Search PubMed⌕ Search

PubMed · 16513527

Factor VIII structure and function.

Abstract

Factor VIII, a non-covalent heterodimer comprised of a heavy chain (A1-A2-B domains) and light chain (A3-C1-C2 domains), circulates as an inactive procofactor in complex with von Willebrand factor. Metal ions are critical to the integrity of factor VIII, with Cu and Ca ions stabilizing the heterodimer and generating the active conformation, respectively. Activation of factor VIII catalyzed by thrombin appears dependent upon interactions with both anion-binding exosites I and II, and converts the heterodimer to the active cofactor, factor VIIIa. This protein, comprised of A1, A2, and A3-C1-C2 subunits, is labile due to weak affinity of the A2 subunit. Association of factor VIIIa with factor IXa to form the intrinsic factor Xase complex is membrane-dependent and involves multiple inter-protein contacts that remain poorly characterized. This complex catalyzes the conversion of factor X to factor Xa, a reaction that is essential for the propagation phase of coagulation. The role of factor VIIIa in this complex is to increase the catalytic efficiency for factor Xa generation by several orders of magnitude. Mechanisms for the down-regulation of factor Xase focus upon inactivation of the cofactor and include dissociation of the A2 subunit as well as activated protein C-catalyzed proteolysis.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Philip J Fay. 2006. Factor VIII structure and function.. https://doi.org/10.1532/ijh97.05113

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Prophylactic treatment of a small child with severe factor VII deficiency using repeat dosing from a single vial of recombinant activated factor VII.

We report our experience with a small child with severe factor VII deficiency and a history of frequent and spontaneous life-threatening hemorrhage. The patient has received several years of successful prophylactic treatment with an every 3-day infusion program in which she receives recombinant activated factor VII (rVIIa) using multiple doses from a single reconstituted vial over a 72-hr period. Comparison is made to prophylactic treatment in this same patient using plasma-derived factor VII (PDVII) using a prothrombin complex concentrate (PCC).

Blood Coagulation Factors↗

The combined antenatal corticosteroids and vitamin K therapy for preventing periventricular-intraventricular hemorrhage in premature newborns less than 35 weeks gestation.

We prospectively evaluated whether combined antenatal corticosteroid and vitamin K administration have any benefit, over and above that of corticosteroid or vitamin K used alone, in reducing the frequency and the degree of PIVH in premature newborns less than 35 weeks' gestation. All of these 280 pregnant women were randomly allocated into five groups according to the in-patient sequence. Group A (vitamin K1 group) including 38 pregnant women (40 newborns) received antenatal intramuscular or intravenously injection of vitamin K1 10 mg per day for 2-7 days. Group B (single dose corticosteroid group) including 57 pregnant women (63 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 1 day. Group C (two dose corticosteroid group) including 62 pregnant women (70 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 2 days. Group D (combined using dexamethasone and vitamin K1) including 41 pregnant women (44 newborns) received dexamethasone 10 mg per day for 1 day and vitamin K110 mg per day for 2-7 days. Control group, including 82 pregnant women (87 newborns) were received neither dexamethasone nor vitamin K1 injection. The results showed PIVH was diagnosed in 17 of 40 (42.5%) in Group A, 34 of 63 (54.0%) in Group B, 36 of 70 (51.4%) in Group C, 14 of 44 (31.8%) in Group D, and 57 of 87 (65.2%) in control infants (p = 0.004). More infants in the control group had grade III or IV intracranial hemorrhage after birth (p = 0.049). After antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly. The total and severe incidence of PIVH in Group B (single doses dexamethasone) and Group C (two courses dexamethasone) there were no significant difference. It showed that after antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly, and combined antenatal corticosteroid and vitamin K administration have much benefit, over and above that of corticosteroid or vitamin K used alone.

Blood Coagulation Factors↗

Clotting factor concentrates given to prevent bleeding and bleeding-related complications in people with hemophilia A or B.

BACKGROUND: People with severe hemophilia A or B, X-linked bleeding disorders due to decreased blood levels of coagulants, suffer recurrent bleeding into joints and soft tissues. Before clotting factor concentrates were available, most people with severe hemophilia developed crippling musculoskeletal deformities. Clotting factor concentrate prophylaxis aims to preserve joint function by converting severe hemophilia (factor VIII or IX less than 1%) into a clinically milder form of the disease. Prophylaxis has long been used in Sweden, but not universally adopted because of medical, psychosocial, and cost controversies. Use of clotting factor concentrates is the single largest predictor of cost in treating hemophilia. OBJECTIVES: To determine the effectiveness of clotting factor concentrate prophylaxis in the management of people with hemophilia A or B. SEARCH STRATEGY: We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register comprising references from comprehensive electronic database searches and handsearches of journals and abstract books. Reference lists of relevant articles were reviewed. Most recent search: November 2005. SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating people with severe hemophilia A or B, receiving prophylactic clotting factor concentrates. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed studies for eligibility, assessed methodological quality and extracted data. MAIN RESULTS: Twenty-nine studies were identified; four studies (including 37 participants) were eligible for inclusion. Three studies evaluated hemophilia A; one showed a decrease in frequency of joint bleeds with prophylaxis compared to placebo (non-physiological dose), with a rate difference (RD) -10.80 (95% confidence interval (CI) -16.33 to -5.27) bleeds per year. The remaining two studies evaluating hemophilia A compared two prophylaxis regimens, one study showed no difference in joint bleed frequency, RD -5.04 (95%CI -17.02 to 6.94) bleeds per year and another failed to demonstrate an advantage of factor VIII dosing based on individual pharmacokinetic data over the standard prophylaxis regimen with RD -0.14 (95% CI -1.34 to 1.05) bleeds per year. The fourth study evaluated hemophilia B and showed fewer joint bleeds with weekly (15 IU/kg) versus bi-weekly (7.5 IU/kg) prophylaxis, RD -3.30 (95% CI -5.50 to - 1.10) bleeds per year. AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised controlled trials to determine whether prophylactic clotting factor concentrates decrease bleeding and bleeding-related complications in hemophilia A or B, compared to placebo, on-demand treatment, or prophylaxis based on pharmacokinetic data from individuals. Well-designed RCTs are needed to assess the effectiveness of prophylactic clotting factor concentrates. Two clinical trials are ongoing.

Blood Coagulation Factors↗