Vascular endothelial growth factor (VEGF) is one of the cytokines causative and predictive of hepatic veno-occlusive disease (VOD) in stem cell transplantation

Hepatic veno-occlusive disease (VOD) is one of the most serious complicatio ns in patients receiving stem cell transplantation (SCT), However, the caus e of VOD remained to be elucidated. Vascular endothelial growth factor (VEG F) has been reported to have various physiological effects including neovas cularization and acceleration of vasopermeability, Because we postulated th at VEGF could be one of the causative factors in VOD after SCT, serum VEGF levels were measured by ELISA in 50 patients receiving SCT, Six of the pati ents showed typical manifestations of VOD and four of them died due to VOD, The mean maximum serum VEGF level in the six patients with VOD was markedl y increased compared to that in the patients without VOD (P < 0.001) and in normal controls (P < 0.001). Moreover, the mean maximum serum VEGF level i n patients with VOD before conditioning chemoradiotherapy for SCT was also high compared to patients without VOD (P = 0.0012) in the same period. Simi larly, serum VEGF levels were significantly higher in patients whose plasma protein C activities decreased below 40% (P < 0.001), During the clinical course of VOD after SCT, the increase of serum VEGF synchronized fairly wel l with the development of VOD, Since VEGF causes the expression of tissue f actor on circulating monocyte/ macrophages and results in hypercoagulabilit y, our observation suggests that in the patients with VOD who showed high s erum VEGF it might account for the development of VOD, Furthermore, this ob servation may indicate a novel therapeutic strategy for prevention of VOD.