Changes in endothelial microparticles and endothelial progenitor cells in obese patients in response to surgical stress.
BACKGROUND
Obese patients undergoing surgery are at increased risk of intraoperative and postoperative cardiovascular complications. The present study was designed to study the changes in endothelial microparticles, endothelial progenitor cells, and adipokines in obese patients in response to limb ischemia during knee surgery.


METHODS
This prospective study included seventy-four patients who underwent total knee arthroplasty. Patients were stratified in tertiles according to their body mass index. Flow cytometry was used for quantification and characterization of endothelial microparticles, endothelial progenitor cells, and adipokines. ELISA (enzyme-linked immunosorbent assay) was used to measure the adiponectin level.


RESULTS
The number of endothelial microparticles was greater in obese compared with nonobese patients. The number of endothelial microparticles increased further immediately after surgery in all tertiles. Three days after surgery, endothelial microparticles returned to the basal preoperative level except in the most obese patients. The percentage of endothelial progenitor cells was lower in obese patients. Concentrations of adipokines increased after surgery, but the increase was more accentuated in obese patients.


CONCLUSIONS
Obese patients present with a high number of endothelial microparticles, a low number of endothelial progenitor cells, and high levels of adipokines, with further increases in adipokines after surgery, suggesting an inflammatory condition that worsens after surgery and may affect endothelial repair.
Anesthesia Unit, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain.
Maria-Victoria
MV
Noci
Physiology Department Módulo II-Planta B, Alcalá de Henares University, Carretera Madrid-Barcelona kilómetro 33,600, 28805, Madrid, Spain.
Rafael
R
Ramírez
Anesthesia Unit, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain.
Mercedes
M
Lluch
Nephrology Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain. E-mail address for J. Carracedo: julia.carracedo.exts@juntadeandalucia.es.
Mariano
M
Rodríguez
Nephrology Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain. E-mail address for J. Carracedo: julia.carracedo.exts@juntadeandalucia.es.
Julia
J
Carracedo
D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D055252:Cell-Derived Microparticles / Q000473:pathology*; D066026:Endothelial Progenitor Cells / Q000473:pathology*; D004730:Endothelium, Vascular / Q000293:injuries* / Q000473:pathology*; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies