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PubMed2004

Update on the mechanism of action and future of activated prothrombin complex concentrates.

Activated prothrombin complex concentrates (aPCCs) are an established treatment for bleeding in patients with inhibitors. These products are derived from prothrombin complex concentrates, purified from human plasma with dedicated activation steps included in their manufacturing process. Despite these activation steps, the majority of the prothrombin complex proteins remain as zymogens, with only a relatively small content of activated coagulation enzymes. Among these, the order of concentration based on activity units is the following: factor VIIa to factor Xa to thrombin to factor IXa. Studies in various in vitro and in vivo model systems indicate that the mechanism of action of aPCCs is primarily based on an enzyme-substrate complex consisting of factor Xa and prothrombin. These findings are complemented by others showing that prothrombin is a major procoagulant that is capable of triggering hemostasis under physiologic and pathophysiologic conditions. Despite the findings of the mechanism of action, aPCCs have a long history of successful clinical use, with established dosing regimens, and a relatively low risk of thromboembolic complications compared with other treatment options for patients with inhibitors.

Blood Coagulation Factors↗
PubMed2005

Prothrombin gene expression in articular cartilage with a putative role in cartilage degeneration secondary to joint immobility.

OBJECTIVE: To test the hypothesis that thrombin is expressed by chondrocytes from human and animal articular cartilage and to monitor its levels of expression during cartilage degeneration induced by joint immobility in a rat model. METHODS: Rat knees were immobilized for periods of 2 or 4 weeks, after which the articular cartilage was harvested, total RNA extracted, and the differential display (ddPCR) protocol applied to identify differentially expressed genes. One differentially expressed fragment showed 100% homology with the prothrombin gene. Results were verified by RT-PCR, Northern and Western blot analysis, and immunohistochemistry in human, rat, and rabbit articular cartilage. RESULTS: In our rat model of cartilage degeneration induced by joint immobilization, increases in the levels of prothrombin mRNA, thrombin protein, and fibrin deposition were observed. Expression of the prothrombin gene by chondrocytes was confirmed by ddPCR (rat), RT-PCR (rat and human), and by Northern blot analysis (rabbit). In addition, thrombin-like immunoreactivity was increased in chondrocytes after a 4 week immobilization period compared with rat knees receiving sham surgery. Thrombin activity was reflected by the presence of fibrin immunoreactivity in operated rat knee joints. CONCLUSION: Articular chondrocytes express the prothrombin gene and its local expression in joints is translated into thrombin protein. Prothrombin expression is increased in response to joint immobility. Our results support generation of thrombin locally in joints and an upregulation of thrombin expression in cartilage degeneration secondary to immobility. These results may provide information on the source of increased thrombin activity in various animal models and in clinical forms of arthritis.

Animals↗
PubMedDate not supplied

[Process of complexation of prothrombine and fibrin E-fragment].

The study is devoted to research of the blood coagulation key proenzyme complexation process. It is prothrombin, and the E-fragment of fibrin can be a component in blood circulation. It is shown, that non-enzyme activation of prothrombin by the E-fragment proceeds as a result of formation of stable non-covalent prothrombin-E fragment complex. The cringle structures of prothrombin and the N-terminal site of beta-chain of E-fragment of fibrin are important for formation of the given complex. It has been defined, that other fragments of fibrin (D and DD) are not capable to induce amydolytic activity of prothrombin.

Blood Coagulation↗
PubMed1991

Production of thrombin by the prothrombinase complex is regulated by membrane-mediated transport of prothrombin.

Production of thrombin by phospholipid-bound prothrombinase complexes has been described as being regulated by the prothrombin concentration in the buffer (free-substrate model) as well as by the concentration of prothrombin adsorbed to the phospholipid surface (bound-substrate model). We studied simultaneous adsorption and conversion of prothrombin on planar bilayers consisting of 20% dioleoylphosphatidylserine and 80% dioleoylphosphatidylcholine. A transport limitation in the conversion of prothrombin was prevented by using a very low (0.3 fmol cm-2) amount of prothrombinase on the bilayer. The Michaelis and catalytic constants thus found were Km = 5.8 +/- 0.7 nM and kcat = 33 +/- 1 s-1 (mean +/- S.D.). The apparent bimolecular rate constant Kcat/Km = 5.7 x 10(9) M-1 s-1 exceeds the theoretically maximal value for the free-substrate model. In contrast, kcat/Km is within the range expected for a diffusion-controlled bound-substrate model. A similar mechanism for prothrombin conversion in suspensions of phospholipid vesicles would imply increasing kcat/Km values for increasing vesicle diameter. This prediction was tested and a 3-fold increase in kcat/Km values was indeed found for vesicles 60-80 nm in diameter compared to vesicles of 20-30 nm diameter. It is concluded that thrombin production is dependent on protein fluxes rather than on protein concentrations.

