Serum concentrations of vascular endothelial growth factor and monocyte-colony stimulating factor in peripheral arterial disease

Vascular endothelial growth factor (VEGF) strongly promotes angiogenesis, and monocyte-colony stimulating factor (M-CSF) regulates the differentiation, proliferation, and survival of monocytes. Both VEGF and M-CSF are expressed in atherosclerotic lesions. The present study was performed to clarify the role of VEGF and M-CSF in the development of peripheral artery disease (PAD). The serum VEGF and M-CSF concentrations were determined in patients with arteriosclerosis obliterans (ASO) and thromboangitis obliterans (TAO). In both patient groups the serum VEGF concentrations were significantly higher than those in the control subjects. In contrast, the serum M-CSF concentrations in the ASO patients were significantly higher than those in both the TAO patients and control subjects, but there were no differences in the M-CSF concentrations between the TAO patients and control subjects. There was no correlation between the serum concentrations of VEGF and M-CSF. In conclusion, the serum VEGF concentration was increased in ASO and TAO patients, but increased concentration of M-CSF was seen only in ASO patients. These results may reflect a difference between ASO and TAO in disease pathogenesis.

Immunological indicators of morbidity in human schistosomiasis mansoni: role of vascular endothelial growth factor and anti-soluble egg antigen IgG4 in disease progression

Based sonographic examinations of 90 schistosomiasis mansoni, they were divided into five groups: lightly infected, heavily infected, intestinal, early hepatosplenic and periportal fibrosis. Using ELISA, the levels of circulating vascular endothelial growth factor (VEGF) and anti-soluble egg antigen (SEA) IgG4 were measured in their sera. Compared to normal controls, VEGF levels were significantly raised in all schistosomiasis patients groups except lightly infected and intestinal patients were insignificantly elevated. The level of VEGF correlated with disease progression from lightly infected to periportal fibrosis patients. It also correlated with sonographic indicators of portal hypertension; presence of portosystemic collaterals, portal vein dilatation and splenomegaly. Serum IgG4 was significantly raised in only periportal fibrosis and portal hypertension patients. The results provided evidence that circulating levels of VEGF can serve as a new indicator of progression of schistosomiasis mansoni reflecting angiogenesis that regulates the granuloma and fibrosis development in liver while IgG4 seemed to be an indicator of only fibrosis development. Both are potential sensitive markers for effectiveness of treatment in periportal fibrosis patients. The understanding of the key role of VEGF in schistosomiasis mansoni pathogenesis may provide a new pharmacological target.

The role of circulating IL-8 and VEGF protein in the progression of gastric cancer

Both vascular endothelial growth factor (VEGF) and interleukin 8 (IL-8) play an important role in the progression of gastric cancer (GC). In this study, we investigated whether circulating levels of VEGF or IL-8 in drainage veins of GC patients were correlated with any clinicopathological factors. Thirty-seven patients with primary GC who underwent gastrectomy at our department between 1999 and 2002 were analyzed. Blood samples were drawn from a peripheral vein just before surgery and from a drainage vein immediately after laparotomy. Plasma VEGF levels were significantly higher than those in 10 healthy controls. There was no correlation between VEGF levels in drainage veins and any clinicopathological variable, whereas there was a significant relationship in the case of VEGF levels in peripheral veins; the levels were higher in patients with venous invasion. We found a significant relationship between IL-8 levels in drainage veins and both tumor size and lymph node metastasis, whereas no significant relationship between IL-8 levels in peripheral veins and any variable was found. There was no correlation between VEGF and IL-8 levels in drainage veins. Large tumors, deeply invasive tumors, lymph node involvement, venous invasion and high IL-8 levels in drainage veins were all significantly associated with shorter disease-free survival, although multivariate analysis revealed that lymph node involvement was the only independent prognostic factor. In conclusion, the measurement of IL-8 levels in drainage veins of GC patients may reflect production mainly by the primary lesion and is valuable as an indicator of risk for recurrent disease.

Effects of oxygen administration on the circulating vascular endothelial growth factor (VEGF) levels in patients with obstructive sleep apnea syndrome

OBJECTIVE

Repeated nocturnal hypoxia is implicated in the pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS). We hypothesized that circulating vascular endothelial growth factor (VEGF) levels are affected by nocturnal hypoxemia in patients with OSAS.

METHODS

We examined the serum VEGF levels in patients with OSAS and in control subjects. We also tested the effects of oxygen or air administration on the subjects' VEGF levels.

PATIENTS AND MATERIALS

Twenty-four OSAS patients (mean age 54.2 +/- 3.6 years) and 24 age-matched control subjects (53.2 +/- 3.6 years). Their serum samples were tested.

RESULTS

Serum VEGF levels at 8:00 AM were significantly higher in OSAS patients than in controls (p<0.01). VEGF levels decreased from 515 +/- 31 (pg/ml) to 178 +/- 16 (pg/m) (p<0.01) in OSAS patients whose nocturnal hypoxemia was found to be improved by administration of 2 l/min of oxygen during the night. However, the administration of compressed air affected neither the VEGF level nor nocturnal oxygen desaturation in OSAS patients.

CONCLUSION

These results indicate that circulating VEGF levels are elevated in OSAS patients, primarily due to nocturnal hypoxemia.

[Role of vascular endothelial growth factor (VEGF) in development and progress of refractory acute myeloid leukemia]

BACKGROUND & OBJECTIVE

The mechanism of refractory leukemia is very complex. Recent studies have shown that overexpression of vascular endothelial growth factor (VEGF) was detected in bone marrow from acute myeloid leukemia (AML) patients, suggesting it may play an important role in AML. However,the effect of VEGF in the development of refractory leukemia is not clear. The current study was designed to explore the effect of overexpression of VEGF on the abnormal proliferation and harringtonine-induced apoptosis of HL-60 cells and to observe VEGF expression in the progression of refractory AML.

