RÉSUMÉ
Based on the idea that the adhesion molecules have becoming one of the most important therapeutic strategies in the medicine, our aim in this study was to elucidate the role played by these molecules in pathogenesis of chronic HCV infection and on the other hand, this work is a trial to find to what extent can the bad habits of smoking aggravate the disease state, and finally to find a hope how modulation of adhesion molecules expression can aid in treating or controlling the wide spread of HCV infection in Egypt. In trial to assess the state of ICAM-1 in chronic hepatitis C, we were not able to neglect the deleterious effects of heavy elements cadmium and lead which are added to the body among other thousands of toxic materials contained in tobacco smoker. Eighty subjects enrolled in this study were properly selected from tropical medicine department and those attending the outpatient clinic between December 1999 and September 200I, they were classified into 4 groups: group I [control group] comprised 20 apparently healthy persons, non smoker with negative tests throughout for any viral hepatitis; group II included 20 non smoker, with chronic hepatitis C infection [positive anti-HCV by ELISA and positive PCR for HCV-RNA]; group III included 20 healthy normal smokers show no evidence for any viral hepatitis tests; and group IV included 20 smoker with chronic hepatitis C infection. All subjects were subjected to full history taking especially that concerning the smoking burden, clinical examinations and abdominal ultrasonography and routine laboratory investigations e.g. liver function test and complete blood picture and HBs antigen to exclude hepatitis B infection for all the patients ICAM-1 was assayed in plasma using ELISA technique also cadmium and lead were assayed in whole blood and urine using atomic absorption spectrophotometer and urine cotinine was measured by radioimmunoassay. Significant rise was recorded in the level of ICAM-1 in hepatitis C patients as compared to control. The effects of cadmium and lead were obvious, in the fact that they evoked more rise in the level of ICAM-1 in smoking hepatitis patients as compared to controls or non-smokers. Levels of ICAM-1, were significantly correlated with serum enzymes and urinary cotinine. Also the concentration of heavy elements in urine and blood correlated significantly with urinary cotinine. Urinary cotinine was chosen as a marker of smoking burden Finally, the idea of advent of specific mono clonal antibodies against adhesion molecules for purposes of control of their mediating inflammatory and metastatic effects, was discussed. To our opinion, this procedure, would be associated with deleterious systemic unavoidable effect, but the idea needs be considered and tried employing more advanced and sophisticated techniques