ENDOTHELIAL ACTIVATION IN PATIENTS WITH CHRONIC DISEASE

Objectives: Leukocyte trapping due to leukocyte-endothelial activation has been implicated as the cause of lipodermatosclerosis and ulcerati on in patients with chronic venous disease. We investigated endothelia l activity in normal controls and patients subjected to short-term ven ous hyper-tension. Methods: Twenty-five normal volunteers and 30 patie nts with chronic venoms disease divided into two groups: varicose vein s with skin changes (LDS, n=15); and varicose veins without skin chang es (VVs, n=15) were studied. Blood samples were taken from a foot vein before and after experimental venous hypertension. Plasma levels of E LAM-1 (endothelial leukocyte adhesion molecule-1), ICAM-1 (intercellul ar adhesion molecule-1), VCAM-1 (vascular cell adhesion molecule-1), a nd von Willebrand factor (vWf) was measured by an ELISA. Results: Ther e aas a significant rise in the plasma concentration of ELAM-1, ICAM-1 and VCAM-1 in patients and normal controls in response to venous hype rtension. Basal levels of plasma VCAM-1 and vWf were higher in patient s with LDS compared to patients with VVs. The magnitude of rise of VCA M-1 was greater in Patients with LDS compared to patients with VVs (p = 0.01, Mann-Whitney U-test). There was no difference in the basal lev els or in the magnitude of change in plasma ICAM-1 and ELAM-1 between the two patient groups. Conclusion: Venous hypertension results in end othelial activation which may aid endothelial-leukocyte adhesion. Pati ents with LDS exhibit increased VCAM-1, which is a counterligand for r eceptors expressed by monocytes and lymphocytes signifying that these cells may be more important in the development of skirt changes.