METHODS

HL-60 cells were transfected with the VEGF(165)cDNA sense vector (HL-60/VEGF(165)) and with the pcDNA3.1-vector (HL-60/neo) as the control using lipofectamine. Reverse transcription-polymerase chain reaction (RT-PCR) was used to determine VEGF mRNA. VEGF concentrations in the cell cultural supernatant were determined by enzyme linked immunosorbent assay (ELISA). Cell proliferation was determined by MTT and colony forming assay in vitro.Flow cytometric Annexin-V-FITC/PI dual labeling technique was performed to observe the effect of VEGF(165) cDNA transfection on harringtonine-induced apoptosis of HL-60 cells. ELISA was used to detect VEGF concentrations in the plasma from refractory and non-refractory AML patient.

RESULTS

The mean VEGF concentration in the cell cultural supernatant of HL-60/VEGF(165) cells (399.07+/-12.45 ng/L) was 2-folds higher than that in HL-60/neo cells (184.45+/-10.53 ng/L)(P< 0.01). The VEGF(165)cDNA sense vector transfected HL-60 exhibited a 2-fold increase in VEGF secretion. The growth rate of HL-60/VEGF(165) cells was significantly higher than those of the controls, and colony formation capacity of HL-60/VEGF(165) increased significantly(P< 0.05);the colony numbers were (157.00+/-17.00)/500 cells and (110+/-12.90)/500 cells for HL-60/VEGF(165) and HL-60/neo, respectively. HL-60/VEGF(165) had less apoptotic cells than HL-60/neo in the same culture condition. High expression of VEGF could reduce the harringtonine-induced apoptosis of HL-60 cells. Refractory AML patients had higher mean plasma VEGF levels (558.90+/-271.25 ng/L) than non-refractory patients(392.54+/-217.82 ng/L), and significant difference was observed between them (P< 0.05).

CONCLUSION

VEGF expression in refractory AML patients is higher than that in non-refractory AML patients. VEGF plays an important role in the abnormal proliferation and apoptosis of AML cells. High expression of VEGF could reduce the harringtonine- induced apoptosis of HL-60 cells.

Circulating VEGF and its soluble receptors sVEGFR-1 and sVEGFR-2 in patients with acute leukemia

Angiogenesis plays an important role in the pathogenesis of acute leukemia, and vascular endothelial growth factor (VEGF) is a crucial, positive regulator of this process. The biological activity of VEGF is mediated by two different receptor tyrosine kinases: VEGFR-2 and VEGFR-1. The soluble form of VEGFR-1 is likely to be a negative regulator of VEGF availability, but the physiological role of sVEGFR-2 is still unclear. The plasma levels of sVEGFR-1 and sVEGFR-2 in patients with acute leukemia have not been investigated. We measured the plasma concentrations of VEGF and its two soluble receptors in 39 AML and 15 ALL patients as well as in the control group, using the ELISA assay. We also correlated the plasma levels of these proteins with disease status and known prognostic factors. The sVEGFR-1 level was significantly higher in patients with AML and ALL than in the healthy subjects (p < 0.002 and p < 0.03 respectively). The sVEGFR-2 level was significantly higher in AML patients compared with the control group (p < 0.03). The VEGF levels in AML and ALL patients and in healthy subjects did not differ significantly. The sVEGFR-1 level was higher in AML patients with > 50% of blasts in the bone marrow (BM), WBC > 20 G/L and elevated LDH level, than in the group with BM blasts < 50% (p < 0.01), WBC < 20 G/L (p < 0.02) and a normal LDH level (p < 0.05). Positive correlations between sVEGFR-1 level and WBC (p < 0.02),% of BM blasts (p < 0.05), the absolute blast count in peripheral blood (ABC) (p < 0.009) and LDH (p < 0.000001) were found. The sVEGFR-1/VEGF ratio (R1) was calculated, and a positive correlation between R1 and ABC in AML (p < 0.03) was determined. A higher (above median) sVEGFR-1/VEGF ratio correlated with a lower CR rate and a shorter survival (p < 0.03 and p = 0.0007 respectively). In conclusion, the plasma concentration of sVEGFR-1 is higher in leukemia patients than in healthy subjects and correlates with tumour burden and poor prognosis. The sVEGFR-1/VEGF ratio may be of greater prognostic value than VEGF alone. Further investigation is recommended to better determine their function.

[The Predictive Role of Vascular Endothelial Growth Factor and Estradiol in Infertile Patients with Ovarian Hyperstimulation Syndrome]

OBJECTIVE

To determine the predictive values of vascular endothelial growth factor (VEGF) and estradiol (E2) in patients with ovarian hyperstimulation syndrome (OHSS) and to go further into the relevant pathogenisis.

METHODS

Blood samples were collected from 51 high risk patients and 30 control patients undergoing superovulation on the day of hCG administration and follicular fluid at the time of egg retrieval. The high risk patients were divided into two groups[OHSS group (n=11) and non-OHSS group (n=40)] VEGF and E2 were detected and then differences between the high risk groups and control group were analyzed.

RESULTS

There wa no significant difference in VEGF between high risk groups and control group on the day of hCG injection (P>0.05). After hCG administration, serum VEGF concentrations rose significantly in OHSS group (P<0.01). The serum and follicular fluid VEGF levels were obviously higher than those of the control group. The follicular fluid concentrations of VEGF were significantly higher than that of serum in every group (P<0.001). E2 concentrations of OHSS group rose obviously after hCG injection (P<0.01) and were significantly higher than those of the control group (P<0.01), but there no statistically significant change in E2 concentrations in non-OHSS groups (P>0.05).

CONCLUSION

The results from this study show that the serum and follicular fluid VEGF concentrations are significantly higher than those of control group on the day of ovum retrieval, indicating that VEGF may play an important role in the pathogenesis of OHSS. It cannot predict the risk of OHSS on the day hCG administration, but it may be considered as a predictive marker for the development of OHSS after hCG administration. Serum VEGF concentrations in combination with consective E2 measurements can assist in predicting OHSS.

