Decreased incidence of EPCR 4678G/C SNP in multiple myeloma patients with thrombosis

Evaluation of thrombosis-related biomarkers before and after therapy in patients with multiple myeloma

Background

Thrombosis is one of the complications in the clinical course of multiple myeloma (MM). Vascular endothelial cells and/or the hemostatic-coagulatory system are thought to play an important role in thrombosis of MM. In addition to melphalan-prednisone (Mel-P) therapy, several new therapeutic drugs such as lenalidomide or bortezomib have been developed and show effectiveness against MM. However, these new drugs also have risk of therapy-related thrombosis.

Methods

We assessed 103 MM patients and 30 healthy controls, using enzyme-linked immunosorbent assays to evaluate five biomarkers: platelet-derived microparticles (PDMP), plasminogen activator inhibitor-1 (PAI-1), high mobility group box protein-1 (HMGB1), endothelial protein C receptor (EPCR), and soluble vascular cell adhesion molecule-1 (sVCAM-1). The effects of Mel-P, bortezomib, and lenalidomide on the plasma concentrations of these biomarkers were investigated.

Results

The plasma concentrations of PDMP, PAI-1, HMGB1, EPCR, and sVCAM-1 were higher in MM patients than in healthy controls. Mel-P, bortezomib, and lenalidomide therapies all reduced biomarker levels after treatment. However, when only patients with higher levels of EPCR were compared, differences were seen between the three therapies in the elevation of PDMP, HMGB1, and PAI-1.

Conclusion

These results suggest that both MM and therapies for MM can induce a hypercoagulable state. The elevated risk of thrombosis conferred by hypercoagulability increases patient morbidity and mortality. Attention should be paid to therapy-related thrombosis when new therapeutic regimens are selected for MM patients.

F11 rs2289252T and rs2036914C Polymorphisms Increase the Activity of Factor XI in Post-trauma Patients with Fractures Despite Thromboprophylaxis

OBJECTIVE

To evaluate the association between F11 rs2289252, rs2036914 polymorphisms and the activity of clotting factor XI in post-trauma patients with fractures receiving routine anticoagulation therapy for deep venous thrombosis (DVT).

METHODS

A case-control study involving 110 consecutive post-trauma patients with fractures and DVT in our hospital was conducted from April 2014 to October 2015; these patients comprised a DVT group. Another 40 sex- and age-matched patients with fractures but without DVT served as controls. Additionally, 40 sex- and age-matched healthy people were chosen as a normal group. Venous blood samples (2 mL) were drawn from all participants and genomic DNA extracted from the leukocytes of the patients with fracture-related DVT, whose genotype and allele frequency distribution of F11 gene rs2089252 and rs2036914 single nucleotide polymorphism were then assessed by a sequencing method. The activity of factor XI was measured by a solidification method in all participants, including those in control and normal groups.

RESULTS

The activity of factor XI in patients with fracture-related DVT and F11 rs2089252 CT was 1.16 times that of those with CC genotypes (P < 0.0001), whereas in patients with fracture-related DVT and F11 rs2089252 TT genotypes it was 1.32 times that of those with CC genotypes (P < 0.0001), in patients with fracture-related DVT and F11 rs2089252 T allele it was 1.24 times that of those with C allele (P < 0.05), in patients with fracture-related DVT and F11 rs2036914 CC it was 1.35 times that of those with TT genotypes, in patients with fracture-related DVT and F11 rs2036914 CT genotypes it was 1.12 times that of those with TT genotypes (P < 0.05), and in patients with fracture-related DVT F11 and rs2036914 C allele it was 1.22 times that of those with T allele (P < 0.05). The activity of factor XI was significantly higher in the control than in the normal group (P < 0.05).

CONCLUSIONS

High activity of factor XI indicates a risk of occurrence of DVT in post-trauma patients with fractures. F11 rs2089252 and rs2036914 (single nucleotide polymorphisms) are associated with activity of factors XI in such patients despite prophylaxis.

Endothelial protein C receptor gene 6936A/G single-nucleotide polymorphism as a possible biomarker of thrombotic risk in acute myeloid leukemia

Protein C (PC) is a natural anticoagulant, which interacts with the endothelial PC receptor (EPCR). EPCR single-nucleotide polymorphism (SNP) 6936A/G results in high levels of a free soluble form of EPCR (sEPCR) and may affect the risk of coagulation. The objective of this study was to assess whether the 6936A/G SNP of the EPCR gene is involved in the procoagulant activity displayed by hematological malignancies. EPCR 6936A/G polymorphism analysis was performed in 205 patients with hematological malignancies and in 63 healthy controls. All the subjects were genotyped for the EPCR 6936A/G SNP (AA, AG and GG genotypes). The 6936A/G polymorphism distribution was similar between healthy donors and patients. The association between EPCR 6936A/G SNP and thrombosis was investigated in 110 patients. The disease-wise break-up revealed that 55 of the patients suffered from acute myeloid leukemia (AML). In AML patients, the incidence of thrombosis was 28.3% and significantly higher in the 6936AG compared with that in the 6936AA genotype (50 vs. 22%, respectively). In conclusion, this study revealed a significant association of the 6936AG genotype of EPCR with thrombotic events in AML. Therefore, the presence of the 6936AG genotype in AML patients may be considered as a risk indicator of thrombosis.