Serum l-selectin and ICAM-1 in patients with Graves’ ophthalmopathy during treatment with corticosteroids
Introduction
The most difficult clinical problem in the treatment of Graves’ disease is severe ophthalmopathy (GO). Some patients with progressive exophthalmos, chemosis, ophthalmoplegia or loss of vision need to be treated with immunosuppressive medications, most often by corticosteroids. However the efficacy of corticosteroids is limited and their use entails considerable risk. There have been many attempts to find reliable predictors of response to immunosuppressive treatment, both clinical, obtained by imaging methods or laboratory but very few involving the immune system [1], [2], [3], [4]. l-selectin is responsible for the initiation of leucocyte migration through the endothelium and thus, shed from the cell surface, may reflect the earliest events of cell adhesion [5]. Circulating forms of l-selectin (sl-selectin) have been found elevated in the active stage of several autoimmune diseases [6], [7]. ICAM-1 (Intercellular adhesion molecule 1) was shown to play an important role in the interaction of immunocompetent cells with fibroblasts of the retroocular tissue in patients with GO [8]. Increased serum ICAM-1 (sICAM-1) was suggested as a marker of subclinical retro orbital connective inflammation in Gd patients [9]. The aim of the study was an estimation of serum l-selectin and ICAM-1 in patients with Graves’ disease with ophthalmopathy during treatment with corticosteroids and an assessment of their potential as a guideline of immunosupressive therapy.
Section snippets
Subjects and methods
The study was carried out in three groups of subjects: 1/17 patients with clinical symptoms of ophthalmopathy (GO)(12 females and five males, mean age 42.2±16.5 years). All the individuals in this group presented a Clinical Activity Score of eye changes (CAS)≥3 [1] and anamnesis of GO≤1 year. All of them underwent corticosteroid therapy consisting of intravenous infusions of methyloprednisolone (MP) (two series, 3 g each time) and subsequent treatment with oral prednisone (P) (60 mg per day for
Results
The results of serum l-selectin and sICAM-1 level determination are shown in Table 1. We found a significantly higher serum l-selectin level both in Gd and GO patients in comparison to the control group (P<0.05). Serum ICAM-1 levels were significantly higher both in Gd and GO individuals in relation to the controls (respectively P<0.01 and 0.001).
The serum l-selectin and sICAM-1 levels during corticosteroid treatment in GO patients are shown in Table 2. There were significant differences in
Discussion
For many years corticosteroids have been accepted as the treatment of choice in the Graves ophthalmopathy however their administration is limited by several problems: an inability to predict which patients will respond, lack of a satisfactory understanding of their mechanism of action and no guidelines of treatment so as to maximize benefits and minimize complications. There are no established predictors of response to immunosuppressive treatment involving the immune system. Some adhesion
Conclusion
Serum l-selectin and ICAM-1 were elevated in patients with active GO 2. Metyloprednizolone decreased levels of the studied adhesion molecules in corticosteroid-responsive patients with GO 3. Lack of clinical results in corticosteroid therapy in patients with a low starting l-selectin level would suggest the possibility of serum l-selectin estimation as a prognostic for immunotherapy efficacy.
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