Endothelial protein C receptor plasma levels increase in chronic liver disease, while thrombomodulin plasma levels increase only in hepatocellular carcinoma

Introduction: Thrombomodulin (TM) and endothelial protein C receptor (EPCR) are two transmembrane endothelial receptors involved in the protein C pathway, that regulates coagulation and inflammation processes. We postulated that soluble thrombomodulin and EPCR are plasmatic markers of progression to hepatocellular carcinoma (HCC) and prognostic indicators in cirrhotic patients. Materials and methods: Plasma Levels of TM and EPCR were measured in 104 patients affected by different stages of liver diseases (66 patients with HCC, and 38 without HCC), and in 52 healthy controls. Results: EPCR levels were higher in patients than in controls (239 +/- 1.8 ng/mL vs. 127 +/- 1.5 ng/mL, p<0.0001). TM levels were higher in patients with HCC than in those without (42.1 +/- 2.0 ng/mL vs. 28.3 +/- 2.1 ng/mL; p=0.039), while EPCR levels were similar in the two groups. No association between TM and clinical outcome was found, white high Levels of EPCR were associated with death and thrombosis of the portal vein. Conclusions: We surmise a possible rote for high levels of TM as a marker of HCC development in patients with cirrhosis, whereas high levels of EPCR are a possible marker of worse HCC prognosis, being a sign of endothetial damage of large vessels. (C) 2006 Elsevier Ltd. All rights reserved.