SOLUBLE CIRCULATING CELL-ADHESION MOLECULES IN HEMOLYTIC-UREMIC SYNDROME

Plasma concentrations of soluble vascular cell adhesion molecule-1 (sV CAM-1), E-selectin (sE-selectin) and intercellular adhesion molecule-1 (sICAM-1) were measured by enzyme-linked immunosorbent assay in four groups of children. Group 1 consisted of 20 patients with acute diarrh oea-associated haemolytic uraemic syndrome (D+HUS), the aetiology of H US being verocytotoxin-producing Escherichia coli infection in each ca se. Controls consisted of 11 patients who had previously had D+HUS (gr oup 2), 12 with chronic renal failure (group 3) and 8 healthy controls (group 4). When compared with healthy controls, the acute D+HUS group had higher sVCAM-1 (median 1,875 ng/ml, range 1,200-6,450 ng/ml vs. 1 ,200 ng/ml, range 975-2,125 ng/ml), von Willebrand factor antigen, (1. 9 U/ml, range 0.85-5.1 U/ml vs. 0.55 U/ml, range 0.3-1.57 U/ml), white cell count (WBC, 14.5x10(9)/l, range 7.8-43.1 10(9)/l vs. 8.9 10(9)/l , range 5.7-10.8 10(9)/l) and neutrophil count (PMN, 10.1x10(9)/l, ran ge 4.3-26.5 10(9)/l vs. 4.3 10(9)/l, range all P<0.005, and sICAM-1 wa s reduced (230 ng/ml, range 130-340 ng/ml vs. 400 ng/ml, range 260-690 ng/ml), P<0.05. Within the acute D+KUS group there was a significant correlation between sICAM-1 and PMN (r=0.56, P<0.01). There was no cor relation between any adhesion molecule and plasma creatinine or von Wi llebrand factor. Comparing the acute HUS group with children with chro nic renal failure, WBC (P<0.001), PMN (P<0.01) and sVCAM-1 (P<0.01) we re significantly elevated, but then was no difference between the von Willebrand factor (P=0.08) or the sICAM-1 (P>0.1). sVCAM-1 is elevated and sICAM-1 decreased in acute DI-HUS. This pattern of altered adhesi on molecule concentration is unlike that in adults with vasculitis and suggests that different endothelial regulatory factors are at play.