Serum hyaluronic acid in patients with veno-occlusive disease following bone marrow transplantation

The development of hepatic veno-occlusive disease following bone marrow tra nsplantation is associated with high-dose combination cytoreductive therapy . Experimental models have suggested that drug-induced inj to hepatic sinus oidal endothelial cells is involved in pathogenesis of this syndrome. Hyalu ronic acid is a polysaccharide that is metabolized, almost exclusively, by hepatic sinusoidal endothelial cells. The aim of the present study was to e valuate serum hyaluronic acid as a marker for endothelial cell injury in pa tients with veno-occlusive disease following bone marrow transplantation. H yaluronic acid was measured in sera from patients with and without veno-occ lusive disease using an enzyme-linked protein binding assay. Mean peak seru m hyaluronic acid levels were significantly greater in patients who had a d iagnosis of VOD compared to those transplant patients who did not, 1173.4 /- 982.9 vs 444.9 +/- 735.6 ng/ml (P = 0.01), Serial serum samples obtained from a separate cohort of patients also demonstrated that serum hyaluronic acid levels were higher in patients with moderate or severe veno-occlusive disease compared to those with none or mild disease at days 7, 17 and 25 f ollowing transplantation (greatest difference at day 25: 366 +/- 327 vs 126 +/- 151, P = 0.01), Serum hyaluronic acid levels are increased in veno-occ lusive disease and increase over time in patients with severe disease. Furt her studies are required to determine if elevated serum hyaluronic acid lev els are due to decreased clearance by injured hepatic sinusoidal endothelia l cells or increased production from early hepatic fibrogenesis associated with the acute liver injury.