Is vascular endothelial growth factor a useful biomarker in giant cell arteritis?. Issue 1 (29th March 2017)

• Record Type: Journal Article
• Authors: Goodfellow, Nicola; Morlet, Julien; Singh, Surjeet; Sabokbar, Afsie; Hutchings, Andrew; Sharma, Vanshika; Vaskova, Jana; Masters, Shauna; Zarei, Allahdad; Luqmani, Raashid
• Other Names: author non-byline.; Lee Ellen author non-byline.; Loban Amanda author non-byline.; Ellis Christopher author non-byline.; Gillett Mike author non-byline.; Bradburn Mike author non-byline.; Schmidt Wolfgang author non-byline.; Dasgupta Bhaskar author non-byline.; Diamantopoulos Andreas author non-byline.; McNally Eugene author non-byline.; Piper Jennifer author non-byline.; Forrester-Barker Wulf author non-byline.; Hamilton Willie author non-byline.; McDonald Brendan author non-byline.; Pease Colin author non-byline.; Salmon John author non-byline.; Wailoo Allan author non-byline.; Wolfe Konrad author non-byline.; Fathers Keri author non-byline.; Marcus-Wan Leo author non-byline.; Farrar Nicola author non-byline.; Manhas Varun author non-byline.; Scott Connor author non-byline.; Sullivan Nicky author non-byline.; Brown Denise author non-byline.; Bicknell Gareth author non-byline.; Kliskey Karolina author non-byline.; Gray David author non-byline.; Mahmood Samiya author non-byline.; Marie Morgan Ann author non-byline.; Ahmed Ifzal author non-byline.; Ehrenstein Michael author non-byline.; Davies Bleddyn author non-byline.; Raza Karim author non-byline.; Mant David author non-byline.; Williamson Lyn author non-byline.; Gilbert Kate author non-byline.; Travis Simon author non-byline.; Sterne Jonathan author non-byline.; Pease Colin author non-byline.; Carruthers David author non-byline.; Klocke Rainer author non-byline.; Saravanan Vadivelu author non-byline.; Makkuni Damodar author non-byline.; Geraldes Ruth author non-byline.; Diamantopoulos Andreas author non-byline.; Neumann Thomas author non-byline.; Pendleton Adrian author non-byline.; Ahmed Khalid author non-byline.; Hull Richard author non-byline.; Chakravarty Kuntal author non-byline.; Lanyon Peter author non-byline.; Chan Antoni author non-byline.; Raj Nicholas author non-byline.; Borg Frances author non-byline.; Molloy Eamonn author non-byline.; Magliano Malgorzata author non-byline.; Wright David author non-byline.;
• Is Part Of: RMD open. Volume 3:Issue 1(2017)
• Publication Date: 2017-03-29
• Subjects: Giant Cell Arteritis -- Systemic vasculitis -- Inflammation; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2016-000353
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : Objectives: To assess the performance of circulating vascular endothelial growth factor (VEGF) levels as a tool for diagnosing giant cell arteritis (GCA) in a cohort of patients referred for assessment of suspected GCA. Methods: We selected 298 patients recruited to the multicentre study Temporal Artery Biopsy versus Ultrasound in diagnosis of suspected GCA (TABUL). In a random subset of 26 biopsy-proven GCA cases and 26 controls, serum from weeks 0, 2 and 26 was analysed for VEGF concentration using ELISA. VEGF concentration at week 0 was used to generate a receiver-operating characteristic curve and thereby identify a cut-off for an abnormal result which was used to analyse the full patient cohort. Sections of paraffin-embedded temporal artery were stained by immunohistochemistry for VEGF. Results: The mean (95% CI) VEGF concentration at week 0 was 873 pg/mL (631 to 1110) in 26 patients versus 476 pg/mL (328 to 625) in 26 controls (p=0.017). This difference was not observed at any other time point. The optimal cut-off of 713 pg/mL was applied to the whole patient cohort (n=298), yielding sensitivity of 32% and specificity of 85%. This was not improved by combination with any clinical parameters. When patients with biopsy-proven GCA were compared with controls, sensitivity was 58% and specificity remained 85%. Sections of biopsy from biopsy-positive GCA showed intense staining in the adventitia which was not seen in controls. Conclusions: Serum VEGF concentration predicts biopsy positivity but is not useful for differentiating clinical cases of GCA from controls. Further studies into VEGF as a prognostic marker and therapeutic target are warranted. Trial registration number: NCT00974883 ; Post-results.