title: Decreases in levels of serum fibronectin predict the severity of vascular leak syndrome in patients treated with ricin A chain-containing immunotoxins.
abstract: The major dose-limiting adverse effect of ricin A chain-containing immunotoxin (IT) therapy is vascular leak syndrome (VLS). Since plasma fibronectin (Fn) plays a role in maintaining microcirculatory integrity and since the gradient between plasma and tissue Fn can be altered in various pathological situations, we determined whether the administration of IT-ricin A chain to patients resulted in changes in the levels of serum Fn and, if so, whether these changes correlated with the severity of VLS. We also measured the serum levels of tumor necrosis factor alpha (TNFalpha), a proinflammatory cytokine which has been implicated in tissue damage and in interleukin 2-mediated VLS. Our results indicate that the most severe manifestations of VLS were associated with the highest pretreatment levels of Fn, the largest decreases in Fn immediately after starting IT therapy, increases in the levels of serum TNFalpha, higher concentrations of circulating IT, and the lowest numbers of circulating tumor cells. These parameters should, therefore, be useful for predicting which patients will have severe VLS.
authors.affiliation: Cancer Immunobiology Center and Department of Microbiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-8576, USA.
authors.forename: R
authors.initials: R
authors.lastname: Baluna
authors.forename: E A
authors.initials: EA
authors.lastname: Sausville
authors.forename: M J
authors.initials: MJ
authors.lastname: Stone
authors.forename: M A
authors.initials: MA
authors.lastname: Stetler-Stevenson
authors.forename: J W
authors.initials: JW
authors.lastname: Uhr
authors.forename: E S
authors.initials: ES
authors.lastname: Vitetta
mesh_terms: D000328:Adult; D000368:Aged; D019559:Capillary Leak Syndrome / Q000139:chemically induced*; D005260:Female; D005353:Fibronectins / Q000097:blood / Q000187:drug effects*; D006801:Humans; D000922:Immunotoxins / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012276:Ricin / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000187:drug effects / Q000378:metabolism
chemical_list: D005353:Fibronectins; D000922:Immunotoxins; D014409:Tumor Necrosis Factor-alpha; D012276:Ricin