title: Differential expression of leukocyte receptors in disseminated intravascular coagulation: prognostic value of low protein C receptor expression.
abstract: BACKGROUND
  The protein C receptor (PROCR), toll-like receptor (TLR) and L-selectin leukocyte receptor play roles in systemic inflammatory response including disseminated intravascular coagulation (DIC). Expression of these receptors, which mediate systemic immune or coagulation responses, is tightly regulated by physiologic or pathologic signals. We investigated whether the expressions of 3 leukocyte receptors (PROCR, TLR4, L-selectin) was related to clinical outcomes in patients suggestive of having DIC.
  
  
  METHODS
  RNA was extracted from the peripheral blood buffy coats of patients suggestive of having DIC. After reverse transcription, mRNA expression levels of PROCR, TLR4, and L-selectin were measured using Taqman Gene Expression Assays. The 28-day hospital mortality rate was used as a clinical outcome.
  
  
  RESULTS
  The expression level of PROCR mRNA in leukocytes was lower in those with overt-DIC as compared to those without overt-DIC, however, this difference was not statistically significant. As for TLR4 and L-selectin mRNA expression, there were no significant differences observed between those with and without overt-DIC. A Kaplan-Meier survival analysis revealed that patients with low PROCR mRNA expression levels showed significantly lower survival rates than those with high expression levels. On multivariate cox regression analysis, low levels of PROCR mRNA expression were an independent prognostic marker. However, expression levels of TLR4 and L-selectin mRNA were not associated with any prognostic value.
  
  
  CONCLUSIONS
  Considering that the PROCR is an important anticoagulant receptor, low PROCR mRNA expression levels associated with a poor prognosis in patients with DIC represents an exhaustion of the natural anticoagulant system, and reflects the final decompensate stage of DIC. The leukocyte PROCR may contribute to a dampening of florid activation of coagulation reactions in vivo.
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Sung
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ki Seok
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyou-Sup
authors.initials: KS
authors.lastname: Han
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. Electronic address: lukekhk@snu.ac.kr.
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000235:genetics*; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000235:genetics*; D015536:Down-Regulation; D000074283:Endothelial Protein C Receptor; D005260:Female; D006801:Humans; D019041:L-Selectin / Q000235:genetics; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012333:RNA, Messenger / Q000032:analysis / Q000235:genetics*; D011956:Receptors, Cell Surface / Q000235:genetics*; D051197:Toll-Like Receptor 4 / Q000235:genetics
chemical_list: D015703:Antigens, CD; D000074283:Endothelial Protein C Receptor; C478370:PROCR protein, human; D012333:RNA, Messenger; D011956:Receptors, Cell Surface; C495345:TLR4 protein, human; D051197:Toll-Like Receptor 4; D019041:L-Selectin
keywords: Disseminated intravascular coagulation; L-selectin; Protein C receptor; Toll-like receptor-4