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O’Hehir ZD, Lynch T, O’Neill S, March L, Xue M. Endothelial Protein C Receptor and Its Impact on Rheumatic Disease. J Clin Med 2024; 13:2030. [PMID: 38610795 PMCID: PMC11012567 DOI: 10.3390/jcm13072030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Endothelial Protein C Receptor (EPCR) is a key regulator of the activated protein C anti-coagulation pathway due to its role in the binding and activation of this protein. EPCR also binds to other ligands such as Factor VII and X, γδ T-cells, plasmodium falciparum erythrocyte membrane protein 1, and Secretory group V Phospholipases A2, facilitating ligand-specific functions. The functions of EPCR can also be regulated by soluble (s)EPCR that competes for the binding sites of membrane-bound (m)EPCR. sEPCR is created when mEPCR is shed from the cell surface. The propensity of shedding alters depending on the genetic haplotype of the EPCR gene that an individual may possess. EPCR plays an active role in normal homeostasis, anti-coagulation pathways, inflammation, and cell stemness. Due to these properties, EPCR is considered a potential effector/mediator of inflammatory diseases. Rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus are autoimmune/inflammatory conditions that are associated with elevated EPCR levels and disease activity, potentially driven by EPCR. This review highlights the functions of EPCR and its contribution to rheumatic diseases.
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Affiliation(s)
- Zachary Daniel O’Hehir
- Sutton Arthritis Research Laboratory, Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney at Royal North Shore Hospital, Sydney, NSW 2065, Australia;
| | - Tom Lynch
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
| | - Sean O’Neill
- Department of Rheumatology, Royal North Shore Hospital, Syndey, NSW 2065, Australia;
| | - Lyn March
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
- Department of Rheumatology, Royal North Shore Hospital, Syndey, NSW 2065, Australia;
| | - Meilang Xue
- Sutton Arthritis Research Laboratory, Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney at Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- The Australian Arthritis and Autoimmune Biobank Collaborative (A3BC), Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney at Royal North Shore Hospital, St Leonards, NSW 2065, Australia; (T.L.); (L.M.)
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Liu X, Huo Y, Zhao J, Wang G, Liu H, Yin F, Pang C, Wang Y, Bai L. Endothelial cell protein C receptor regulates neutrophil extracellular trap-mediated rheumatoid arthritis disease progression. Int Immunopharmacol 2022; 112:109249. [PMID: 36152537 DOI: 10.1016/j.intimp.2022.109249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022]
Abstract
Endothelial cell protein C receptor (EPCR) is a 46 kDa transmembrane protein receptor, expressed in most immune cells (T cells, monocytes, dendritic cells, polymorphonuclear neutrophils [PMN]). EPCR reportedly plays a vital role in rheumatoid arthritis (RA). Our results confirmed that EPCR expression exists in the PMN of RA patients, and animal experiments demonstrated that down-regulation of EPCR expression affects disease progression in collagen-induced arthritis (CIA) mice. PMN is the immune cell type that first enters the site of inflammation in the early stages of inflammation. In the early stage of RA, PMN cells migrate into the joint cavity and function in the process of RA synovial inflammation, aggravating the bone destruction found in RA and mediating the progression of RA disease progression. We verified the differences in EPCR expression in PMN cells between RA and osteoarthritis (OA) patients by Western blot and then confirmed this difference in animals. We found that CIA mice treated with PMN-neutralizing antibody intervention had reduced disease performance. On this basis, EPCR was knocked down at the same time. The therapeutic effect of PMN-neutralizing antibody treatment was subsequently diminished. To explore the relationship between EPCR and PMN in RA, we used immunofluorescence to detect the expression of PMN-neutrophil extracellular traps (NETs) in RA patients and used EPCR neutralizing antibodies as an intervention. The results showed that the formation of PMN-NETs in RA patients increased. Finally, through in vitro intervention experiments involving EPCR and PMN transcriptome analysis of the peripheral blood of RA patients, we concluded that EPCR may regulate the formation of PMN-NETs in RA patients through the activated protein C (APC)-EPCR signaling pathway, thereby affecting the progression of disease in RA patients.
