FRI0333 Hemoglobin, Complement 3 and Carotid IMT Are Associated with Low Free Protein S in SLE
Authors: J.-Y. Jung, H.-A. Kim, C.-H. Suh
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Protein S plays a role as a cofactor not only in coagulation pathway, but also in the removal of apoptotic remnants. Free protein S was investigated whether it could represent as a disease related marker in systemic lupus erythematosus (SLE), which has a defect in clearance of apoptotic debris<sup>1,2</sup>. In SLE, cardiovascular diseases including myocardial infarction and stroke develop more frequently and earlier than healthy population. It has become important to find underline mechanisms about the advanced atherosclerosis in SLE<sup>3</sup>. <h3>Objectives</h3> We measured free protein S and carotid atherosclerosis using Doppler sonography among SLE patients, and analyzed their associations with clinical features including disease activity markers. <h3>Methods</h3> Total of 110 female patients with SLE were recruited and serum free protein S level was evaluated by enzyme-linked immunosorbent assay. The carotid artery intima media thickness (cIMT) and plague were measured by Doppler ultrasound and the clinical characteristics were collected. <h3>Results</h3> Mean level of free protein S was 67.4±19.7%, and 21 patients had low level of free protein S, defined as less than 50%. Hemoglobin and lymphocyte count were significantly lower (11.4±1.4 vs 12.5±1.4, <i>p</i>=0.002 and 1, 221±609 vs 1,720±1,097, <i>p</i>=0.047), and erythrocyte sedimentation rate (ESR) was significantly higher (30.1±20.6 vs 20.8 ± 17.8, <i>p</i>=0.033), complement 3 (C3) and complement4 (C4) were significantly lower (80.8±27.6 vs 103.4±25.8, <i>p</i>=0.001 and 15.6±10.4 vs 21.5±7.6, <i>p</i>=0.005) in SLE patients with low free proteins S level compared to those not. Carotid IMT levels were different (3.78±0.69 vs 4.13±0.87, <i>p</i>=0.051) while plaque index was not different between two groups. On univariate logistic analysis, hemoglobin (OR 0.6, <i>p</i>=0.003), lymphocyte (OR 1.0, <i>p</i>=0.03), ESR (OR 1.03, <i>p</i>=0.041), C3 (OR 0.96, <i>p</i>=0.001), and C4 (OR 0.91, <i>p</i>=0.007) were related with free protein S. With adjustments, hemoglobin (OR 0.57, <i>p</i>=0.023), C3 (OR 0.94, <i>p</i>=0.017) and cIMT (OR 0.51, <i>p</i>=0.046) were associated with low free protein S. <h3>Conclusions</h3> Hemoglobin, complement 3 and cIMT were independently associated with low free protein S in SLE patients. Moreover, cIMT showed negative influence to low free protein S. From this clinical data, endothelial thickness might contribute free protein S rise in SLE patients. <h3>References</h3> Recarte-Pelz P et al. Vitamin K-dependent proteins GAS6 and protein S and TAM receptors in patients of systemic lupus erythematosus: correlation with common genetic variants and disease activity. Arthritis Res Ther. 2013;15:R41 Suh CH et al. TAM receptor ligands in lupus: Protein S but not Gas6 levels reflect disease activity in systemic lupus erythematosus. Arthritis Res Ther. 2010;12:R146. Ruiz-Limon P et al. Atherosclerosis and cardiovascular disease in systemic lupus erythematosus: effects of in vivo statin treatment. Ann Rheum Dis. 2015;74:1450–8 <h3>Disclosure of Interest</h3> None declared