Thrombomodulin-protein C-EPCR system: integrated to regulate coagulation and inflammation.
Late in the 18th century, William Hewson recognized that the formation of a clot is characteristic of many febrile, inflammatory diseases (Owen C. A History of Blood Coagulation. Rochester, Minnesota: Mayo Foundation; 2001). Since that time, there has been steady progress in our understanding of coagulation and inflammation, but it is only in the past few decades that the molecular mechanisms linking these 2 biologic systems have started to be delineated. Most of these can be traced to the vasculature, where the systems most intimately interact. Thrombomodulin (TM), a cell surface-expressed glycoprotein, predominantly synthesized by vascular endothelial cells, is a critical cofactor for thrombin-mediated activation of protein C (PC), an event further amplified by the endothelial cell protein C receptor (EPCR). Activated PC (APC), in turn, is best known for its natural anticoagulant properties. Recent evidence has revealed that TM, APC, and EPCR have activities that impact not only on coagulation but also on inflammation, fibrinolysis, and cell proliferation. This review highlights recent insights into the diverse functions of this complex multimolecular system and how its components are integrated to maintain homeostasis under hypercoagulable and/or proinflammatory stress conditions. Overall, the described advances underscore the usefulness of elucidating the relevant molecular pathways that link both systems for the development of novel therapeutic and diagnostic targets for a wide range of inflammatory diseases.
Van de Wouwer
Marlies
M
The Center for Transgene Technology and Gene Therapy, University of Leuven and the Flanders Interuniversity Institute for Biotechnology (VIB), Belgium.
Collen
Désiré
D
Conway
Edward M
EM
D000818:Animals; D015703:Antigens, CD; D017209:Apoptosis; D001777:Blood Coagulation / Q000502:physiology*; D025901:Carboxypeptidase B2 / Q000502:physiology; D000074283:Endothelial Protein C Receptor; D016232:Endothelins / Q000096:biosynthesis / Q000235:genetics / Q000502:physiology*; D005342:Fibrinolysis / Q000502:physiology; D005786:Gene Expression Regulation; D006023:Glycoproteins; D006706:Homeostasis; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000188:drug therapy; D051379:Mice; D010215:Papio; D011486:Protein C / Q000502:physiology*; D017434:Protein Structure, Tertiary; D011956:Receptors, Cell Surface; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000097:blood / Q000188:drug therapy; D013312:Stress, Physiological / Q000097:blood; D013329:Structure-Activity Relationship; D013917:Thrombin / Q000502:physiology; D018180:Thrombomodulin / Q000737:chemistry / Q000235:genetics / Q000502:physiology* / Q000627:therapeutic use
D015703:Antigens, CD; D000074283:Endothelial Protein C Receptor; D016232:Endothelins; D006023:Glycoproteins; C478370:PROCR protein, human; D011486:Protein C; D011956:Receptors, Cell Surface; D011994:Recombinant Proteins; D018180:Thrombomodulin; D025901:Carboxypeptidase B2; D013917:Thrombin