Adsorption↗
PubMed1990

The antithrombotic properties of human prothrombin fragment 1.2 in mice.

We have investigated the antithrombotic properties of prothrombin fragment 1.2 (F1.2) in this study. To do this, we established the minimum concentration of human placental tissue factor or human alpha-thrombin that was lethal in mice within 5 min after intravenous injection. Prothrombin F1.2 protected the mice from the lethal effect of tissue factor or alpha-thrombin in a dose dependent manner, with 500 micrograms (14 nmoles) of prothrombin F1.2 per mouse being the minimum amount required to protect all mice from the lethal effect of either thrombogenic stimulus. The minimum dose of heparin which protected mice from the lethal effect of thrombin or tissue factor was 6 units or approximately 3.3 nmoles. The observation that prothrombin F1.2 has antithrombotic properties suggests prothrombin F1.2 can modulate coagulation in vivo, as it has previously been shown to do in vitro.

Animals↗
PubMed1988

Purification and characterization of a prothrombin activator from the venom of the Australian brown snake, Pseudonaja textilis textilis.

A simple procedure, involving chromatography on concanavalin A-Sepharose and gel filtration, has been developed for the purification of a prothrombin activator from the venom of the Australian brown snake Pseudonaja textilis textilis. The prothrombin activator, which is a major venom component, is a high molecular weight protein (Mr greater than or equal to 200,000) which yields a number of subunits when examined by SDS-PAGE. It is related antigenically to the venom prothrombin activator of the taipan Oxyuranus scutellatus. P. textilis prothrombin activator is able to coagulate citrated plasma, warfarin plasma, and Factor V- and Factor X-deficient plasmas; to convert purified human prothrombin to thrombin; and to hydrolyse the peptide p-nitroanilide substrate S-2222. Calcium ions and phospholipids had little if any effect on the rates of coagulation of citrated plasma or S-2222 hydrolysis catalysed by this enzyme.

Animals↗
PubMed1988

Evidence that the thrombin-catalyzed feedback cleavage of fragment 1.2 at Arg154-Ser155 promotes the release of thrombin from the catalytic surface during the activation of bovine prothrombin.

During the course of prothrombin activation, as catalyzed by Factor Xa, Factor Va, Ca2+, and negatively-charged phospholipid vesicles, the three proteins distribute between the fluid phase and the vesicle surface. On the vesicle, efficient Factor Xa-catalyzed proteolysis yields thrombin plus Fragment 1.2. Further thrombin-catalyzed feedback cleavage of the latter then yields Fragment 1 plus Fragment 2. Prior to this cleavage Fragment 1.2 might retain thrombin at the site of catalysis since it binds both phospholipid and thrombin through its respective Fragment 1 and Fragment 2 domains. In order to study the role of the feedback cleavage, light scattering at right angles was used to deduce the nature of the components associated with the vesicle during prothrombin activation by continuous monitoring of the relative molecular weight of the vesicle-protein complex. When prothrombin (1.4 microM) was added to homogeneously sized phospholipid vesicles of phosphatidylcholine-phosphatidylserine (3:1) at a total phospholipid concentration of 20 microM, the scattering intensity doubled. Upon subsequent addition of Factor Xa and Factor Va (5.0 nM each) the scattering intensity smoothly decreased to a value about 1.25-fold greater than that of the vesicles alone. Analysis of the composition of the reaction mixture at intervals during the course of the reaction by gel electrophoresis and laser densitometry, provided a good correlation between the mass of the vesicle-protein complex measured by light scattering and its mass inferred by composition. In addition, the decrease in mass of the vesicle-protein complex measured by light scattering correlated temporally with cleavage of Fragment 1.2. When the reaction was initiated in the presence of the reversible thrombin inhibitor dansylarginine-N-(3-ethyl-1,5-pentanediyl)amide no cleavage of Fragment 1.2 occurred, as indicated by gel electrophoresis, and no change in the mass of the vesicle-protein complex occurred as indicated by light scattering. The absence of change in scattering intensity in the presence of dansylarginine-N-(3-ethyl-1,5-pentanediyl)amide suggests a 1:1 replacement of prothrombin at the catalytic surface by components of equivalent mass (Fragment 1.2 plus thrombin), whereas the decrease in scattering in the absence of dansylarginine-N-(3-ethyl-1,5-pentanediyl)amide suggests replacement of prothrombin by Fragment 1 only. Together these results indicate that the thrombin-catalyzed cleavage of Fragment 1.2 promotes release of thrombin from the catalytic surface.