[Expression of serum vascular endothelial growth factor correlates with clinical outcome in multiple myeloma]

A total of 34 multiple myeloma (MM) patients (17 recently diagnosed and 17 in progression of the disease) treated at the Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation Medical University in Wrocław were studied. Among the 19 females and 15 males, aged 31-72 years, there were 17 IgG, 9 IgA and 1 IgM, one with plasma cell leukaemia and 6 with light chain disease. Staging according to Durie and Salmon disclosed: 7--IIA stage, 15--IIIA and 12--IIIB. Blood hyperviscosity symptoms (HS) developed in 9 patients, and precomatic state or coma was observed in four of them. Control group was constituted of 14 healthy subjects--10 women and 4 men aged 32-51 years. Vascular endothelial growth factor (VEGF) serum concentration in MM patients varied from 0 pg/ml to 760 pg/ml, mean 148.75 pg/ml, SD = 204.4 and in controls 0 pg/ml--164 pg/ml, mean 31.5, SD = 23.3; p < 0.05. The mean VEGF level in recently diagnosed patients was higher than in progression of the disease, mean 188.6 pg/ml, SD = 230.6 and mean 110.9 pg/ml, SD = 177.9; respectively, but the difference was not statistically significant. The patients with stage III had significantly (p < 0.05) higher VEGF level than those in stage II (mean 303.1 pg/ml, SD = 302.2 and mean 89.0 pg/ml SD = 121.6) respectively. The group of MM patients with renal failure (creatinine level > 2 mg%) had higher VEGF level than those with normal renal function: mean 199.9 pg/ml, SD = 235, and mean 46.9 SD = 47 respectively, p < 0.01. Elevated VEGF level was also present in comatic and precomatic patients when compared with hyperviscosity patients without these symptoms (p < 0.05). In multiple myeloma patients no correlation was found between the serum VEGF level and percentage of bone marrow plasma cells, serum beta-2-m and monoclonal Ig levels, levels of Hb, albumine and LDH. Median survival time (M-ST) of patients with VEGF higher than 71, 0 pg/ml was 32 months, M-ST of patients with VEGF below 71 pg/ml was 52 months. In summary: serum level of VEGF in advanced state of multiple myeloma was elevated and correlated with clinical state. An elevated serum level of VEGF is associated with a poor prognosis.

Mechanism of interferon alpha on inhibition of metastasis and angiogenesis of hepatocellular carcinoma after curative resection in nude mice

The aim of this study was to examine the mechanism of interferon alpha (IFN-alpha) on inhibition of metastasis and recurrence of hepatocellular carcinoma (HCC). Nude mice bearing human HCC xenografts with high metastatic potential (LCI-D20) underwent curative resection of tumors on postimplant day 11. IFN-alpha was begun the next day at different dosages given subcutaneously for 35 consecutive days; normal saline solution was injected into the control mice. The mice were killed 48 hours after the final treatment, and the parameters were evaluated. The HCC intrahepatic recurrence rate, the size of the recurrent lesions, the rate of lung metastasis, the serum vascular endothelial growth factor level, and the microvessel density (immunohistochemistry) were as follows: 100%, 2136+/-794 mm(3)(mean+/-standard deviation), 100%, 265.7+/-154.7 pg/ml, and 144+/-37/HP, respectively, in the control mice, whereas these same values were 62.5%, 89+/-45 mm(3), 12.5%, 53.3+/-9.9 pg/ml, and 86+/-25/HP, respectively, in the IFN-alpha 1.5 x 10(7)U/kg treatment group (P<0.05) and 26.7%, 46+/-21 mm(3), 0%, 65.2+/-17.9 pg/ml, and 39+/-14/HP in the IFN-alpha 3 x 10(7)U/kg treatment group, respectively (P<0.05). However, a significant difference was not found in the serum levels of basic fibroblast growth factor among the control and IFN-alpha treatment groups. IFN-alpha inhibits metastasis and recurrence of human HCC after curative resection in nude mice mediated by antiangiogenesis through downregulating expression of vascular endothelial growth factor but not basic fibroblast growth factor.

[Detection of serum levels of MMP-9 and VEGF in patients with bladder cancer]

OBJECTIVE

To detect serum levels of MMP-9 and VEGF in patients with bladder cancer.

METHODS

Serum levels of MMP-9 and VEGF in 58 patients with bladder cancer and 45 healthy controls were measured by sandwich-ELISA.

RESULTS

Serum levels of MMP-9 and VEGF (737.12 micro g/L and 1148.88 ng/L) were significantly higher in the cancer patients than those of controls (423.51 micro g/L and 846.96 ng/L, P < 0.01). The serum levels were associated with tumor stage and grade. In patients with invasive cancer, the levels were significantly higher than those of superficial cancer (P < 0.01). Patients with distant metastasis had significantly higher levels of MMP-9 and VEGF than those with localized invasion (P < 0.01). But there was no significant difference between patients with superficial cancer and controls. Patients with G(3) tumors had significantly higher levels of MMP-9 and VEGF than those of patients with G(1) and G(2) tumors (P < 0.01).

CONCLUSIONS

Elevated MMP-9 and VEGF levels are associated with a high stage and grade of bladder cancer and they may serve as markers of tumor progression in the future.

Diabetic patients and retinal proliferation: an evaluation of the role of vascular endothelial growth factor (VEGF)

Vascular endothelial growth factor (VEGF) has been shown to play a major role in intraocular neovascularisation in ischaemic retinal diseases. The aim of this study was to evaluate the concentration of VEGF in vitreous, aqueous and epiretinal membranes of diabetic and non-diabetic patients, with other pathological conditions requiring surgical intervention. Higher VEGF concentration were found in samples from the eyes of diabetic patients versus other pathologies as well as in epiretinal membranes versus the other eye compartments in diabetic patients. However, high VEGF levels were also found in retinal detachment and proliferative vitreoretinopathy of non-diabetic patients. We concluded that VEGF is produced locally and plays a fundamental, but not specific, role in diabetic retinal neovascularisation and proliferation.

[Plasma VEGF levels are increased in women with severe preeclampsia or HELLP syndrome]

AIM

To investigate vascular endothelial growth factor (VEGF) serum levels in severe preeclampsia (PE) and HELLP syndrome.

