title: Vascular endothelial growth factor as a marker of disease activity in neurotuberculosis.
abstract: Vascular endothelial growth factor (VEGF) is a potent angiogenesis mediator. Scant reports are available defining the role of VEGF in active and inactive tubercular meningitis (TBM) with no studies on brain tuberculoma. We quantified VEGF levels by enzyme linked immunoassay (ELISA) in cerebrospinal fluid (CSF) and serum in 20 cases each with active and inactive TBM as well as 22 cases of intraparenchymal tuberculoma. VEGF expression and microvessel angiogenesis quantification was done in 7 cases where tuberculomas were excised. Significantly increased VEGF levels in CSF were found in active TBM cases (106.0+/-50.0 pg/ml) compared to inactive TBM cases (14.7+/-10.0 pg/ml) (p<0.001). Mean serum VEGF levels in active TBM, inactive TBM and tuberculoma were 694.93+/-820.66 pg/ml, 499.61+/-238.33 pg/ml and 541.0+/-389.0 pg/ml, respectively. Immunohistochemical staining of excised tuberculoma demonstrated high expression of VEGF in granulomatous areas with intense positivity in inflammatory mononuclear cells, Langhan's giant cells as well as reactive astrocytes and fibrocytes. A strong positive correlation was observed between microvessel density and VEGF expression. Serial decrease in serum VEGF levels was observed with increasing duration of therapy in tuberculoma. We conclude that increased CSF and serum VEGF levels are a measure of activity of the disease in neurotuberculosis and its gradual decrease over a period of time is probably an indicator of therapeutic response.
authors.affiliation: Department of Pathology, King George's Medical University, Lucknow, 226003, India. drnuzhathusain@hotmail.com
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Husain
authors.forename: Seema
authors.initials: S
authors.lastname: Awasthi
authors.forename: Mohd
authors.initials: M
authors.lastname: Haris
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Gupta
authors.forename: Mazhar
authors.initials: M
authors.lastname: Husain
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid / Q000378:metabolism; D003470:Culture Media; D004269:DNA, Bacterial / Q000032:analysis / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D009389:Neovascularization, Pathologic; D016133:Polymerase Chain Reaction / Q000379:methods; D014375:Tuberculoma / Q000097:blood / Q000175:diagnosis / Q000378:metabolism* / Q000382:microbiology; D014390:Tuberculosis, Meningeal / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000378:metabolism*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood / Q000134:cerebrospinal fluid / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D003470:Culture Media; D004269:DNA, Bacterial; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A