THE WHITE BLOOD-CELL ADHESION MOLECULE E-SELECTIN PREDICTS RESTENOSISIN PATIENTS WITH INTERMITTENT CLAUDICATION UNDERGOING PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY

Background Experimental studies have shown that endothelial dysfunctio n is an early event preceding restenosis. Monocytes and neutrophils ha ve been shown to bind to damaged endothelium via the cell adhesion mol ecules (CAMs). The selectins are involved in capturing the leukocytes and tethering them to the endothelium. E-selectin is a CAM that is onl y expressed on activated endothelial cells. Its ligands are expressed on monocytes and neutrophils and it has been found to exist in a solub le form. This soluble form may represent a marker for endothelial dama ge and may be a precursor of smooth muscle proliferation. Methods and Results Fifty-four patients who were undergoing peripheral arterial ba lloon angioplasty had blood sampled before angioplasty. E-selectin was measured in plasma with the use of an ELISA. At follow-up angiogram, 30% (n=14) of the patients had restenosed at 1 year. There was a signi ficant difference in baseline E-selectin levels in patients who resten osed compared with those who did not (65.3 ng/mL, [58.25 to 78.05] ver sus 52.3 [34.2 to 62.1], Mann-Whitney U, P<.007). Endothelial activati on with subsequent adherence of white blood cells is an important step in restenosis. Conclusions We have shown an increased level of shed E -selectin in patients destined for restenosis and suggest that this wo rk further supports a role for white blood cell/endothelial interactio n in restenosis after angioplasty.