Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 14, 2006; 12(10): 1607-1612
Published online Mar 14, 2006. doi: 10.3748/wjg.v12.i10.1607
Hyperhomocysteinemia and hypercoagulability in primary biliary cirrhosis
Maria Rosa Biagini, Alessandro Tozzi, Rossella Marcucci, Rita Paniccia, Sandra Fedi, Stefano Milani, Andrea Galli, Elisabetta Ceni, Marco Capanni, Raffaele Manta, Rosanna Abbate, Calogero Surrenti
Maria Rosa Biagini, Alessandro Tozzi, Stefano Milani, Andrea Galli, Elisabetta Ceni, Marco Capanni, Raffaele Manta, Calogero Surrenti, Rita Paniccia, Sandra Fedi, Rosanna Abbate, Department of Clinical Pathophysiology, Gastroenterology Unit, University of Florence, AOU Careggi, Florence, Italy Rossella Marcucci, Thrombosis Center, Department of Critical Area, University of Florence, AOU Careggi, Florence, Italy
Author contributions: All authors contributed equally to the work.
Correspondence to: Tozzi Alessandro, MD PhD, Gastroenterology Unit, Department of Clinical Pathophysiology, University of Florence, Viale Morgagni 85 50134, Firenze, Italy.
Telephone: +39-55-4271411 Fax: +39-55-4222409
Received: April 22, 2005
Revised: June 1, 2005
Accepted: August 26, 2005
Published online: March 14, 2006

AIM: To assess the hypercoagulability in PBC and its relationship with homocysteine (HCY) and various components of the haemostatic system.

METHODS: We investigated 51 PBC patients (43F/8M; mean age: 63 ± 13.9 yr ) and 102 healthy subjects (86 women/16 men; 63 ± 13 yr), and evaluated the haemostatic process in whole blood by the Sonoclot analysis and the platelet function by PFA-100 device. We then measured HCY (fasting and after methionine loading), tissue factor (TF), thrombin-antithrombin complexes (TAT), D-dimer (D-D), thrombomodulin (TM), folic acid, vitamin B6 and B12 plasma levels. C677T 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphism was analyzed.

RESULTS: Sonoclot RATE values of patients were significantly (P < 0.001) higher than those of controls. Sonoclot time to peak values and PFA-100 closure times were comparable in patients and controls. TAT, TF and HCY levels, both in the fasting and post-methionine loading, were significantly (P < 0.001) higher in patients than in controls. Vitamin deficiencies were detected in 45/51 patients (88.2%). The prevalence of the homozygous TT677 MTHFR genotype was significantly higher in patients (31.4%) than in controls (17.5%) (P < 0.05). Sonoclot RATE values correlated significantly with HCY levels and TF.

CONCLUSION: In PBC, hyper-HCY is related to hypovitaminosis and genetic predisposing factors. Increased TF and HCY levels and signs of endothelial activation are associated with hypercoagulability and may have an important role in blood clotting activation.

Keywords: Homocysteinemia, Hypercoagulability, Primary biliary cirrhosis, Tissue factor, Folic acid