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An optimized assay for prekallikrein activator activity in human plasma products.

Prekallikrein activator (PKA) assay is described. PKA was measured indirectly by allowing it to generate kallikrein from prekallikrein and then measuring the amidolytic activity of kallikrein by using the synthetic chromogenic substrate S-2302. It was ensured that sufficient amounts of substrates were included in both enzymatic phases of the assay, and the pH and ionic strength which seemed to be very important in the assay were carefully controlled. Both a kinetic assay and a simple endpoint assay are described. Other amidolytic enzymes probably present in plasma products are also estimated and a correction is made to exclude their role in the assay result. The precision of the kinetic assay is characterized by the coefficient of variation of 3.1% within an assay and the reproducibility by that of 4.8% between assays. For the endpoint assay both values are 4.8%.

Amidohydrolases↗

Isolation and anticoagulant properties of polysaccharides of Typha Augustata and Daemonorops species.

Polysaccharides were isolated from Dragon's Blood (DB), a red resinous secretion from the fruits of Daemonorops species and from pollens of Typha Augustata (TA) by alcohol precipitation followed by deaminoethylaminoethyl (DEAE) cellulose chromatography. The purified polysaccharides of DB and TA gave specific rotations of [alpha]D20 64 and [alpha]D20 of 80 and their molecular weights by membrane osmometry were approximately 25000 and approximately 30000 respectively. The effect of addition of the polysaccharides on coagulation of pooled normal human plasma was investigated. They were found to accelerate the recalcified plasma times at concentrations below 100 micrograms/ml while inhibiting them at higher concentrations. Their procoagulant properties were due to their effects on the activation of Hageman factor (XII) while the anticoagulant effect was mainly directed towards fibrinogen. Studies of the mechanism of the anticoagulant effect showed that addition of TA polysaccharide inhibited the rate of release of fibrinopeptides by thrombin and also the aggregation of fibrin monomers.

Anticoagulants↗

A comparison of the abilities of plasma kallikrein, beta-Factor XIIa, Factor XIa and urokinase to activate plasminogen.

In order to compare the relative potencies of plasma kallikrein, beta-Factor XIIa, Factor XIa and urokinase as plasminogen activators, plasminogen activation by these proteins was studied using a radiolabeled fibrin plate assay. Urokinase was approximately 20,000 times more active than kallikrein or Factor XIa and 300,000 times more active than beta-Factor XIIa. Kallikrein and Factor XIa were approximately equal in plasminogen activator activity and were 20 times more potent than beta-Factor XIIa.

Endopeptidases↗

Assay characteristics and fibrin affinity of plasminogen activators of the intrinsic fibrinolytic system.

Plasminogen activators (PA) in the euglobulin fraction of dextran sulfate activated plasma (DS-EF) were assayed on fibrin plates. Activity related to tissue plasminogen activator (t-PA) or urokinase (u-PA) was quantified by antiserum inhibition. The DS-EF contained 30% t-PA, 30% u-PA and 40-50% activity unrelated to t-PA or u-PA. The latter was completely inhibited by 1.7 mumol/1 C1-inhibitor (C1INH), the two former were less sensitive. Addition of flufenamate to the DS-EF (DS-EF/Fluf) from normal and two factor XII (F XII)-deficient plasmas increased their activities to the same high level. More than 50% of the activity was unrelated to t-PA or u-PA, 30-40% was u-PA and 5-10% t-PA related. After addition of fibrinogen to DS-EF/Fluf and clotting with thrombin, the remaining solution contained only about 30% of the total activity, including less than 10% u-PA. The epsilon-aminocaproic acid inhibition pattern obtained with the DS-EF was uniform, and thus different from the biphasic pattern obtained with the low fibrin affinity PA, two-chain urokinase. Thus, both the plasma u-PA and the major unidentified PA in plasma have affinity for fibrin.

Adult↗

Interaction of trypsin, beta-factor XIIa, and plasma kallikrein with a trypsin inhibitor isolated from barley seeds: a comparison with the corn inhibitor of activated Hageman factor.

