title: Anti-inflammatory and anticoagulant properties of the protein C system in inflammatory bowel disease.
abstract: BACKGROUND
  In patients with inflammatory bowel disease (IBD), disbalance between procoagulant, anticoagulant, and fibrinolytic factors has been shown. The hemostatic system is an indispensable component of the inflammatory process. Deficiencies in the protein C (PC) pathway components not only promote thrombosis, but also exacerbate inflammation.
  
  
  OBJECTIVE
  The aim of the study was to assess the components of the PC system and their correlations with disease activity in patients with IBD.
  
  
  METHODS
  The levels of PC, free protein S (PS), and soluble thrombomodulin (sTM) were measured in 55 consecutive patients with ulcerative colitis (UC), 50 patients with Crohn's disease (CD), and 41 healthy volunteers. Correlations between PC system components and disease activity, hemostatic variables, and inflammatory markers were assessed.
  
  
  RESULTS
  sTM levels in patiens with UC were higher compared with controls (24.5 vs. 17.5 ng/ml; P = 0.0042). In patients with IBD, PC activity was higher and PS activity was lower compared with controls (P <0.001). Tumor necrosis factor α (TNF-α) levels were higher in patients with IBD, and interleukin 6 (IL-6) levels were higher only in patients with CD. In patients with UC, a positive correlation was observed between sTM and both PC and PS levels (r = 0.28 and r = 0.34, respectively, P <0.05). Only PC levels correlated with UC activity (r = 0.3, P <0.05). No correlations of TNF-α, IL-6, and C-reactive protein with PC, PS, and sTM levels were observed.
  
  
  CONCLUSIONS
  The PC pathway is defective in patients with CD and UC. Hypercoagulability in IBD might be associated not only with the inflammatory process but also with disturbances in the anticoagulant system, since defective PC pathway was observed both in active and nonactive disease.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland. owczarek@su.krakow.pl
authors.forename: Danuta
authors.initials: D
authors.lastname: Owczarek
authors.forename: Dorota
authors.initials: D
authors.lastname: Cibor
authors.forename: Kinga
authors.initials: K
authors.lastname: Sałapa
authors.forename: Andrzej
authors.initials: A
authors.lastname: Cieśla
authors.forename: Mikołaj K
authors.initials: MK
authors.lastname: Głowacki
authors.forename: Halina
authors.initials: H
authors.lastname: Pocztar
authors.forename: Tomasz H
authors.initials: TH
authors.lastname: Mach
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000097:blood*; D000925:Anticoagulants / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D015415:Biomarkers; D015850:Interleukin-6; D011486:Protein C; D014409:Tumor Necrosis Factor-alpha