Endothelial protein C receptor plasma levels increase in chronic liver disease, while thrombomodulin plasma levels increase only in hepatocellular carcinoma.
BACKGROUND
Thrombomodulin (TM) and endothelial protein C receptor (EPCR) are two transmembrane endothelial receptors involved in the protein C pathway, that regulates coagulation and inflammation processes. We postulated that soluble thrombomodulin and EPCR are plasmatic markers of progression to hepatocellular carcinoma (HCC) and prognostic indicators in cirrhotic patients.


METHODS
Plasma levels of TM and EPCR were measured in 104 patients affected by different stages of liver diseases (66 patients with HCC, and 38 without HCC), and in 52 healthy controls.


RESULTS
EPCR levels were higher in patients than in controls (239+/-1.8 ng/mL vs. 127+/-1.5 ng/mL, p<0.0001). TM levels were higher in patients with HCC than in those without (42.1+/-2.0 ng/mL vs. 28.3+/-2.1 ng/mL; p=0.039), while EPCR levels were similar in the two groups. No association between TM and clinical outcome was found, while high levels of EPCR were associated with death and thrombosis of the portal vein.


CONCLUSIONS
We surmise a possible role for high levels of TM as a marker of HCC development in patients with cirrhosis, whereas high levels of EPCR are a possible marker of worse HCC prognosis, being a sign of endothelial damage of large vessels.
Biguzzi
Eugenia
E
Bianchi Bonomi Haemophilia and Thrombosis Centre, University of Milan and Department of Medicine and Medical Specialties, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, Milan, Italy. eugeniabiguzzi@yahoo.it
Franchi
Franca
F
Bucciarelli
Paolo
P
Colombo
Massimo
M
Romeo
Raffaella
R
D000368:Aged; D015703:Antigens, CD / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood*; D016022:Case-Control Studies; D002908:Chronic Disease; D000074283:Endothelial Protein C Receptor; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood; D008107:Liver Diseases / Q000097:blood*; D008113:Liver Neoplasms / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011956:Receptors, Cell Surface / Q000097:blood*; D012995:Solubility; D018180:Thrombomodulin / Q000097:blood*
D015703:Antigens, CD; D015415:Biomarkers; D000074283:Endothelial Protein C Receptor; C478370:PROCR protein, human; D011956:Receptors, Cell Surface; D018180:Thrombomodulin