PATIENTS AND METHODS

Serum concentrations of VEGF, progesterone, estradiol and estriol were measured in 16 patients with PE and 14 patients with HELLP syndrome and in 30 well-matched normotensive pregnant controls. Determination of VEGF was performed by a commercially available immunoassay (Quantikine(R), R&D Systeme, Wiesbaden), those of sex steroids by a radioimmunoassay (Fa. Biermann, Bad Nauheim).

RESULTS

Serum VEGF levels were significantly higher in the study than in the control group (172.0 +/- 98.9 pg/ml versus 41.4 +/- 30.5 pg/ml, U-Test: p < 0.001). In patients with HELLP syndrome mean serum VEGF concentrations were increased when compared with healthy controls but serum levels were significantly lower than in patients with PE (109.2 +/- 68.5 pg/ml versus 219.0 +/- 72.9, U-Test: p < 0.05). We could demonstrate a positive correlation between VEGF and estradiol serum concentrations in the study and control patients (Spearman rang correlation: p < 0.05).

CONCLUSIONS

It is concluded that patients suffering from PE or HELLP syndrome have either an increased placental expression of VEGF as a result of hypoxia or show an increased extraplacental production of this growth factor such as in maternal or fetal endothelial cells, macrophages or smooth muscle tissue.

Vascular endothelial growth factor in patients with high-altitude pulmonary edema

To examine the role of VEGF in the pathogenesis of high-altitude pulmonary edema (HAPE), we measured the concentrations of VEGF in venous serum and bronchoalveolar lavage fluid in patients with HAPE and in healthy volunteers. The VEGF in venous serum of the patients was normal at admission and significantly increased at recovery. Similarly, the VEGF in bronchoalveolar lavage fluid of the patients was increased at recovery compared with admission, but values at both admission and recovery were significantly lower than those of the controls. The present finding suggests that VEGF probably is destroyed in the lung of HAPE, and it appears less likely to have a critical part in the pathogenesis of HAPE but has rather an important role in the repair process for the impaired cell layer.

Vascular endothelial growth factor and oxidative damage in cancer

OBJECTIVES

VEGF may be an indicator for the angiogenic potential of a tumor and stimulates NO which plays complex roles in cancer. In our study, we investigated the levels of MDA, NO and VEGF in the plasma of various types cancer patients (untreated, yet).

DESIGN AND METHODS

The level of VEGF was determined by using ELISA. Plasma MDA, NO and VEGF levels were measured in 45 patients with various cancer types and in 21 healthy subjects.

RESULTS

Plasma MDA and VEGF levels were significantly higher than those of the healthy subjects (p < 0,0001). NO levels of the patients were significantly lower vs. the healthy subjects (p < 0,001).

CONCLUSIONS

Increased plasma VEGF and MDA concentrations and decreased plasma NO levels have been found in patients with various types of human cancer. Howewer, the prognostic and clinical significance of plasma VEGF in cancer patients is unknown.

Phase II trial of tetrathiomolybdate in patients with advanced kidney cancer

PURPOSE

Tetrathiomolybdate (TM), a copper-lowering agent, has been shown in preclinical murine tumor models to be antiangiogenic. We evaluated the antitumor activity of TM in patients with advanced kidney cancer in a Phase II trial.

EXPERIMENTAL DESIGN

Fifteen patients with advanced kidney cancer were eligible to participate in this trial. TM was initiated p.o. at 40 mg three times a day with meals and 60 mg at bedtime to deplete copper. A target serum ceruloplasmin (CP) level of 5-15 mg/dl was defined as copper depletion. Doses of TM were reduced for grade 3-4 toxicity and to maintain a CP level in the target range. Once copper depletion was attained, patients underwent baseline tumor measurements and then again every 12 weeks for response assessment. Patients not exhibiting progressive disease at 12 weeks after copper depletion continued on treatment. Serum levels of Interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were assayed pretreatment and at various time points on treatment. Dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) was performed on selected patients in an attempt to assess changes in tumor vascularity.

RESULTS

All of the patients rapidly became copper depleted. Thirteen patients were evaluable for response. No patient had a complete response or PR. Four patients (31%) had stable disease for at least 6 months during copper depletion (median, 34.5 weeks). TM was well tolerated, with dose reductions most commonly occurring for grade 3-4 granulocytopenia of short duration not associated with febrile episodes. Serum levels of IL-6, IL-8, VEGF, and bFGF did not correlate with clinical activity. Serial DCE-MRI was performed only in four patients, and a decrease in vascularity seemed to correlate with necrosis of a tumor mass associated with tumor growth.

CONCLUSIONS

TM is well tolerated and consistently depletes copper as measured by the serum CP level. Clinical activity was limited to stable disease for a median of 34.5 weeks in this Phase II trial in patients with advanced kidney cancer. Serum levels of proangiogenic factors IL-6, IL-8, VEGF, and bFGF may correlate with copper depletion but not with disease stability in this small cohort. TM may have a role in the treatment of kidney cancer in combination with other antiangiogenic therapies.

[The short-term outcomes of patients with acute leukemia treated by thalidomide]

OBJECTIVE

To study the efficacy of thalidomide for treating acute leukemia (AL).

METHODS

38 cases of AL were studied. 27 of the 38 cases receiving initial treatment were randomly divided into two groups, one treated with routine chemotherapy plus thalidomide (A) and the other with routine chemotherapy alone (B). 11 of the 38 were relapsing cases and all treated with routine chemotherapy plus thalidomide (C). Marrow microvascular density (MVD) and vascular endothelial growth factor (VEGF) were examined with factor-VIII related antigen/CD(34) immunohistological stain and ELISA respectively before and after the treatment. The initial dose of thalidomide was 200 mg/d and increased to 400 - 500 mg/d by increasing 50 mg/d weekly for 4 to 6 months.

