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PubMed1991

Detection of protein C deficiency during oral anticoagulant therapy--use of the protein C:factor VII ratio.

Laboratory diagnosis of protein C deficiency is complicated by the fact that many patients referred for investigation are already being treated with oral anticoagulants. Protein C and factor VII have similar half lives and by using the protein C:factor VII ratio we hoped to be able to detect protein C deficiency in patients receiving oral anticoagulants. We have studied activity levels of protein C and factor VII to produce protein C:factor VII activity ratios in 105 patients receiving oral anticoagulants, 42 normal subjects, and nine patients with known inherited protein C deficiency. The mean ratios for these groups were 1.38, 1.12 and 0.63 respectively. In patients receiving oral anticoagulants, the protein C level showed a poor correlation with the international normalized ratio (INR) value. Reference ranges for protein C at different levels of anticoagulation were therefore considered unsuitable for the identification of inherited protein C deficiency. Five patients with inherited protein C deficiency were studied with and without oral anticoagulation; their protein C:factor VII ratios remained relatively unchanged, despite alterations in the level of the individual proteins. These results suggest that measurement of the protein C:factor VII ratio may help to identify patients with inherited protein C deficiency whilst on oral anticoagulants.

Adolescent↗
PubMed1999

Presence of factor-VII and -XIII activity in ultrafiltrate during hemofiltration.

UNLABELLED: Bleeding complications during renal replacement therapies can be attributed to coagulation system and platelet function alterations in uremia, and the application of heparin in extracorporeal circulation. Small protein losses during hemofiltration are always described, however the high molecular weight of coagulation factors should significantly prevent their removal during hemofiltration. To exclude degradation of coagulation factors under conditions of spontaneous ultrafiltration, the hemofiltrate of 40 patients with acute renal failure (treated with continuous veno-venous hemofiltration, CVVH) was sampled from the filtrate line after 1 h from the beginning of treatment and in 5 patients also after 12 and 24 h. Samples were investigated with human factor deficient plasma (VII, X, XI, XII) from donors with a congenital deficiency and with human plasma depleted of factor V, VIII, IX, and protein S and C. Factor XIII was detected photometrically. Subsequently the presence of factor- XIII and -VII activity was investigated in plasma and hemofiltrate from 16 patients treated with intermittent hemofiltration before (plasma) and after (plasma, hemofiltrate) therapy. These patients also suffered from acute renal failure and needed renal replacement therapies. Quality control was carried out with a buffer solution (<1% activity in the assays according to recommended protocols). RESULTS: Factor-V, -VIII, -IX, -X, -XI, and -XII activity, and protein C and S could not be detected in the hemofiltrate from continuous hemofiltration. Factor-VII and -XIII activity was present in the hemofiltrate (mean activity in CVVH: 1.93% for factor VII and 6.9% for factor XIII, mean activity in intermittent hemofiltration: <1% for factor-VII and 7.3% for factor-XIII). Three were no significant differences (Student's t-test) in plasma activity before and after intermittent hemofiltration of factor VII (44 vs. 47%, p = 0.39) and factor XIII (44 vs. 52%, p = 0.24). The presence of factor-VII and -XIII activity in the hemofiltrate cannot influence plasma activities in intermittent hemofiltration. Rapid new synthesis and short half-life should neutralize these effects. Elimination of coagulation factor-XIII activity should be excluded by the next generation of highly permeable membranes and on-line hemodiafiltration.

Acute Kidney Injury↗
PubMed1985

Cysteine proteinase procoagulant from amnion-chorion.

