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Sachs UJ, Kirsch-Altena A, Müller J. Markers of Hereditary Thrombophilia with Unclear Significance. Hamostaseologie 2022; 42:370-380. [PMID: 36549289 DOI: 10.1055/s-0042-1757562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Thrombophilia leads to an increased risk of venous thromboembolism. Widely accepted risk factors for thrombophilia comprise deficiencies of protein C, protein S, and antithrombin, as well as the factor V "Leiden" mutation, the prothrombin G20210A mutation, dysfibrinogenemia, and, albeit less conclusive, increased levels of factor VIII. Besides these established markers of thrombophilia, risk factors of unclear significance have been described in the literature. These inherited risk factors include deficiencies or loss-of-activity of the activity of ADAMTS13, heparin cofactor II, plasminogen, tissue factor pathway inhibitor (TFPI), thrombomodulin, protein Z (PZ), as well as PZ-dependent protease inhibitor. On the other hand, thrombophilia has been linked to the gain-of-activity, or elevated levels, of α2-antiplasmin, angiotensin-converting enzyme, coagulation factors IX (FIX) and XI (FXI), fibrinogen, homocysteine, lipoprotein(a), plasminogen activator inhibitor-1 (PAI-1), and thrombin-activatable fibrinolysis inhibitor (TAFI). With respect to the molecular interactions that may influence the thrombotic risk, more complex mechanisms have been described for endothelial protein C receptor (EPCR) and factor XIII (FXIII) Val34Leu. With focus on the risk for venous thrombosis, the present review aims to give an overview on the current knowledge on the significance of the aforementioned markers for thrombophilia screening. According to the current knowledge, there appears to be weak evidence for a potential impact of EPCR, FIX, FXI, FXIII Val34Leu, fibrinogen, homocysteine, PAI-1, PZ, TAFI, and TFPI on the thrombotic risk.
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Affiliation(s)
- Ulrich J Sachs
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany.,Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus Liebig University, Giessen, Germany
| | - Anette Kirsch-Altena
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany
| | - Jens Müller
- Institute for Experimental Haematology and Transfusion Medicine, Bonn University Hospital, Bonn, Germany
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2
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Chen Y, Phoon PHY, Hwang NC. Heparin Resistance During Cardiopulmonary Bypass in Adult Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:4150-4160. [PMID: 35927191 PMCID: PMC9225936 DOI: 10.1053/j.jvca.2022.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
The use of heparin for anticoagulation has changed the face of cardiac surgery by allowing a bloodless and motionless surgical field throughout the introduction of cardiopulmonary bypass (CPB). However, heparin is a drug with complex pharmacologic properties that can cause significant interpatient differences in terms of responsiveness. Heparin resistance during CPB is a weighty issue due to the catastrophic consequences stemming from inadequate anticoagulation, and the treatment of it necessitates a rationalized stepwise approach due to the multifactorial contributions toward this entity. The widespread use of activated clotting time (ACT) as a measurement of anticoagulation during CPB is examined, as it may be a false indicator of heparin resistance. Heparin resistance also has been repeatedly reported in patients infected with COVID-19, which deserves further exploration in this pandemic era. This review aims to examine the variability in heparin potency, underlying mechanisms, and limitations of using ACT for monitoring, as well as provide a framework towards the current management of heparin resistance.
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Affiliation(s)
- Yufan Chen
- Department of Anaesthesiology, Singapore General Hospital, Singapore,Department of Cardiothoracic Anesthesia, National Heart Centre, Singapore
| | - Priscilla Hui Yi Phoon
- Department of Anaesthesiology, Singapore General Hospital, Singapore,Department of Cardiothoracic Anesthesia, National Heart Centre, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anesthesia, National Heart Centre, Singapore.