RESULTS

The complete remission (CR) rate and efficacy rate were 57.1%, 53.8% and 78.6%, 76.9% in the two groups respectively with no statistical difference. The CR rate and efficacy rate in the relapsing group were 27.3%, 54.5%. The relapsing rate 6 months after the treatment was low in the thalidomide group. MVD and VEGF were significantly different before and after the treatment (P < 0.001). There was a negative correlation between the MVD, VEGF and efficacy. The relapsing rate was low in cases with low MVD, VEGF. No particular side effects were observed in thalidomide group.

CONCLUSION

Anti-angiogenesis may decrease relapse and maintain recovery state of AL patients. There are no severe side effects in the thalidomide group.

[Clinical significance and expression of vascular endothelial growth factor in serum of patients with acute leukemia]

OBJECTIVE

To determine the serum vascular endothelial growth factor (VEGF) level in patients with acute leukemia and to elucidate the relation of its level with the carcinogenesis or relapse of acute leukemia and its clinical significance.

METHODS

The VEGF levels in the serum and leukemic cell cultured supernatants were measured by sandwich ELISA in 88 acute leukemia patients and 30 healthy individuals.

RESULTS

The pre-chemotherapeutic serum and supernatant VEGF level in newly diagnosed or relapsed patients with acute leukemia were significantly higher than those in healthy subjects (P < 0.01). The serum VEGF level was correlated with the count of blast cells in bone marrow or peripheral blood of patients with acute leukemia (P < 0.05).

CONCLUSION

The pretherapeutic serum VEGF level of patients with acute leukemia appears to be a predictor of the carcinogenesis or relapse of acute leukemia and reflects the tumor burden of acute leukemia.

[Value of serum-vascular endothelial growth factor in the differential diagnosis of solitary pulmonary nodule]

OBJECTIVE

To evaluate serum-vascular endothelial growth factor (S-VEGF) in the differentiation of solitary pulmonary nodule (SPN).

METHODS

Serum level of VEGF of 68 patients with SPN was measured by ELISA kit, and compared with the control group of 20 normal subjects. The nodules were diagnosed by operation and pathology.

RESULTS

The median level of S-VEGF was 42.5 (range from 10 to 170) pg/ml in the control, 44 (range from 18 to 360) pg/ml in benign nodule group and 75 (range from 18 to 890) pg/ml in lung cancer group, with significant difference observed between the nodule group and control (P < 0.01), and between the lung cancer group and the benign nodule group (P < 0.05), but not between the benign nodule group and the control. In addition, when S-VEGF in different pathologic types of the limited number of lung cancer patients were compared, no significant difference was observed.

CONCLUSION

S-VEGF is valuable in the differential diagnosis of solitary pulmonary nodule. An elevated S-VEGF level >or= 100 pg/ml in patients with SPN may strongly speak for a malignant nodule. Operation is suggested.

Molecular pathways regulating mobilization of marrow-derived stem cells for tissue revascularization

Adult bone marrow is a rich reservoir of hematopoietic and vascular stem and progenitor cells. Mobilization and recruitment of these cells are essential for tissue revascularization. Physiological stress, secondary to tissue injury or tumor growth, results in the release of angiogenic factors, including vascular endothelial growth factor (VEGF), which promotes mobilization of stem cells to the circulation, contributing to the formation of functional vasculature. VEGF interacts with its receptors, VEGFR2 and VEGFR1, expressed on endothelial and hematopoietic stem cells, and thereby promotes recruitment of these cells to neo-angiogenic sites, accelerating the revascularization process. The mobilization of stem cells from marrow is a dynamic process, regulated by shear stress imparted by blood flow, and the activation of metalloproteinases that induce the release of 'Kit ligand', facilitating egress from the marrow to the circulation. Identification of the molecular pathways that support the proliferation and differentiation of vascular stem and progenitor cells will open up new avenues for the design of clinical trials to accelerate tissue vascularization and organogenesis.

Serum levels of basic fibroblast growth factor reflect disseminated disease in patients with testicular germ cell tumors

The potential role of angiogenesis stimulators in the pathogenesis of different tumor entities has been confirmed in several studies. We measured the serum levels of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) in 51 patients with testicular germ cell tumors and in 39 healthy volunteers. Serum concentrations of bFGF, VEGF and PDGF-AB were determined by enzyme-linked immunosorbent assay. The median serum bFGF level for tumor patients was 3.46 pg/ml (range 0-61.6) compared to 0.7 pg/ml (0-11) in the control group (P<0.01). In patients with metastatic disease, the median serum bFGF level was 10.3 pg/ml (0-61.6) in contrast to 2.8 pg/ml (0-50) in patients with localized disease (P<0.01). The median serum VEGF and PDGF levels were 270 pg/ml (0-1,903) and 37,837 pg/ml (9,075-108,800), respectively, for tumor patients and 200 pg/ml (44-585) and 23,000 pg/ml (4,250-70,650) in the control group ( P<0.05). Our data suggest that angiogenesis, as reflected by serum concentrations of bFGF, VEGF and PDGF, plays a functional role in the growth and progression of testicular germ cell tumors.

