Vascular endothelial growth factor: does it play a pathogenic role in systemic sclerosis?

ABSTRACT

To evaluate the level of the vascular endothelial growth factor [VEGF] in the sera of systemic sclerosis [SSc] patients and its possible correlation with the clinical findings for a better understanding of the pathogenesis of the disease. Thirty-two SSc patients, 20 with diffuse SSc [dSSc] and 12 with limited SSc [lSSc] as well as 11 apparently healthy controls participated in this study. Clinical evaluation was done for all of them. Skin involvement was assessed using the modified Rodnan Skin Score and nailfold capillaroscopy [NFC] and pulmonary function tests including forced vital capacity% [FVC%] and forced expiratory volume% in the first second [FEV[1]%] were done for all participants. Their sera were collected and some laboratory investigations were carried out. Additionally, serum VEGF level was measured using enzyme-linked immunosorbent assay [ELISA]. Serum VEGF level was significantly higher in both SSc and dSSc patients than the controls [p< 0.01 and p < 0.001, respectively]. Also, dSSc patients showed a significantly higher serum VEGF level than lSSc patients [p< 0.001]. No statistically significant difference was found between lSSc and the control group [p> 0.05]. There was a significant lowering of nailfold capillary density in SSc patients as compared to the control group [p < 0.05]. SSc patients with elevated serum VEGF level had pulmonary fibrosis more frequently than those with normal VEGF [p < 0.01]. There was a positive correlation between serum VEGF level and extent of skin sclerosis as determined by modified Rodnan Skin Score [r= 0.55]. However, serum VEGF level correlated negatively with nailfold capillary density, FVC%, and FEV[1]% [r= -0.62, r= -0.63, and r= -0.71, respectively]. The elevated serum VEGF level may contribute to the disease process in SSc patients in particular to the development of skin sclerosis and pulmonary fibrosis. Serum VEGF level may also serve as an indicator of nailfold capillary damage in SSc