Related Experiment Videos
Monocyte procoagulant activity in Whipple's disease
Abstract:
We have studied the expression of procoagulant activity by the circulating mononuclear cells of four patients with Whipple's disease. There was a spontaneous expression of procoagulant activity in two patients with active untreated Whipple's disease. This activity was shown to originate in the monocyte fraction of the mononuclear cells and was demonstrated to cleave prothrombin directly. This prothrombinase activity was not Factor Xa, because it was not neutralized by anti-Factor X serum and was not inhibited by an established panel of Factor Xa inhibitors. The prothrombinase activity was not expressed by the monocytes of these patients following 8 weeks of antibiotic therapy, by which time the patients' symptoms resolved, and was not found in two patients previously treated for Whipple's disease who were in clinical remission or in normal subjects. Serial studies in one patient with active disease showed that monocytes failed to express increased prothrombinase within 2 weeks of antibiotic therapy. A second procoagulant activity was produced in response to endotoxin (LPS) by cells from controls and patients with Whipple's disease and was identified as thromboplastin. These observations suggest that circulating monocytes of patients with active Whipple's disease are endogenously stimulated to express prothrombinase activity, which may contribute, at least in part, to the pathophysiology of this condition.
Insights
Patients with active Whipple's disease show spontaneous monocyte prothrombinase activity, a clotting factor not seen after treatment. This suggests monocytes contribute to the disease's pathology.
Area of Science:
- Hematology
- Infectious Diseases
- Pathophysiology
Background:
- Whipple's disease is a rare infectious disease with complex pathophysiology.
- Circulating mononuclear cells play a role in immune responses and coagulation.
- Understanding procoagulant activity in monocytes is crucial for disease insight.
Observation:
- Two of four patients with active Whipple's disease exhibited spontaneous procoagulant activity.
- This activity originated from monocytes and directly cleaved prothrombin, distinct from Factor Xa.
- Monocytes from treated patients or healthy subjects did not display this prothrombinase activity.
Findings:
- Active Whipple's disease is associated with endogenous monocyte stimulation, leading to prothrombinase expression.
- Antibiotic therapy resolved this monocyte prothrombinase activity, correlating with symptom improvement.
- Endotoxin stimulation produced thromboplastin in both patients and controls, indicating a separate pathway.
Implications:
- Circulating monocytes in active Whipple's disease may contribute to the condition's pathophysiology through prothrombinase activity.
- This finding offers a potential therapeutic target for managing Whipple's disease.
- Further research can elucidate the mechanisms of monocyte activation in this disease.