Acta Medica Iranica 2009. 47(2):97-102.

Assessment of Serum Thrombomodulin in Patients with Systemic Lupus Erythematosus in Rheumatology Research Center
Mahmood Akbarian, Farhad Gharibdoost, Mehrzad Hadjaliloo, Abdolhadi Nadji, Ahmad Reza Jamshidi, Farhad Shahram, Masoomeh Akhlaghi, Shahrzad Khosravi, Simin Almasi, Fereydoun Davatchi


At present, some clinical presentations and serological parameters such as products of complement activation and elevation of autoantibodies (e.g. dsDNA antibodies), erythrocyte sedimentation rate (ESR), levels of C-reactive protein (CRP), or cytokines such as IL-2/IL-2 receptor, IL-6 and IL-10 are used as indirect serological markers with variable degrees of significance. To date, no specific serological parameter is available to assess disease activity in SLE. Soluble serum thrombomodulin is a new marker of endothelial cell injury and vasculitis. The objective of this study was to determine in vivo soluble thrombomodulin as a marker of disease activity in SLE pa-tients and compare serum thrombomodulin in SEL patients with and without renal involvement and inactive SLE patients. Sixty-four patients fulfilling ACR criteria with proven SLE with differ-ent disease activities were tested for serum levels of Thrombomodulin and dsDNA by ELISA. C3, C4 and FANA were also measured by standard laboratory tests. The clinical disease activity was evaluated by the Systemic Lupus Erythematosus Activity Index (SLEDAI). Elevated soluble thrombomodulin had significant correlations with an increased ANA level (P= 0.037), decrease level of C3 (P =0.017), increase of SLEDAI (P=0.003) and strongly associated with renal in-volvement in SLE. Thrombomodulin level and Anti dsDNA in active patients with and without re-nal disease were higher than inactive patients. In SLE, serum thrombomodulin seems to be impor-tant marker for evaluation of disease activity.


Systemic Lupus Erythematosus; Thrombomodulin; SLE disease Activity

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Koffler D. Immunopathogenesis of systemic lupus erythematosus. Annu Rev Med 1974; 25: 149-64.

Esdaile JM, Abrahamowicz M, Joseph L, MacKenzie T, Li Y, Danoff D. Laboratory tests as predictors of disease exacerbations in systemic lupus erythematosus. Why some tests fail. Arthritis Rheum 1996; 39(3): 370-8.

Spronk PE, Limburg PC, Kallenberg CG. Serological markers of disease activity in systemic lupus erythematosus. Lupus 1995; 4(2): 86-94.

Manzi S, Rairie JE, Carpenter AB, Kelly RH, Jagarlapudi SP, Sereika SM, et al. Sensitivity and specificity of plasma and urine complement split products as indicators of lupus disease activity. Arthritis Rheum 1996; 39(7): 1178-88.

Swaak AJ, Groenwold J, Bronsveld W. Predictive value of complement profiles and anti-dsDNA in systemic lupus erythematosus. Ann Rheum Dis 1986; 45(5): 359-66.

Gabay C, Roux-Lombard P, de Moerloose P, Dayer JM, Vischer T, Guerne PA. Absence of correlation between interleukin

and C-reactive protein blood levels in systemic lupus erythematosus compared with rheumatoid arthritis. J Rheumatol 1993; 20(5): 815-21.

ter Borg EJ, Horst G, Hummel EJ, Limburg PC, Kallenberg CG. Measurement of increases in anti-double-stranded DNA antibody levels as a predictor of disease exacerbation in systemic lupus erythematosus. A long-term, prospective study. Arthritis Rheum 1990; 33(5): 634-43.

terBorg EJ, Horst G, Limburg PC, Kallenberg CG. Changes in plasma levels of interleukin-2 receptor in relation to disease,exacerbations and levels of anti-dsDNA and complement in systemic lupus erythematosus. Clin Exp Immunol 1990; 82(1): 21-6.