A trypsin inhibitor was purified from barley seeds by a modification of published procedures. We determined the dissociation constant, Ki, for the complexes of the barley inhibitor with trypsin, beta-Factor XIIa, and plasma kallikrein. We compared these constants for those of the same enzymes with the corn Hageman Factor inhibitor, which is a homolog of the barley inhibitor. The strength of interaction of the barley inhibitor with the three enzymes was: trypsin greater than beta-Factor XIIa greater than plasma kallikrein. In contrast, the corn inhibitor inhibits beta-Factor XIIa most strongly and does not inhibit plasma kallikrein at all. A possible structural basis for the difference in inhibition specificity is discussed.

Amino Acid Sequence↗

A new assay for high molecular weight kininogen in human plasma using a chromogenic substrate.

High molecular weight kininogen (HK), the cofactor of contact-activated plasma proteolysis, is currently assayed by coagulant or immunological methods. The former is limited by the need for rare, congenitally-deficient plasma and a high coefficient of variation (CV), and the latter, by failure to distinguish nonfunctional protein. The surface activation of factor XI requires HK as its cofactor to transport its zymogen form to a negatively-charged surface where it is converted to its enzymatic form by factor XIIa. Based on this principle, we developed an assay for HK using the chromogenic substrate pyroGlu-Pro-Arg-p-nitroanilide (S-2366, KabiVitrum), which is hydrolyzed by factor XIa. Plasma is first acidified to inactivate protease inhibitors. After neutralization and dilution, the plasma is incubated with an excess of factor XI, factor XIIa, and soybean trypsin inhibitor (to inactivate generated kallikrein), in the presence of a negatively-charged surface (kaolin) in order to form factor XIa. EDTA is included in the buffer to prevent calcium-dependent reactions. This activation process is stopped by adding corn trypsin inhibitor to inactivate the enzyme in this reaction, factor XIIa. Then, S-2366 is added and is hydrolyzed by the factor XIa that was formed. Since factor XI and factor XIIa are in excess of the concentration of HK in the diluted plasma, HK is the rate-limiting protein in this assay for the formation of factor XIa (after subtracting the small amount of factor XIa generated in the absence of HK). The assay is specific for HK, since no activity is detected in kininogen-deficient plasma, and when compared with the HK coagulant assay, r = 0.95 and slope = 0.95. The mean of 21 normal donors was 0.98 U/ml (range 0.68 - 1.28 U/ml) as compared with pooled, normal plasma. The CV for 1 U/ml HK for the chromogenic assay was 2% as compared with 9.5% for the coagulant assay. When purified reagents become commercially available, this assay could prove useful in clinical laboratories or intensive care units for monitoring the progression of various disease states in which contact activation occurs.

Colorimetry↗

Group A streptococci bind human plasmin but not other structurally related proteins.

Certain group A streptococci are known to possess a receptor for the human enzyme plasmin. Plasmin is a member of a super gene family that includes other serine proteases and kringle containing proteins. In this study we have examined the interaction of a group A streptococcus with structurally related proteins, including plasmin, glu-plasminogen, tissue plasminogen activator, kallikrein, factor XII, prothrombin, thrombin, trypsin, and urokinase. Our studies indicate that only the key fibrinolytic enzyme, plasmin, demonstrates significant binding activity to the group A streptococcus.

Animals↗

Plasma recalcification as a measure of contact phase activation and heparinization efficacy after contact with biomaterials.

The rate of plasma clotting was measured in order to investigate two different processes. In both cases normal, pooled platelet-poor plasma was used as a substrate for measurement of clotting. The intrinsic coagulation pathway was studied by bringing a variety of biomaterials into contact with a plasma aliquot and observing the rate of clotting diminish by virtue of factor XII activation. The efficacy of heparinization was investigated by measuring the increase in clotting time of a plasma aliquot during biomaterial contact. In both cases, clotting time was measured turbidometrically. Marked differences in intrinsic pathway activation were observed between a variety of materials. There were clear differences between the materials and the negative and positive controls. The assay showed that heparinized materials could be distinguished from non-heparinized materials and a non-activated plasma control.

Biocompatible Materials↗

Activation of human Hageman factor by Pseudomonas aeruginosa elastase in the presence or absence of negatively charged substance in vitro.

