4G/5G Polymorphism of PAI-1 Gene Promoter and Fibrinolytic Capacity in Patients with Deep Vein Thrombosis

Maria Teresa Sartori; Björn Wiman; Silvia Vettore; Francesco Dazzi; Antonio Girolami; Giovanni Maurizio Patrassi

doi:10.1055/s-0037-1615395

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1998; 80(06): 956-960
DOI: 10.1055/s-0037-1615395

Letters to the Editor

Schattauer GmbH

4G/5G Polymorphism of PAI-1 Gene Promoter and Fibrinolytic Capacity in Patients with Deep Vein Thrombosis

Maria Teresa Sartori

¹Institute of Medical Semeiotics, II Chair of Internal Medicine,University of Padua Medical School, Padua, Italy

,

Björn Wiman

²Department of Clinical Chemistry and Blood Coagulation, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden

,

Silvia Vettore

¹Institute of Medical Semeiotics, II Chair of Internal Medicine,University of Padua Medical School, Padua, Italy

,

Francesco Dazzi

¹Institute of Medical Semeiotics, II Chair of Internal Medicine,University of Padua Medical School, Padua, Italy

,

Antonio Girolami

¹Institute of Medical Semeiotics, II Chair of Internal Medicine,University of Padua Medical School, Padua, Italy

,

Giovanni Maurizio Patrassi

¹Institute of Medical Semeiotics, II Chair of Internal Medicine,University of Padua Medical School, Padua, Italy

› Author Affiliations

Abstract

Summary

A deletion/insertion polymorphism (4G or 5G) in the promoter of the plasminogen activator inhibitor type 1 gene has been suggested to be involved in regulation of the synthesis of the inhibitor, the 4G allele being associated with enhanced gene expression. A relationship between 4G/5G polymorphism and PAI-1 levels was found in patients with cardiovascular and metabolic diseases, but not in healthy subjects. In the present work we studied the distribution of PAI-1 4G/5G geno-type and its relation to fibrinolytic capacity in 70 unrelated patients with deep vein thrombosis. Each patient was assayed before and after 20 min. Venous occlusion for euglobulin lysis time, t-PA antigen and activity, and PAI-1 antigen and activity. The prevalence of 5G homozygous carriers was significantly lower in patients than in controls (10% vs. 26%, p = 0.009). The 5G allele frequency was reduced, even though not significantly, in DVT patients compared to healthy subjects (0.40 vs. 0.51, respectively). In the patient group, the mean PAI-1 antigen and activity levels were significantly higher than among controls and related to the 4G/5G polymorphism. In patients with 4G/5G and 4G/4G genotype a significant correlation was found between PAI-1 levels and the global fibrinolytic activity as evaluated by euglobulin lysis time. The prevalence of a reduced fibrinolytic potential due to PAI-1 excess was 45.7% among DVT patients. Moreover, the prevalence of PAI-1 induced hypofibrinolysis was strongly related to PAI-1 polymorphism, since it was significantly lower in 5G homo-zygous patients (28.6%) than in both 4G/5G carriers (55.3%, p <0.001) and 4G homozygous patients (57.9%, p <0.001).

In conclusion, in patients with deep vein thrombosis the 4G polymorphism of PAI-1 gene promoter may influence the expression of PAI-1 and it should be taken into consideration as a facilitating condition for pathological fibrinolysis together with other environmental and genetic factors. Whether this has any significance in regard to the pathogenesis of venous thrombosis remains to be proven.

Full Text

References

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