Detection of verocytotoxin bound to circulating polymorphonuclear leukocytes of patients with hemolytic uremic syndrome.
The epidemic form of hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure in children and is characterized by a prodromal phase of sometimes bloody diarrhea. The role of verocytotoxin (VT)-producing Escherichia coli has been strongly implicated. Although antibodies against VT have been detected in the serum of patients with HUS, VT itself has never been detected in circulating blood. In this study, VT-2 was detected in the systemic circulation in 9 of 10 patients with the epidemic form of HUS. In those cases, VT-2 was bound exclusively to polymorphonuclear leukocytes (PMN). The detection of VT-2 bound to PMN was associated with the presence of diarrhea at the time the blood samples were obtained. The one patient for whom VT was not detected presented with atypical HUS. For 5 of the 10 patients with HUS who were studied, the time course of VT binding was analyzed; binding decreased in four patients. The finding of VT bound to PMN in the systemic circulation of patients with HUS is important for a clearer understanding of the pathogenesis of HUS and suggests new approaches for treatment in the future.
Department of Pediatrics, University Hospital Nijmegen, Nijmegen, The Netherlands.
D Maroeska W M
DMWM
Te Loo
Gaubius Laboratory TNO-PG, Leiden, The Netherlands.|Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, The Netherlands.
Victor W M VAN
VWMV
Hinsbergh
Department of Pediatrics, University Hospital Nijmegen, Nijmegen, The Netherlands.
Lambertus P W J VAN DEN
LPWJVD
Heuvel
Department of Pediatrics, University Hospital Nijmegen, Nijmegen, The Netherlands.
Leo A H
LAH
Monnens
D001773:Blood Cells / Q000378:metabolism*; D003967:Diarrhea / Q000209:etiology; D006463:Hemolytic-Uremic Syndrome / Q000097:blood* / Q000150:complications; D006801:Humans; D009504:Neutrophils / Q000378:metabolism*; D022641:Shiga Toxin 2; D022603:Shiga Toxins / Q000097:blood*; D013997:Time Factors
D022641:Shiga Toxin 2; D022603:Shiga Toxins; C430449:verocytotoxin 2