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Adhesion molecules in nonrheumatic aortic valve disease: endothelial expression, serum levels and effects of valve
N K Ghaisas1, J B Foley, D S O'Briain
1Department of Cardiology, St. James's Hospital, Dublin, Ireland.
Insights
Inflammation plays a role in aortic valve disease. Diseased aortic valves show increased expression of adhesion molecules, like E-selectin, which correlates with blood levels and decreases after valve replacement surgery.
Area of Science:
- Cardiovascular Biology
- Immunology
- Pathology
Background:
- Nonrheumatic aortic valve disease is traditionally viewed as degenerative.
- Elevated levels of adhesion molecules are associated with inflammatory processes.
Purpose of the Study:
- To investigate the expression of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and E-selectin on aortic valve endothelium.
- To assess the correlation between serum levels and endothelial expression of these molecules.
- To evaluate changes in serum levels following aortic valve replacement surgery.
Main Methods:
- Immunohistochemistry was used to study aortic valves from 22 surgical and 6 autopsy cases.
- Peripheral blood levels of soluble adhesion molecules were measured preoperatively and at 6 and 18 months postoperatively.
- Comparisons were made with control groups.
Main Results:
- The majority of surgically removed tricuspid and bicuspid aortic valves expressed E-selectin, ICAM-1, and VCAM-1.
- Normal postmortem valves showed no expression, while diseased valves did.
- Endothelial E-selectin expression strongly correlated with serum levels (r = 0.695, p = 0.004).
- Soluble E-selectin levels were significantly higher in patients than controls (p = 0.017) and decreased significantly by 18 months postoperatively (p = 0.005).
Conclusions:
- Adhesion molecule expression on diseased aortic valves suggests an inflammatory component in aortic valve disease.
- Diseased valves may be the primary source of elevated soluble E-selectin.
- Postoperative reduction in soluble E-selectin levels supports the role of the valve in its production.
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.