Various coagulation abnormalities are associated with pregnancy. Several investigators have suggested that there may be a unique procoagulant associated with amniotic tissue and fluid. We identified a cysteine proteinase from malignant tissue, cancer procoagulant, and had reason to believe a similar proteinase may be present in amniotic tissue. Amniotic fluid and extracts of amnion-chorion were purified by immunoaffinity chromatography with an antibody that was developed to cancer procoagulant antigen. The purified amnion-chorion procoagulant initiated clotting in normal and factor VII-deficient citrated human plasma and directly activated pure human factor X in a two-stage clotting assay. It was inhibited by 1 mmol/L of iodoacetamide and 0.1 mmol/L of HgCl2, and the procoagulant activity was activated by 10 mmol/L of KCN; these are classic properties of cysteine proteinases. The pure amnion-chorion procoagulant had the same mol wt and immunologic determinants as cancer procoagulant from rabbit V2 carcinoma, as determined by crossed immunodiffusion, suggesting that the same or very similar proteins were associated with both tissues. Thus, this procoagulant may be derived from both undifferentiated and dedifferentiated cells.

Amnion↗
PubMed1960

Multiple congenital coagulation deficiencies.

A 6-week-old infant is presented who suffered from a congenital haemorrhagic disorder which caused death from subdural haemorrhage following mild trauma. Haematological investigation revealed deficiencies of factor VII and Christmas factor. Prower-Stuart factor was probably also deficient although investigation of this clotting factor was carried out only on serum obtained at necropsy.

Blood Coagulation↗
PubMed1983

Evaluation of a coagulation assay determining the activity state of factor VII in plasma.

A coagulation assay is described that allows the measurement of the degree of activation of factor VII in circulating blood. The test is based on the use of both bovine and human brain thromboplastin, together with an artificial factor VII-deficient plasma. The latter can be prepared on a relatively large scale which makes it possible to measure factor VII activation in large series of patients. The determination of factor VII activation during incubation at 4 degrees C of plasma of women using oral contraceptives shows that the test described adequately measures factor VII activation. Differences in the time course of factor VII activation during this incubation in glass and plastic containers are found and implicate that rigorous standardization of blood sampling and test conditions is necessary. A possible mechanism that causes this critical dependence upon the test conditions is discussed.

Animals↗
PubMed1990

Purification and preliminary characterization of rabbit vitamin K-dependent coagulation proteins.

We describe herein a procedure for the purification of protein C, protein S, prothrombin, factor VII, and factor X to apparent homogeneity from rabbit plasma. The initial steps, which are common to the purification of vitamin K-dependent proteins from other mammalian species, include adsorption onto and elution from barium followed by anion exchange chromatography. Proteins were further purified using a variety of techniques, including affinity chromatography, gel filtration, and anion exchange chromatography in a Fast Protein Liquid Chromatography system. Significant structural homologies exist between rabbit, human, and bovine vitamin K-dependent proteins. As is true for protein C and factor X in human and bovine plasma, rabbit protein C and factor X are two-chain proteins which can be converted to active proteases by specific venom activators. Rabbit factor VII is also a two-chain protein and can restore coagulant activity to human or bovine plasma deficient in factor VII. In contrast, rabbit protein S and prothrombin are single chain proteins. In view of the well-described species specificity of many of the vitamin K-dependent proteins, purified rabbit coagulant and anticoagulant proteins should be useful in the development of animal models of coagulation and/or thrombosis.

Animals↗
PubMed1992

Triflavin, an Arg-Gly-Asp containing snake venom peptide, inhibits aggregation of human platelets induced by human hepatoma cell line.