Human Hageman factor, a plasma proteinase zymogen, was activated in vitro under a near physiological condition (pH 7.8, ionic strength I = 0.14, 37 degrees C) by Pseudomonas aeruginosa elastase, which is a zinc-dependent tissue destructive neutral proteinase. This activation was completely inhibited by a specific inhibitor of the elastase, HONHCOCH(CH2C6H5)CO-Ala-Gly-NH2, at a concentration as low as 10 microM. In this activation Hagemen factor was cleaved, in a limited fashion, liberating two fragments with apparent molecular masses of 40 and 30 kDa, respectively. The appearance of the latter seemed to correspond chronologically to the generation of activated Hageman factor. Kinetic parameters of the enzymatic activation were kcat = 5.8 x 10(-3) s-1, Km = 4.3 x 10(-7) M and kcat/Km = 1.4 x 10(4) M-1 x s-1. This Km value is close to the plasma concentration of Hageman factor. Another zinc-dependent proteinase, P. aeruginosa alkaline proteinase, showed a negligible Hageman factor activation. In the presence of a negatively charged soluble substance, dextran sulfate (0.3-3 micrograms/ml), the activation rate by the elastase increased several fold, with the kinetic parameters of kcat = 13.9 x 10(-3) s-1, Km = 1.6 x 10(-7) M and kcat/Km = 8.5 x 10(4) M-1 x s-1. These results suggested a participation of the Hageman factor-dependent system in the inflammatory response to pseudomonal infections, due to the initiation of the system by the bacterial elastase.

Amino Acid Sequence↗

Isolation and biological activity of [Trp5]bradykinin from the plasma of the phylogenetically ancient fish, the bowfin and the longnosed gar.

The holostean fish occupy an important position in vertebrate phylogeny as extant representatives of a ancient group of ray-finned fish with evolutionary connections to present-day teleosts. Incubation of heat-denatured plasma from the bowfin Amia calva with trypsin generated bradykinin-like immunoreactivity. The primary structure of bowfin bradykinin was established as Ala-Pro-Pro-Gly-Trp-Ser-Pro-Phe-Arg. This amino acid sequence contains one amino acid substitution (Phe5 --> Trp) compared with mammalian bradykinin. The same peptide was generated in heat-denatured plasma from the longnosed gar Lepisosteus osseus. Treatment of plasma from either the bowfin or gar with glass beads under conditions previously shown to activate Factor XII in the plasma of mammals and reptiles did not generate bradykinin. Bolus injections of synthetic bowfin bradykinin (0.1, 0.3, and 1.0 nmol/kg) into the bulbus arteriosus of unanesthetized bowfin resulted in an immediate fall in arterial blood pressure of 5-10 min duration that was followed by a dose-dependent rise in pressure that was sustained for 30-60 min. There was no change in heart rate following bradykinin administration. The data suggest that the kallikrein-kinin system may predate the appearance of teleosts and may play a role in cardiovascular regulation in holosteans.

Amino Acid Sequence↗

Active and inactive renin in the plasma of the snake Bothrops jararaca.

1. Complementing the work of Gervitz R. K., Hiraichi E., Fichman M. and Lavras A. A. C. Comp. Biochem. Physiol. 86A, 503-507 (1987), conditions have been established for measuring plasma renin activity (PRA) of the venomous snake Bothrops jararaca (Bj). 2. It corresponded to 115.9 +/- 11.5 ng equivalents of angiotensin II (AII) per ml of plasma (N = 13). 3. PRA did not increase when Bj plasma was submitted to acid-cryo-trypsin Bitis arietans venom activation of inactive renin. 4. This may indicate either absence of inactive renin in this plasma or lack of its activation, due to the already demonstrated (Nahas L., Kamiguti A. S., Betti F., Martins I. S. S. and Rodrigues M. I., Comp. Biochem. Physiol. 69A, 739-743, 1981; Prezoto B. C., Hiraichi E., Abdalla F. M. F. and Picarelli Z. P., Comp. Biochem. Physiol. 99C, 135-139, 1991) absence of factor XII.

Animals↗

Interaction of bovine factor XIIa with an inhibitor from bovine plasma.