Linker-Israeli M, Bakke AC, Kitridou RC, Gendler S, Gillis S, Horwitz DA. Defective production of interleukin 1 and interleukin 2 in patients with systemic lupus erythematosus (SLE). J Immunol 1983; 130(6): 2651-5.

Kling E, Bieg S, Boehme M, Scherbaum WA. Circulating intercellular adhesion molecule 1 as a new activity marker in patients with systemic lupus erythematosus. Clin Investig 1993; 71(4): 299-304.

Spronk PE, ter Borg EJ, Limburg PC, Kallenberg CG. Plasma concentration of IL-6 in systemic lupus erythematosus; an indicator of disease activity? Clin Exp Immunol 1992; 90(1): 106-10.

el-Gamal YM, Heshmat NM, el-Kerdany TH, Fawzy AF. Serum thrombomodulin in systemic lupus erythematosus and juvenile idiopathic arthritis. Pediatr Allergy Immunol 2004; 15(3): 270-7.

Esmon CT, Owen WG. Identification of an endothelial cell cofactor for thrombin-catalyzed activation of protein C. Proc Natl Acad Sci U S A 1981; 78(4): 2249-52.

Dittman WA, Majerus PW. Structure and function of thrombomodulin: a natural anticoagulant. Blood 1990; 75(2): 329-36.

Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25(11): 1271-7.

Gladman DD, Urowitz MB, Keystone EC. Serologically active clinically quiescent systemic lupus erythematosus: a discordance between clinical and serologic features. Am J Med 1979; 66(2): 210-5.

Boehme MW, Autschbach F, Zuna I, Scherbaum WA, Stange E, Raeth U, et al. Elevated serum levels and reduced immunohistochemical expression of thrombomodulin in active ulcerative colitis. Gastroenterology 1997; 113(1): 107-17.

Boehme MW, Schmitt WH, Youinou P, Stremmel WR, Gross WL. Clinical relevance of elevated serum thrombomodulin and soluble E-selectin in patients with Wegener's granulomatosis and other systemic vasculitides. Am J Med 1996; 101(4): 387-94.

Boehme MW, Deng Y, Raeth U, Bierhaus A, Ziegler R, Stremmel W, et al. Release of thrombomodulin from endothelial cells by concerted action of TNF-alpha and neutrophils: in vivo and in vitro studies. Immunology 1996; 87(1): 134-40.

Hergesell O, Andrassy K, Nawroth P. Elevated levels of markers of endothelial cell damage and markers of activated coagulation in patients with systemic necrotizing vasculitis. Thromb Haemost 1996; 75(6): 892-8.

Tanaka A, Ishii H, Hiraishi S, Kazama M, Maezawa H. Increased thrombomodulin values in plasma of diabetic men with microangiopathy. Clin Chem 1991; 37(2): 269-72.

Takakuwa T, Endo S, Nakae H, Kikichi M, Suzuki T, Inada K, et al. Plasma levels of TNF-alpha, endothelin-1 and thrombomodulin in patients with sepsis. Res Commun Chem Pathol Pharmacol 1994; 84(3): 261-9.

Endo S, Inada K, Nakae H, Takakuwa T, Kasai T, Yamada Y, Blood levels of endothelin-1 and thrombomodulin in patients with disseminated intravascular coagulation and sepsis. Res Commun Mol Pathol Pharmacol 1995; 90(2): 277-88.

Boehme MW, Werle E, Kommerell B, Raeth U. Serum levels of adhesion molecules and thrombomodulin as indicators of vascular injury in severe Plasmodium falciparum malaria. Clin Investig 1994; 72(8): 598-603.

Hemmer CJ, Bierhaus A, von Riedesel J, Gabat S, Liliensiek B, Pitronik P, et al. Elevated thrombomodulin plasma levels as a result of endothelial involvement in plasmodium falciparum malaria. Thromb Haemost 1994; 72(3): 457-64.


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