Triflavin, an Arg-Gly-Asp (RGD)-containing peptide, purified from snake venom of Trimeresurus flavoviridis, inhibits human platelet aggregation through the blockade of fibrinogen binding to fibrinogen receptors associated with glycoprotein IIb/IIIa complex. In this report, we examined the effect of triflavin on tumor cells (human hepatoma J-5)-induced platelet aggregation (TCIPA) of heparinized platelet-rich plasma (PRP). ADP-scavenger agents, apyrase (10 U/ml) and creatine phosphate (5 mM)/creatine phosphokinase (5 U/ml) did not inhibit TCIPA while hirudin (5 U/ml) completely inhibited it. J-5 cells initially induced platelet aggregation, then blood coagulation occurred. J-5 cells concentration-dependently shortened the recalcification time of normal as well as Factor VIII, IX-deficient human plasmas, while it was inactive at shortening the recalcification time of Factor VII-deficient plasma, suggesting J-5 cells induced platelet aggregation through activation of extrinsic pathway, leading to thrombin formation as evidenced by the amidolytic activity on s-2238 by expressing tissue factor-like activity. Triflavin inhibited TCIPA in a dose-dependent manner (IC50, 0.02 microM). When compared on molar ratio, triflavin was approximately 30,000 times more potent than GRGDS (IC50, 0.58 mM). On the other hand, GRGES showed no significant effect on TCIPA, even its concentration was raised to 4 mM. Additionally, the monoclonal antibodies, raised against glycoprotein IIb/IIIa complex (i.e., 7E3 and 10 E5) inhibited J-5 TCIPA. In conclusion, we suggest the inhibitory effect of triflavin on J-5 TCIPA may be chiefly mediated by the binding of triflavin to the fibrinogen receptor associated with glycoprotein IIb/IIIa complex on platelet surface membrane.

Amino Acid Sequence↗
PubMed1964

COAGULATION AND FIBRINOLYSIS IN INJURED PATIENTS.

Serial changes in coagulation and fibrinolysis studied among 42 patients admitted to hospital with a wide variety of injuries are reported. The first hours after trauma are dominated by an acceleration of fibrinolysis (clot lysis) and clotting time which are often followed by an abrupt rebound to prolonged fibrinolysis and normal clotting. Evidence is presented that acceleration of fibrinolysis is due to flooding of the circulation by plasminogen activator and that prolongation is probably due to an inhibitor. A prolonged prothrombin time, increased prothrombin consumption index, an acceleration of the heparin-retarded clotting time, and a fall in the platelet count are also frequent during the first hours after injury. There is evidence also of an early deficiency in factor V and the onset of a fall in factor VII and prothrombin. The following days are characterized by continued prolongation of fibrinolysis, a lengthening of clotting time, and an increased prothrombin consumption index suggestive of a defect in thrombo-plastin generation. Subsequent periods of prolonged fibrinolysis may develop. Prothrombin time often continues prolonged for one to three weeks and may vary phasically; plasma prothrombin and factor VII are reduced but there is now little change in factor V. The platelet count continues to fall for one to three days, then a thrombocytosis develops, often with abnormally high platelet levels, a week or so later. Plasma fibrinogen rises within 24 hours to reach a plateau maximum a few days later and levels remain high for prolonged periods in the severely injured. Various changes are related to or influenced by the severity of trauma. Mechanisms are discussed, including thrombosis in vivo, and reference is made to homeostatic significance and its possible breakdown.

Blood Coagulation↗
PubMed2002

The in vitro analysis of the coagulation mechanism of activated factor VII using thrombelastogram.

We investigated the effects of addition of recombinant activated coagulation factor VII (rFVIIa) to coagulation factor-deficient plasma and whole blood, using thrombelastograms (TEGs). The addition of rFVIIa to factor II- or X-deficient plasma did not correct hemostatic parameters, whereas it produced partial responses in factor V-, VIII- or IX-deficient plasma and good responses in factor VII-, XI- or XII-deficient plasma. Furthermore, the addition of rFVIIa and platelets (30-100 x 10(3)/ micro l) to platelet-poor plasma produced marked corrections, producing TEGs similar to those of platelet-rich plasma. These results indicate that factors II and X are essential for the hemostatic effects of rFVIIa, and that factors V and VIII promote these effects. We believe that TEGs are, at present, one of the most useful tools for evaluating in vitro hemostatic effects of rFVIIa.

Adult↗
PubMed1995

Characterization of platelet aggregation induced by human breast carcinoma and its inhibition by snake venom peptides, trigramin and rhodostomin.

