ELEVATED LEVELS OF CIRCULATING SOLUBLE ADHESION MOLECULES IN PATIENTSWITH NONRHEUMATIC AORTIC-STENOSIS

Aortic stenosis (AS) is the most common valvular lesion in the elderly in western societies. Previously this has been thought to be a degene rative condition, but recent data suggest an inflammtory process.1,2 R heumatic fever and congenital bicuspid valves are known predisposing f actors for the development of AS in young and middle-aged subjects, su ggesting that postinfectious immune reactions and mechanical trauma ma y be important etiologic factors. Immunohistochemical studies on nonrh eumatic tricuspid stenotic aortic valves obtained from symptomatic sub jects undergoing valve replacement and from autopsy specimens with mil d macroscopic leaflet thickening have demonstrated activated T lymphoc ytes in affected valves, suggesting that immune mechanisms may be invo lved in the pathogenesis.(1,2) The fundamental role of cellular adhesi on molecules in immunologic and inflammatory conditions has been eluci dated in the past few years. Adhesion molecules are expressed on vascu lar endothelium and on immune and inflammatory cells. They play a role in the migration of cells to sites of inflammation, transmigration of lymphocytes, and in immune effector functions. The molecules intercel lular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin are expressed on vascular endothelium and ser ve as ligands for counterreceptors on circulating inflammatory cells.( 3) Soluble adhesion molecules are detectable at low levels in serum of healthy people but are increased in various disorders, particularly i n those with inflammatory or vascular etiology. This study examines th e serum levels of the adhesion molecules ICAM-1, VCAM-1, and E-selecti n in a group of patients with nonrheumatic AS compared with healthy co ntrols.