Algorithms↗
PubMed1987

Evidence for self-association of prothrombin fragment 1 in the absence of calcium ions. Implications for the interpretation of cooperativity of calcium binding.

Sedimentation equilibrium studies have demonstrated that prothrombin fragment 1 from either human or bovine plasma reversibly dimerizes in the absence of Ca2+ with an equilibrium constant of 1,000 M-1. In the presence of 10 mM Ca2+ this association constant increased to 10,000 M-1. A model for preferential binding of Ca2+ to the pre-existing dimer has been found capable of accounting quantitatively for the cooperative Ca2+ binding to this prothrombin fragment, and for the dependence of its sedimentation coefficient on protein concentration in the presence and absence of metal ion. Sedimentation equilibrium studies of intact bovine and human prothrombins have confirmed previous reports that these prothrombins dimerize. For both prothrombins the association constant is 10,000 M-1, both in the absence and presence of Ca2+.

Animals↗
PubMed1986

The prothrombinase-catalyzed activation of prothrombin proceeds through the intermediate meizothrombin in an ordered, sequential reaction.

The activation of bovine prothrombin by prothrombinase (Factor Xa, Factor Va, synthetic phospholipid vesicles, and calcium ion) was studied in the presence of the fluorescent, reversible thrombin inhibitor dansylarginine-N-(3-ethyl-1,5-pentanediyl) amide (DAPA). Recordings of fluorescence intensity during prothrombin activation exhibited maxima that decreased to stable limiting values. These data suggested the transient appearance of the meizothrombin-DAPA complex, which exhibits fluorescence with 1.5-fold greater intensity than the thrombin-DAPA complex. At substrate concentrations well below Km, progress curves could be fitted by equations describing an ordered, sequential conversion of prothrombin to thrombin through the intermediate meizothrombin via two pseudo-first order steps. The pseudo-first order rate constants for both steps varied linearly with enzyme concentration, indicating that both steps are catalyzed by prothrombinase. The progress of the reaction was also monitored by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and densitometry analyses of aliquots removed at intervals spanning the reaction. These analyses confirmed both the existence of meizothrombin and its time course as predicted from the equations used to analyze fluorescence intensity profiles. Meizothrombin levels peaked at about 0.3 mol/mol initial prothrombin under the conditions typically studied. In addition, prethrombin 2, which is the intermediate expected from cleavages occurring in the order opposite that required to form meizothrombin, was not observed under any of the conditions examined. These data indicate that prothrombin activation catalyzed by the fully assembled prothrombinase complex proceeds via an ordered, sequential reaction with meizothrombin as the sole intermediate.

Animals↗
PubMed1979

Kinetics of the activation of human prothrombin by human coagulation factor Xa. Initial rate studies in the presence of Ca2+ and phospholipid.

Steady state kinetic studies have been performed to investigate the formation of thrombin from prothrombin by human coagulation Factor Xa in the presence of Ca2+ and phospholipid. The concentration of ligand which gives 50% of the maximum velocity (K0.5) is 2.3 mM for Ca2+, 7.4 microM for phospholipid, and 0.006 microM for prothrombin. Hill plots of the Ca2+ enhancement of the reaction give a Hill coefficient of 3.1, indicating positive cooperativity. The initial velocity patterns are consistent with an ordered addition of reactants with phospholipid as the second reactant to bind to the enzyme. Although our results do not differentiate between Ca2+ or the prothrombin substrate as the first reactant to bind to Factor Xa, it is established that Ca2+ can bind to Factor Xa in the absence of the other reactants. Thus, the most probable order of addition of reactants is Ca2+, phospholipid, and the prothrombin substrate. Plots of (v)-1 versus (prothrombin)-1 or (v)-1 versus [(Ca2+)3]-1 at several constant concentrations of phospholipid indicate that the major effect of phospholipid is to increase the turnover number of Factor Xa.

Calcium↗
PubMed1979

Activated protein C inhibits platelet prothrombin-converting activity.

