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World J Clin Infect Dis. Aug 25, 2013; 3(3): 37-46
Published online Aug 25, 2013. doi: 10.5495/wjcid.v3.i3.37
Physiological functions and clinical implications of fibrinogen-like 2: A review
Genyan Yang, W Craig Hooper
Genyan Yang, W Craig Hooper, Clinical and Molecular Hemostasis Laboratory Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30301, United States
Author contributions: Yang G and Hooper WC contributed to this paper.
Correspondence to: W Craig Hooper, PhD, Clinical and Molecular Hemostasis Laboratory Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., Atlanta, GA 30329, United States.
Telephone: +1-404-6393570 Fax: +1-404-6391638
Received: June 28, 2013
Revised: July 23, 2013
Accepted: August 16, 2013
Published online: August 25, 2013

Fibrinogen-like 2 (FGL2) encompasses a transmembrane (mFGL2) and a soluble (sFGL2) form with differential tertiary structure and biological activities. Typically, mFGL2 functions as prothrombinase that is capable of initiating coagulation in tissue without activation of the blood clotting cascade, whereas sFGL2 largely acts as an immunosuppressor that can repress proliferation of alloreactive T lymphocytes and maturation of bone marrow dendritic cells. Protein sequences of FGL2 exhibit evolutionary conservation across wide variety of species, especially at the carboxyl terminus that contains fibrinogen related domain (FRED). The FRED of FGL2 confers specificity and complexity in the action of FGL2, including receptor recognition, calcium affiliation, and substrate binding. Constitutive expression of FGL2 during embryogenesis and in mature tissues suggests FGL2 might be physiologically important. However, excessive induction of FGL2 under certain medical conditions (e.g., pathogen invasion) could trigger complement activation, inflammatory response, cellular apoptosis, and immune dysfunctions. On the other hand, complete absence of FGL2 is also detrimental as lack of FGL2 can cause autoimmune glomerulonephritis and acute cellular rejection of xenografts. All these roles involve mFGL2, sFGL2, or their combination. Although it is not clear how mFGL2 is cleaved off its host cells and secreted into the blood, circulating sFGL2 has been found correlated with disease severity and viral loading among patients with human hepatitis B virus or hepatitis C virus infection. Further studies are warranted to understand how FGL2 expression is regulated under physiological and pathological conditions. Even more interesting is to determine whether mFGL2 can fulfill an immunoregulatory role through its FRED at carboxyl end of the molecule and, and vice versa, whether sFGL2 is procoagulant upon binding to a target cell. Knowledge in this area should shed light on development of sFGL2 as an alternative immunosuppressive agent for organ transplantation or as a biomarker for predicting disease progression, monitoring therapeutic effects, and targeting FGL2 for repression in ameliorating fulminant viral hepatitis.

Keywords: Fibrinogen-like 2, Prothrombinase, Immunosuppressor, Infectious disease

Core tip: Fibrinogen-like 2 (FGL2) protein promotes coagulation as a prothrombinase, or acts as an immunosuppressor to repress function of T lymphocytes and dendritic cells and induce apoptosis of B lymphocytes. Ectopic expression of FGL2 has been proven relevant for the pathogenesis of viral infections. Induction of FGL2 in response to pathogen invasion causes focal prothrombin activation and fibrin deposition. This process may lead to inflammation, microvascular thrombosis, and subsequent organ failure. FGL2-mediated immunosuppression can facilitate pathogen proliferation and expansion. The understanding of FGL2-mediated pathophysiology offers an insight into biomarker development and clinical intervention of FGL2-associated medical conditions such as viral hepatitis.