title: C-reactive protein contributes to the hypercoagulable state in coronary artery disease.
abstract: OBJECTIVE
  Elevated plasma C-reactive protein (CRP) levels predict coronary events, but it is unclear whether CRP plays a role in thrombosis associated with these events. We investigated tissue factor (TF) induction by CRP on peripheral blood mononuclear cells (PBMC) from patients with coronary disease.
  
  
  METHODS
  PBMC from 35 patients with stable angina (SA) in study 1, 10 male patients with SA, 10 with unstable angina (UA) and 10 matched controls in study 2, and 25 patients with inflammatory disorders (ID) and 24 normal controls in study 3 were stimulated with CRP, interferon-gamma (IFN) or lipopolysaccharide (LPS), or their combination. PBMC from additional normal donors were also stimulated with CRP in adherent and non-adherent conditions, and TF activity, antigen and mRNA expression detected.
  
  
  RESULTS
  CRP (5-25 microg mL(-1)) dose dependently induced more TF on PBMC from SA patients than 42 contemporary controls (P = 0.001, study 1). Compared with controls, patients with SA or UA had higher basal, and much higher CRP- or CRP/LPS-induced monocyte TF activity although serum CRP levels were similar (study 2). IFN induced monocyte TF activity in patients with angina, but not in controls. Basal or CRP-induced TF levels did not differ between controls and ID, even though ID patients had much higher serum CRP levels (study 3). CRP-induced monocyte TF activity correlated with serum CRP levels in controls (P = 0.005) and ID (P = 0.007) in study 3, but not in patients with angina (P =0.84) in study 2. CRP induced more TF activity, protein and mRNA under adherent than non-adherent conditions implying that it may mainly target macrophages in lymphocyte-rich lesions.
  
  
  CONCLUSIONS
  Our results indicate that monocytes from patients with angina are preactivated and express TF but CRP is unlikely to be a major priming factor in vivo. IFN and CRP further increase TF levels that may contribute to the hypercoagulable state in coronary disease.
authors.affiliation: School of Medical Sciences, The University of New South Wales, Sydney, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Song
authors.forename: A
authors.initials: A
authors.lastname: Nakagomi
authors.forename: S
authors.initials: S
authors.lastname: Chandar
authors.forename: H
authors.initials: H
authors.lastname: Cai
authors.forename: I G S
authors.initials: IG
authors.lastname: Lim
authors.forename: H P
authors.initials: HP
authors.lastname: McNeil
authors.forename: S B
authors.initials: SB
authors.lastname: Freedman
authors.forename: C L
authors.initials: CL
authors.lastname: Geczy
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood; D002097:C-Reactive Protein / Q000494:pharmacology*; D016022:Case-Control Studies; D002478:Cells, Cultured; D003324:Coronary Artery Disease / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005786:Gene Expression Regulation / Q000187:drug effects; D006801:Humans; D007371:Interferon-gamma / Q000494:pharmacology; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000473:pathology; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D019851:Thrombophilia / Q000139:chemically induced*; D013925:Thromboplastin / Q000235:genetics
chemical_list: D008070:Lipopolysaccharides; D007371:Interferon-gamma; D002097:C-Reactive Protein; D013925:Thromboplastin