title: Endothelial protein C receptor is overexpressed in rheumatoid arthritic (RA) synovium and mediates the anti-inflammatory effects of activated protein C in RA monocytes.
abstract: OBJECTIVE
  (1) To investigate whether inflammatory synovial tissues from patients with rheumatoid arthritis (RA) express endothelial protein C receptor (EPCR) and (2) to determine the major cell type(s) that EPCR is associated with and whether EPCR functions to mediate the effects of activated protein C (APC) on these cells.
  
  
  METHODS
  EPCR, CD68 and PC/APC in synovial tissues were detected by immunostaining and in situ PCR. Monocytes were isolated from peripheral blood of patients with RA and treated with APC, lipopolysaccharide (LPS), and/or EPCR blocking antibody RCR252. Cells and supernatants were collected for RT-PCR, western blotting, enzyme-linked immuosorbent assay and chemotaxis assay.
  
  
  RESULTS
  EPCR was expressed by both OA and RA synovial tissues but was markedly increased in RA synovium. EPCR was colocalised with PC/APC mostly on CD68 positive cells in synovium. In RA monocytes, APC upregulated EPCR expression and reduced monocyte chemoattractant protein-1-induced chemotaxis of monocytes by approximately 50%. APC also completely suppressed LPS-stimulated NF-kappaB activation and attenuated TNF-alpha protein by more than 40% in RA monocytes. The inhibitory effects of APC were reversed by RCR252, indicating that EPCR is required.
  
  
  CONCLUSIONS
  Our results demonstrate for the first time that EPCR is expressed by synovial tissues, particularly in RA, where it co-localises with PC/APC on monocytes/macrophages. In addition, APC inhibits the migration and activation of RA monocytes via EPCR. These inhibitory effects on RA monocytes suggest that PC pathway may have a beneficial therapeutic effect in RA.
authors.affiliation: Sutton Arthritis Research Laboratories, Level 1, Block 4, University of Sydney at Royal North Shore Hospital, St Leonards NSW, 2065 Australia. mlxue@med.usyd.edu.au
authors.forename: Meilang
authors.initials: M
authors.lastname: Xue
authors.forename: Lyn
authors.initials: L
authors.lastname: March
authors.forename: Philip N
authors.initials: PN
authors.lastname: Sambrook
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukudome
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Jackson
mesh_terms: D020016:Activated Protein C Resistance; D000328:Adult; D000704:Analysis of Variance; D015703:Antigens, CD / Q000032:analysis / Q000378:metabolism*; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D001172:Arthritis, Rheumatoid / Q000378:metabolism*; D015153:Blotting, Western / Q000379:methods; D018932:Chemokine CCL2 / Q000494:pharmacology; D002634:Chemotaxis, Leukocyte; D000074283:Endothelial Protein C Receptor; D004730:Endothelium, Vascular / Q000276:immunology / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008070:Lipopolysaccharides / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D016328:NF-kappa B / Q000032:analysis / Q000378:metabolism; D010003:Osteoarthritis / Q000378:metabolism; D011486:Protein C / Q000032:analysis / Q000378:metabolism*; D011956:Receptors, Cell Surface / Q000032:analysis / Q000378:metabolism*; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D013583:Synovial Membrane / Q000737:chemistry / Q000276:immunology / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D018932:Chemokine CCL2; D000074283:Endothelial Protein C Receptor; D008070:Lipopolysaccharides; D016328:NF-kappa B; D011486:Protein C; D011956:Receptors, Cell Surface; D014409:Tumor Necrosis Factor-alpha; C111835:CCL2 protein, human; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C478370:PROCR protein, human