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Published on: December 15, 2017
Tissue factor exposing microparticles in inflammatory bowel disease
Julia Palkovits1, Gottfried Novacek, Marietta Kollars
1Department of Internal Medicine III, Division of Gastroenterology and Hepatology; Medical University of Vienna, Vienna, Austria.
Background:
Circulating procoagulant microparticles (MPs) are thought to be involved in the pathogenesis of venous thromboembolism in patients with inflammatory bowel disease (IBD). However, the exposure of tissue factor, the primary initiator of coagulation activation, on microparticles (TF(+)MPs) and its association with hemostasis activation has not yet been studied in IBD patients.
Methods:
In this case-control study 49 IBD patients (28 Crohn's disease, 21 ulcerative colitis) and 49 sex- and age-matched, healthy controls were included. Clinical disease activity (Crohn's Disease Activity Index and Clinical Activity Index, respectively) was assessed and IBD-related data were determined by chart review. Numbers, cellular origin and procoagulant activity of TF(+)MPs in plasma were determined using flow cytometry and a chromogenic activity assay. D-dimer and high-sensitive C-reactive protein (CRP) served as markers for coagulation activation and inflammation, respectively. The primary endpoint was the number of TF(+)MPs in IBD patients compared to controls.
Results:
Median number (interquartile range) of TF(+)MPs was higher in IBD patients than in controls (14.0 (11.9-22.8)×10(3)/mL vs. 11.9 (11.9-19.1)×10(3)/mL plasma, P=0.029). This finding was due to generally higher plasma levels of MPs from platelets and leukocytes in IBD patients. However, the number of TF(+)MPs was neither correlated with their procoagulant activity and D-dimer nor with disease activity and CRP.
Conclusions:
Increased numbers of circulating TF(+)MPs represent a new facet of hemostatic abnormalities in IBD. However, the lack of association with activation of the coagulation system and disease activity questions their pathogenetic role for venous thromboembolism in this patient group.
Insights
Increased numbers of circulating tissue factor-positive microparticles (TF(+)MPs) were found in inflammatory bowel disease (IBD) patients. However, these TF(+)MPs did not correlate with coagulation activation or disease activity in IBD.
Area of Science:
- Hematology
- Gastroenterology
- Pathophysiology
Background:
- Circulating procoagulant microparticles (MPs) are implicated in venous thromboembolism (VTE) in inflammatory bowel disease (IBD).
- The role of tissue factor-positive microparticles (TF(+)MPs), key initiators of coagulation, in IBD pathogenesis remains unstudied.
Purpose of the Study:
- To investigate the number, origin, and procoagulant activity of TF(+)MPs in IBD patients.
- To assess the association of TF(+)MPs with hemostasis activation and disease activity in IBD.
Main Methods:
- A case-control study included 49 IBD patients (Crohn's disease and ulcerative colitis) and 49 healthy controls.
- Flow cytometry and chromogenic assays quantified TF(+)MPs. D-dimer and C-reactive protein (CRP) measured coagulation and inflammation.
- Clinical disease activity was assessed using established indices.
Main Results:
- IBD patients exhibited significantly higher plasma levels of TF(+)MPs compared to controls (P=0.029).
- Elevated TF(+)MPs were primarily attributed to increased platelet and leukocyte-derived MPs.
- No correlation was found between TF(+)MP numbers and procoagulant activity, D-dimer levels, or disease activity markers (CRP).
Conclusions:
- Elevated circulating TF(+)MPs represent a novel hemostatic abnormality in IBD.
- The lack of correlation with coagulation activation and disease activity challenges the direct pathogenetic role of TF(+)MPs in IBD-related VTE.
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