Bovine platelets that have been activated by thrombin facilitate the conversion of prothrombin to thrombin in the presence of calcium ions and factor Xa. Activated protein C, a vitamin-K-dependent plasma protein, inhibits this platelet prothrombin-converting activity. The inhibition is time dependent and is not reversed by increasing concentrations of factor Xa. However, factor Xa is able to protect the platelet prothrombin-converting activity from inactivation by activated protein C. The activated protein C causes a parallel loss of factor Xa receptor sites and platelet prothrombin-converting activity. Activated protein C may contribute to the regulation of clotting through inactivation of the platelet prothrombin-converting activity.

Animals↗
PubMed1984

Synthesis and turnover of prothrombin during experimental inflammation in rats.

The response of prothrombin to inflammatory reactions was investigated in rats. Inflammation was induced by the administration of either subcutaneous turpentine or intraperitoneal endotoxin, and its effects were studied 24 h and 48 h later. Albumin and alpha 1-acute-phase globulin served as the controls. There were only insignificant changes in plasma prothrombin concentration during inflammation which contrasts sharply with a decrease in circulating albumin by approximately 25% and an increase in alpha 1-acute-phase globulin by 300-400%. These changes were paralleled by similar changes in the incorporation of [3H]lysine into these proteins during the incubation of liver slices from rats that had been pretreated with the phlogistic agents. Prothrombin catabolism, studied using 131I-prothrombin, was increased by approximately 20%; albumin turnover, studied simultaneously with 125I-albumin, was not significantly affected, though the capillary transfer rate of albumin was significantly elevated 48 h after the induction of inflammation. It is concluded that rat prothrombin is not an acute-phase protein.

Animals↗
PubMed1984

Human hepatoma cells secrete single chain factor X, prothrombin, and antithrombin III.

The human hepatoma cell line, Hep G2, was analyzed for the ability to synthesize and secrete several coagulation proteins. Using specific radioimmunoassays, factor X, prothrombin, and antithrombin III were present in 8-day culture supernatants at 62, 405, and 1,220 ng/mL, respectively. Factor IX was not detected, either in supernatants or in cell extracts. Intrinsically labeled factor X was secreted as a single-chain polypeptide of 66,000 daltons, as measured by sodium dodecylsulfate-polyacrylamide gels under nonreduced and reduced conditions. Immunoblots of Hep G2 supernatants and normal human plasma also indicate the presence of single-chain factor X. These findings support the hypothesis of a postsecretion proteolytic cleavage of factor X into the two-chain form. Prothrombin and antithrombin represented their plasma protein counterparts structurally, with molecular weights of 73,000 and 61,000, respectively. Secreted factor X, prothrombin, and antithrombin III were biologically active, as determined in coagulation or chromogenic assays, and all three activities were neutralized by monospecific antibodies. Vitamin K increased the quantity of prothrombin secreted by twofold, without affecting the rate of secretion over a five-day culture period, and had an apparent transient inhibitory effect on secretion of antithrombin III. Warfarin caused a three to fourfold decrease in the rate and quantity of secreted prothrombin, but did not affect intracellular concentrations. The intracellular and extracellular concentrations and rate of secretion of antithrombin III were not modulated by warfarin. These data suggest that the Hep G2 cell line may provide a useful model for assessing the regulation of biosynthesis and secretion of human coagulation proteins.

Antithrombin III↗
PubMed1983

The adsorption of prothrombin to phosphatidylserine multilayers quantitated by ellipsometry.

We investigated by means of an automated ellipsometer the adsorption of prothrombin from a buffer solution by multilayers of 14:0/14:0- and 18:1/18:1-phosphatidylserine (PS) stacked on chromium slides. In this instrument thickness and refractive index of the adsorbed phospholipid and proteins are monitored continuously. Two equations are derived to relate the mass of stacked phospholipids and the mass of protein adsorbed to the thickness and refractive index. These equations are based upon the Lorentz-Lorenz relation among the molar refractivities, refractive indices, and the densities of binary mixtures. Experimental validation of these equations is performed by measuring stacked multilayers of known mass of phosphatidylserine and the adsorption of [125I] albumin and [3H]prothrombin on these multilayers. Using these equations we measured the dissociation constants Kd and the number of binding sites nb of prothrombin. Values of Kd = 0.15 x 10(-8) M and nb = 122 molecules of PS/molecule of prothrombin were observed for di C14:0 PS and values of Kd = 0.45 x 10(-8) M and nb = 54 molecules of PS/molecule of prothrombin for di C18:1 PS. These data compare well to data obtained by other methods available in the literature.