Circulating angiogenic cytokines in multiple myeloma and related disorders

We investigated the serum concentrations of selected angiogenic cytokines including: vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), transforming growth factor beta 1 (TGF-beta1) and basic fibroblast growth factor (bFGF) in 162 patients with multiple myeloma (MM), 5 patients with Waldenstr m's macroglobulinaemia (WM), and 31 healthy controls. Among the MM patients there were 2 cases of primary plasma cell leukemia (PCL) and one case of extramedullary plasmacytoma. The levels of measured cytokines were correlated with the phase and stage of the disease as well as the most important clinical and laboratory parameters associated with disease activity (haemoglobin, creatinine, albumins, calcium, M-component, CRP,beta2m, LDH and bone involvement). We have found correlations between serum levels of angiogenic cytokines and some parameters depicting the disease activity and advancement. The serum level of VEGF in MM patients (median 244.5 pg/mL) correlated with serum concentrations of beta-2-microglobulin (beta2m) greater than 2.5 mg/L (p = 0.0005) and abnormal values of lactate dehydrogenase (> 425 U/L, median 329.0 pg/mL and < 210 U/L, median 426.6 pg/mL, p = 0.004 and p = 0.04 respectively). MM patients in stage III had higher serum levels of HGF (median 1 411.3 pg/mL) than those in stage I (median 1 219 pg/mL) (p = 0.01) according to Durie and Salmon staging, and those in phase I (at diagnosis) (median 1 555.6 pg/mL) and phase III (in progression) (median 1 309.7 pg/mL) had higher levels than those in phase II (plateau phase) (median 1 047.9 pg/mL) (p = 0.002 and p = 0.02 respectively). Significantly elevated values of HGF were found in MM patients with anaemia (median 1 962.0 pg/mL) and hypercalcaemia (median 2 085.6 pg/mL) (p = 0.00001 and 0.04 respectively). TGF-beta1 (median 33.9 ng/mL) correlated positively with highbeta2m values (> 2.5 mg/L) (p = 0.04) and was significantly higher in phase I (median 40.1 ng/mL) than in phase II (median 30.9 ng/mL) (p = 0.03) of the disease. The concentration of bFGF was significantly higher in stage III of MM (median 3.1 pg/mL) than in stage I (median 1.2 pg/mL) (p = 0.04). We found that the survival probability was statistically higher for newly diagnosed MM patients with a concentration of VEGF lower than the median value for this cytokine. The concentrations of the cytokines analyzed in patients with Waldenstr m's macroglobulinaemia (WM), primary plasma cell leukaemia (PCL) and non-secretory (NS) myeloma were not distinguishable from those found in MM patients. We also studied the relationship between the levels of cytokines analyzed and found positive correlations between bFGF and TGF-beta1 (rhô = 0.183, p < 0.02), as well as VEGF and TGF-beta 1 (rhô = 0.537, p < 0.001) and VEGF and bFGF (rhô = 0.197, p < 0.02). In conclusion, our data indicate a strong relationship between angiogenic cytokine serum levels and clinical course as well as selected laboratory parameters of patients with MM.

[Serum level and expression of vascular epithelial growth factor in ovarian epithelial carcinoma]

BACKGROUND & OBJECTIVE

This study was designed to examine the level of serum vascular epithelial growth factor (VEGF) and VEGF expression in the patients with ovarian epithelial carcinoma (EOC) and to evaluate the relationship between VEGF and the clinicopathological factors.

METHODS

Seventy-three patients with ovarian epithelial tumor were selected as study group, including 24 benign epithelial ovarian tumor (BET), 7 borderline epithelial ovarian tumor (BOT), 42 EOC. Twenty women without obvious gynecologic diseases were selected as serum control group (CON). VEGF expression in the epithelial ovarian tumor tissues from 73 patients were analyzed immunohistochemically. Serum VEGF in 71 patients and ascite VEGF in 10 patients were detected by enzyme-linked immunosorbent assay (ELISA) and 7 cases with EOC were continuously determined after operation.

RESULTS

(1) Positive immunostaining of VEGF was observed in 86.3% of EOC, which was significantly higher than that of BOT (66.67%, P < 0.005) and BET (37.5%, P < 0.005). (2) There were significant differences in serum VEGF level among BET, BOT, and EOC group (P < 0.01). Serum VEGF levels before operation in patients with EOC were significantly higher than those with BOT, BET, and CON (P < 0.01). Serum VEGF levels in EOC patients at advanced stage (stage III or IV), low differentiation (G3) were apparently higher than those at early stage (stage I or II) (P < 0.05) and high differentiation (G1, G2) (P < 0.01), respectively. Serum VEGF levels decreased after the successful removal of tumor in ovarian cancer patients. The serum VEGF levels were re-elevated during relapse in three patients.

CONCLUSION

(1) The elevated serum VEGF levels and increased VEGF expression in EOC were associated with its maligment behavior. (2) Serum VEGF could be used as a marker for monitoring the clinical course of the patients with epithelial ovarian carcinoma.

Vascular endothelial growth factor (VEGF-A) plasma levels in non-small cell lung cancer: relationship with coagulation and platelet activation markers

Platelet activation, commonly found in lung cancer patients, may cause the release of angiogenic factors, such as vascular endothelial growth factor (VEGF-A). The present study was designed to investigate whether plasma VEGF-A levels were associated to different stages of non-small cell lung cancer (NSCLC). Moreover, sP-selectin, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin III complex (TATc) and D-dimer levels were measured to test the hypothesis of an involvement of platelet and coagulation activation in tumor angiogenesis. VEGF-A, sP-selectin, F1+2, TATc and D-dimer levels were elevated in 65 patients with NSCLC, particularly in metastatic patients. sP-selectin (p <0.003) and F1+2 (p <0.005) levels were independently associated to VEGF-A. In addition, patients with positive levels of both sP-selectin and F1+2 had the highest levels of VEGF-A. In conclusion, our findings support the hypothesis that thrombin generation might induce platelet activation and VEGF-A release in NSCLC.

[Vascular endothelial growth factor and plasminogen activators in endometrial carcinoma and hyperplasia]

Vascular endothelial growth factor (VEGF) and such plasminogen activation system components as uPA, PAI-1 and tPA were determined by enzyme immunoassay methods in endometrial tumors from 121 patients and 18 samples of endometrial hyperplasia of varying degree. Endometrial carcinoma concentrations of uPA vs. PAI-1 were significantly higher than those in hyperplasia. Significant direct correlations--uPA vs. VEGF, uPA vs. PAI-1 and PAI-1 vs. VEGF--were established in endometrial tumors, and inverse ones for tPA vs. uPA and tPA vs. VEGF. A marked correlation with prognostic factors was found for PAI-1 and VEGF: levels of these proteins were relatively higher in cases of tumor progression (FIGO stage and deeper myometrial invasion), poor cell differentiation, and loss of hormone sensitivity. Higher uPA expression was associated with deeper myometrial invasion while, in endometrial tumors with unfavorable prognosis, it was VEGF level alone that was significantly higher.

