VCAM-1 and ICAM-1 Serum Levels as Markers of Relapse in Visceral Leishmaniasis.

Abstract

Objectives-Methods. Visceral leishmaniasis (VL) is characterized by chronicity and relapses despite efficacious treatment. Acute and chronic inflammatory processes and concomitant disturbances in cell adhesion characterize the pathogenesis of the disease. To investigate these processes further we measured adhesion molecules (L-selectin, ICAM-1 and VCAM-1) serum levels in 16 children with VL, as well as in 20 healthy controls. All children were treated with liposomal amphotericin B (3 mg/kg) on days 1 to 5, 14, and 21. Measurements were performed at days 0, 15 and 30. Results. All children responded well to treatment in both clinical and laboratory terms. In three cases relapse occurred at 3, 5 and 6 months after treatment had ended. Serum L-selectin levels, both pre-treatment and post-treatment, did not significantly differ between patients and controls. VCAM-1 and ICAM-1 median levels were similar in patients and controls (P>0.05) at day 0 and significantly increased at day 15 (P<0.05). Interestingly, VCAM-1 and ICAM-1 dropped at day 30, with median levels comparable to those before treatment in the 13 children who subsequently had a good outcome without relapses (P>0.05), but not in the 3 patients who relapsed (P<0.05). Conclusions. Despite the small number of the patients, the changes in VCAM-1 and ICAM-1 levels indicate the anti-parasite activation of the immune system during the course of VL and the effect of treatment. Decline in post-treatment serum VCAM-1 and ICAM-1 levels might be used as a marker of treatment efficacy in childhood VL.