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Factor XIII in ulcerative leg disease: background and preliminary clinical results.

The therapy concept of topical factor XIII application was developed on the basis of clinical and experimental investigations on improvement of wound healing, as well as on the morphological and pathophysiological topical site of venous ulcers. Topical treatment with factor XIII is special with regard to mode of application as well as efficacy, since a lot of other medications used for local wound treatment contain a fibrinolytic component. In the last 32 months, 23 inpatients (17 female, 6 male) averaging 62.9 +/- 14.1 years and suffering ulcerative leg disease were treated with topically applied factor XIII. The average period of distal venous ulcer in these patients was 3.3 +/- 2.04 years. The extent of the ulcer surface ranged between 2.5 x 3.0 cm (minimum) and 18.5 x 8.0 cm (maximum). All patients had been in medical consultation for several years. The venous ulcers were based upon a "postthrombotic syndrome" in 15 patients. Six patients were suffering from ulcerations due to arterial and venous mixed disease, and there were 2 patients with ulcerations of unknown etiology. In 5 patients, 2 with unknown etiology and 3 with arterial and venous mixed disease, local treatment with factor XIII was discontinued after 4 weeks because there was definitely no improvement in wound healing. Additionally, 3 patients with ulcerations due to arterial and venous mixed disease were treated for a maximum of 6 weeks with only moderate improvement in healing. Twelve of the 15 patients (79.3%) with extended, chronic ulceration on the basis of a postthrombotic syndrome showed such a distinct improvement of topical site after an average of only 3.15 +/- 1.14 weeks that they were released for further ambulatory treatment. Three patients had to be treated for a maximum period of 6 weeks, also with distinct improvement in wound healing. Apart from a wound surface reduction and a clinically documentable improvement of granulation tendency, there was a marked reduction of secretion and bleeding tendency within the ulcer area observed in all patients. None of the patients showed any systemic or local allergic reactions.

Administration, Topical↗

Influences of thrombin, factor XIII and fibronectin on the growth of tumor cells and leukemic cells in vitro.

Thrombin, factor XIII and fibronectin were incubated with cultures of mouse sarcoma cells, human cervix carcinoma cells (HeLa cells) and cells of an acute lymphoblastic leukemia. Thrombin induced a significant increase of 3H-thymidine uptake into cells with a 1,5- to 2-fold increase of cell count. The cells of an acute lymphoblastic leukemia showed a similar response to the influence of thrombin. Factor XIII merely induced an increase of 3H-thymidine uptake in tumor cells, the cell count remained constant. These results differ from experiments with cultures of normal fibroblasts. Decreased receptor density in tumor cells toward factor XIII and thrombin would play a role so that the mitogenic stimulus is impaired. The cells of an acute lymphoblastic leukemia showed under the influence of factor XIII a significant increase of cell count and thymidine uptake. HeLa cell growth was optimal at low fibronectin concentrations. Fibronectin concentrations of 1 mg/ml to 3 mg/ml inhibited HeLa- and mouse sarcoma cell growth.

Animals↗

[Identification of two novel mutation in two Chinese hereditary coagulation factor XIII deficiency families].

OBJECTIVE: To explore gene defect of hereditary coagulation factor XIII deficiency. METHODS: PCR and gene sequencing or ARMS-PCR were used to detect the FXIIIA gene of peripheral white blood cell (PBC) from two Chinese hereditary coagulation factor XIII deficiency family members and 60 normal subjects respectively. The level of FXIIIA gene mRNA was tested by RT-PCR. RESULTS: (1) Nucleotide sequence analysis of the two probands' and their family members' DNA revealed that all of the three patients had homozygous missense mutation in FXIII A subunit gene. Proband 1 had a C to G transition at nucleotide (nt) 1 241 in exon 10 and proband 2 and his sister a C to T transition at nt 232 in exon 3 of FXIII A gene, which resulted in the substitution of Ser413 with Trp and Arg 77 with Cys, respectively. Family study showed that the two mutations were inherited from the parents who were correspondingly heterozygotes at nt 1 241 or nt 232. (2) The two mutations were not found in the normal subjects. (3) The FXIIIA gene mRNA level in the two probands was a little decreasing. CONCLUSION: It is the two novel mutations that results in FXIIIA deficiency. The two mutations of FXIIIA gene may affect its function or alter protein folding. The defective FXIII which is unstable and degraded rapidly in cytoplasm may be the main cause of FXIII deficiency.

