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Is VEGF under-expressed in Indian children with Perthes disease?
V Tiwari1, R R Poudel1, S A Khan2
1Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Insights
Vascular Endothelial Growth Factor (VEGF) is underexpressed in Indian children with Legg-Calve-Perthes disease (LCPD). This finding suggests VEGF may be a therapeutic target and a valuable marker for monitoring LCPD progression.
Area of Science:
- Pediatric Orthopedics
- Molecular Biology
- Biochemistry
Background:
- Legg-Calve-Perthes disease (LCPD) involves avascular necrosis of the femoral head.
- The role of vascular endothelial growth factor (VEGF) in LCPD pathogenesis, particularly in the Indian population, remains under-investigated.
- VEGF is crucial for angiogenesis and bone development.
Purpose of the Study:
- To evaluate serum VEGF-A levels in Indian children diagnosed with LCPD.
- To compare VEGF-A levels between LCPD patients and healthy controls.
- To analyze VEGF-A levels across different stages of LCPD based on Waldenstrom's classification.
Main Methods:
- A case-control study involving 42 children with LCPD and 21 healthy controls (all under 14 years).
- Serum VEGF-A levels were quantified using the sandwich enzyme-linked immunosorbent assay (ELISA).
- Patients were radiographically staged using Waldenstrom's classification.
Main Results:
- Median serum VEGF-A levels were significantly lower in LCPD patients (162.5 pg/ml) compared to controls (652 pg/ml) (p=0.013).
- No significant difference in VEGF-A levels was observed between lower (initial/fragmentation) and higher (re-ossification/healing) Waldenstrom stages (p=0.305).
- Mean age in both groups was 9 years.
Conclusions:
- VEGF is underexpressed in Indian children with LCPD.
- Reduced VEGF may impact endochondral ossification, suggesting potential therapeutic avenues.
- Serum VEGF-A could serve as a biomarker for LCPD follow-up and management.
- Further multi-center studies with larger cohorts are needed to elucidate VEGF's role in LCPD pathophysiology.
Background:
The role of vascular endothelial growth factor (VEGF) after ischaemic necrosis of the femoral head in Legg-Calve-Perthes disease (LCPD) has not been adequately studied in humans, especially in Indian population. Therefore, we aimed to evaluate the serum levels of VEGF-A in Indian children with various stages of LCPD and compare them with those of an age- and sex-matched control group of healthy children.
Methods:
In this case-control study, we enrolled 42 children (below 14 years age) suffering from LCPD and 21 age- and sex-matched healthy controls. Patients were classified radiographically according to Waldenstrom's classification. Serum VEGF-A was estimated by sandwich enzyme-linked immunosorbent assay technique. The serum values were compared between the patient group and the control group, as well as between the Waldenstrom subgroups. Results were expressed as means with ranges or median with interquartile range.
Results:
The mean age in the patient as well as the control group was 9 years (range 4-13 years). The median value (interquartile range) of serum VEGF-A was 162.5 pg/ml (673.75 pg/ml) in the patient group and 652 pg/ml (190.5 pg/ml) in the control group (p = 0.013). When compared between lower Waldenstrom stages (initial stage + stage of fragmentation) and higher Waldenstrom stages (re-ossification stage + stage of healing), the mean values of serum VEGF-A were 464.7 pg/ml (range 0-2211 pg/ml) and 301.1 pg/ml (range 0-1910 pg/ml), respectively (p = 0.305).
Conclusions:
VEGF is under-expressed in Indian children suffering from LCPD. As VEGF acts as a key regulator of endochondral ossification, our finding may open new therapeutic approaches to the disease. Also, serum VEGF may act as a valuable marker for the follow-up of the disease. Our study also provides baseline data about serum VEGF-A levels in Indian cohort of LCPD patients. Future multi-centre studies are warranted with a larger sample size to fully appreciate the patho-physiological changes in VEGF occurring in LCPD.
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