MCF-7 cells, a metastatic human breast carcinoma line, caused dose-dependent platelet aggregation in heparinized human platelet-rich plasma (PRP). MCF-7 tumor cell-induced platelet aggregation (TCIPA) was almost blocked by apyrase (0.5 U/ml) and completely inhibited by hirudin (5 U/ml). This TCIPA was unaffected by cysteine proteinase inhibition with E-64 (10 microM), but was limited by cell pretreatment with phospholipase A2. MCF-7 cell suspension caused marked, dose-dependent decrease in plasma recalcification times using normal, Factor VIII-deficient, and Factor IX-deficient human plasma. This effect was potentiated in cell lysates but was inhibited in intact cells preincubated with sphingosine. MCF-7 cell suspension did not affect the recalcification time of Factor VII-deficient plasma. Taken together, these data suggest that MCF-7 TCIPA arises from MCF-7 tissue factor activity expression. Trigramim and rhodostomin, RGD-containing snake venom peptides which antagonized the binding of fibrinogen to platelet membrane glycoprotein IIb/IIIa, prevented MCF-7 TCIPA. Likewise, synthetic peptide GRGDS as well as monoclonal antibodies against human tissue factor, platelet membrane glycoprotein IIb/IIIa and Ib prevented MCF-7 TCIPA, which was unaffected by control peptide GRGES. On a molar basis, trigramin (IC50, 0.1 microM) and rhodostomin (IC50, 0.03 microM), were about 5,000 and 18,000 times, respectively, more potent than GRGDS (IC50, 0.54 mM).

Adenocarcinoma↗
PubMed1988

Procoagulant activity in respiratory tract secretions from horses with chronic pulmonary disease.

Cell-free supernatants (sol phases), obtained after centrifugation (50,000 x g for 45 minutes) of respiratory tract secretions from horses with chronic pulmonary disease, were assayed for procoagulant activity (PCA) in a one-stage clotting assay. Of the 103 specimens tested, 59% (61) contained PCA. Procoagulant activity was detected most often in respiratory tract secretions of severely affected horses and was correlated with the quantity of neutrophils in the respiratory tract secretions. In 12 of the 17 secretions tested, the clotting time was decreased in a dose-dependent manner. However, in the coagulation assay, some reversal of PCA or inhibition of coagulation was observed in 4 secretion specimens when greater volumes of sol phase were added. Procoagulant activity was characterized tentatively as tissue factor, because it was temperature stable and was inhibited by phospholipase C and by concanavalin A. Clotting was induced in factor VIII-deficient human plasma; however, with the exception of 1 respiratory secretion specimen, clotting was not enhanced in factor VII-deficient human plasma. Procoagulant activity is a useful indicator of airway inflammation.

Animals↗
PubMed1981

Chromogenic substrate spectrophotometric assays for the measurement of clotting function.

Spectrophotometric assays for the measurement of coagulation factor activities in plasma have been developed using a relatively specific chromogenic substrate for thrombin. The tissue-factor-activated assay system involves the activation of factors VII and X and prothrombin. The surface-activated assay system involves the activation of factors XII, PK, XI, IX, VII, X and prothrombin using factors V and VIII as cofactors. The thrombin generated subsequent to activation in these two assay systems is measured via its activity on the chromogenic substrate Sarc-Pro-Arg-pNA. These spectrophotometric assays provide a higher degree of sensitivity as compared with the clotting time assays. The tissue-factor-activated system provides a sensitive method for monitoring coumarin therapy. The surface-activated assay system can detect deficiencies of all the factors measured by the conventional APTT assay system, as well as factor VII. Furthermore, this assay provides a sensitive method for monitoring heparin therapy.

Animals↗
PubMed2005

Role of the 2 adenine (g.11293_11294insAA) insertion polymorphism in the 3' untranslated region of the factor VII (FVII) gene: molecular characterization of a patient with severe FVII deficiency.

