组中，MSC 亚群比非 ECMO 组高 71%。循环 EPC 数量没有明显变化。在 ECMO 期间，与非 ECMO 组相比，VEGF 和 Ang2 血清水平保持不变（p = 0.16），但 ARDS 非幸存者的 Ang2 血清水平增加了 100%（p = 0.02）。
ARDS 中的 ECMO 支持与循环 MSC 数量的增加有关，这很可能是由于动员增加所致，但与 EPC 数量或 VEGF 和 Ang2 的血清浓度无关。