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Affiliation(s)
- Xuanqi Liu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Yinping Huo
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Jingyang Zhao
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; The Central Lab, the First Affiliated Hospital of Baotou Medical College (Inner Mongolia Autoimmune Key Laboratory), Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Guan Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Huiyang Liu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Fangrui Yin
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; The Central Lab, the First Affiliated Hospital of Baotou Medical College (Inner Mongolia Autoimmune Key Laboratory), Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Chunyan Pang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; The Central Lab, the First Affiliated Hospital of Baotou Medical College (Inner Mongolia Autoimmune Key Laboratory), Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Yongfu Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; The Central Lab, the First Affiliated Hospital of Baotou Medical College (Inner Mongolia Autoimmune Key Laboratory), Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China
| | - Li Bai
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; The Central Lab, the First Affiliated Hospital of Baotou Medical College (Inner Mongolia Autoimmune Key Laboratory), Baotou 014010, China; Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000, China.
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Hu YQ, Wang ZX, Xiang K, He YS, Feng YT, Shuai ZW, Pan HF. Elevated circulating thrombomodulin levels in systemic lupus erythematosus: a systematic review and meta-analysis. Curr Pharm Des 2021; 28:306-312. [PMID: 34766888 DOI: 10.2174/1381612827666211111152319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Thrombomodulin (TM) is closely related to the pathogenesis of autoimmune diseases, including systemic lupus erythematosus (SLE). However, current evidence on circulating TM levels in SLE patients is contradictory. We conducted this meta-analysis to more accurately assess circulating TM levels in patients with SLE and lupus nephritis (LN) and to analyze related influencing factors. METHODS Systematic search of relevant documents was conducted in PubMed, Embase, and The Cochrane Library databases (up to 28 February 2021). Studies on the comparison of circulating TM between SLE patients and controls were screened and evaluated for inclusion. Random-effects model analysis was applied to calculate the combined standardized mean difference (SMD) with a 95% confidence interval (CI). Heterogeneity was estimated by Q statistics and I2. RESULTS A total of 353 articles were identified, 14 provided adequate information for this study finally. The results illustrated that SLE patients had higher TM levels than healthy controls (SMD =0.38, 95% CI: 0.02 to 0.74, p=0.04). Circulating TM levels were increased in patients with active SLE compared to inactive SLE patients (SMD=1.12, 95% CI: 0.03 to 2.20, p=0.04). In addition, circulating TM levels of SLE patients with LN were higher than those without LN (SMD=4.55, 95% CI: 1.97 to 7.12, p=0.001). CONCLUSIONS The circulating TM levels in SLE patients are enhanced. In addition, circulating TM levels may be practical in reflecting the disease activity and nephritis involvement of SLE patients.
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Affiliation(s)
- Yu-Qian Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Zhi-Xin Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Kun Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Yi-Sheng He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Ya-Ting Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Zong-Wen Shuai
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
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Bai L, Liu W, Guo P, Bai J, Liu Y, Hua Y, Pang C, Zhang W, Yin F, Wang Y. Elevated levels of soluble Endothelial protein C receptor in rheumatoid arthritis and block the therapeutic effect of protein C in collagen-induced arthritis. Int Immunopharmacol 2020; 81:106255. [PMID: 32007797 DOI: 10.1016/j.intimp.2020.106255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endothelial protein C receptor (EPCR) is a membranous protein that can be combined with a variety of ligands and plays important roles in anticoagulant and anti-inflammation. Recent reports have shown that surface EPCR expression on T cells is negatively associated with Th17 differentiation and is co-expressed with other immunosuppressive molecules, such as The programmed cell death 1 (PD-1) and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4). Hence, we hypothesized that EPCR may play a critical role in rheumatoid arthritis (RA) disease progression that is mediated by Th17 differentiation. In order to explore the role of EPCR on RA disease pathogenesis, we detected membranous EPCR (mEPCR) expression in CD4+ T cells and soluble EPCR (sEPCR) expression in the sera of RA patients. METHODS The proportion of CD4+/EPCR+ T cells in the peripheral blood of RA patients was detected by flow cytometry, and the expression of sEPCR in the sera of RA patients was detected by enzyme-linked immunosorbent assay (ELISA). For in vitro experiments, protein C (PC) and EPCR recombinant proteins were used to block peripheral blood mononuclear cell (PBMC) activation and to detect Th17 differentiation. For in vivo experiments in DBA/1 mice with collagen-induced arthritis (CIA), we administered PC and EPCR recombinant proteins, monitored disease progression, and evaluated the role of EPCR in disease progression. RESULTS The proportion of CD4+/EPCR+ T cells in the peripheral blood of RA patients was lower than that of osteoarthritis (OA) patients, while the expression level of sEPCR in the sera of RA patients was concomitantly higher than that in OA patients. Subsequent analysis revealed that sEPCR expression was positively correlated with rheumatoid factors (RF) and other inflammatory indicators in RA patients. Further studies confirmed that sEPCR administration alleviated the progression of collagen-induced arthritis and partially blocked the therapeutic effect of PC in CIA mice. CONCLUSION Soluble EPCR is associated with RA disease progression and induces disease remission in CIA mice by inhibiting Th17 differentiation.