Mathematics↗
PubMed1978

[Mechanisms of non-specific prothrombin activation].

The review of different mechanisms of non-physiological non-specific prothrombin activation is given as compared with the specific activation by the factor Xa. The use of snake venom enzymes or staphylocoagulase makes possible the thrombin generation from pathological forms of prothrombin lacking of gamma-carboxyglutamic acid and incapable of complete activation into thrombin by the specific activator, factor Xa. This fact stimulated the use of non-specific activators in medicine. Investigation of non-specific prothrombin activators made possible to reveal and to trace pathways of the formation of thrombin active site. It is demonstrated that prothrombin, like other serine proenzymes (trypsinogen, chymotrypsinogen), has already formed active site. This site can be revealed under changes of the conformation of the prothrombin molecule due to the chemical modification or the complex formation with staphylocoagulase.

1-Carboxyglutamic Acid↗
PubMed1995

Evaluation of a commercially available prothrombin time assay kit for use in dogs and cats.

A commercially available assay kit provided a rapid, inexpensive means of evaluating prothrombin time, requiring only 1 drop of fresh blood. We evaluated the assay kit for its ability to accurately measure prothrombin time in dogs and cats, comparing it with a validated prothrombin time assay performed in laboratories. Prothrombin times determined by validated laboratory and assay kit methods were compared, using simple regression analysis. Correlations were high (canine study, r2 = 0.96; feline study, r2 = 0.90; P = 0.0001 in both studies). We concluded that the assay kit compared favorably with the validated laboratory technique. The simplicity and speed with which the test can be performed, accuracy of results, small blood volume required, and cost-effectiveness make the assay kit well suited for prothrombin time measurement by small animal practitioners.

Animals↗
PubMed1994

Characterization of a stable form of human meizothrombin derived from recombinant prothrombin (R155A, R271A, and R284A).

Meizothrombin is a transient intermediate produced during the activation of prothrombin by the prothrombinase complex. Because meizothrombin is very sensitive to further activation and autolysis, its isolation is possible only in the presence of active site thrombin inhibitors. This complicates studies of the activities and functions of meizothrombin. As a model, we have expressed a mutant human prothrombin cDNA (R155A, R271A, R284A) with three of the cleavage sites modified so that they are no longer cleaved by factor Xa or thrombin. Several stable baby hamster kidney cell lines were isolated that secreted up to 20 micrograms/ml of carboxylated mutant prothrombin. After purification, the mutant prothrombin was activated by the prothrombinase complex or by ecarin, resulting in the formation of a meizothrombin-like molecule. Electrophoretic analysis and NH2-terminal sequence analysis were consistent with cleavage of a single bond between Arg320-Ile321 and proper processing of the prepropeptide. The meizothrombin was stable for weeks at 4 degrees C. Activation in the presence of dansylarginine N-(3-ethyl-1,5-pentanediyl) amide confirmed the conversion of prothrombin via meizothrombin. Compared with human plasma-derived thrombin, recombinant meizothrombin demonstrated approximately 7% clotting activity, 100% p-toluene-sulfonylarginine methyl ester esterase activity, and approximately 35% S2238 amidolytic activity, and could attenuate fibrinolysis.

Amino Acid Sequence↗
PubMed1993

Comparison of the membrane binding kinetics of bovine prothrombin and its fragment 1.

Total internal reflection fluorescence microscopy has been used to compare the membrane binding characteristics of fluorescein-labeled bovine prothrombin and fluorescein-labeled bovine prothrombin fragment 1. The Ca(2+)-dependent association of these proteins with quartz-supported planar membranes composed of mixtures of phosphatidylserine (2-10 mol%) and phosphatidylcholine was examined. Equilibrium binding measurements showed that the apparent equilibrium dissociation constants increased with decreasing molar fractions of phosphatidylserine and that the dissociation constants were somewhat lower for intact prothrombin. Kinetic measurements, using fluorescence photobleaching recovery, showed that the measured dissociation rates were approximately equivalent for prothrombin and fragment 1 and did not change with the protein solution concentration or the molar fraction of phosphatidylserine. The kinetic data also implied that the surface binding mechanism for both proteins is more complex than a simple reversible reaction between monovalent proteins and monovalent surface sites. Measured equilibrium and kinetic constants are reported and compared for prothrombin and fragment 1 on planar membranes.

Animals↗