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Prepublished online as a Blood First Edition Paper on September 11, 2003; DOI 10.1182/blood-2003-05-1612.

Submitted May 20, 2003
Accepted July 15, 2003
Marked elevation of the chemokine CCL18 / PARC in Gaucher disease: a novel surrogate marker for assessing therapeutic intervention
Rolf G Boot*, Marri Verhoek, Maaike de Fost, Carla E M Hollak, Mario Maas, Boris Bleijlevens, Marielle J van Breemen, Marjan van Meurs, Leonie A Boven, Jon D Laman, Mary Teresa Moran, Timothy M Cox, and Johannes M F G Aerts
Department of Biochemistry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Immunology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
* Corresponding author; email: r.g.boot{at}amc.uva.nl.
Gaucher disease is characterized by storage of glucosylceramide in lysosomes of tissue macrophages as the result of an autosomal recessively inherited deficiency in glucocerebrosidase. Progressive accumulation of these glycolipid-laden Gaucher cells causes a variety of debilitating symptoms. The disease can be effectively treated by costly intravenous infusions with recombinant glucocerebrosidase. Chitotriosidase is massively secreted by Gaucher cells and its plasma levels are employed to monitor efficacy of enzyme therapy. Broad scale application is hampered by the common genetic defect in this surrogate marker. We report that in plasma of symptomatic Gaucher patients the chemokine CCL18 is on average 29 fold elevated, without overlap between patients' and control values (median control plasma level is 33 ng/ml; range: 10-72, median Gaucher plasma level is 948 ng/ml; range: 237-2285). Plasma CCL18 concentrations decrease during therapy, comparably to chitotriosidase levels. Immunohistochemistry demonstrates that Gaucher cells are the prominent source of CCL18. Plasma CCL18 levels can serve as alternative surrogate marker for storage cells in Gaucher patients and monitoring of plasma CCL18 levels proves to be very useful in determination of therapeutic efficacy, especially in patients that are deficient in chitotriosidase activity. The potential physiological consequences of chronically elevated CCL18 in Gaucher patients are discussed.

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