Soluble thrombomodulin [STM] and human adrenomedullin [AM] in systemic lupus erythematosus [SLE] and their relation to disease activity and renal affection

ABSTRACT

To study the status of endothelial markers as plasma soluble thrombomodulin [sTM] and adrenomedullin [AM] in systemic lupus erythematosus [SLE] patients versus control subjects. Also, to clarify their relation to renal affection in these patients and to highlight their association with disease activity as evaluated with SLE-disease activity index [SLEDAI] and other laboratory parameters of disease activity. We recruited forty five SLE patients and twenty healthy matched controls. After thorough history taking, clinical examination and laboratory investigations were done, we assessed disease activity and looked for clinical and laboratory parameters of renal affection. Then we measured plasma sTM with ELISA and AM with RIA techniques. Thrombomodulin [sTM] and adrenomedullin [AM] were found to be significantly higher in SLE patients group than control group. On dividing our patients according to disease activity and comparing both groups, we found that sTM and AM were significantly more in the active than in the inactive group. The group of renal affection included 14 cases [31.1%], and on comparing them with the rest of SLE patients, we found a significant difference regarding sTM and AM, being higher in the patients with renal disease. sTM and AM were also found to be correlated with SLEDAI, laboratory parameters of disease activity as ESR, Hb% and anti-ds-DNA; Also with parameters of kidney affection as C3c, serum albumin, 24-h urinary protein, BUN and serum creatinine. Both sTM and AM showed a significant positive intercorrelation. Thrombomodulin [sTM] and adrenomedullin [AM] are elevated in SLE patients and correlated with disease activity and with renal affection. They are involved in the pathophysiology of SLE and reflect a state of persistent endothelial cell activation. They may help as indicators for early and more aggressive treatment