Clinical relevance of circulating vascular endothelial growth factor [VEGF] in patients with acute leukemia and non-Hodgkin's lymphoma

Vascular endothelial growth factor [VEGF] is a potent regulatory molecule of the process of new blood vessel formation [angiogenesis]. It is a critical process for tumor growth and metastasis. It might represent a promising therapeutic target in hematologic malignancies. The aim of this study is to assess serum level of VEGF, and its prognostic significance in non-Hodgkin's lymphoma [NHL], acute lymphoblastic leukemia [ALL] and acute myeloid leukemia [AML] patients. VEGF level was assessed in the sera of 47 patients before treatment [NHL; n=20, ALL; n=13, and AML; n=14] and controls [n=13]. Samples were collected again from patients with remission after chemotherapy [25 patients: 10 NHL, 8 ALL and 7 AML patients]. Before treatment serum VEGF levels in NHL and AML patients revealed significant elevation compared with control group [P-values: 0.048 and 0.032 respectively]. On the contrary, a highly significant reduction of serum VEGF was elicited in ALL patients compared with control group [P= 0.009]. After treatment, the serum VEGF levels were significantly reduced nearly to the control values in NHL and AML patients. ALL patients exhibited increasing trend of serum VEGF level in remission approaching control values. In NHL patients the correlation statistics revealed a significant positive correlation between serum VEGF level and serum LDH, uric acid, ESR, B-symptoms, and BM lymphocytes [P- 1 values: 0.007, 0.028, 0.001, 0.003, I and 0.023 respectively]. ALL patients I elicited non-significant correlation between serum VEGF and all other studied parameters. In AML patients, a significant correlation was found between serum VEGF level, and both -ESR [r sr 0.49, P= 0.024] and absoIute neutrophilic count [r = 0.617, P= 0.019]. Serum VEGF levels I showed prognostic information in predicting response to treatment of NHL and AML patients. In ALL patients serum VEGF level could be an early predictor of renewal of normal hematopoiesis after remission induction. Serum level of VEGF may be used to predict clinical outcome and/or monitor treatment of hematologicai malignancy

TNF-alfa in patients with liver cirrhosis and ascites: relationship to cirrhotic cardiomyopathy

Backgrounds: cirrhotic cardiomyopathy characterized by baseline increased cardiac output, attenuated systolic contractile and diastolic relaxant responsiveness to inotropic and chronotropic stimuli Elevated TNF-alfa has been demonstrated in cirrhotic patients. However, it is poorly known whether there is a relationship between this cytokine and the development of cirrhotic cardiomyopathy

Objective: to study cardiac abnormalities in patients with liver cirrhosis and ascites with mid without renal impairment [RI], and to assess the role of TNF-alfa in the development of this cardiac dysfunction

Subjects and Methods: we studied 40 patients with liver cirrhosis and ascites [2O patients without RI [aged 42.21 +/- 3.73 years] and 20 patients with RI [aged 42.63 +/- 4.1 years] l and 10 age-matched healthy control subjects. Full history and complete clinical examination were done with the following investigations: complete blood picture fating and postprandial blood sugar S.creatkine. S. bilirubin, S.abumin, prothrombin time, S. transaminase [ALT and AST], plasma and ascetic fluid TIVF-alfa abdominal ultrasonography, resting ECG and echocardiography

Results: plasma TNF-alfa was significantly higher in the studied two ascetic groups compared to the control group [28.1 +/- 5.85, 64.2 +/- 9.13 vs 1.9 +/- 1.31 pg/ml, respectively, [P> 0.001]. also plasma and ascetic TNF-alfa were significantly higher in ascetic group with. RI compared to ascetic group without RI [64.2 +/- 9.13 vs 28.1 +/- 5.85 pg/ml, 152.3 +/- 17: 14 vs 49.2 +/- 5.56 pg/ml respectively, p<0.001]. There were significant increase in left atrial diameter [LAD] and right ventricular end diastolic diameter [RVDD] in the ascetic two groups compared to control group [37.7 +/- 5.1, 40.9 +/- 4.66 vs 30.1 +/- 4.61mm 30.01 +/- 4.32, 33 +/- 4.82 vs 19.2 +/- 5.52 mm respectively, [P<0,00l], also there were significant increase in LaD and RVDD in acetic group with RI compared to ascetic group without RI [40.9 +/- 4.66 vs 37.7 +/- 5.1mm, 33 +/- 4.82 vs 30.01 +/- 4.32mm respectively, P<0.05]. A significant decrease in E/A ratio was found in both ascetic groups compared to control group 10.98 +/- 0.12. 0.9 +/- 0.09 vs 1.11 +/- 0.06, P<0.05] and in ascetic group with RI compared to ascetic group without RI [0.9+8.09 vs 8.98+0.12, P>0.025].There was non significant change in systolic function in ascetic group without RP compared to control group [P<0.05], however, systolic dysfunction was detected in ascetic group RI compared to both control group and ascetic group without RI [P<0.05]. There were significant positive correlation between both plasm and arctic TNF-alfa and parameters of both diastolic and systolic dysfunction

Conclusion: cirrhotic patients with ascites diastolic dysfunction and increase in TNF-alfa where systolic function is still normal. With the development of rend impairment systolic dysfunction occur with associated more increase in TNF-alfa which may suggest a mechanistic role of TNF-alfa in the development of cirrhotic cardiomyopathy