Abstract
Systemic capillary leak syndrome (SCLS; Clarkson disease) is a rare orphan disorder characterized by transient yet recurrent episodes of hypotension and peripheral oedema due to diffuse vascular leakage of fluids and proteins into soft tissues. Humoral mediators, cellular responses and genetic features accounting for the clinical phenotype of SCLS are virtually unknown. Here, we searched for factors altered in acute SCLS plasma relative to matched convalescent samples using multiplexed aptamer‐based proteomic screening. Relative amounts of 612 proteins were changed greater than twofold and 81 proteins were changed at least threefold. Among the most enriched proteins in acute SCLS plasma were neutrophil granule components including bactericidal permeability inducing protein, myeloperoxidase and matrix metalloproteinase 8. Neutrophils isolated from blood of subjects with SCLS or healthy controls responded similarly to routine pro‐inflammatory mediators. However, acute SCLS sera activated neutrophils relative to remission sera. Activated neutrophil supernatants increased permeability of endothelial cells from both controls and SCLS subjects equivalently. Our results suggest systemic neutrophil degranulation during SCLS acute flares, which may contribute to the clinical manifestations of acute vascular leak.
Highlights
Systemic capillary leak syndrome (SCLS) is an extremely rare and po‐ tentially fatal disorder of unknown aetiology
From our proteomic screening study of SCLS plasma, we discovered that neutrophils are activated during SCLS disease flares
As early as 1977, tracking studies of proteins of varying mo‐ lecular weights in SCLS sera during flares determined that albumin levels decreased by 30%‐50% during an epi‐ sode, C1 decreased only 10% and IgM levels rose in direct proportion to the increase in hematocrit.[14]
Summary
Systemic capillary leak syndrome (SCLS) is an extremely rare and po‐ tentially fatal disorder of unknown aetiology. As noted above functionally enriched pathways in acute samples included signal‐ ling involving IL‐8, a well‐known neutrophil chemoattractant, and LPS, which activates neutrophils.[11] Given these findings, we TA B L E 1 Characteristics of SCLS patients
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