الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
the process of angiogenesis in human tumors is now known to play a critical role in many facets of tumor development. the vascularization of solid tumors is linked to its subsequent ability to disseminate with resultant more aggressive disease. recently, a variety of abnormalities in the angiogenic status of patients with all and cll have been defined. the aim of this study is to determine the serum levels of vegf, tnf- endostatin and mmp-9; asses the capability of the circulating blood cells of all and cll patients to produce bfgf; compare the pretreatment levels of these pro- and anti-angiogenic cytokines to their levels in remission and correlate the pretreatment levels of these cytokines to the clinical and laboratory prognostic parameters. the subjects were categorized into four groups: group i: comprised 25 newly diagnosed all patients. group ii: comprised 15 newly diagnosed cll patients. group iii: comprised 23 of these patients in remission (14 all and 9 cll). group iv: comprised 13 apparently healthy individuals of matched age and sex a reference group. the following investigations were carried out for all subjects: complete history and clinical examination. complete blood picture. bone marrow aspiration and examination. liver and kidney functions, serum uric acid and ldh. serum assay of vegf level by eia. assay of bfgf level in culture supernatant by elisa. serum assay of tnf- gas level by elisa. serum assay of endostatin level by elisa. serum assay of mmp-9 level by elisa. results in all patients: serum vegf level was significantly decreased than contro1 and increased near control level in remission. bfgf level was significantly higher than the control and decreased near control level in remission. serum tnf-gas level was insignificantly increased than control and decreased near control level in remission. serum endostatin level showed no significant difference comparing to control and remission groups. serum mmp-9 level was significantly decreased than control level. in cll patients: serum vegf, bfgf and tnf- gas levels were significantly increased than control and decreased near control level in remission. serum endostatin level showed no significant difference as compared to control and remission groups. serum mmp-9 level was significantly increased than control levels. conclusion: the disturbance in the balance between pro- and anti- angiogenic factors may have an important influence on the course of all and cll resulting in an increased production rate of pro-angiogenic factors, namely vegf, bfgf and tnf- gas in cll patients and bfgf in all patients. on the other hand, endostatin-an antiangiogenic cytokine has no role in all and cll patients. all and cll cells are capable of secretion of a pro-angiogenic molecule (bfgf). pro-angiogenic cytokines levels may be used as valuable prognostic markers for identifying the clinical outcome of patients with all and cll. recommendations: further studies are required to evaluate the exact role of these angiogenic and antiangiogenic factors in the pathophysiology of all and cll. large scale studies about other angiogenic and antiangiogenic factors are needed to obtain a more complete characterization of the angiogenic status of all and cll. this work could be extended to compare intracellular levels of these factors with their levels in the sera and in the urine of the patients. anti-angiogenesis is a promising therapeutic approach in cancer. targeting both tumor cells with conventional cytotoxic agents and endothelial cells with angiogenesis inhibitors may lead to a synergistic anti-tumor effect. these angiogenic cytokines have multiple biological effects e. g. , besides the angiogenic effects of cll-cell derived vegf, the cytokine may also have important autocrine effects on different aspects of cll-cell behaviour, such as transmigration from blood to tissues and prolonged cll-cell survival. these different biological functions should also be studied