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Clinical Investigations: DIFFUSE LUNG DISEASE |

Value of ICAM-1 Expression and Soluble ICAM-1 Level as a Marker of Activity in Sarcoidosis*

Dong Soon Kim, MD; Sang Hoon Paik, MS; Chae Man Lim, MD; Sang Do Lee, MD; Younsuck Koh, MD; Woo Sung Kim, MD; Won Dong Kim, MD, FCCP
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*From the Department of Internal Medicine (Drs. D.S. Kim, Lim, Lee, Koh, W.S. Kim, and W.D. Kim), Asan Medical Center, Ulsan University, Seoul, Korea; and Asan Life Science Institute (Mr. Paik), Seoul, Korea.



Chest. 1999;115(4):1059-1065. doi:10.1378/chest.115.4.1059
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Background: The natural course of sarcoidosis is variable, but no single parameter has been generally accepted as a good marker for disease activity. Adhesion molecules are required for the migration of inflammatory cells; thus, they may be markers of activity in sarcoidosis.

Methods: In 16 patients with active sarcoidosis and 11 with inactive disease (10 were male, 17 were female; mean age [± SD], 39.6 ± 11.0 years; mean follow-up, 21 ± 16 months), the expression of adhesion molecules on cells obtained with BAL (measured by flow cytometry) and the level of soluble intercellular adhesion molecule 1 (sICAM-1) in the serum and BAL fluid (BALF) were measured at the time of diagnosis and during the follow-up. The changes in serum sICAM-1 level and ICAM-1 expression on cells obtained with BAL were compared with the clinical course of the disease.

Results: In patients with active disease, the ICAM-1 on alveolar macrophage (AM) (relative linear median fluorescence intensity [RMFI], 3.21 ± 1.55) and sICAM-1 levels in serum (575 ± 221 ng/mL) and BALF (47.3 ± 19.3 ng/mL) were higher than those for patients with inactive disease (RMFI, 1.67 ± 0.66; p = 0.0034; serum, 263 ± 98.5 ng/mL; p = 0.0001; BALF, 27.5 ± 19.0 ng/mL; p = 0.0209). In the patients with active disease, ICAM-1 on AM and serum sICAM-1 decreased (RMFI, 1.51 ± 0.84; 284 ± 118 ng/mL, respectively) after steroid therapy, but no significant change was noted in patients with inactive disease. We also found that the initial ICAM-1 on AM and serum sICAM-1 had a significant correlation with the degree of improvement in pulmonary function tests after the therapy. The disease relapsed in four patients after the discontinuation of steroids, and the serum sICAM-1 level was elevated again at the time of relapse.

Conclusion: Our data suggest that the serum sICAM-1 level and the ICAM-1 expression on AM may be good markers of disease activity and also a predictor of outcome in sarcoidosis.

Abbreviations: ACE = angiotensin-converting enzyme; AM = alveolar macrophage; BALF = BAL fluid; ICAM-1 = intercellular adhesion molecule 1; IL = interleukin; MFI = median fluorescence intensity; MoAb = monoclonal antibody; RMFI = relative linear median fluorescence intensity; sICAM-1 = soluble intracellular adhesion molecule-1; TNF-α = tumor necrosis factor-α

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