We thank Dr Bhatia, Dr Clesham and Dr Turner for their interest in our paper [1], and we agree with them that the studies on the serum levels of endostatin, VEGF and HGF under administration of heparin should be interpreted very carefully, and there is an important limitation in our study. However, we disagree with them on some points as follows. We think that the significant decrease in serum VEGF levels after reperfusion may be due to down-regulation of VEGF production (although we did not state in our paper) as well as internalization of VEGF after binding to its receptor (which may be facilitated by heparin [2]). VEGF was shown to be internalized in HUVECs (human umbilical vein endothelial cells) [3]. In fact, we found that VEGF concentrations in culture supernatants of cardiac myocytes increased rapidly and then decreased in response to acute hypoxia in vitro without addition of any drugs including heparin (Y. Seko, unpublished work). This is also the case for endostatin. Recently, it has been reported that AIDS-related Kaposi's sarcoma cells rapidly internalize endostatin [4]. We also found that concentrations of endostatin in culture supernatants of cardiac myocytes subjected to hypoxia in vitro increased a little later than those of VEGF, suggesting that VEGF and endostatin are similarly released into culture supernatants in response to hypoxia (Y. Seko, unpublished work).Kawamoto et al. [5] reported that the serum concentration of VEGF in patients with acute myocardial infarction was reduced by up to 93% 1 h after administration of intravenous heparin. However, it is strange that the authors [5] did not report the serum VEGF levels at the time of admission before the start of heparin administration, and that heparin administration markedly decreased the serum VEGF level, but had no effects on the serum bFGF (basic fibroblast growth factor) level, although both growth factors are heparin-binding proteins. Moreover, we analysed the same serum samples with an ELISA kit from R&D Systems and that from Immuno-Biological Laboratories (as used by Kawamoto et al. [5]), but the data were quite different between the two kits. As we stated in our paper [1], marked elevation of serum levels of HGF after reperfusion was thought to be at least in part (but not entirely) due to heparin administration. However, we could not exclude a possibility that HGF may be released into the circulation in response to reperfusion and play a protective role against the reperfusion-induced oxidative stress [6].In conclusion, to know the precise effects of myocardial ischaemia/reperfusion on the serum levels of endostatin, VEGF and HGF, further studies using animal models without administration of any drugs, including heparin, are needed.
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