SIGNIFICANCE OF DIMINISHED FACTOR-XIII IN CROHNS-DISEASE

Objective: Coagulation factor XIII is a plasma transglutaminase involv ed in crosslinking of fibrin, the last step of the coagulation system and a connective tissue factor contributing to the wound healing proce ss. It circulates as a heterotetrameric molecule consisting of two ide ntical proenzyme subunits (factor XIIIA) and two carrier protein subun its (factor XIIIS). The aim of this study was to determine the disease features associated with the diminution of factor XIII in Crohn's dis ease. Methods: Factor XIIIA and factor XIIIS levels were assessed in p atients presenting with Crohn's disease, ulcerative colitis, infectiou s colitis, or diverticulitis, in patients with rheumatoid arthritis, a nd in control subjects. Prothrombin fragment 1 + 2 assay, as a marker of the generation of thrombin and measurement of C-terminal telopeptid e of type I collagen as an estimate of degradation of collagen type I, were performed. Results: Factor XIIIA was significantly decreased in Crohn's disease, in ulcerative colitis, and in infectious colitis by c omparison with subjects presenting with diverticulitis, normal, and rh eumatoid subjects p = 0.0001). Factor;XIIIS was unmodified in patients with Crohn's disease by comparison with controls but was reduced in t hose presenting with intestinal bleeding (p = 0.0002). In Crohn's dise ase, the lowest level of factor XIIIA was observed in patients with in testinal bleeding (p = 0.0003). Factor XIIIA was correlated with the V an Hees index (r = -0.5661; p = 0.0001) and with the C-terminal telope ptide of type I collagen (r = -0.4110; p = 0.0011) but not with prothr ombin fragment 1 + 2. The multiple regression analysis showed that onl y Van Hees index and intestinal bleeding were independent variables fo r explaining the diminution of Factor XIIIA in Crohn's disease. Conclu sions: Factor XIIIA subunit is an indicator of Crohn's disease activit y. Our study suggests that a low factor XIIIA level is related to the presence of intestinal lesions and might be linked to intestinal repai r mechanisms; loss in intestinal lumen could be also involved, especia lly in patients with intestinal bleeding. (C) 1998 by Am. Coll. of Gas troenterology.