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Important of Angiopoietic System in Evaluation of Endothelial Damage in Children with Crimean–Congo Hemorrhagic Fever

Sancakdar, Enver MD*; Guven, Ahmet S. MD; Uysal, Elif B. MD; Deveci, Köksal MD*; Gültürk, Esra PhD§

The Pediatric Infectious Disease Journal: August 2015 - Volume 34 - Issue 8 - p e200–e205
doi: 10.1097/INF.0000000000000706
Pathogenesis and Host Response

Background: Crimean–Congo hemorrhagic fever (CCHF) causes endothelial activation and dysfunction by affecting the endothelium directly or indirectly. In maintaining the vascular integrity, vascular endothelial growth factor (VEGF-A) and its receptor (VEGFR1) and angiopoietin-2 (Ang-2) and its receptor (Tie-2) are very important mediators. For this reason, we aimed at studying the association of Ang-2 and VEGF and their receptors Tie-2 and VEGFR1 with CCHF infection.

Methods: Thirty one CCHF patients and 31 healthy controls (HC) were included in the study. CCHF patients were classified into 2 groups in terms of disease severity (severe and nonsevere). VEGF-A, VEGFR1, Ang-2 and Tie-2 levels were measured in all groups.

Result: Serum levels of Tie-2, Ang-2, VEGF-A and VEGFR1 were significantly increased in CCHF patients compared with the HC. Furthermore, serum Tie-2, Ang-2, VEGF and VEGFR1 levels were found to be significantly higher in the severe group than in the nonsevere and HC groups (P < 0.05 and P < 0.001, respectively). Also, Tie-2, Ang-2, VEGF-A and VEGFR1 levels were significantly higher in the nonsevere group than in the HC group (P < 0.05).

Conclusion: Having statistically significant higher Ang-2, Tie-2, VEGF-A and VEGFR1 levels in the severe group when compared with the other groups suggested that VEGF-related Ang-2/Tie-2 system played a critical role in the pathogenesis of the disease, and these markers could be used as the severity criteria.

From the *Department of Biochemistry, Department of Pediatrics, Department of Microbiology, and §Department of Biostatistics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.

Accepted for publication February 20, 2015.

The authors have no conflicts of interest or funding to disclose.

Address for correspondence: Enver Sancakdar, MD, Department of Medical Biochemistry, Faculty of Medical, Cumhuriyet University, 58140 Sivas, Turkey. E-mail:

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