Vascular endothelial growth factor and hypertrophic osteoarthropathy

Objective Hypertrophic osteoarthropathy (HOA) is characterized by the coexi stence of digital clubbing and periosteal proliferation of the tubular bone s. Localized vascular proliferation associated with platelet/endothelial ce ll activation are recognized features of this syndrome. Current knowledge s uggests that HOA develops from the presence in the systemic circulation of one or more growth factors that are normally inactivated in the lugs. The n ature of these purported growth factors has nor yet been identified. Vascul ar endothelial growth factor(VEGF) has several features that may fit in wit h the pathogenesis of HOA. The objective of our study was to measure serum and plasma levels of VEGF in different groups of patients with HOA. Methods We studied 24 patients with HOA; of these, in 12 the HOA was second ary to cyanotic congenital heart disease and in 7 to lung cancer, while 5 r epresented primary cases. As cona-ols lye studied 28 individuals without HO A; of these, 12 were apparently healthy individuals, 7 had cyanosis seconda ry to chronic obstructive pulmonary disease, and 9 had lung cancer ELISA wa s used to measure serum and plasma levels of VEGF. Results Plasma levels of VEGF were significantly higher in the patients wit h primary HOA (median 46.2; range 19.4 - 398.8 pg/ml) and in those with lun g cancer-HOA (median 75.5; range 24.6 - 166.7), compared to healthy control s (median 7.4; range: 0 - 26.1), p < 0.05. Serum VEGF levels were higher in patients with lung cancer and HOA (median 411.4; range 164.2 - 959.5 pg/ml ) compared with lung cancer patients without HOA (median 74.5; range 13.2 - 205.4), p < 0.001. Conclusions Patients with primary HOA and those with HOA and lung cancer ha ve increased circulating levels of VEGF This cytokine may play a role in th e pathogenesis of HOA.