Background: Reduced bioactive vascular endothelial growth factor (VEGF) has been demonstrated in\ud several inflammatory lung conditions including the acute respiratory distress syndrome (ARDS). sVEGFR-1,\ud a soluble form of VEGF-1 receptor, is a potent natural inhibitor of VEGF. We hypothesised that sVEGFR-1\ud plays an important role in the regulation of the bioactivity of VEGF within the lung in patients with ARDS.\ud Methods: Forty one patients with ARDS, 12 at risk of developing ARDS, and 16 normal controls were\ud studied. Bioactive VEGF, total VEGF, and sVEGFR-1 were measured by ELISA in plasma and\ud bronchoalveolar lavage (BAL) fluid. Reverse transcriptase polymerase chain reaction for sVEGFR-1 was\ud performed on BAL cells.\ud Results: sVEGFR-1 was detectable in the BAL fluid of 48% (20/41) of patients with early ARDS (1.4–\ud 54.8 ng/ml epithelial lining fluid (ELF)) compared with 8% (1/12) at risk patients (p = 0.017) and none of\ud the normal controls (p = 0.002). By day 4 sVEGFR-1 was detectable in only 2/18 ARDS patients\ud (p = 0.008). Patients with detectable sVEGFR-1 had lower ELF median (IQR) levels of bioactive VEGF than\ud those without detectable sVEGFR-1 (1415.2 (474.9–3192) pg/ml v 4761 (1349–7596.6) pg/ml, median\ud difference 3346 pg/ml (95% CI 305.1 to 14711.9), p = 0.016), but there was no difference in total VEGF\ud levels. BAL cells expressed mRNA for sVEGFR-1 and produced sVEGFR-1 protein which increased\ud following incubation with tumour necrosis factor a.\ud Conclusion: This study shows for the first time the presence of sVEGFR-1 in the BAL fluid of patients with\ud ARDS. This may explain the presence of reduced bioactive VEGF in patients early in the course of ARDS
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