Blood Coagulation Disorders, Inherited↗

[Evaluation of coagulation factor XIII. Critical study of the different techniques used (author's transl)].

A critical study of various techniques of factor XIII determination was performed. The method using dansyl-cadaverin seems to be the most sensitive one but not easily usable in routine tests. The biological techniques using factor XIII-free fibrinogen (screening test and classical test) are satisfactory in clinical trials but are not sensitive for the detection of moderate deficiency of factor XIII. The immunological tests used are the electro-immuno-diffusion test and the test of the consumption of an anti-serum. However, only the antibody directed against the sub unit. A must be used. All these techniques were performed in acquired deficiency of factor XIII and a good correlation was obtained. However, in factor XIII congenital deficiency, we propose to associate a biological assay and the antigenic determination of factor XIII in order to detect a possible abnormal factor XIII.

Cadaverine↗

"A" subunit of factor XIII is present on bovine platelet membrane and mediates collagen-induced platelet activation.

The Fab fragment of a polyclonal antibody against platelet factor XIII inhibited the collagen-induced platelet aggregation in a dose-dependent manner. This inhibitory effect was specific for collagen, and it had no effect on arachidonic acid-, ADP-, and serotonin-induced aggregations. This finding strengthens our notion that platelet factor XIII is involved in collagen-induced platelet aggregation. (Saito, Y., Imada, T., Takagi, J., Kikuchi, T. and Inada, Y. J. Biol. Chem. 261, 1355-1358, 1986). We have investigated membrane localization of bovine platelet factor XIII using immunological techniques. Immunofluorescent visualization revealed that the factor XIII was expressed on the surface of non-permeabilized bovine platelets, where we detected neither lactate dehydrogenase, a cytoplasmic enzyme marker, nor B subunit of factor XIII, which is present in plasma. Cell surface iodination and immunoprecipitation also confirmed that it existed on the surface of platelets.

Animals↗

Degradation of human plasma fibrin stabilizing factor XIII subunits by human granulocytic proteinases.

Decreased activity of fibrin stabilizing factor XIII may occur in diseases with enhanced destruction of granulocytes. Haemorrhage and impaired wound healing may result. It has been shown by means of SDS-polyacrylamide gel electrophoresis that the neutral proteinases from human polymorphonuclear granulocytes, the Elastase Like Proteinase (ELP), and the Chymotrypsin Like Proteinase (CLP), are able to digest purified human plasma factor XIII. Both subunits, a and b, are affected at concentrations which might locally or systemically occur under pathophysiological conditions. Higher concentrations are required for the degradation of subunit b. Depending on the proteinases, the concentration used and the time of incubation, numerous split products were formed. To obtain comparable effects, the concentration of CLP had to be about twice that of ELP. Aprotinin had only a slight inhibitory effect on the two leukocyte proteinases. The results presented indicate that factor XIII is degraded and inactivated by granulocytic proteinases, both subunits being altered by these proteinases. Therefore the determination of subunit b may be helpful in differentiating between the proteolytic effect of thrombin which degrades only subunit a, and the granulocyte proteinases.

Aprotinin↗

[Autoradiographic investigation into the influence of factor XIII on wound healing in the animal experiment (author's transl)].

1. In Wistar rats pretreated with factor XIII, placebo (human albumin solution), or physiological saline, a muscle wound was produced. For pre- and postlabelling purposes the animals received 3H-thymidine. 2. Autoradiographic and histological examinations revealed wound healing promoting activity of factor XIII from 72 h post operationem onwards. 3. 7 days after surgery, in contrast to the controls, the animals pretreated with factor XIII displayed sturdy, directed connective tissue in the wound bed with ample vascularization. 4. The method with pre- and postlabelling with 3H-thymidine elucidates that wound healing through factor XIII prevailingly occurs by faster fibroblast formation.

Animals↗

[Factor XIII and the risk of postoperative impaired wound healing and bleeding (author's transl)].

Factor XIII concentration was investigated pre- and postoperatively in the plasma of 139 patients undergoing major abdominal surgery. Postoperative complications (impairment of wound healing and haemorrhage) were significantly more frequently seen in patients with a low concentration of factor XIII. A low preoperative concentration of factor XIII can be interpreted as a high risk factor.

Factor XIII↗

A fluorescent spot test for coagulation factor XIII.

