[The history of hemophilia treatment].
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Hemophilia A↗
Biomedical subjects
Rainer Seitz
Publications and source records attributed to Rainer Seitz.
A novel assay for factor XIII based on cross-linking of synthetic peptides: analysis of different substrates.
A novel assay for factor XIII is described that utilizes exclusively small synthetic peptides as substrates for the cross-linking reaction catalyzed by activated factor XIII (FXIIIa). The acyl donor substrate (selection peptide) is immobilized on a microplate via biotin while the acyl acceptor substrate (detection peptide) is labeled with the fluorochrome Oregon green to allow sensitive detection without the need for secondary enzyme systems for signal amplification. Starting with an amino acid sequence from the fibrin gamma-chain (GQQHHLGGAKQAGDV) as a prototype peptide, the influence of amino acid exchanges were investigated with respect to their impact on the FXIIIa-catalyzed reaction. It was found that FXIIIa readily accepts a broad range of substrate peptides, with a proline neighboring the essential lysine having the most detrimental effect. The assay appears to be valuable for the molecular characterization of factor XIII and may be used for a deeper investigation into the substrate requirements of this final enzyme of wound repair, and eventually also for the characterization of other transglutaminases.
Cross-Linking Reagents↗
Induction of intracellular signalling in human endothelial cells by the hyaluronan-binding protease involves two distinct pathways.
Recently a novel plasma serine protease with high affinity to hyaluronic acid and glycosaminoglycans, such as heparin and heparan sulfate, has been described and termed hyaluronan-binding protease (HABP). HABP cleaves kininogen in vitro, releasing the vasoactive peptide bradykinin, and activates plasminogen activators, suggesting a vascular cell-directed physiological function of this novel plasma protease. Here we show that HABP stimulates human umbilical vein endothelial cells (HUVECs) by activating two distinct cell-surface receptors. On the one hand, HABP releases bradykinin from cell surface-bound or soluble kininogen and triggers a bradykinin B2-receptor-dependent mobilisation of intracellular Ca2+. On the other hand, HABP activates the p44/42-dependent MAPK (ERK1/2) signalling cascade independent of the B2-receptor, but involving the fibroblast growth factor receptor-1 and basic fibroblast growth factor. This signalling pathway leads to phosphorylation of the kinases Raf, MEK1/2 and ERK1/2. The extracellular activity of HABP also affects the gene expression level through phosphorylation of two transcription factors, the cAMP-responsive element binding protein CREB and the proto-oncogene c-Myc. Our results indicate a proangiogenic potential of HABP, which, in combination with a profibrinolytic activity, directs the physiological function of this plasma protease to processes in which clot lysis, cell motility and neovascularisation are pivotal processes, e.g., in wound healing, tissue repair and tumour progression.
Bradykinin↗
Prothrombin overload causes thromboembolic complications in prothrombin complex concentrates: in vitro and in vivo evidence.
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Animals↗
Inhibition of bFGF/EGF-dependent endothelial cell proliferation by the hyaluronan-binding protease from human plasma.
Recently we identified a plasma serine protease with a high affinity to glycosaminoglycans like heparin or hyaluronic acid, termed hyaluronan-binding protease (HABP). Since glycosaminoglycans are found on cell surfaces and in the extracellular matrix a physiological role of this plasma protease in a pericellular environment was postulated. Here we studied the influence of HABP on the regulation of endothelial cell growth. We found that HABP efficiently prevented the basic fibroblast growth factor/epidermal growth factor (bFGF/EGF)-dependent proliferation of human umbilical vein endothelial cells. Proteolytic cleavage of adhesion molecules was found to be involved, but was not solely responsible for the anti-proliferative activity. Pre-treatment of growth factor-supplemented cell culture medium with HABP indicated that no direct contact between the active protease and cells was required for growth inhibition. In vitro studies revealed a growth factor-directed activity of HABP, resulting in complexation and partial hydrolysis and, thus, inactivation of basic fibroblast growth factor, a potent mitogen for endothelial cells. Heparin and heparan sulfate fully protected bFGF from complexation and cleavage by HABP, although these glycosaminoglycans are known to enhance the proteolytic activity of HABP. This finding suggested that free circulating bFGF rather than bFGF bound to heparan sulfate proteoglycans would be a physiologic substrate. In conclusion, down-regulation of bFGF-dependent endothelial cell growth represents an important mechanism through which HABP could control cell growth in physiologic or pathologic processes like angiogenesis, wound healing or tumor development.
Blood Proteins↗
A secreted metallo protease from Aeromonas hydrophila exhibits prothrombin activator activity.
