The role of the microcirculation in multiple organ dysfunction syndrome (MODS): a review and perspective

Abstract

Major advances in intensive care medicine during the past two decades have altered the spectrum of disease encountered by intensive care physicians, anaesthesiologists, traumatologists and pathologists. One of the most important manifestations of severe trauma or infections is the multiple organ dysfunction syndrome (MODS), a life-threatening condition that often ends in multiple organ failure (MOF) and death. Evidence gathered from clinical and morphological observations in humans, taken together with experimental animal studies and a vast accumulation of in vitro data, clearly indicate that the microcirculation lies at the centre of this complex process, which results in peripheral vascular insufficiency, inadequate oxygen delivery to vital organs, and hence, severe organ dysfunction. The multifunctional nature of the endothelium makes it a prime candidate for study of the pathomechanisms of MODS. This paper reviews the evidence for the hypothesis that the microcirculation, and in particular its endothelial component, has a central role in the pathogenesis of MODS. The evidence is reviewed principally from the standpoints of classical morbid anatomy and cell pathobiology.

Effect of Fluid Resuscitation with and without Endothelin A Receptor Blockade on Hemoconcentration and Organ Function in Experimental Pancreatitis

“…Research in this field with promising results even in severe human AP has lately been focusing on vasoactive substances which appear to affect organ function by impairing microcirculation and increasing vascular permeability [18,19]. With a view to preclinical testing of a novel treatment to further reduce these early complications in AP, this study characterizes fluid loss and sequestration as well as parameters reflecting cardiorespiratory and renal function in the early course of a well-established rat model of severe AP.…”

Interaction of Bartonella henselae with Endothelial Cells Promotes Monocyte/Macrophage Chemoattractant Protein 1 Gene Expression and Protein Production and Triggers Monocyte Migration

“…They control vascular permeability, regulate coagulation and thrombosis, direct passage of leukocytes into areas of inflammation, and produce pro-inflammatory cytokines such as IL-1, IL-6, IL-8, and adhesion molecules. Vascular endothelial cells line the luminal side of blood vessels and mediate interactions between blood and tissue (10,23). Although they are not professional phagocytes, endothelial cells express toll-like receptors (tlr) which can be activated in response to pattern recognition molecules and therefore play a role in innate immunity.…”

Generation of Human Pulmonary Microvascular Endothelial Cell Lines

“…Neither HUVEC that are of macrovascular embryonic origin nor the currently available permanent cells lines are representative for adult microvascular endothelium. Relevant cell culture models are crucial to the study of the pathobiology of the lung microvascular endothelium and an understanding of lung metastasis (Lehr et al, 2000) and disorders such as acute respiratory distress syndrome (Kirkpatrick et al, 1996).…”