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Thromb Haemost 2012; 107(03): 507-512
DOI: 10.1160/TH11-08-0591
Blood Coagulation, Fibrinolysis and Cellular Hemostasis
Schattauer GmbH

Increase in the plasma levels of protein Z-dependent protease inhibitor in normal pregnancies but not in non-pregnant patients with unexplained recurrent miscarriage

Masayoshi Souri
1   Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata Japan
,
Mayumi Sugiura-Ogasawara
2   Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
,
Shigeru Saito
3   Department of Obstetrics and Gynecology, Toyama University, Graduate School of Medical Sciences, Toyama, Japan
,
Bettina Kemkes-Matthes
4   Haemostasis Center, Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany
,
Joost C. M. Meijers
5   Departments of Vascular Medicine and Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
,
Akitada Ichinose
1   Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Yamagata Japan
› Author Affiliations
Further Information

Publication History

Received: 26 August 2011

Accepted after major revision: 16 January 2011

Publication Date:
29 November 2017 (online)

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Summary

Protein Z (PZ)-dependent protease inhibitor (ZPI) is a serine protease inhibitor which efficiently inactivates activated factor X, when ZPI is complexed with PZ in plasma. Reduced plasma levels of ZPI and PZ have been reported in association with thrombosis. It has also been reported that PZ increases during pregnancy and that its partial deficiency is related to early pregnancy loss or recurrent miscarriage (RM). However, until now there has been no report on ZPI in pregnancy. To explore the possible role(s) of ZPI in the maintenance of pregnancy, we studied 42 non-pregnant normal women, 32 women with normal pregnancies, and 134 cases of unexplained RM in Japan, as well as 64 non-pregnant normal German females. Plasma ZPI was measured by in-house ELISA. There were significantly higher concentrations of plasma ZPI in normal pregnancies compared to non-pregnant women. The present study also confirmed that both factor X, the major target of ZPI, and protein Z increased during normal pregnancies. This increased ZPI and PZ may counteract the increased activated factor X, which may in turn contribute to the maintenance of normal placental circulation. Plasma ZPI levels were unchanged in non-pregnant RM women, while the plasma PZ level was slightly reduced, a finding consistent with existing reports. The exact relationship between RM and this unaltered ZPI with mild PZ reduction relative to normal pregnancies warrants further investigation.

This work was presented at the 23rd International Society on Thrombosis and Haemostasis meetings in Kyoto, July 2011.

Keywords

Anti-coagulation system - protein Z-dependent protease inhibitor - protein Z - pregnancy - recurrent miscarriage

 

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