Adhesion Molecules in Kidney Diseases - Adhesion Molecules - page 247

tubules in acute rejection, and even greater reactivity was observed in the distal
tubules. h e upregulation of β6 integrin as well as TGF-β1 in CAD may serve as
an alternative target for the treatment of CAD (Sawada et al. 2004).
Reduced vascular endothelial (VE)-cadherin expression in peritubular
endothelial cells in acute rejection at er human renal transplantation has been
reported. It was postulated that the downregulation of VE-cadherin could be
responsible for the lymphocyte transmigration into interstitial tissues leading to
grat dysfunction (Roussoulières et al. 2007) (Table 2) .
Chronic Renal Failure and Hemodialysis
Chronic renal failure is a slow, progressive loss of kidney function resulting in
permanent kidney failure, and hemodialysis (HD) is the most common method
used to treat advanced and permanent kidney failure. However, HD induces
several changes in the circulating blood cells and protein systems. h ese changes
range from activation of the coagulation pathway, the complement and kallikrein-
kinin systems to alterations in adhesion molecule expression and cytokine
synthesis by the dif erent leukocyte subtypes. Adhesion molecules are involved
in the extravasation of leukocytes from the vessel lumen into the surrounding
tissue as well as in the binding of leukocytes to other circulating cells. Granulocyte
rolling is predominantly mediated by the selectin family and their counterligands.
P- and E-selectin (CD62P and CD62E, respectively) are expressed by endothelial
cells upon activation.
h e current literature on soluble adhesion molecules in HD patients is in part
contradictory. L-selectin (CD62L) expression on granulocytes decreases during
HD with cellulose dialyzers, while during HD with polysulfone dialyzers it does
not. Some authors have demonstrated that soluble P-selectin is released during
HD and that this is dependent on the type of dialyzer used. Nevertheless, some
studies have shown dif erent plasma level results when using the same type of
dialyzer. Some of them found soluble P-selectin unchanged during HD with a
polysulfone dialyzer, but P-selectin plasma levels increased (Musial et al. 2004) or
decreased (Bonomini et al. 1998) with cuprophane and cellulose dialyzers.
Suliman et al. (2006) investigated concentrations of soluble ICAM-1 and
VCAM-1 in relation to all-cause and cardiovascular mortality in pre-dialysis
patients. h ey showed that high levels of ICAM-1 and VCAM-1 are associated
with signs of malnutrition, inl ammation and cardiovascular disease, and also
that high ICAM levels predict all-cause and cardiovascular mortality in patients
starting dialysis treatment, even at er adjustment for conventional risk factors,
suggesting that increased levels of soluble adhesion molecules may be involved
in the process of atherosclerosis and increased mortality in pre-dialysis patients
(Suliman et al. 2006).