Introduction
The pathophysiology and therapeutic options in sepsis-induced lung injury remain elusive. High Dose Interleukin-2 therapy (HDIL-2) is an important protocol for advanced malignancies but is limited by systemic inflammation and pulmonary edema that is indistinguishable from sepsis. In pre-clinical models, IL-2 stimulates angiopoietin-2 secretion, which increases endothelial permeability and causes pulmonary edema. However, these relationships have not been fully elucidated in humans. Further, the relevance of plasma angiopoietin-2 to organ function is not clear.
We hypothesized that plasma angiopoietin-2 concentrations increase during HDIL-2, and are relevant to clinical pathophysiology.
Methods
We enrolled 13 subjects with metastatic melanoma or renal cell carcinoma admitted to receive HDIL-2, and collected blood and spirometry data daily. The plasma concentrations of angiopoietin-2 and interleukin-6 were measured with ELISA.
Results
At baseline, the mean angiopoietin-2 concentration was 2.5 ng/mL (SD 1.0 ng/mL). Angiopoietin-2 concentrations increased during treatment: the mean concentration on the penultimate day was 16.0 ng/mL (SD 4.5 ng/mL) and increased further to 18.6 ng/mL (SD 4.9 ng/mL; p < 0.05 vs penultimate) during the last day of therapy. The Forced Expiratory Volume in one second (FEV-1) decreased during treatment. Interestingly, plasma angiopoietin-2 concentrations correlated negatively with FEV-1 (Spearman r=−0.78, p < 0.0001). Plasma angiopoietin-2 concentrations also correlated with plasma interleukin-6 concentrations (r = 0.61, p < 0.0001) and Sequential Organ Failure Assessment (SOFA) scores (r = 0.68, p < 0.0001).
Conclusions
Plasma angiopoietin-2 concentrations increase during HDIL-2 administration, and correlate with pulmonary dysfunction. HDIL-2 may serve as a clinical model of sepsis and acute lung injury. Further investigation is warranted.
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