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Blood, 15 October 2005, Vol. 106, No. 8, pp. 2761-2768. Prepublished online as a Blood First Edition Paper on July 12, 2005; DOI 10.1182/blood-2004-12-4623.
Submitted December 8, 2004
Laboratory of Experimental Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands * Corresponding author; email: t.vanderpoll{at}amc.uva.nl.
Thrombomodulin (TM) plays an essential role in the generation of activated protein C (APC), a mediator with both anticoagulant and anti-inflammatory properties, and is preferentially expressed in lungs. To investigate the role of TM in the coagulant and inflammatory response in the lung during tuberculosis, mice with a mutation in the TM gene that results in a minimal capacity for APC generation (TMpro/pro mice) were intranasally infected with live virulent Mycobacterium tuberculosis. Whereas pulmonary tuberculosis was not associated with activation of coagulation in either wild type or TMpro/pro mice, 5 weeks after infection TMpro/pro mice displayed an uncontrolled inflammatory response in their lungs, as reflected by higher lung weights, a diminished ability to form well-shaped granulomas, elevated levels of proinflammatory cytokines and concurrently reduced concentrations of anti-inflammatory cytokines. During a 36-week follow up after infection with a lower dose of M. tuberculosis, 35% of TMpro/pro mice died from week 28 onward versus none of the wild type mice, and the surviving TMpro/pro mice displayed increased lung inflammation accompanied by higher mycobacterial loads in liver and spleen. These data suggest that a TM mutation that impairs APC generation results in uncontrolled lung inflammation during tuberculosis.
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