Elevated levels of soluble tumour necrosis factor receptor 1, thrombomodulin and soluble endothelial cell adhesion molecules in patients with dengue haemorrhagic fever

The pathological mechanism of dengue haemorrhagic fever (DHF) is still poorly understood. Previous studies have suggested that immune responses contribute to an increase in capillary permeability. We examined the levels of cytokines and activated endothelial substances in serum samples collected from DHF patients in Indonesia. We measured the levels of soluble TNF-R1, MCP-1, GM-CSF, IL-17, TNF-α, soluble thrombomodulin, soluble E-selectin, soluble ICAM-1 and soluble VCAM-1. The levels of activated endothelial substances such as sE-selectin, sICAM-1 and sVCAM-1 were higher in DHF patients than in healthy controls. High levels of soluble activated endothelial substances suggest that endothelial cells are highly activated. When compared with patients with other febrile illness (OFI) or healthy controls, the levels of sTNF-R1 were higher in DHF patients. A similar trend was observed in the level of thrombomodulin. MCP-1, GM-CSF and IL-17 were not detected in serum samples from any patients and healthy controls. TNF-α was detected in 5(9%) of 53 patients. The results suggest that endothelial cells are highly activated in DHF patients and TNF-α is one of the factors which contributes to the activation.