title: Significance of diminished factor XIII in Crohn's disease.
abstract: OBJECTIVE
  Coagulation factor XIII is a plasma transglutaminase involved in crosslinking of fibrin, the last step of the coagulation system and a connective tissue factor contributing to the wound healing process. It circulates as a heterotetrameric molecule consisting of two identical proenzyme subunits (factor XIIIA) and two carrier protein subunits (factor XIIIS). The aim of this study was to determine the disease features associated with the diminution of factor XIII in Crohn's disease.
  
  
  METHODS
  Factor XIIIA and factor XIIIS levels were assessed in patients presenting with Crohn's disease, ulcerative colitis, infectious colitis, or diverticulitis, in patients with rheumatoid arthritis, and in control subjects. Prothrombin fragment 1 + 2 assay, as a marker of the generation of thrombin and measurement of C-terminal telopeptide of type I collagen as an estimate of degradation of collagen type I, were performed.
  
  
  RESULTS
  Factor XIIIA was significantly decreased in Crohn's disease, in ulcerative colitis, and in infectious colitis by comparison with subjects presenting with diverticulitis, normal, and rheumatoid subjects p = 0.0001). Factor XIIIS was unmodified in patients with Crohn's disease by comparison with controls but was reduced in those presenting with intestinal bleeding (p = 0.0002). In Crohn's disease, the lowest level of factor XIIIA was observed in patients with intestinal bleeding (p = 0.0003). Factor XIIIA was correlated with the Van Hees index (r = -0.5661; p = 0.0001) and with the C-terminal telopeptide of type I collagen (r = -0.4110; p = 0.0011) but not with prothrombin fragment 1 + 2. The multiple regression analysis showed that only Van Hees index and intestinal bleeding were independent variables for explaining the diminution of Factor XIIIA in Crohn's disease.
  
  
  CONCLUSIONS
  Factor XIIIA subunit is an indicator of Crohn's disease activity. Our study suggests that a low factor XIIIA level is related to the presence of intestinal lesions and might be linked to intestinal repair mechanisms; loss in intestinal lumen could be also involved, especially in patients with intestinal bleeding.
authors.affiliation: Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpital de Hautepierre, Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Chamouard
authors.forename: L
authors.initials: L
authors.lastname: Grunebaum
authors.forename: M L
authors.initials: ML
authors.lastname: Wiesel
authors.forename: J
authors.initials: J
authors.lastname: Sibilia
authors.forename: G
authors.initials: G
authors.lastname: Coumaros
authors.forename: C
authors.initials: C
authors.lastname: Wittersheim
authors.forename: R
authors.initials: R
authors.lastname: Baumann
authors.forename: J P
authors.initials: JP
authors.lastname: Cazenave
mesh_terms: D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000097:blood; D001424:Bacterial Infections / Q000097:blood; D002352:Carrier Proteins / Q000032:analysis; D003092:Colitis / Q000097:blood; D003093:Colitis, Ulcerative / Q000097:blood; D003094:Collagen / Q000097:blood; D024042:Collagen Type I; D003424:Crohn Disease / Q000097:blood*; D004238:Diverticulitis / Q000097:blood; D005176:Factor XIII / Q000032:analysis*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D010455:Peptides / Q000097:blood; D011498:Protein Precursors / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D012044:Regression Analysis; D011503:Transglutaminases / Q000032:analysis
chemical_list: D002352:Carrier Proteins; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011498:Protein Precursors; C052929:collagen type I trimeric cross-linked peptide; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D011516:Prothrombin; D003094:Collagen; D005176:Factor XIII; D011503:Transglutaminases