Angiogenic and inflammatory markers of cardiopulmonary changes in children and adolescents with sickle cell disease.
BACKGROUND
Pulmonary hypertension and left ventricular diastolic dysfunction are complications of sickle cell disease. Pulmonary hypertension is associated with hemolysis and hypoxia, but other unidentified factors are likely involved in pathogenesis as well.


METHODS
Plasma concentrations of three angiogenic markers (fibroblast growth factor, platelet derived growth factor-BB [PDGF-BB], vascular endothelial growth factor [VEGF]) and seven inflammatory markers implicated in pulmonary hypertension in other settings were determined by Bio-Plex suspension array in 237 children and adolescents with sickle cell disease at steady state and 43 controls. Tricuspid regurgitation velocity (which reflects systolic pulmonary artery pressure), mitral valve E/Edti ratio (which reflects left ventricular diastolic dysfunction), and a hemolytic component derived from four markers of hemolysis and hemoglobin oxygen saturation were also determined.


RESULTS
Plasma concentrations of interleukin-8, interleukin-10 and VEGF were elevated in the patients with sickle cell disease compared to controls (P<or=0.003). By logistic regression, greater values for PDGF-BB (P = 0.009), interleukin-6 (P = 0.019) and the hemolytic component (P = 0.026) were independently associated with increased odds of elevated tricuspid regurgitation velocity while higher VEGF concentrations were associated with decreased odds (P = 0.005) among the patients with sickle cell disease. These findings, which are consistent with reports that PDGF-BB stimulates and VEGF inhibits vascular smooth muscle cell proliferation, did not apply to E/Etdi.


CONCLUSIONS
Circulating concentrations of angiogenic and pro-Inflammatory markers are altered in sickle cell disease children and adolescents with elevated tricuspid regurgitation velocity, a subgroup that may be at risk for developing worsening pulmonary hypertension. Further studies to understand the molecular changes in these children are indicated.
Niu
Xiaomei
X
Center for Sickle Cell Disease, Howard University, Washington, DC, United States of America.
Nouraie
Mehdi
M
Campbell
Andrew
A
Rana
Sohail
S
Minniti
Caterina P
CP
Sable
Craig
C
Darbari
Deepika
D
Dham
Niti
N
Reading
N Scott
NS
Prchal
Josef T
JT
Kato
Gregory J
GJ
Gladwin
Mark T
MT
Castro
Oswaldo L
OL
Gordeuk
Victor R
VR
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000276:immunology*; D002318:Cardiovascular Diseases / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D000860:Hypoxia; D007249:Inflammation; D016753:Interleukin-10 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D009389:Neovascularization, Pathologic; D042461:Vascular Endothelial Growth Factor A / Q000097:blood / Q000378:metabolism
D006454:Hemoglobins; D016209:Interleukin-8; D042461:Vascular Endothelial Growth Factor A; D016753:Interleukin-10