Detection, purification, and partial characterization of a protease from Aeromonas hydrophila capable of cleaving prothrombin into active thrombin is described. The protease has been characterized with respect to enzymatic characteristics such as optimum reaction conditions for prothrombin activation, usage of additional substrates, as well as sensitivity against inhibitors. The protease activity can reversibly be inhibited by Me2+ chelating agents like ethylenediamine tetraacetic acid. The enzyme exhibits a pI value of 4.4 and can withstand temperatures up to 55 degrees C without loss of activity. With respect to prothrombin the enzyme exhibits a K(M) value of 1.47 micromol/l and a vmax value of 1.66 mol/min per mol enzyme. Amino terminal sequence analysis as well as mass spectrometry of fragments obtained by trypsin digest showed identity to a recently described elastase type protease from the same organism and homology to known proteases from other procaryotes (e.g. Aeromonas caviae, Vibrio proteolytica, Pseudomonas aeruginosa).
Aeromonas hydrophila↗
Identification of prothrombin as a major thrombogenic agent in prothrombin complex concentrates.
Prothrombin complex concentrates (PCC) were compared in an in vitro test system for thrombogenicity (thrombin generation assay) employing plasma from coumarin-treated patients. Among these concentrates one had a proven history of thrombogenicity, whereas the remainder did not cause such fatal casualties in the past. Investigations into the thrombogenic component were performed by spiking experiments in which we biased a typical PCC without reported thromboembolic complications into one with a performance in the thrombin generation assay like that with a proven history of thrombogenicity. Hereby, it was possible to identify prothrombin as the most plausible thrombogenic component. Additional experiments performed with anticoagulant components (antithrombin together with heparin) resulted in a perfect reversal of the observed in vitro thrombogenicity. Our in vitro observations corroborate on an experimental basis the widespread medicinal usage of antithrombin administration as a regimen for the avoidance of thromboembolic complications during treatment with PCC and related products, and vice versa. Our observation casts doubts upon the widely accepted idea of activated factor IX as the thromboembolic agent in PCC. Also, our finding may be taken as an example for the feasibility of this test system as an in vitro model for thrombogenicity.
Blood Coagulation Factors↗
Charge analysis of N-glycans from human recombinant coagulation factor VIII and human FVIII standards.
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Animals↗
Factor VIII determination in patient's plasma and concentrates: a novel test equally suited for both matrices.
A novel assay for the determination of factor VIII (FVIII) is described. The assay uses a fluorescence-based detection system comparable with the common chromogenic test. At the same time, the assay is analogous to the clotting test as it does not involve pre-activation of FVIII. The assay was adjusted to perform equally well with patient's plasma and FVIII concentrates as samples. The combined employment of two different FVIII-deficient plasmas turned out to be of crucial importance in order to render the matrices as similar as possible to patient's plasma and, simultaneously, to obtain maximum sensitivity. Samples with a FVIII content down to 0.01 IU/ml are readily measured as are samples with a FVIII content of 1 IU/ml or somewhere in between. Upon dilution of samples, concentrates and plasma exhibited the same dose-response characteristics.
Calibration↗
A multi-centre collaborative study on the potency estimation of ReFacto.
Seven laboratories estimated factor VIII coagulant activity in recombinant B-domain-deleted (ReFacto) and plasma-derived FVIII concentrates (Octonativ-M) using chromogenic methods relative to the WHO 6th International Standard FVIII Concentrate (WHO 6th IS), European Pharmacopoeia BRP#2 (EP#2) and the ReFacto Laboratory Standard (RLS). Significantly higher estimates were obtained for all batches of product when calculated relative to the RLS in comparison with estimates vs WHO 6th IS and EP#2. Mean estimates for two batches of ReFacto product vs the RLS were within 10% of the labelled potency whereas estimates vs WHO 6th IS and EP#2 ranged from 21 to 31% lower than the label. Conversely, mean estimates for Octonativ-M relative to WHO 6th IS and EP#2 were within 10% of the label whereas the mean estimate vs RLS was 117% of label. Mean estimates for the ReFacto product, vs the WHO 6th IS and EP#2, varied considerably between the different chromogenic kits whereas estimates vs the RLS showed good agreement between kits. Mean estimates for the RLS vs the WHO 6th IS (8.10 IU/vial) and the EP#2 (7.66 IU/vial) were lower than the assigned value of 9.4 IU/vial. The results are consistent with ReFacto and full-length FVIII responding differently to variations in assay methodology and also indicate that the assigned value on the RLS may be too high. Since this study the unitage on the RLS has been adjusted to effectively increase the amount of ReFacto in the product by 20%.
Chromogenic Compounds↗
Quality of therapeutic plasma-requirements for marketing authorization.