Polymorphic variants in the gene encoding factor VII (F7) affect the plasma levels of this coagulation protein and modify the clinical phenotype of FVII deficiency in some patients. In this study we report the in vitro functional analysis of a novel polymorphic variant located in the 3' untranslated region of F7: g.11293_11294insAA. To determine whether this variant regulates FVII expression, we initially compared an expression vector containing FVII cDNA with g.11293_11294insAA with the FVII wild-type (WT) construct. The kinetics of mRNA production showed that the insertion decreases the steady-state FVII mRNA levels. To assess whether the insertion influences the phenotype of FVII-deficient patients, we evaluated its effect on the expression of FVII in a patient with severe FVII deficiency (undetectable FVII activity and antigen) carrying two additional homozygous missense variations (p.Arg277Cys and p.Arg353Gln). The two substitutions alone reduced the expression of FVII activity and antigen in vitro, but with the insertion polymorphism in our expression vector the patient's phenotype of undetectable plasma FVII was recapitulated. The insertion polymorphism in the 3' untranslated region of F7 is another modifier of FVII expression that might explain the poor genotype-phenotype correlation in some FVII-deficient patients.

3' Untranslated Regions↗
PubMed1981

Procoagulant activity of human mononuclear leukocytes: dissociation of the effect of mitogens on procoagulant activity and mitogen-stimulated lymphocyte proliferation.

The role of mononuclear cells in generating procoagulant activity was examined by incubating Ficoll-Hypaque-separated mononuclear leukocytes with or without mitogens (phytohemagglutinin, pokeweed mitogen, and concanavalin A). The procoagulant activity was assayed by a modification of a one-stage plasma recalcification time. Significant procoagulant activity developed after 24 hr incubation and was dose dependent; mitogens alone had no effect on the clotting time. The increase in activity was paralleled by the increase in tritiated thymidine incorporation into replication DNA. However, mitomycin C had little inhibitory effect on the development of procoagulant activity, whereas thymidine incorporation was inhibited. The major procoagulant activity was associated with intact cells and not the conditioned supernatant. The removal of adherent mononuclear cells (mostly monocytes) by polystyrene bead columns abolished the procoagulant activity, whereas purification of mononuclear leukocyte populations for monocytes markedly increased the activity as compared to purified lymphocytes. The procoagulant activity was shown to act by the extrinsic limb of the coagulation sequence because of substitution factor VII-deficient plasma for normal plasma resulted in marked depression of procoagulant activity, whereas factor VIII-deficient plasma resulted in a clotting time only minimally longer then normal plasma. Thus, although procoagulant activity in cultures of mononuclear cells is stimulated by the mitogen reagent, these studies suggest that the activity may not be the result of the mitogenic effect on lymphocytes per se. Whether it is a direct effect of the mitogen on the adherent cell or is an effect of a contaminant of the mitogen reagent, such as endotoxin, remains to be determined.

Adult↗
PubMedDate not supplied

Antithrombin III deficiency in a Romanian family. Pathogenic role of concomitantly increased plasma level of clotting factors VII and X.

Antithrombin III deficiency in a Romanian family is presented. The propositus, a 27 year-old man, had a history of recurrent venous thrombosis and was found to present a plasma antithrombin III level of only 50% of the normal values. His mother and two of his five children had low antithrombin III levels but no episodes of venous thrombosis. In opposition to his family members, the propositus presented overweight, slight hypertriglyceridemia and displayed a high level of clotting factors VII and X. The findings suggest that development of thromboembolic disease in a subject with familial antithrombin III deficiency is enhanced by additional factors, for example by an increased plasma level of vitamin K-dependent clotting factors.

Adult↗
PubMedDate not supplied

Genetic markers: genes involved in thrombosis.

This article summarizes the genetic markers of human venous and arterial thrombotic disorders. For venous thromboembolism, a factor V mutation (Arg 506-->Gln) has the highest risk, followed by protein C, S and antithrombin III gene defects. By contrast, these genetic defects are not associated significantly with arterial atherothrombotic disorders. Instead, a glycoprotein IIIa polymorphism (Pro33 versus Leu 33) has been reported to be associated with myocardial infarction. Fibrinogen Bbeta chain, factor VII, and plasminogen activator inhibitor-1 gene polymorphisms have been reported to influence the plasma levels of these factors and may indirectly be risk factors for arterial thrombotic disorders. Further studies will uncover additional genetic markers for thrombosis.

Antithrombin III Deficiency↗