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3
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Lin WY, Zhu R, Zhang Z, Lu X, Wang H, He W, Hu Y, Tang L. RNAi targeting heparin cofactor II promotes hemostasis in hemophilia A. MOLECULAR THERAPY-NUCLEIC ACIDS 2021; 24:658-668. [PMID: 33996250 PMCID: PMC8093307 DOI: 10.1016/j.omtn.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Abstract
Hemophilia A is a hemorrhagic disease due to congenital deficiencies of coagulation factor VIII (FVIII). Studies show that hemophilia patients with anticoagulant deficiency present less severe hemorrhagic phenotypes. We aimed to find a new therapeutic option for hemophilia patients by RNA interference (RNAi) targeting heparin cofactor II (HCII), a critical anticoagulant protein inactivating the thrombin. The optimal small interfering RNA (siRNA) was conjugated to an asialoglycoprotein receptor ligand (N-acetylgalactosamine [GalNAc]-HCII), promoting targeted delivery to the liver. After administration, GalNAc-HCII demonstrated effective, dose-dependent, and persistent HCII inhibition. After 7 days, in normal mice, GalNAc-HCII reduced HCII levels to 25.04% ± 2.56%, 11.65% ± 2.41%, and 6.50% ± 1.73% with 2, 5, and 10 mg/kg GalNAc-HCII, respectively. The hemostatic ability of hemophilia mice in the GalNAc-HCII-treated group significantly improved, with low thrombus formation time in the carotid artery thrombosis models and short bleeding time in the tail-clipping assays. After repeated administration, the prolonged activated partial thromboplastin time (APTT) was reduced. A 30 mg/kg dose did not cause pathological thrombosis. Our study confirmed that GalNAc-HCII therapy is effective for treating hemophilia mice and can be considered a new option for treating hemophilia patients.
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Affiliation(s)
- Wen-Yi Lin
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiqi Zhu
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Zhang
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuan Lu
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huafang Wang
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjuan He
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Tang
- Institute of Hematology, Union Hospital Affiliated Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4
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Eggenschwiler R, Patronov A, Hegermann J, Fráguas-Eggenschwiler M, Wu G, Cortnumme L, Ochs M, Antes I, Cantz T. A combined in silico and in vitro study on mouse Serpina1a antitrypsin-deficiency mutants. Sci Rep 2019; 9:7486. [PMID: 31097772 PMCID: PMC6522476 DOI: 10.1038/s41598-019-44043-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 05/07/2019] [Indexed: 01/15/2023] Open
Abstract
Certain point-mutations in the human SERPINA1-gene can cause severe α1-antitrypsin-deficiency (A1AT-D). Affected individuals can suffer from loss-of-function lung-disease and from gain-of-function liver-disease phenotypes. However, age of onset and severity of clinical appearance is heterogeneous amongst carriers, suggesting involvement of additional genetic and environmental factors. The generation of authentic A1AT-D mouse-models has been hampered by the complexity of the mouse Serpina1-gene locus and a model with concurrent lung and liver-disease is still missing. Here, we investigate point-mutations in the mouse Serpina1a antitrypsin-orthologue, which are homolog-equivalent to ones known to cause severe A1AT-D in human. We combine in silico and in vitro methods and we find that analyzed mutations do introduce potential disease-causing properties into Serpina1a. Finally, we show that introduction of the King’s-mutation causes inactivation of neutrophil elastase inhibitory-function in both, mouse and human antitrypsin, while the mouse Z-mutant retains activity. This work paves the path to generation of better A1AT-D mouse-models.
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Affiliation(s)
- Reto Eggenschwiler
- Research Group Translational Hepatology and Stem Cell Biology, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, 30625, Germany. .,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, 30625, Germany.
| | - Atanas Patronov
- Protein Modelling Group, Department of Life Sciences, Technical University Munich, Freising, 85354, Germany.,TUM School of Life Sciences, Center for Integrated Protein Science (CIPSM), Technical University Munich, Freising, 85354, Germany
| | - Jan Hegermann
- Research Core Unit Electron Microscopy, Hannover Medical School, Hannover, 30625, Germany.,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, 30625, Germany.,Imaging Platform of the Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, 30625, Germany
| | - Mariane Fráguas-Eggenschwiler
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, 30625, Germany.,TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, 30625, Germany
| | - Guangming Wu
- Max Planck Institute for Molecular Biomedicine, Cell and Developmental Biology, Münster, 48149, Germany
| | - Leon Cortnumme
- Research Group Translational Hepatology and Stem Cell Biology, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, 30625, Germany.,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, 30625, Germany
| | - Matthias Ochs
- Research Core Unit Electron Microscopy, Hannover Medical School, Hannover, 30625, Germany.,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, 30625, Germany.,Imaging Platform of the Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, 30625, Germany.,Institute of Vegetative Anatomy Charité - Universitaetsmedizin Berlin, Berlin, 10115, Germany
| | - Iris Antes
- Protein Modelling Group, Department of Life Sciences, Technical University Munich, Freising, 85354, Germany.,TUM School of Life Sciences, Center for Integrated Protein Science (CIPSM), Technical University Munich, Freising, 85354, Germany
| | - Tobias Cantz
- Research Group Translational Hepatology and Stem Cell Biology, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, 30625, Germany. .,Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, 30625, Germany. .,Max Planck Institute for Molecular Biomedicine, Cell and Developmental Biology, Münster, 48149, Germany.
