CLINICAL STUDY: VALVE DISEASE
Adhesion molecules in nonrheumatic aortic valve disease: endothelial expression, serum levels and effects of valve replacement
Nitin K. Ghaisas, MD, MRCPI*,
J. Brendan Foley, MD, MRCP*,
D. Sean O’Briain, MRCPath ,
Peter Crean, FRCPI*,
Dermot Kelleher, MD, MRCPI and
Michael Walsh, MD, FRCPI, FACC*
* Department of Cardiology, St. James’s Hospital, Dublin, Ireland
Department of Pathology, St. James’s Hospital, Dublin, Ireland
Department of Clinical Medicine, St. James’s Hospital, Dublin, Ireland
Manuscript received January 20, 2000;
revised manuscript received June 1, 2000,
accepted July 14, 2000.
Reprint requests and correspondence: Dr. Brendan Foley, Department of Cardiology, CREST Directorate, St. James’s Hospital, James’s Street, Dublin 8, Republic of Ireland
bfoley{at}tcd.ie
OBJECTIVES
We studied the expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and endothelial selectin (E-selectin) on aortic valve endothelium in patients undergoing valve replacement. We also assessed the relation between serum levels and endothelial expression and also the changes in serum levels following surgery.
BACKGROUND
Nonrheumatic aortic valve disease is believed to be a degenerative condition. Increased tissue and soluble adhesion molecule levels are described in inflammatory conditions.
METHODS
Aortic valves from 22 surgical (16 bicuspid, 6 tricuspid) and 6 autopsy (4 normal, 2 thickened) cases were studied by immunohistochemistry. Soluble adhesion molecules were measured in peripheral blood preoperatively, and at 6 and 18 months postoperatively, and compared with controls.
RESULTS
The majority of the surgically removed tricuspid and bicuspid valves expressed adhesion molecules (E-selectin, 75% and 100%; ICAM-1, 75% and 80%; VCAM-1, 69% and 60%, respectively). The normal postmortem valves did not express these, while the diseased ones did. Endothelial expression of E-selectin correlated strongly with serum levels (r = 0.695, p = 0.004). Soluble E-selectin levels were significantly higher at baseline compared with controls (p = 0.017) and fell significantly at 18 months postoperatively (p = 0.005).
CONCLUSIONS
Adhesion molecule expression on diseased valves supports an inflammatory component in "degenerative" aortic valve disease. The diseased valves may be the main source of elevated soluble E-selectin in this condition as blood levels correlate with endothelial expression and blood levels fall at 18 months postoperatively.
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Abbreviations and Acronyms
| | AR | = aortic regurgitation | | AS | = aortic stenosis | | AV | = aortic valve | | CAM(s) | = cellular adhesion molecule(s) | | ELISA | = enzyme-linked immunosorbent assay | | E-selectin | = endothelial selectin | | ICAM-1 | = intercellular adhesion molecule 1 | | TRIS | = trishydroxymethylaminomethane | | VCAM-1 | = vascular cell adhesion molecule 1 |
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