A new method is described for the rapid detection of coagulation factor XIII. The technique utilizes the amine monodansylcadaverine in a fluorescent spot test. The method allows the checking of large numbers of samples during purification procedures. This test can also be used to diagnose factor XIII deficiency in plasma samples.

Cadaverine↗

Clotting factors and platelets. Immunofluorescence evidence that fibrinogen and factor VIII are present in human washed platelets, whereas prothrombin complex factors and factor XIII are lacking.

Factor I (fibrinogen) and factor VIII were shown, by an indirect immunofluorescence technique, to be present in human washed platelets. In the case of fibrinogen, the immunofluorescent pattern had a 'clod distribution' up to a 1:128 dilution of the antiserum. Factor VIII showed a 'speckled' pattern up to the 1:64 dilution. Cross-absorption studies confirmed the presence of such factors. Factor II, VII, IX, X and XIII, however, were not found in washed platelets. A diffuse fluorescence was noted using normal rabbit sera, but this was due to a cross-reaction, since it disappeared using a 1:32 diluted sera.

Animals↗

Effect of Venoruton on the factor XIII activity in rat plasma.

The effect of Venoruton [O-(beta-hydroxyethyl)-rutoside] on the activity of factor XIII in rat plasma was studied in vivo. The drug was administered to the animals intragastrically 6 times a week during 90 days in doses of 5 mg/100 g body weight. An about twofold increase in factor XIII activity beginning after several days of treatment and lasting for several weeks was observed. Then an attenuation of factor XIII activity down to the control level took place in spite of systematic Venoruton administration. Spectrofluorimetric determinations of factor XIII activity were confirmed by thromboelastrographic studies.

Animals↗

Congenital factor XIII deficiency: report of a case and literature review.

We described a five-year-old boy with congenital deficiency of factor XIII. He had bled from the umbilical and circumcision sites during the first week of life. He had frequent ecchymoses and hematomas within 12-24 hours after trauma. His parents are first cousins. The screening hemostatic tests of this patient and his parents were within normal limits. Factor XIII, known as "fibrin-stabilizing factor", is a transpeptidase that produces strong covalent bonds between soluble fibrin monomers formed during coagulation. Presumptive diagnosis of factor XIII deficiency was made with a clot solubility screening test and confirmation was accomplished by demonstrating the absence of factor XIII by latex agglutination.

Child, Preschool↗

Thrombin-independent activation of platelet factor XIII by endogenous platelet acid protease.

Platelets contain factor XIII, an A subunit zymogen form of transglutaminase (TGase), that is activated by thrombin. In addition a thrombin-independent TGase (A#) was observed. A# was formed in platelet preparations lysed at acid pH, and its generation inhibited by protease inhibitors and alkaline pH. When maximal A# activity was generated in acidified lysates no further TGase activity could be induced by subsequent treatment with thrombin. Both FXIII zymogen and A# copurified as for FXIII, from either alkaline or from acidified platelet lysates respectively, by the conventional procedure. The pH optima, Km's for NN dimethyl casein, molecular weights, heat lability of active forms, requirements for calcium and reducing agents, and immunological characteristics of both TGases were the same. Studies with inhibitor substrates suggested that a thrombin-like cathepsin C or carboxypeptidase was responsible for A# formation. Purified FXIII zymogen could be activated directly by cathepsin C. Thus, the predominant, and probably only, TGase of platelets is factor XIII, which may be activated either by thrombin or by endogenous platelet acid protease(s).

Aspartic Acid Endopeptidases↗

Platelet factor XIII increases the fibrinolytic resistance of platelet-rich clots by accelerating the crosslinking of alpha 2-antiplasmin to fibrin.

Platelet clots resist fibrinolysis by plasminogen activators. We hypothesized that platelet factor XIII may enhance the fibrinolytic resistance of platelet-rich clots by catalyzing the crosslinking of alpha 2-antiplasmin (alpha 2AP) to fibrin. Analysis of plasma clot structure by polyacrylamide gel electrophoresis and immunoblotting revealed accelerated alpha 2AP-fibrin crosslinking in platelet-rich compared with platelet-depleted plasma clots. A similar study of clots formed with purified fibrinogen (depleted of factor XIII activity), isolated platelets, and specific factor XIII inhibitors indicated that this accelerated crosslinking was due to the catalytic activity of platelet factor XIII. Moreover, when washed platelets were aggregated by thrombin, there was evidence of platelet factor XIII-mediated crosslinking between platelet alpha 2AP and platelet fibrin(ogen). Specific inhibition (by a monoclonal antibody) of the alpha 2AP associated with washed platelet aggregates accelerated the fibrinolysis of the platelet aggregate. Thus in platelet-rich plasma clots, and in thrombin-induced platelet aggregates, platelet factor XIII actively formed alpha 2AP-fibrin crosslinks, which appeared to enhance the resistance of platelet-rich clots to fibrinolysis.