An inhibitor of factor XIIa has been purified from bovine plasma and characterized (Thornton, R.D. and Kirby, E.P. (1987) J. Biol. Chem. 262, 12714-12721). This inhibitor interacts with XIIa to form a very stable complex with a 1:1 stoichiometry. The active site of XIIa, located on the light chain, is directly involved in the interaction, and complex formation between factor XIIa inhibitor and XIIa can be blocked by diisopropyl fluorophosphate, corn trypsin inhibitor, or the chromogenic substrate S2302. Incubation of the complex with excess XIIa does not result in cleavage of the complex. The complex does not spontaneously dissociate and is stable to boiling, SDS, thiocyanate, acid, and hydroxylamine or Tris at pH 7-10. In addition to complex formation, a cleaved form of factor XIIa inhibitor can be observed. We suggest that the inhibitor is acting as a mechanism-based inactivator, using the criteria of time-dependent inactivation under pseudo-first-order conditions, 1:1 stoichiometry, active site involvement, kinetic protection by substrate or by an active site inhibitor, and partitioning between cleavage of factor XIIa inhibitor and inactivation by complex formation.

Animals↗

Difference between human and guinea pig Hageman factors in activation by bacterial proteinases: cleavage site shift due to local amino acid substitutions may determine the activation efficiency of serine proteinase zymogens.

Human and guinea pig Hageman factors have been subjected to the action of pseudomonal elastase and serratial E15 proteinase. The pseudomonal elastase cleaved 22-24% of the human molecule at Arg353-Val354, and the remainder at Gly357-Leu358 resulting in the generation of about 20% of potential activity as activated Hageman factor, compared with trypsin activation, while it hydrolyzed Arg340-Ile341 bond in guinea pig molecule and generated about 75% of activity as activated Hageman factor. The serratial proteinase did not hydrolyze the essential cleavage site (Arg353-Val354) of the human zymogen but Gly356-Gly357 (30%) and Gly357-Leu358 (70%) bonds. Both products showed no activity. The guinea pig zymogen, in contrast, was cleaved mostly at Arg340-Ile341 (70%) and less abundantly at Gly344-Leu345 (30%), generating about 85% of the whole potential activity as activated Hageman factor. From the high correspondence between the proportions of activation and of hydrolysis at the essential cleavage site in activation, it was concluded that hydrolysis of the bonds different from the essential bond did not cause activation, even when the spatial separation was only 3 or 4 residues. Considering the amino acid differences between human and guinea pig Hageman factors, -Met351-Thr-Arg-Val-Val-Gly-Gly-Leu-Val-Ala360- and -Leu338-Ser-Arg-Ile-Val-Gly-Gly-Leu-Val-Ala347-, respectively, it was realized that even the minor amino acid substitutions caused the cleavage site shift which resulted in significant differences in activation efficiency of the proteinase zymogens.

Amino Acid Sequence↗

Antiphospholipid antibodies in pediatric patients with prolonged activated partial thromboplastin time during infection.

OBJECTIVE: To investigate the close association between different antiphospholipid antibodies (aPL) caused by infection and their appearance together with a prolonged activated partial thromboplastin time (aPTT). METHODS: Sera from 122 children were evaluated in this study. Thirty-seven children with mild to medium prolonged aPTT (>37.2s) and elevated C-reactive protein (CRP) levels during various forms of infections (group 2), 18 children without infections (group 3) but with mild to medium prolonged aPTT and 13 children with infections (group 4) and with elevated CRP-level as well as a control group (group 1) of 54 patients without any infection and normal aPTT and negative CRP levels were investigated with commercially available ELISA tests (AESKU.Diagnostics, Wendelsheim, Germany) for the presence of antibodies directed against cardiolipin (CL), phosphatidylserine (PS) and beta2-glycoprotein I (beta 2GPI). The cutoff for positive results was defined with the healthy, aged matched control group (group 1) using the mean OD values plus 2 standard deviations. The lupus anticoagulant (dilute Russell's Viper Venom time, dRVVT) and coagulation Factor XII were determined with routine tests (Dade Behring). RESULTS: Detection of at least one antibody to phospholipids was possible in 89.2% of group 2. It could be shown that IgM anti-beta 2GPI antibodies were found in 27 (59.5%) of group 2, but only in 1 (5.6%) of group 3 (p=0.024) and only in 4 (7.4%) of the controls (p=0.014). The presence of IgG-anti-beta 2GPI antibodies showed no significant difference in the different groups. Furthermore, children of groups 2, 3 and 4 had statistically significant higher levels of antibodies against PS IgG and PS IgM than controls. Also, antibodies to CL of the IgG-type were more frequently detected in children of group 2 than in controls (p=0.038). Detection of CL-IgM antibodies did not reach a significant level in the comparison of the different groups. CONCLUSION: During commonly acquired infections elevation of aPL of nearly all types seems to be a common process. Mild prolongation of aPTT might reflect this presence of aPL in the course of the infectious disease. Our data suggest that there exists no differences in specificity in comparison to the "pathogenic" aPL but the presence over time might be the trigger for the autoimmune activity to begin.