Leptin in acute leukaemias: relationship to interleukin-6 and vascular endothelial growth factor

Leptin alone and in combination with other cytokines has a stimulatory effect on proliferation of leukaemic cells. This effect may be due to prevention of apoptosis of progenitor cells or upregulation of specific receptors on leukaemic precursors that make them more responsive to stimuli. This work investigates the relationship between serum leptin level, serum interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in acute leukaemic patients. The relationship to blood cell counts, haemoglobin and response to chemotherapy was also investigated. The study included 25 acute leukaemic male patients [15 acute myeloid leukaemia (AML) and 10 acute lymphoblastic leukaemia (ALL)] and 15 age and sex matched healthy controls. All were subjected to thorough history taking, clinical examination, complete blood picture, hepatic and renal function tests and determination of serum leptin, IL-6 and VEGF levels. In addition, patients were subjected to bone marrow aspiration, cytochemistry and immunophenotyping study and serum leptin assay after chemotherapy. Serum leptin level showed statistically significant elevation only in AML group (p<0.01). This elevation was unrelated to the presence of extramedullary infiltration or response to chemotherapy and correlated only with body mass index (p<0.05). In ALL, the mean serum leptin level was insignificantly different from the controls. In both AML and ALL, there was no significant difference in serum leptin level before and after treatment. Statistically significant elevation of IL-6 and VEGF, uncorrelated with serum leptin level was detected in AML patients when compared with the controls. No correlation was found between serum leptin level and any of the studied haematological parameters. It is concluded that the release of leptin, IL-6 and VEGF may be regulated by different mechanisms leading to diversity in clinical features of the disease.

Circulating endothelial progenitor cells are reduced in hemodialysis patients

OBJECTIVE

The risk of cardiovascular disease in hemodialysis patients is far greater than in the general population. Endothelial progenitor cells (EPCs) circulating in the peripheral blood contribute to neovascularization in the ischemic tissue. EPCs are considered to be included in CD34 positive (CD34+) or AC133 positive (AC133+) mononuclear cells (MNCs). This study's aim was to determine the number and functional activity of EPCs in hemodialysis patients and age-matched control subjects.

METHODS

The numbers of CD34+ MNCs and AC133+ MNCs in the peripheral blood were quantified by flow cytometry. The peripheral blood EPCs were also examined by an in vitro culture assay. The levels of serum vascular endothelial growth factor (VEGF) were measured by sandwich enzyme immunoassay.

RESULTS

The numbers of CD34+ MNCs and AC133+ MNCs were significantly reduced by 56% and 49%, respectively, in hemodialysis patients (n = 50) compared with control subjects (n = 36). The number of EPCs determined by the culture assay was also significantly reduced by 41% in hemodialysis patients compared with control subjects. Multivariate analysis revealed that none of the atherosclerotic risk factors were independent predictors of reduced CD34+ MNC counts. The serum VEGF levels in hemodialysis patients were not different from those in control subjects and did not correlate with CD34+ MNC counts.

CONCLUSION

Circulating EPCs are significantly reduced in hemodialysis patients, which might be related to impaired neovascularization and cardiovascular disease in these patients.

[Serum levels of VEGF and nitric oxide in esophageal squamous carcinoma patients and the clinical significance]

BACKGROUND & OBJECTIVE

Angiogenesis is necessary for the growth and metastasis of malignant tumor and is closely related to vascular endothelial growth factor (VEGF) and nitric oxide (NO). This investigation was aimed to detect the serum levels of VEGF and NO in squamous carcinoma patients and analyze the clinical significance for prognosis evaluation.

METHODS

Serum VEGF and NO levels were detected by enzyme-linked immunosorbant assay (ELISA) and spectrophotometry, respectively, and their clinical significance was analyzed.

RESULTS

Serum levels of VEGF and NO in squamous carcinoma patients were significantly higher than that of in normal persons (P < 0.01). There was a positive correlation between serum VEGF, NO levels and tumor pathological phases, histological grades and lymph node metastasis (P < 0.01). There was also a positive correlation between serum VEGF level and serum NO level (P < 0.01).

CONCLUSION

Serum levels of VEGF and NO in squamous carcinoma patients were significantly correlated to the growth, development and malignant behavior of tumor and thus may serve as the indexes for clinical prognosis evaluation.

[The study of vascular endothelial growth factor in nasopharyngeal carcinoma patients before and after radiotherapy]

OBJECTIVE

The purpose of this study was to determine the serum vascular endothelial growth factor (VEGF) level before and after radiotherapy in the nasopharyngeal carcinoma.

METHOD

In this study we used the methods of ELISA to test the serum VEGF level of 66 cases which including 46 cases of nasopharyngeal carcinoma and 20 cases of healthy controls.

RESULT

The serum VEGF levels in nasopharyngeal carcinoma patients were significantly higher than those of healthy controls (P < 0.01). The serum levels of VEGF were significantly reduced at the end of radiotherapy (P < 0.01). The recurrence or metastasis rate was significantly higher in cases with > 150 ng/L VEGF level than those with < 150 ng/L.

CONCLUSION

VEGF plays an important role in the growth and prognosis of nasopharyngeal carcinoma.

Elevated level of plasma basic fibroblast growth factor in multiple myeloma correlates with increased disease activity

Recent reports that bone marrow angiogenesis is increased in multiple myeloma prompted us to examine plasma concentrations of angiogenic growth factors and to elucidate their clinical and biological significance. In 45 cases including 36 cases of multiple myeloma and 9 cases of monoclonal gammopathies of undetermined significance (MGUS), plasma concentrations of basic fibroblast growth factor (FGF-2) and vascular endothelial growth factor (VEGF) were evaluated. FGF-2 was significantly elevated in 25 out of 45 (56%) of the patients with multiple myeloma compared with control subjects (median 9.01 pg ml vs. 1.58 pg/ml, P < 0.0001). The 25 cases were all active multiple myeloma, and none of the non-active myeloma and MGUS patients showed a high FGF-2 level. VEGF level was also elevated in 26 out of 45 patients (58%) compared with control subjects (median 42.0 pg/ml vs. 15.8 pg/ml, P < 0.0001 for VEGF). VEGF concentration was high in 20 active myelomas, but also in one non-active myeloma and five MGUS. Elevation of FGF-2 level was associated with beta2-microglobulin level, anemia and bone marrow plasma cell percentage, which represent disease activity. Interestingly, none of five Bence-Jones type myelomas, including four clinically active cases, revealed a high plasma FGF-2 level, while all of them showed a high VEGF level. In all five responders, the plasma FGF-2 levels were significantly decreased after chemotherapy. FGF-2 was immunohistochemically detected in the bone marrow myeloma cells of the patients with high plasma FGF-2 level. We conclude that plasma concentration of FGF-2 can be a useful indicator of disease activity.