Blood Coagulation Factors↗

Haplotypes of the coagulation factor XIII A subunit locus in normal and deficient subjects.

Several RFLPs have been detected using a cDNA fragment encoding the amino-terminal half of the A subunit of factor XIII. The RFLPs show little linkage disequilibrium and form many different haplotypes that can be used to identify chromosomes transmitting factor XIII A subunit deficiency. Southern blot analysis of three deficient individuals from two families showed that, in these cases, factor XIII A subunit deficiency did not result from a major gene deletion or rearrangement. Factor XIII A subunit deficiency was found to be associated with three different haplotypes, suggesting heterogeneity in the mutations causing this disorder.

Cloning, Molecular↗

Adult Henoch-Schönlein purpura with severe abdominal pain treated with dapsone and factor XIII concentrate.

We describe an adult patient with Henoch-Schönlein purpura who had arthralgia, severe abdominal pain, and low plasma factor XIII activity. Corticosteroids were not used because of his history of multidrug-resistant pulmonary tuberculosis. Dapsone had no immediate effect on his abdominal pain, but appeared to have some effect on the purpura and arthralgia. Marked improvement of the abdominal pain was observed immediately after the administration of factor XIII concentrate. Factor XIII concentrate may be useful for alleviating abdominal pain in Henoch-Schönlein purpura patients when corticosteroids are contraindicated

Abdominal Pain↗

Regulation of transglutaminase activity in articular chondrocytes through thrombin receptor-mediated factor XIII synthesis.

Transglutaminases are a family of enzymes that catalyze the formation of epsilon-(gamma-glutamyl)lysine isopeptide bonds in proteins, an activity that has been implicated in the pathogenesis of cartilage matrix mineralization in degenerative arthritis. Type II transglutaminase and thrombin-activatable factor XIII have been identified in articular cartilage. Thrombin, a coagulation protease, is found in pathological synovial fluids, and is known to stimulate transglutaminase activity in non-articular tissues. We investigated the effects of thrombin on transglutaminase activity in porcine articular chondrocytes. Direct addition of thrombin to chondrocyte lysates resulted in increased transglutaminase activity due to proteolytic conversion of factor XIII to XIIIa. Thrombin-treated chondrocyte cultures (0.001 to 2.0 U/ml) also showed increased transglutaminase activity. Thrombin treatment of chondrocyte cultures increased transglutaminase activity as early as 15 minutes after addition, an effect that we attributed to factor XIII activation. Additional stimulatory effects of thrombin were observed in cultured chondrocytes at 4 and 24 hours. A thrombin receptor agonist peptide (TRAP) which activates the PAR1 thrombin receptor mimicked these later effects. Thrombin treatment of chondrocyte cultures increased factor XIII mRNA and protein levels, without affecting levels of type II transglutaminase. Thus, thrombin stimulates transglutaminase activity in articular cartilage by directly cleaving factor XIII and by receptor-mediated up-regulation of factor XIII synthesis. Such increases in potential transglutaminase activity may facilitate pathological matrix calcification in degenerative arthritis.

Animals↗

[Activation of factor XIII by beta-thrombin].

It was found that similar to alpha-thrombin, beta-thrombin (possessing a high esterase and only a trace coagulating activities) converts plasmic transglutaminase (factor XIII) into its active form, thus promoting stabilization of fibrin. Activation of pure and plasmic preparations of factor XIII after incubation with beta-thrombin was observed in vitro. alpha-Thrombin at concentration corresponding to the trace coagulating activity of beta-thrombin had no activating effects. An intravenous injection of beta-thrombin to animals with aminazine-inhibited anticoagulating system reflectory arc resulted in an increase of factor XIII activity in the same way as was observed in vitro. On the other hand, an intravenous injection of beta-thrombin to intact animals did not increase factor XIII activity, which may be accounted for by a decrease in the level of factor XIII due to activation of the anticoagulating system.

Enzyme Activation↗