Serum levels of soluble adhesion molecules in stem cell transplantation-related complications

Abstract

Summary:To assess the involvement of vascular endothelial cell activation and damage in stem cell transplantation (SCT)-related complications, such as acute and chronic GVHD and thrombotic microangiopathy (TMA), we investigated the changes in serum levels of soluble forms of vascular cell adhesion molecule-1 (sVCAM-1) and Eselectin (sE-selectin) in SCT. The soluble form of intercellular adhesion molecule-1 (sICAM-1) was also analyzed. In patients with acute GVHD (grades II-IV), serum levels of sE-selectin and sICAM-1 increased around onset of GVHD (day 30). While the increase of sE-selectin levels was transient, sICAM-1 levels remained high until day 60. In patients with extensive chronic GVHD, sVCAM-1 as well as sE-selectin levels significantly increased. The appearance of clinical symptoms was preceded by elevations of sVCAM-1 and sE-selectin levels on day 60, and sICAM-1 levels on days 30 and 60. For the analysis of TMA, to exclude the influence of GVHD, serum levels were measured in auto-SCT patients. Around the onset of TMA, sVCAM-1 and sE-selectin levels significantly increased in patients with TMA without an increase of sICAM-1 levels. These findings support the notion that activation and injury of endothelium are commonly involved in the pathogenesis of acute and chronic GVHD and TMA. Bone Marrow Transplantation (2001) 27, 977-982.

In vitro monitoring of endothelial complications following hematopoietic allogeneic stem cell transplantation

“…9 In line with the cited report, we found that maximal VCAM-1 release into patients' serum in the first 100 days post SCT correlated with GvHD (P ¼ 0.03; data not shown), suggesting that, indeed, serum analyses not only reflect damage but also allow activation of endothelial cells.…”

Transplant-associated microangiopathy (TAM) in recipients of allogeneic hematopoietic stem cell transplants

“…3,12 Patients meeting criteria of TAM but without aGvHD were more likely to have received grafts with major or bidirectional ABO blood group barrier (Po0.025), further supporting this hypothesis. Increased soluble vascular cell adhesion molecules reported in GvHD and TAM 41 as markers of endothelial damage may represent a common pathophysiologic pathway. Elevated number of circulating endothelial cells may be useful for diagnosis.…”

“…To further test these hypotheses, measures of endothelial damage may be helpful. 2,3,41 Plasma exchange has been used extensively to treat TAM but is now not considered to be effective. Plasma exchange is used in classical TTP and this use is in accordance with today's understanding of its pathophysiology.…”

The role of the endothelium in the short-term complications of hematopoietic SCT

“…Takatsura et al 23 did not observe any impact of TBI on VWF and TM levels. Matsuda et al 24 investigated the serum levels of sVCAM-1, sE-selectin and sICAM-1 in HSCT, excluding patients with severe infections. They showed that all soluble adhesion molecules increased after HSCT (day þ 30) and that levels were higher after allo-compared with auto-HSCT.…”