Hepatic allograft rejection is associated with increased levels of soluble intercellular adhesion molecule-1

Biomarkers for the diagnosis of acute cellular rejection in liver transplant recipients: A review

The gold standard for the diagnosis of acute cellular rejection (ACR) is a liver biopsy. The quest for an alternative non-invasive biomarkers has been long and is ongoing. However, an efficient and useful biomarker has not been developed yet. In this manuscript, we review all possible candidate biomarkers that have been studied in recent years, starting with cytokines and ending with an overview of different newly discovered "omics". Promising paths are being explored but a valid non-invasive biomarker has not been discovered yet.

The role of sICAM-1 detection in the diagnosis of acute rejection following liver transplantation

In order to evaluate the applied value of soluble intracellular adhesion molecule-1 (sICAM-1) in acute rejection (AR) following liver transplantation, the expression of sICAM-1 protein was sequentially detected by using ELISA in serum and bile of 43 patients receiving liver transplantation. In AR group, the expression levels of sICAM-1 protein were increased 3 days before and immediately on the establishment of AR diagnosis, and there was significant difference in the expression of bile between AR group and control group (P<0.01). After reversion of AR with hormone intensive therapy, there was significant difference in the sICAM-1 protein expression of serum and bile between AR group and control group. It was concluded that the sequential detection of sICAM-1 protein level in serum and bile was a reliable and noninvasive method for the early diagnosis of AR after liver transplantation and was valuable to observe the curative effects of anti-AR therapy.

Early differentiation between rejection and infection in liver transplant patients by serum and biliary cytokine patterns

BACKGROUND

Differentiation between acute liver graft rejection and infection remains a clinical challenge during the early posttransplantation period. Although cytokines play a pivotal role in mediating allograft rejection, previous studies demonstrate that most cytokines are not specific for liver graft rejection or infections. However, other studies suggest that adhesion molecules and cytokines in bile reflect the immunologic activity within the liver more closely. Therefore, we postulated that by combining cytokine patterns in serum and bile, early recognition of acute liver graft rejection and differentiation from infectious complications can be improved.

METHODS

We performed a prospective study in 45 patients who were monitored daily for clinical events and cytokine patterns in serum and bile during the first month after liver transplantation.

RESULTS

Soluble intercellular adhesion molecule-1 (sICAM-1) in serum and interleukin-8 in bile were specifically increased at the onset of acute rejection (P<0.001), whereas serum soluble tumor necrosis factor-receptor II was also significantly increased in patients with infectious complications and serum interleukin-6 only in patients with rejection during infection. In 68% of patients with increased sICAM-1, acute rejection was diagnosed within 10 days, whereas rejection occurred in only 26% of patients with low serum levels of sICAM-1. In patients with increased sICAM-1, the relative risk for rejection was 4.8 (P=0.009).

CONCLUSIONS

Cytokine patterns in bile do not provide rejection markers with higher specificity compared with serum cytokines. Daily monitoring of sICAM-1 in serum could identify patients at risk for rejection; therefore, acute liver graft rejection may be recognized earlier in those patients.

Increased circulating soluble intercellular adhesion molecule-1 in acute myocardial infarction: a possible predictor of reperfusion ventricular arrhythmias

OBJECTIVES

Myocardial ischemia/reperfusion induces ventricular reperfusion arrhythmias (RAs). Significant parts of RAs are considered to be evoked by oxygen free radicals. Inasmuch as activated leukocytes release oxygen free radicals, and as the intercellular adhesion molecule-1 (ICAM-1) plays a major role in leukocyte infiltration, we examined whether there may be a relationship between plasma levels of soluble ICAM-1 (sICAM-1) and frequency of RAs in patients with acute myocardial infarction (AMI).

DESIGN

Prospective study comparing the two AMI patient groups with or without RAs.

SETTING

Coronary care unit and cardiac catheterization laboratories in a general hospital.

PATIENTS

Twenty-three AMI patients (eight women and 15 men, aged 32 to 79 yrs).

INTERVENTIONS

All patients received percutaneous balloon angioplasty with or without previous intracoronary thrombolysis. Significant RAs were defined as at least one of nonsustained ventricular tachycardia, multifocal premature ventricular contraction, and frequent premature ventricular contraction occurring >15 times/min, which were not observed before reperfusion.

MEASUREMENTS AND MAIN RESULTS

Plasma sICAM-1 levels were measured using an enzyme-linked immunosorbent assay. The plasma sICAM-1 levels at admission were significantly greater in RA(+) (243 +/- 60 ng/mL) than RA(-) group (192 +/- 44 ng/mL) (p < .05). We followed plasma sICAM-1 levels up to 3 wks, and found that sICAM-1 levels were consistently higher in the RA(+) than the RA(-) group. Simple regression analysis showed no significant relationship between plasma sICAM-1 levels and age, systolic and diastolic blood pressures, or serum creatine kinase activity. The two AMI groups showed no differences in age, gender, events of major coronary risk factors, preinfarction angina, and medication.

CONCLUSIONS

The increase in the plasma levels of sICAM-1 was observed in patients manifesting ventricular RAs. This increase in sICAM-1 levels was observed as early as at admission. The increased plasma sICAM-1 levels may be a useful biochemical marker for predicting myocardial reperfusion injury such as RAs in AMI.

Adhesion molecules in patients after lung transplantation

Leukocyte adhesion molecules, such as intercellular adhesion molecule (ICAM)-1 and its ligands, are involved in inflammatory processes of the lung. For ICAM-1, differential expression during different kinds of complications after transplantation has been proposed. We analyzed the role of ICAM-1, CD18, CD11a, CD11b, and CD11c during episodes of rejection or infection in patients after lung transplantation and compared the results to episodes without apparent complication. A total of 98 bronchoalveolar lavage (BAL) samples and 90 serum samples were analyzed. ICAM-1, CD18, CD11a, CD11b, and CD11c expressions were detected immunocytochemically on alveolar macrophages. Soluble ICAM-1 was quantified in serum and BAL. In the control group, 49.8 +/- 18% of macrophages stained positive for CD11b. During rejection, the mean of cells showing CD11b on the surface was significantly higher (64.6 +/-11.4%) with no difference compared to episodes of infection (59.7 +/-22.7). All other epitopes were not expressed differently with regard to a normal clinical course or episodes of infection and rejections. In summary, assessment of ICAM-1 and corresponding ligands did not allow for a reliable discrimination between episodes of rejection or infection in lung transplantation.

A pilot study of soluble adhesion molecules as surrogate markers for acute liver allograft rejection

BACKGROUND

Tissue endothelial adhesion molecule expression is increased during acute liver allograft rejection. Soluble forms exist, but their correlation to rejection and their clinical value have not been determined.

METHODS

We studied endothelial adhesion molecule tissue expression and soluble levels in blood and bile and correlated these to the clinical course of 11 adult patients followed for 30 consecutive days after liver transplantation.

RESULTS

Three biopsies showing acute rejection demonstrated increased intercellular adhesion molecule (ICAM)-1 but not endothelial leukocyte adhesion molecule-1 expression on hepatic endothelial cells during rejection. Vascular cell adhesion molecule (VCAM)-1 staining was focally increased in two of three specimens. Levels of soluble ICAM-1 or soluble VCAM-1 by ELISA did not distinguish acute rejection from nonrejection conditions.

CONCLUSION

We confirmed that endothelial ICAM-1 expression is more intense in rejecting allografts and is more sensitive than changes in VCAM-1 or endothelial leukocyte adhesion molecule-1. However, soluble adhesion molecule determination was not useful in the accurate detection of acute rejection.