Study of serum and urinary vascular cell adhesion molecule-1 in patients with lupus nephritis

Systemic lupus erythenwtosus [SLE] is a chronic multisystem autoimmune disease. Renal involvement [lupus nephritis; LN] is a frequent and potentially serious complication that worsens morbidity and mortality. LN is a chronic disease with remissions and relapses, and this is important to predict aiming for optimal management. However, a consistent approach still has not been adopted. To study serum and urinary' soluble vascular cell adhesion molecule-I [sVCAM-1] levels in patients with lupus nephr itis and their correlation with the disease activity, laboratory data and renal pathology. Twenty three patients with lupus nephritis and twenty age, sex and ethnic matched healthy controls were subjected to physical examination, abdominal ultrasound, laboratory investigations including: Complete blood cell count, eiythrocyte sedimentation rate [ESR], renal functions, urine analysis, 24-hour urinary protein excretion, liver functions, serum antinuclear antibody [ANA], anti-double stranded deoxyribonucleic acid [anti-dsDNA], serum and urinaly soluble VCAM-1 [sVCAM-1] and other necessary investigations. Percutaneous renal biopsy, with histopathological assessment and determination of activity and chronicity indices, was done for all patients. LN patients had a statistically sign[ficantly higher serum [S] and urinary sVCAM-1, S. ANA, S. antidsDNA, ESR, blood urea, S.creatinine, S.uric acid, 24-hour urinary protein excretion and S. alanine and aspartate aminotransferases, and a statistically significantly lower hemoglobin concentration, S. albumin and creatinine clearance tjian healthy controls. Renal biopsy assessment showed World Health Organization [WHO] class 11 LN in 3 patients, class iii in 4 patients, class IV in 13 patients and class V in 3 patients. S. sVCAM-1 was statistically significantly higher in classes III, IV and V LN than controls and in class IV LN than class II. Urinary sVCAM-1 was statistically signficantly higher in classes II, III, IV and V LN than controls and in classes III and IV LN than class II. Anti-dsDNA was statistically significantly higher in classes III and IV LN than controls, with no statistically significant differences in between the WHO classes. S. and urinary sVCAM-1 showed a statistically wreianon with the total SLEDAI score, pathologic activity index and urinary protein excretion, with a significantly positive correlation between S. and urinary sVCAM-1. A significantly negative correlation was present between S. sVCAM-1 and hemoglobin concentration, and between urinary sVCAM-1 and S. albumin. As regards anti-dsDNA, no statistically significant correlations were observed. In patients with LN, serum and urinary sVCAM-1 are positively correlated with the total SLEDAI score, pathologic activity index and urinary protein excretion. Measurement of their levels, specially urinary sVCAM-1, seems to be valuable in evaluating LNpatients. Further studies are recommended to assess the role of repeated measurements. Whether a blockade of soluble VCAM-1 could have a therapeutic implication in LN remains to be investigated

Expression of CD44 protein and cytokeratin 20 in non Bilharzial and Bilharzial bladder carcinoma

Carcinoma of the urinary bladder is one of the most common cancers world wide. It is the fourth most common malignancy in males and the ninth most common malignancy in females. CD44 is a family of cell-surface transmembrane glycoproteins that serve as receptors for hyaluronate and bind extracellular matrix components. CD44 plays a definite role in cell- cell and cell- matrix interactions. Thus, its down-regulation would facilitate loss of cell - cell cohesion, detachment from the basement membrane, and subsequent infiltration of the underlying tissues. It is suggested that the expression of CD44 is associated with differentiation and prognosis in bladder carcinoma. Cytokeratins [CKs] are a family of proteins that form the intermediate filament cytoskeleton of epithelial cells. Cytokeratin 20 [CK20] has been proposed as a marker of neoplastic change as well as a predictor for progression of urothelial carcinoma. The aim of the work is to study the immunohistochemical expression of CD44 and CK20 in carcinoma of the urinary bladder and correlate the immunohistochemical expression of CD44 and CK20 with different prognostic parameters including the grade and stage of the studied tumors. The studied 71 specimen were subjected to the ordinary H and E staining and immunohistochemical staining for CD44 and CK20. Correlative studies between CD44 and CK20 expression with different prognostic parameters including the grade and stage of the studied tumors revealed statistically significant correlation between CD44 and CK20 expression and the tumor grade and stage of urothelial carcinoma cases. No relation was found between the expression of CD44 and CK20 and the presence of Bilharziasis. Loss or reduction of CD44 immunoreactivity and increasing CK20 positiviiy were significantly associated with increasing tumor grade and stage in the studied cases of urothelial carcinoma and to each other, so, they have combined utility in predicting the behaviour and prognosis of urothelial carcinoma, with no significant difference in their expression between non Bilharzial and Bilharzial bladder carcinomas