Plasma Macrophage Migration Inhibitory Factor as a Biomarker of Thromboinflammatory Dysregulation in Anti-Neutrophil Cytoplasmic Antibody- Associated Vasculitis

Abstract

Background/Aims: Anti-neutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) is an autoimmune disorder characterized by necrotizing inflammation of small vessels. This study investigates the relationship among macrophage migration inhibitory factor (MIF), coagulation parameters, and thrombotic events in AAV.

Materials and Methods: Plasma and urine samples obtained from 45 AAV patients and 16 healthy controls were analyzed. Then, the MIF levels were quantified via enzyme-linked immunosorbent assay. Afterwards the coagulation markers (prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), fibrin degradation products (FDP), and prothrombin activity (PTA)), renal function (estimated glomerular filtration rate (eGFR)), and disease activity (Birmingham Vasculitis Activity Score (BVAS)) were assessed. Finally, the thrombotic events were radiologically confirmed.

Results: The plasma MIF levels were significantly elevated in AAV patients when compared to healthy controls (716.35 vs. 293.26 pg/mL, P < .05). Beyond demonstrating the associations with disease severity and renal function (which had a positive correlation with BVAS (r = 0.391, P = .008) and a negative correlation with eGFR (r = −0.298, P = .047)), MIF further exhibited inverse relationships with high-density lipoprotein cholesterol (r = −0.334, P=.043). Notably, plasma MIF had significant positive correlations with multiple coagulation parameters, which included PT (r = 0.351), INR (r = 0.346), APTT (r = 0.380), FIB (r = 0.374), and FDP (r = 0.301) (all, P < .05), and a negative correlation with PTA (r = −0.346, P = .020). Complementing these findings, urinary MIF levels were inversely correlated to thrombin time (r = −0.367, P = .039), collectively reinforcing the role of MIF in thromboinflammatory dysregulation.

Conclusion: Although plasma MIF correlates with thromboinflammatory dysregulation, its predictive value for thrombosis warrants validation in larger cohorts.

Cite this article as: Lv T, Li Y, Xu L, Hao J. Plasma macrophage migration inhibitory factor as a biomarker of thromboinflammatory dysregulation in anti-neutrophil cytoplasmic antibody-associated vasculitis. Arch Rheumatol. 2026;41(2):108-116.