Adolescent↗

Transcatheter closure of atrial septal defect and patent foramen ovale with ASDOS device (a multi-institutional European trial).

A clinical trial was conducted to assess the feasibility, safety, and efficacy of the atrial septal defect (ASD) occlusion system for transcatheter closure of secundum ASD and patent foramen ovale (PFO) after episodes of cerebral embolism. Occlusion was attempted in 200 patients aged 1 to 74 years (mean 32). The procedure failed in 26 patients (13%); the device was retrieved through a catheter in 20 and through surgery in 6 patients. Procedure-related complications necessitating surgical removal of the device included device embolization in 2, device entrapment within the Chiari network in 1, frame fracture in 1, and perforation of atrial wall in 2. All 6 patients experienced an uneventful postoperative course. An additional 11 patients (6%) underwent surgical removal of the device during follow-up. There were 163 patients (81%) with an implanted ASD occlusion system at follow-up of from 6 to 36 months (mean 17). Thrombus formation around the device was detected by transesophageal echocardiography in 9 patients 1 to 4 weeks after implantation. One of these patients (who had a coagulation factor XII deficiency) suffered a cerebral thromboembolism. Late atrial wall perforation (5, 6, and 8 months after implantation) occurred in 3 adult patients. Infectious endocarditis developed in 2 adult patients (1%). No late device embolization and no atrioventricular valve injury occurred. An asymptomatic device frame fracture was found in 14% and frame deformity in 4% of all patients during the follow-up period of >230 patient-years. Immediately after closure, a moderate/large residual shunt remained in 8% and a small shunt in 29% of patients. After 1 year, a moderate/large shunt was present in 2% and a small one in 26% of patients. During a total follow-up of 49 patient-years, only 1 of 46 patients with PFO had a transient neurologic event after the closure. The study indicates that patients with centrally situated secundum ASD and those with PFO after cerebral embolism can be treated with this system with a high success rate and an acceptable morbidity.

Adolescent↗

Aprotinin and the systemic inflammatory response after cardiopulmonary bypass.

Cardiopulmonary bypass is associated with a systemic inflammatory response, a spectrum of pathophysiologic changes ranging from mild organ dysfunction to multisystem organ failure. Complications include coagulation disorders (bleeding diathesis, hyperfibrinolysis) from platelet defects and plasmin activation, as well as pulmonary dysfunction from neutrophil sequestration and degranulation. Diverse injuries are a consequence of multiple inflammatory mediators (complement, kinins, kallikrein, cytokines). Both plasmin and kallikrein amplify the inflammatory response by activating components of the contact activation system. The full-Hammersmith (high dose) of aprotinin, a serine protease inhibitor approved for reducing blood loss and transfusion requirements in cardiopulmonary bypass, inhibits kallikrein and plasmin, resulting in suppression of multiple systems involved in the inflammatory response. Specifically, inhibition of factor XII, bradykinin, C5a, neutrophil integrin expression, elastase activity, and airway nitric oxide production are observed. Clinical correlates include reduced capillary leak, preserved systemic vascular resistance and blood pressure, and improved myocardial recovery following ischemia. Overall, evidence indicates that aprotinin attenuates the systemic inflammatory response associated with cardiopulmonary bypass.

Animals↗