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Affiliation(s)
- Li Bai
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Institute of Immunology and Rheumatology, Baotou Medical College (Inner Mongolia Key Laboratory of Autoimmunity), Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Wenjia Liu
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Pengnian Guo
- Department of Orthopedic, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
| | - Jingru Bai
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Yuan Liu
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Yana Hua
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Chunyan Pang
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Institute of Immunology and Rheumatology, Baotou Medical College (Inner Mongolia Key Laboratory of Autoimmunity), Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Wei Zhang
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Institute of Immunology and Rheumatology, Baotou Medical College (Inner Mongolia Key Laboratory of Autoimmunity), Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Fangrui Yin
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Institute of Immunology and Rheumatology, Baotou Medical College (Inner Mongolia Key Laboratory of Autoimmunity), Baotou 014010, China; Baotou Medical College, Baotou 014010, China
| | - Yongfu Wang
- Department of Rheumatology, The First Affiliated Hospital of Baotou Medical College, Baotou 014010, China; Institute of Immunology and Rheumatology, Baotou Medical College (Inner Mongolia Key Laboratory of Autoimmunity), Baotou 014010, China; Baotou Medical College, Baotou 014010, China.
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Cayci FS, Ekim M, Egin Y, Gökce H, Yalcinkaya F, Ozcakar B, Akar N. An analysis of the levels of the soluble form of the endothelial protein C receptor in children with Henoch-Schönlein Purpura. Pediatr Hematol Oncol 2015; 32:115-22. [PMID: 24308805 DOI: 10.3109/08880018.2013.860648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The pathogenesis of Henoch-Schönlein Purpura (HSP) has not been clearly defined. Inflammatory cytokines have been associated with HSP but there are only a few reports that have focused on coagulation. The endothelial protein C receptor (EPCR), which has anticoagulant and antiinflammatory activity, is the key component of the protein C pathway. Recent studies have implicated the soluble form of EPCR (sEPCR) in Wegener's granulomatosis, Behçet's disease, and systemic lupus erythematosus. The aim of this study was to evaluate the levels of sEPCR in HSP children. Twenty-two children with HSP and 17 healthy children were included. We found no significant differences (P > .05) between patient and control groups in the levels of von Willebrand factor and thrombomodulin. The median sEPCR values in the HSP group were lower than the control group (79 vs. 102 ng/mL, respectively) (P > .05). The mean sEPCR value in HSP patients with severe abdominal pain was lower than without (88.8 ± 54.9 vs. 108.2 ± 66.3 ng/mL, respectively) (P > .05). In addition, the mean IL-6 serum levels were significantly elevated in HSP patients during the acute stage of HSP (2.1 ± 1.7 vs. 1.5 ± 1.2 pg/mL, P = .038). We also observed a slight negative correlation between the levels of sEPCR and IL-6 (R = -.135, P > .05). To our knowledge, this was the first study to analyze sEPCR levels in HSP. Our results did not conclusively identify a direct role of sEPCR in HSP, but our findings warrant further investigations, especially in severe HSP cases characterized by gastrointestinal bleeding or renal involvement.
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Affiliation(s)
- Fatma Semsa Cayci
- Department of Pediatric Nephrology and Rheumatology, Ankara University School of Medicine , Ankara , Turkey
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