Serum concentration of adhesion molecules in postoperative biliary atresiapatients: Relationship to disease activity and cirrhosis

Background/Purpose: Biliary atresia (BA) is associated with progressive liv er fibrosis, which may be mediated by immunologic abnormalities involving a dhesion molecules. This study investigates the relationship between serum i ntercellular adhesion molecule-1 (sICAM-1), serum vascular cell adhesion mo lecule-1 (sVCAM-1), and the clinical and histologic severity of BA. Methods: Serum ICAM-1 and VCAM-1 levels were measured by enzyme-linked immu nosorbent assay in 35 patients with BA and 20 healthy controls. Standard li ver function tests (LFTs), and frozen section liver biopsy specimens were u sed to determine liver status. On the basis of LFT results, the BA patients were classified into group I (n = 10; normal LFTs), group II (n = 15; elev ated LFTs, anicteric), and group III (n = 10; elevated LFTs, icteric). Eigh t subjects in group II, and all subjects in group III had portal hypertensi on (PH). Results: sICAM-1 levels were significantly elevated in group III (1760.0 +/ - 717.5 ng/mL) compared with group II (555.1 +/- 199.4 ng/mL), group I (272 .1 +/- 59.9 ng/mL) and controls (256.3 +/- 71.6 ng/mL). Although sVCAM-1 le vels were significantly elevated in group III (1932.9 +/- 282.6 ng/mL) comp ared with group II (1054.3 +/- 297.0 ng/mL), group I (605.4 +/- 112.4 ng/mL ), and controls (616.0 +/- 112.0 ng/mL; P < .001), there was no statistical ly significant difference between groups I, II, or controls. sVCAM-1 levels were elevated significantly in BA subjects in group II with PH (1253.0 +/- 245.1 ng/mL) compared with those who did not have PH (827.3 +/- 151.7 ng/m L; P < .01). PH did not affect sICAM-1 levels. There was strong expression of ICAM-1 and VCAM-1 in proliferating bile ductules, endothelial cells, and liver cells in group III compared with group II and controls. Conclusions: In BA, sICAM-1 and sVCAM-1 levels could be useful as markers o f end-stage liver disease, with sVCAM-1 being more specific for PH. Inducti on of ICAM-1 and VCAM-1 may be an important factor in the development of ci rrhosis. J Pediatr Surg 36:1297-1301. Copyright (C) 2001 by W.B. Saunders C ompany.