The study on the relationship between serum vascular endothelial growth factor and proteinuria in adriamycin-induced nephrotic rats

To study the relationship between serum vascular endothelial growth factor (VEGF) and proteinuria in adriamycin-induced nephrotic rats, a rat model of adriamycin-induced nephrotitis was developed by injection of adriamycin into a tail vein in a rat. At different time points, 24-h urinary protein excretion was measured by using Coomassie brilliant blue method and the serum VEGF levels detected by using ELISA assay. The interventional effect of VEGF on this model was observed. The results showed that: (1) The adriamycin-induced nephrotic syndrome rat model was developed successfully; (2) Serum VEGF levels and proteinuria were significantly increased at 7th day after intravenous injection of adriamycin. There was a positive correlation between serum VEGF levels and 24-h urinary protein excretion (r = 0.67, P < 0.05). (3) The 24-h urinary protein excretion was significantly increased in the rats receiving administration of VEGF (P < 0.05). It was concluded that VEGF might play an important role in the pathogenesis of proteinuria in adriamycin-induced nephrotic rats.

Serum levels of vascular endothelial growth factor in patients with angina pectoris and acute myocardial infarction

OBJECTIVE

To determine whether serum vascular endothelial growth factor (VEGF) concentrations are altered in several kinds of coronary heart disease patients.

MATERIALS AND METHODS

Using a VEGF enzyme-linked immunosorbent assay (ELISA), serum VEGF concentrations were determined in antecubital venous blood of 16 patients with stable angina pectoris (SAP), 16 with unstable angina pectoris (UAP) and 16 with acute myocardial infarction (AMI) before and after thrombolytic therapy, and of 16 age- and sex-matched healthy volunteers who used as controls.

RESULTS

The concentrations of serum VEGF in patients with SAP (98.60 +/- 26.99 pg/ml) and UAP (103.61 +/- 24.89 pg/ml) tended to be higher than those in control subjects (80.44 +/- 24.57 pg/ml), but the differences did not reach statistical significance (P > 0.05 for each). Before thrombolytic therapy, the concentrations of serum VEGF in patients with AMI (285.92 +/- 125.15 pg/ml) were significantly higher than those in patients with SAP, UAP or control subjects (P < 0.01, respectively), and correlated with synchronous serum creatine kinase (CK) and its MB isoenzyme (CK-MB) contents (r = 0.866, P < 0.001 and r = 0.948, P < 0.001; respectively). Three hours after thrombolysis, the concentrations of VEGF had fallen to 111.57 +/- 31.29 pg/ml (P < 0.01 vs x before thrombolytic therapy and P < 0.05 vs x control subjects).

CONCLUSION

The present study shows that serum concentrations of VEGF in patients with AMI are markedly elevated and that increased serum VEGF levels may be one of the most sensitive indexes in diagnosing AMI and judging reperfusion.

[Changes and significance of concentrations of serum vascular endothelial growth factor in patients with pregnancy induced hypertension]

OBJECTIVE

To detect the changes of concentrations of serum vascular endothelial growth factor (VEGF) in patients with pregnancy induced hypertension (PIN) as well as to explore the relationship between VEGF and pathogenesis of PIN.

METHODS

Serum VEGF concentrations in 23 healthy nonpregnant women (nonpregnant group), 30 normal pregnant women (normal pregnancy group) and 37 women with PIH (PIH group) were measured by sandwich enzyme-linked immunoadsorbent assay (ELISA).

RESULTS

Serum concentrations of VEGF were significantly higher in normal pregnancy group (149.39 +/- 27.15) ng/L than those in nonpregnant group (11.98 +/- 3.99) ng/L (P < 0.001), peaking in the second trimester of pregnancy (183.84 +/- 49.02) ng/L and decreasing in the third trimester (118.37 +/- 34.29) ng/L. Serum VEGF concentrations (64.45 +/- 24.33) in PIH group were significantly lower than those in normal late pregnancy group (118.37 +/- 34.29) ng/L (P < 0.01). There was a trend that serum VEGF concentrations in PIH group decreased with the severity of PIH (P < 0.05).

CONCLUSION

The decrease of VEGF may play and important role in the pathogenic mechanism of PIH.

Menstrual state should be considered in determining sero-positivity of soluble angiogenic factors in breast cancer

We investigated whether blood angiogenic factor (vascular endothelial growth factor, VEGF; angiogenin; basic fibroblast growth factor, bFGF; platelet-derived growth factor-AB, PDGF-AB) levels change during menstrual cycle of healthy premenopausal females or after menopause. We also measured the serum angiogenic factor levels in 34 operable breast cancer patients and compared them to those of healthy volunteer controls. No differences in the four angiogenic factor levels were found between the follicular and luteal phases of normal menstruation. However, angiogenin and bFGF levels were higher in pre-menopausal females than post-menopausal female and young male healthy volunteers. In cancer patients, the sero-positivity rate of the bFGF was 8.8% with menstrual-state-unmatched cut-off points, which increased to 36.4% with menstrual-state-matched cut-off points. This discrepancy was especially high in post-menopausal cancer patients. In conclusion, physiological elevation of the bFGF during normal menstruation can influence the precise interpretation of the pathological elevation of the bFGF in pre-menopausal breast cancer patients.