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Authors:  (Luca Siracusano, Viviana Girasole)
Abstract:
Adiponectin is an adipokine provided with antiatherosclerotic, insulin sensitizing, anti-inflammatory and cardioprotective actions.
The adipose tissue, considered in the past as a long-term energy storage organ with a relatively reduced metabolic activity, is now considered as an important player in the regulation of the metabolism and of the immune function carrying out a fundamental role in the outcome of the critically ill patient.
The finding of a paradoxical reduction of adiponectin, produced almost exclusively in the adipose tissue, in obesity, diabetes, metabolic syndrome, sepsis and critical diseases have led to study the significance of the serum levels of this adipokine showing they are strictly related to the outcome in critically ill patients.
Considering that sepsis is characterized by a disregulated inflammatory reaction and the important role that the reduced insulin sensitivity has been attributed to in the septic patient it is not surprising that hypoadiponectinemia may have a prognostic role in this setting by influencing metabolism and immune system.
Adiponectin is downregulated during experimental ischemia-reperfusion injury but it is provided with a powerful cardioprotective action through the activation of the enzymes of the Reperfusion Injury Salvage Kinase (RISK) pathway Akt\PI3K and through the inhibition of mitochondrial permeability pore transition . The cardioprotection conferred by adiponectin is also mediated by its ability to induce myocardial preconditioning.
The altered secretion of adipokines in sepsis is probably connected to the dysfunction adipose tissue undergoes in this disease characterized by reduced insulin sensitivity, inflammation, metabolic dysfunction reciprocally impairing themselves.
Hypoadiponectinemia in sepsis may be set in a picture of adipose tissue dysfunction, called adiposopathy, and characterized not only by accumulation of fat but also by the
inability of adipose tissue to store correctly lipid giving rise to the lipotoxicity and organ damage. Adiponectin may potentially correct many of the metabolic alterations present in sepsis impacting strongly on outcome. This complex of protective activities may explain the relationships between adiponectin serum levels and the outcome in the septic and critically ill patient. 


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Sepsis and adiponectin (pp. 81-104)