Assessment of plasma prothrombotic factors in patients with Buerger's disease

Abstract

The pathogenesis of Buerger' disease (thrombangiitis obliterans; TAO) remains unknown, although a strong association with tobacco use has been established. Blood coagulation and fibrinolytic factors as well as selected clinical chemistry parameters have been evaluated in 37 patients with Buerger's disease. Median levels of prothrombotic factors were higher in patients with TAO than in healthy control: annexin V (P < 0.0003), factor VII (P < 0.0001), factor VIII (P < 0.0000001), factor XI (P < 0.000003), homocysteine (P < 0.014) and fibrinogen (P = 0.00007). Patients with Buerger's disease also showed higher median plasma levels of urokinase type plasminogen activator (uPA) (P < 0.000004), its receptor (uPAR) (P < 0.0008) and uPA complex with plasminogen activator inhibitor 1 (uPA-PAI-1) P < 0.000006). In contrast, plasma concentrations of apolipoprotein A and folic acid were lower in patients with TAO than in control (P < 0.004 and P < 0.0006; respectively). Higher plasminogen (P < 0.05) and cholesterol (P < 0.003), as well as lower folic acid (P < .0.05) levels were noted in the smokers group than in nonsmoking patients. We found higher plasminogen (P < 0.05), factor VII (P < 0.05), total lipids (P < 0.003), cholesterol (P < 0.05) and triglycerides (P < 0.002) levels in patients requiring surgical treatment for limb-threatening ischaemia than the patients treated only conservatively. These findings suggest an important role of haemostatic risk factors in the pathogenesis of Buerger's disease, with special regard to hyperhomocysteinemia that might be aggravated by low serum folic acid level. In patients with aggressive clinical course, disturbances in serum lipids were more pronounced. Further studies are warranted to establish whether diet supplementation of folic acid as well as normalization of lipids balance might influence the clinical course of TAO.

Recent Updates and Advances in Winiwarter-Buerger Disease (Thromboangiitis Obliterans): Biomolecular Mechanisms, Diagnostics and Clinical Consequences

“…In 2013, Hus et al reported significantly higher cholesterol serum levels in cigarettesmoking TAO patients compared with non-smoking ones. However, regarding the serum level of cholesterol in these patients, it has not been reported whether it was in the normal range [21].…”

“…Even if the mechanism of disease decreases blood sugar and lipids, the basic levels of these molecules are different in each patient, depending on their genetic and history. Therefore, we see different levels of FBS and lipid profile in these patients [20][21][22][23]27,28]. These differences should not cause the early rule out of TAO diagnosis.…”

“…In addition, a few cases of diabetes in patients with TAO diagnosis, confirmed by pathology without any atherosclerotic plaque, have been reported. Notably, the patients' fast blood sugar (FBS) was not more than 113 mg/dL [21,27,28].…”

“…The serum cholesterol level in TAO patients has been reported ranging from 157 mg/dL to 225 mg/dL, whereas LDL and HDL levels were 94-112 mg/dL and 34-54 mg/dL, respectively [21][22][23].…”

“…Also, increased thrombin formation has been reported in TAO patients [112]. Although a significantly higher level of urokinase-plasminogen activator (uPA) and lower level of plasminogen activator inhibitor I (PAI-1) have been reported in TAO, fibrinolysis seems to be impaired [21,113]. However, another study reported that PAI-1 was expressed along the internal elastic lamina, whereas urokinase-type plasminogen activator and MMP-3 were slightly expressed in intima and media [114].…”