[Prognostic role of adhesion molecules sELAM-1 and sICAM-1 in glucocorticoid therapy of active ophthalmopathy].

Inflammatory process is connected with the increased expression on cells of adhesion molecules, also including intercellular adhesion molecule-1 (ICAM-1) and endothelial leukocyte adhesion molecule-1 (ELAM-1). In active ophthalmopathy (GO) this process, of various severity, is progressing in orbital tissue. This is reflected by the increase in blood of these molecules soluble forms. The aim of the project was to study sELAM-1 and sICAM-1 concentrations in sera of patients with GO in the course of Graves' disease (GD) gratified to glucocorticoid therapy, as well as the analysis of this treatment influence on both adhesion molecules with taking into consideration their prognostic role in an applied treatment. The analysis included 25 subjects with eye changes in the class at least 2c (ATA). The duration of GO did not exceed 2 years. Patients received 3 i.v. "pulses" of methyloprednisolone (1 g/d, every second day), followed by oral administration of prednisone during 3 months (60 mg/d, with gradual dose reduction). The blood was taken before treatment, next day after the last methyloprednisolone infusion, after 2 week of prednisone therapy and after completing of glucocorticoid treatment. As a result of the applied therapy 15 subjects obtained clinical improvement (group 1A), on the contrary 10 persons did not gain positive effects after finishing prednisone (group 1B). Before starting the treatment sICAM-1 and sELAM-1 levels in group 1A were lower than those in group 1B. After methyloprednisolone therapy sICAM-1 and sELAM-1 concentrations declined in both groups. This was related in the most of patients to clinical improvement, which occurred at that time. After 2 weeks of prednisone application concentrations of both adhesion molecules were still decreased. After completing of glucocorticoid therapy in patients with clinical improvement (group 1A) sICAM-1 concentration remained suppressed, in the range of concentrations present in sera of healthy subjects (group 2). In patients without clinical response (group 1A), with gradual recurrence of inflammatory symptoms together with reduction of prednisone dose sICAM-1 concentration increased again to values comparable to initial levels. sELAM-1 concentration in group 1A still did not markedly change after completing of glucocorticoid therapy, on the contrary--in group 1B the level of this adhesion molecule slightly increased. These values, in contradistinction to sICAM-1, did not drop during therapy to concentrations characteristic for normal range. According to the results it may be concluded, that clinical improvement after glucocorticoid therapy is connected with lower adhesion molecules concentrations before treatment. Glucocorticosteroids are causing decrease of sICAM-1 and sELAM-1 concentrations in patients with GO in the grade dependent on the dose of medication, on the contrary changes in sELAM-1 concentration are less significant. Maintenance of decreased sICAM-1 concentration during glucorticoid therapy is a positive prognostic factor.