Monitoring of endothelial leucocyte adhesion molecule-1 in anti-neutrophil-cytoplasmic-antibody-positive vasculitis

• Published in: American journal of nephrology Vol. 16; no. 2; p. 106
• Main Authors: Yaqoob, M, West, D C, McDicken, I, Bell, G M
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-1996
• Subjects: Adult; Aged; Antibodies, Antineutrophil Cytoplasmic - blood; C-Reactive Protein - metabolism; E-Selectin - blood; Female; Glomerulonephritis - blood; Glomerulonephritis - complications; Granulomatosis with Polyangiitis - blood; Granulomatosis with Polyangiitis - complications; Humans; Longitudinal Studies; Male; Middle Aged; Monitoring, Physiologic; von Willebrand Factor - metabolism
• ISSN: 0250-8095
• DOI: 10.1159/000168980

Soluble endothelial leucocyte adhesion molecule-1 (ELAM-1) has been shown to act as a neutrophil chemoattractant and may also represent a specific marker of endothelial cell damage or activation. Nine patients with anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis (p-ANCA: n = 4, c-ANCA: n = 5) were prospectively monitored for disease activity by serial serum ELAM-1, C-reactive proteins (CRPs), von Willebrand factor (vWF) and ANCA levels. Six patients presented acutely with biopsy-proven renal vasculitis. One patient on dialysis, one in remission with stable renal function and one renal transplant patient developed clinical and serological relapse. Seven patients had abnormally high ELAM-1 (>60 ng/ml) levels at presentation. These fell within normal limits a week following pulse methyl prednisolone therapy. This preceded a fall in CRP, vWF and subsequent clinical remission. p-ANCA serology remained positive in 3 cases. One patient relapsed with rising ELAM-1 levels. Two patients developed erroneously positive ANCA serology but serum ELAM-1 remained normal. Six patients with chronic renal impairment of non-vasculitic origin who presented acutely with septicaemia had normal serum ELAM-1 levels (mean +/- SD: 31 +/- 10 ng/ml) at presentation and during the subsequent clinical course. These preliminary findings are encouraging, especially when ELAM-1 is combined with ANCA monitoring in vasculitis. However, further data from larger controlled studies are needed to validate the utility of ELAM-1 in the monitoring of patients with vasculitis.