Nobile-Orazio E - Neurology - 17-MAR-2009; 72(11): 1024-6
This study confirms that serum VEGF levels are constantly increased in patients with POEMS syndrome, if only markedly increased levels (>3,489 pg/mL in our system) were specifically associated with this syndrome. VEGF levels were also moderately, though significantly, increased in patients with immune-mediated neuropathies (excluding MMN) compared to other PN and were significantly associated with immune-mediated neuropathies. These results indicate that moderately increased VEGF levels should be interpreted cautiously in the diagnosis of POEMS, whereas once this diagnosis is excluded, they may help in identifying an immune-mediated neuropathy.
VEGF is a potent multifunctional cytokine inducing angiogenesis and microvascular hyperpermeability, which may explain many of the symptoms of POEMS. Its possible pathogenetic role in POEMS is supported by its highly increased levels in this syndrome and their decrease concomitant to clinical improvement. The origin and pathogenetic role of VEGF in immune-mediated neuropathies remains unclear. Its presence in inflammatory neuropathies such as CIDP and GBS and in vasculitic neuropathy a possible relation with vascular involvement whereas its increase in PN+IgM where no inflammation or vascular involvement has been reported suggests that it might be related to the immune response itself. Whether this increase may also have a role in the progression of these neuropathies remains to be elucidated.
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