MONITORING OF ENDOTHELIAL-LEUKOCYTE ADHESION MOLECULE-1 IN ANTI-NEUTROPHIL-CYTOPLASMIC-ANTIBODY-POSITIVE VASCULITIS

Soluble endothelial leucocyte adhesion molecule-1 (ELAM-1) has been sh own to act as a neutrophil chemoattractant and may also represent a sp ecific 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 Will ebrand factor (vWF) and ANCA levels. Six patients presented acutely wi th biopsy-proven renal vasculitis. One patient on dialysis, one in rem ission with stable renal function and one renal transplant patient dev eloped clinical and serological relapse. seven patients had abnormally high ELAM-1 (>60 ng/ml) levels at presentation. These fell within nor mal limits a week following pulse methyl prednisolone therapy. This pr eceded a fall in CRP, vWF and subsequent clinical remission. p-ANCA se rology remained positive in 3 cases. One patient relapsed with rising ELAM-1 levels. Two patients developed erroneously positive ANCA serolo gy but serum ELAM-1 remained normal. Six patients with chronic renal i mpairment of non-vasculitic origin who presented acutely with septicae mia had normal serum ELAM-1 levels (mean +/- SD: 31 +/- 10 ng/ml) at p resentation and during the subsequent clinical course. These prelimina ry findings are encouraging, especially when ELAM-1 is combined with A NCA monitoring in vasculitis. However, further data from larger contro lled studies are needed to validate the utility of ELAM-1 in the monit oring of patients with vasculitis.