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Title: Alterations in Adipose Tissue during Critical Illness: An Adaptive and Protective Response?
Authors: Langouche, Lies ×
Vander Perre, Sarah
Thiessen, Steven
Gunst, Jan
Hermans, Greet
D'Hoore, André
Kola, Blerina
Korbonits, Márta
Van den Berghe, Greet #
Issue Date: Aug-2010
Publisher: American Lung Association
Series Title: American Journal of Respiratory and Critical Care Medicine vol:182 issue:4 pages:507-516
Abstract: Rationale: Critical illness is characterized by lean tissue wasting, whereas adipose tissue is preserved. Overweight and obese critically ill patients may have a lower risk of death than lean patients, suggestive of a protective role for adipose tissue during illness. Objectives: To investigate whether adipose tissue could protectively respond to critical illness by storing potentially toxic metabolites, such as excess circulating glucose and triglycerides. Methods: We studied adipose tissue morphology and metabolic activity markers in postmortem biopsies of 61 critically ill patients and 20 matched control subjects. Adipose morphology was also studied in in vivo biopsies of 27 patients and in a rabbit model of critical illness (n = 22). Measurements and Main Results: Adipose tissue from critically ill patients revealed a higher number and a smaller size of adipocytes and increased preadipocyte marker levels as compared with control subjects. Virtually all adipose biopsies from critically ill patients displayed positive macrophage staining. The animal model demonstrated similar changes. Glucose transporter levels and glucose content were increased. Glucokinase expression was up-regulated, whereas glycogen and glucose-6-phosphate levels were low. Acetyl CoA carboxylase protein and fatty acid synthase activity were increased. Hormone-sensitive lipase activity was not altered, whereas lipoprotein lipase activity was increased. A substantially increased AMP-activated protein kinase activity may play a crucial role. Conclusions: Postmortem adipose tissue biopsies from critically ill patients displayed a larger number of small adipocytes in response to critical illness, revealing an increased ability to take up circulating glucose and triglycerides. Similar morphologic changes were present in vivo. Such changes may render adipose tissue biologically active as a functional storage depot for potentially toxic metabolites, thereby contributing to survival.
URI: 
ISSN: 1073-449X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory for Intensive Care Medicine (-)
Laboratory for Clinical Infectious and Inflammatory Disorders
Abdominal Surgical Oncology
Laboratory of Intensive Care Medicine
× corresponding author
# (joint) last author

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