VASCULAR ENDOTHELIAL LESION IN PATIENTS UNDERGOING BONE-MARROW TRANSPLANTATION

Changes in endothelial cell activity are likely to play a role in the thrombotic complications of bone marrow transplantation (BMT) such as the development of veno-occlusive disease, Accordingly, we measured es tablished plasma endothelial cell markers von Willebrand factor (vWf), soluble thrombomodulin (sTM), soluble ICAM-1 (sICAM-1), and possible inducers of these molecules, TNF alpha and elastase, in the plasma of 25 patients, 1 week before as well as 1 and 3 weeks after BMT. Compare d to healthy age and sex-matched controls, patients exhibited increase d vWf and sTM. One week after transplantation, there were significant increases in vWf and sICAM-1, with a significant fall in elastases, Th ree weeks after the transplantation, sICAM-1 and, to a lesser extent, vWf increased still further, whereas elastases were unchanged, There w ere no significant changes in sTM and in TNF alpha through the serial study. Our data suggest that before conditioning, vascular endothelium is damaged by both injury and activation, as seen by the variations o f vWf and sTM. After transplantation, the enhancement of this damage s eems to be more specifically related to activation, since we observed a strong subsequent increase in vWf and markedly in sICAM-1.