title: C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor.
abstract: The acute inflammatory response is frequently accompanied by serious thrombotic events. We show that C-reactive protein (CRP), an acute-phase reactant that markedly increases its serum concentration in response to inflammatory stimuli, induced monocytes to express tissue factor (TF), a potent procoagulant. Purified human CRP in concentrations commonly achieved in vivo during inflammation (10 to 100 micrograms/mL) induced a 75-fold increase in TF procoagulant activity (PCA) of human peripheral blood mononuclear cells (PBM), with a parallel increase in TF antigen levels. CRP-induced PCA was completely blocked by a monoclonal antibody against human TF but not by irrelevant murine IgG. Dot blot analysis showed a significant increase of TF mRNA after 4 hours of incubation with CRP, followed by a peak of PCA within 6 and 8 hours. Actinomycin D and cycloheximide blocked CRP-stimulated PCA, suggesting that de novo TF protein synthesis was required. Endotoxin (LPS) contamination of CRP was excluded as the mediator of TF synthesis because: (1) CRP was Limulus assay negative; (2) induction of TF PCA by CRP was not blocked by Polymyxin B, in contrast to LPS-induced PCA; (3) antihuman CRP IgG inhibited CRP-induced PCA, but not LPS-induced PCA; (4) CRP was able to stimulate TF production in LPS-pretreated PBM refractory to additional LPS stimulation; and, (5) unlike LPS, CRP was incapable of inducing TF in human umbilical vein endothelial cells. We suggest that CRP-mediated TF production in monocytes may contribute to the development of disseminated intravascular coagulation and thrombosis in inflammatory states.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis 55455.
authors.forename: J
authors.initials: J
authors.lastname: Cermak
authors.forename: N S
authors.initials: NS
authors.lastname: Key
authors.forename: R R
authors.initials: RR
authors.lastname: Bach
authors.forename: J
authors.initials: J
authors.lastname: Balla
authors.forename: H S
authors.initials: HS
authors.lastname: Jacob
authors.forename: G M
authors.initials: GM
authors.lastname: Vercellotti
mesh_terms: D000911:Antibodies, Monoclonal; D001777:Blood Coagulation / Q000187:drug effects; D002097:C-Reactive Protein / Q000276:immunology / Q000494:pharmacology*; D002478:Cells, Cultured; D003513:Cycloheximide / Q000494:pharmacology; D003609:Dactinomycin / Q000494:pharmacology; D004730:Endothelium, Vascular / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007700:Kinetics; D008070:Lipopolysaccharides / Q000494:pharmacology; D009000:Monocytes / Q000187:drug effects / Q000378:metabolism*; D012333:RNA, Messenger / Q000378:metabolism; D013925:Thromboplastin / Q000096:biosynthesis* / Q000235:genetics / Q000276:immunology; D014471:Umbilical Veins / Q000378:metabolism
chemical_list: D000911:Antibodies, Monoclonal; D008070:Lipopolysaccharides; D012333:RNA, Messenger; D003609:Dactinomycin; D002097:C-Reactive Protein; D013925:Thromboplastin; D003513:Cycloheximide