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The white blood cell adhesion molecule E-selectin predicts restenosis in patients with intermittent claudication
1University Department of Medicine, Ninewells Hospital and Medical School, Dundee, Scotland.
Insights
Elevated levels of soluble E-selectin, a marker of endothelial activation, predict restenosis after angioplasty. This finding supports the role of white blood cell-endothelial interactions in post-angioplasty restenosis.
Area of Science:
- Cardiovascular research
- Endothelial biology
- Inflammation and immunology
Background:
- Endothelial dysfunction is an early indicator of restenosis.
- Cell adhesion molecules (CAMs), like E-selectin, mediate leukocyte binding to damaged endothelium.
- Soluble E-selectin may indicate endothelial damage and contribute to smooth muscle proliferation.
Purpose of the Study:
- To investigate the association between plasma E-selectin levels and restenosis after peripheral arterial balloon angioplasty.
- To determine if soluble E-selectin can serve as a predictive marker for restenosis.
Main Methods:
- Blood samples were collected from 54 patients undergoing peripheral arterial balloon angioplasty.
- Plasma E-selectin levels were quantified using ELISA.
- Patients were monitored for restenosis via angiogram at 1-year follow-up.
Main Results:
- A significant difference in baseline E-selectin levels was observed between patients who restenosed and those who did not (65.3 ng/mL vs. 52.3 ng/mL, P<.007).
- 30% of patients experienced restenosis at 1 year.
- Higher baseline E-selectin levels were associated with an increased risk of restenosis.
Conclusions:
- Increased levels of shed E-selectin were found in patients who developed restenosis.
- These findings support the role of white blood cell-endothelial interactions in the development of restenosis following angioplasty.
Background:
Experimental studies have shown that endothelial dysfunction is an early event preceding restenosis. Monocytes and neutrophils have been shown to bind to damaged endothelium via the cell adhesion molecules (CAMs). The selectins are involved in capturing the leukocytes and tethering them to the endothelium. E-selectin is a CAM that is only expressed on activated endothelial cells. Its ligands are expressed on monocytes and neutrophils and it has been found to exist in a soluble form. This soluble form may represent a marker for endothelial damage and may be a precursor of smooth muscle proliferation.
Methods And Results:
Fifty-four patients who were undergoing peripheral arterial balloon angioplasty had blood sampled before angioplasty. E-selectin was measured in plasma with the use of an ELISA. At follow-up angiogram, 30% (n=14) of the patients had restenosed at 1 year. There was a significant difference in baseline E-selectin levels in patients who restenosed compared with those who did not (65.3 ng/mL [58.25 to 78.05] versus 52.3 [34.2 to 62.1], Mann-Whitney U, P<.007). Endothelial activation with subsequent adherence of white blood cells is an important step in restenosis.
Conclusions:
We have shown an increased level of shed E-selectin in patients destined for restenosis and suggest that this work further supports a role for white blood cell/endothelial interaction in restenosis after angioplasty.
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