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DOI: 10.1055/s-2008-1038908
© Georg Thieme Verlag KG Stuttgart · New York
Plasma Soluble E-Selectin in Necrotising Enterocolitis
Publikationsverlauf
received June 23, 2008
accepted after revision July 7, 2008
Publikationsdatum:
14. November 2008 (online)
Abstract
Aim: E-selectin is an important mediator of leukocyte-endothelial adhesion. It is expressed on activated endothelium, and shed into the circulation in its soluble form. In babies with necrotising enterocolitis (NEC), increased intestinal expression of E-selectin has been associated with multiple organ failure and an adverse outcome. The aim of this study was to determine whether increased circulating soluble E-selectin (sE-selectin) was associated with a worse prognosis. Methods: With ethical approval, plasma samples from 20 infants with Bell stage II and III NEC were analysed. Both pre- and postoperative samples were available in 6 infants. The severity of illness was assessed using a sequential organ failure assessment score (SOFA) specifically designed for use in NEC. Plasma concentration of sE-selectin was determined by ELISA. Data, which were not normally distributed, were compared by Spearman's rank correlation coefficient and Wilcoxon signed rank test. Results: Plasma sE-selectin was strongly negatively correlated with corrected gestational age at the time of sampling (r = − 0.425, p = 0.006). There was no association between plasma sE-selectin and outcome (death or survival to discharge), severity of intestinal disease (focal, multifocal or pan-intestinal), or SOFA score. Surgery for suspected perforation, however, caused a significant elevation in sE-selectin levels (p = 0.031). Conclusions: Plasma sE-selectin, a described marker of endothelial activation, is increased following surgery for NEC. However, prematurity appears to be the cause of an increase in sE-selectin level, confounding the potential use of sE-selectin levels as a predictor of severity of illness in NEC.
Key words
necrotising enterocolitis - adhesion molecules - E‐selectin - inflammation
References
- 1 Austgulen R, Arntzen K J, Haereid P E, Aag S, Dollner H. Infections in neonates delivered at term are associated with increased serum levels of ICAM‐1 and E-selectin. Acta Paediatr. 1997; 86 274-280
- 2 Ballabh P, Kumari J, Krauss A N, Shin J J, Jain A, Auld P A. et al . Soluble E-selectin, soluble L-selectin and soluble ICAM‐1 in bronchopulmonary dysplasia, and changes with dexamethasone. Pediatrics. 2003; 111 461-468
- 3 Bevilacqua M P, Nelson R M. Selectins. J Clin Invest. 1993; 91 379-387
- 4 Cowley H C, Heney D, Gearing A J, Hemingway I, Webster N R. Increased circulating adhesion molecule concentrations in patients with the systemic inflammatory response syndrome: a prospective cohort study. Crit Care Med. 1994; 22 651-657
- 5 Dollner H, Vatten L, Austgulen R. Early diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6, soluble tumour necrosis factor receptors and soluble adhesion molecules. J Clin Epidemiol. 2001; 54 1251-1257
- 6 Eaton S, Hall N, Rees C M, Pierro A. Necrotizing enterocolitis: pathogenesis, medical management and surgery. Br J Intensive Care. 2004; 14 101-105
- 7 Fasoli L, Turi R A, Spitz L, Kiely E M, Drake D, Pierro A. Necrotizing enterocolitis: extent of disease and surgical treatment. J Pediatr Surg. 1999; 34 1096-1099
- 8 Gearing A J, Hemingway I, Pigott R, Hughes J, Rees A J, Cashman S J. Soluble forms of vascular adhesion molecules, E-selectin, ICAM‐1, and VCAM‐1: pathological significance. Ann N Y Acad Sci. 1992; 667 324-331
- 9 Hall N J, Ali J, Pierro A, Eaton S. Total glutathione is not decreased in infants with necrotising enterocolitis. J Pediatr Surg. 2005; 40 769-773
- 10 Langouche L, Vanhorebeek I, Vlasselaers D, Vander P S, Wouters P J, Skogstrand K. et al . Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest. 2005; 115 2277-2286
- 11 Ley K, Laudanna C, Cybulsky M I, Nourshargh S. Getting to the site of inflammation: the leukocyte adhesion cascade updated. Nat Rev Immunol. 2007; 7 678-689
- 12 Lin P W, Stoll B J. Necrotising enterocolitis. Lancet. 2006; 368 1271-1283
- 13 Ng P C, Cheng S H, Chui K M, Fok T F, Wong M Y, Wong W. et al . Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 1997; 77 F221-F227
- 14 Okajima K, Uchiba M, Murakami K, Okabe H, Takatsuki K. Plasma levels of soluble E-selectin in patients with disseminated intravascular coagulation. Am J Hematol. 1997; 54 219-224
- 15 Okajima K, Harada N, Sakurai G, Soga Y, Suga H, Terada T. et al . Rapid assay for plasma soluble E-selectin predicts the development of acute respiratory distress syndrome in patients with systemic inflammatory response syndrome. Transl Res. 2006; 148 295-300
- 16 Pierro A, Hall N. Surgical treatments of infants with necrotizing enterocolitis. Semin Neonatol. 2003; 8 223-232
- 17 Rees C M, Eaton S, Pierro A. Trends in infant mortality from necrotizing enterocolitis in England and Wales and the USA. Arch Dis Child. 2008;
- 18 Stefanutti G, Lister P, Smith V V, Peters M J, Klein N J, Pierro A. et al . P-Selectin expression, neutrophil infiltration and histological injury in neonates with necrotizing enterocolitis. J Pediatr Surg. 2005; 40 942-948
- 19 Upperman J S, Potoka D, Grishin A, Hackam D, Zamora R, Ford H R. Mechanisms of nitric oxide-mediated intestinal barrier failure in necrotizing enterocolitis. Semin Pediatr Surg. 2005; 14 159-166
- 20 Wyble C W, Desai T R, Clark E T, Hynes K L, Gewertz B L. Physiologic concentrations of TNFalpha and IL-1beta released from reperfused human intestine upregulate E-selectin and ICAM‐1. J Surg Res. 1996; 63 333-338
PhD Simon Eaton
Department of Paediatric Surgery
Institute of Child Health
30, Guilford Street
London WC1N 1EH
UK
eMail: s.eaton@ich.ucl.ac.uk