Fresh frozen plasma (FFP) contains higher levels of intact coagulation factors and coagulation and fibrinolysis inhibitors than solvent/detergent-treated plasma (SD plasma), and also greater residual cell contamination. SD plasma is a particle-free plasma of uniform quality. SD treatment, however, has the specific result of reducing the activities of some inhibitors. Both plasma types carry a minimal residual risk of transmitting human immunodeficiency virus (HIV)-1/2, hepatitis virus B (HBV), and hepatitis virus C (HCV), but SDP is, in addition, also safe with respect to other lipid-enveloped viruses and perhaps with respect to hepatitis virus A (HAV), also due to its antibody (Ab) content. Future revisions of therapeutic plasma safety and quality standards should consider the following points:For FFP:reduce residual cell count in all FFP units to values below 5 x 10(6) leukocytes/l;screen donors for Parvovirus B19 genome and antibodies in order to establish a sufficiently large collection of genome-negative and antibody-positive donors whose FFP can be used for selected patients;For SDP:introduce pool testing for Parvovirus B19 genome; fix an upper limit for genome and a lower limit for antibody content;in addition to the standard quality control methods for therapeutic plasma, focus on assays to test for functionally intact proteinase inhibitors such as alpha(2)antiplasmin (alpha(2)AP) and alpha(1)proteinase inhibitor (alpha(1)PI) that are important for plasma indications. Commercially available kits may not be sufficient to show changes in inhibition kinetics. For both types:introduce an activation marker such as thrombin-antithrombin complex (TAT) as a random test to monitor activation processes during withdrawal, separation, manufacturing, and storage;abolish inappropriate parameters like Antithrombin III (AT III) and coagulation factor XI that are not relevant for changes in plasma quality;finally, support every effort towards establishing an efficient documentation and reporting system on efficacy and side effects of plasma transfusions. Effective reporting alone might help to reveal deficiencies of specific plasma quality and to overcome them through modifications to manufacturing processes and testing, or by defining its indications more precisely.
Blood Cell Count↗
Comparison of two von Willebrand factor collagen-binding assays with different binding affinities for low, medium, and high multimers of von Willebrand factor.
The use of von Willebrand factor collagen-binding assay (vWF:CBA) as an alternative method for the quantification of the physiological activity of vWF in plasma from patients with von Willebrand disease (vWD) and in blood clotting factor (F) VIII concentrates (FVIII/vWF concentrates) for the therapy of vWD is currently being discussed. We compared two vWF:CBAs that are distinctive with regard to the type and structure of collagen and the coating principle used. After analyzing samples of a plasma pool from normal donors, we received results that were in very good compliance with both methods. However, significantly different results (p < or =0.005) were obtained when FVIII/vWF concentrates were tested. In an attempt to elucidate these discrepancies, vWF multimers were separated by heparin affinity chromatography and analyzed by vWF antigen enzyme-linked immunosorbent assay (ELISA), ristocetin cofactor activity test, both vWF:CBAs, and a multimer analysis. From our data we conclude that the assay with pepsin-digested collagen (human, type III) that was covalently linked to preactivated microtiter plates (vWF:CBAPDC) revealed a higher affinity for low and medium vWF multimers, whereas the assay with collagen fibrils (equine, type I) that were adsorbed to microtiter plates (vWF:CBACF) predominantly bound high vWF multimers. Based on results reported by others, we assume that the discrepancies between both vWF:CBAs were not related to the type and species of collagen used. Taken together our results imply rather that fragmentation of collagen by pepsin digestion or subsequent covalent linkage to the microtiter plate, or both, increased the affinity for low and medium vWF multimers, whereas the fibrillar structure of collagen was required for the binding of high vWF multimers, which exhibit the highest physiological activity in primary hemostasis.
Animals↗
The hyaluronan-binding serine protease from human plasma cleaves HMW and LMW kininogen and releases bradykinin.
The influence of the hyaluronan-binding protease (PHBSP), a plasma enzyme with FVII- and pro-urokinase-activating potency, on components of the contact phase (kallikrein/kinin) system was investigated. No activation or cleavage of the proenzymes involved in the contact phase system was observed. The pro-cofactor high molecular weight kininogen (HK), however, was cleaved in vitro by PHBSP in the absence of any charged surface, releasing the activated cofactor and the vasoactive nonapeptide bradykinin. Glycosoaminoglycans strongly enhanced the reaction. The cleavage was comparable to that of plasma kallikrein, but clearly different from that of coagulation factor FXIa. Upon extended incubation with PHBSP, the light chain was further processed, partially removing about 60 amino acid residues from the N-terminus of domain D5 of the light chain. These cleavage site(s) were distinct from plasma kallikrein or FXIa cleavage sites. PHBSP and, more interestingly, also plasma kallikrein could cleave low molecular weight kininogen in vitro, indicating that domains D5H and D6H are no prerequisite for kininogen cleavage. PHBSP was also able to release bradykinin from HK in plasma where the pro-cofactor circulates predominantly in complex with plasma kallikrein or FXI. In conclusion, PHBSP represents a novel kininogen-cleaving and bradykinin-releasing enzyme in plasma that shares significant catalytic similarities with plasma kallikrein. Since they are structurally unrelated in their heavy chains (propeptide), their similar in vivo catalytic activities might be directed at distinct sites where PHBSP could induce processes that are related to the kallikrein/kinin system.
Binding Sites↗