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5
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Wang Q, Yu C, Shi S, Su X, Zhang J, Ding Y, Sun Y, Liu M, Li C, Zhao X, Jiang W, Wei T. An analysis of plasma reveals proteins in the acute phase response pathway to be candidate diagnostic biomarkers for depression. Psychiatry Res 2019; 272:404-410. [PMID: 30611956 DOI: 10.1016/j.psychres.2018.11.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 10/14/2018] [Accepted: 11/30/2018] [Indexed: 12/28/2022]
Abstract
Globally, depression is one of the most serious debilitating psychiatric mental disorders. In this study, we validated the expression levels of fibrinogen alpha (FGA), fibrinogen beta (FGB), fibrinogen gamma (FGG), Complement factor B (CFB) and serpin family D member 1(SERPIND1) in the acute phase response signaling pathway in plasma samples using enzyme-linked immunosorbent assay (ELISA).Then illuminate the roles of FGA, FGB, FGG, CFB, SERPIND1 in depression using microarray data. Gene expression dataset GSE98793 was downloaded from the Gene Expression Omnibus database. There were 128 whole blood samples included 64 patients with major depressed patients and 64 healthy controls. Differentially expressed genes (DEGs) were identified, and then protein-protein interaction (PPI) network was constructed to screen crucial genes associated with FGA, FGB, FGG, CFB and SERPIND1. Moreover, gene ontology (GO) biological processes analyses was performed. The ELISA data showed that the expression levels of FGA, FGB, FGG, CFB and SERPIND1 were up-regulated in depressed patients. The enriched GO terms were predominantly associated with the biological processes including more genes were inflammation related. The PPI network was found these five genes interacted with 11 genes. FGA, FGB, FGG, CFB and SERPIND1 may be important in the pathogenesis of depression.
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Affiliation(s)
- Qi Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Chunyue Yu
- Department of Biopharmaceutical Sciences, College of Pharmacy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Shanshan Shi
- Department of Biopharmaceutical Sciences, College of Pharmacy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Xiaojie Su
- Department of Biochemistry and molecular biology, College of Medical laboratory and technology, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Jian Zhang
- College of Medical Informatics, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Yongqing Ding
- Department of Women's Psychological Clinic, Fifth Affiliated Hospital of Harbin Medical University, Daqing, Heilongjiang 163000, PR China
| | - Yanan Sun
- Department of Biopharmaceutical Sciences, College of Pharmacy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Min Liu
- Department of Biopharmaceutical Sciences, College of Pharmacy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Chunquan Li
- College of Medical Informatics, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China
| | - Xiwu Zhao
- Department of Neurology, The Third People's Hospital of Daqing, Daqing, Heilongjiang 163000, PR China
| | - Wenhai Jiang
- Department of Neurology, The Third People's Hospital of Daqing, Daqing, Heilongjiang 163000, PR China
| | - Taiming Wei
- Department of Biopharmaceutical Sciences, College of Pharmacy, Harbin Medical University-Daqing, Daqing, Heilongjiang 163000, PR China.
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6
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Dou H, Song A, Jia S, Zhang L. Heparinoids Danaparoid and Sulodexide as clinically used drugs. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 163:55-74. [DOI: 10.1016/bs.pmbts.2019.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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7
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Label-free quantitative proteomics reveals fibrinopeptide B and heparin cofactor II as potential serum biomarkers in respiratory syncytial virus-infected mice treated with Qingfei oral liquid formula. Chin J Nat Med 2018; 16:241-251. [DOI: 10.1016/s1875-5364(18)30054-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Indexed: 01/28/2023]
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8
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9
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de la Morena-Barrio M, Antón A, Martínez-Martínez I, Padilla J, Miñano A, Navarro-Fernández J, Águila S, López M, Fontcuberta J, Vicente V, Corral J. Regulatory regions of SERPINC1 gene: Identification of the first mutation associated with antithrombin deficiency. Thromb Haemost 2017; 107:430-7. [DOI: 10.1160/th11-10-0701] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/29/2011] [Indexed: 12/19/2022]
Abstract
SummaryAntithrombin is the main endogenous anticoagulant. Impaired function or deficiency of this molecule significantly increases the risk of thrombosis. We studied the genetic variability of SERPINC1, the gene encoding antithrombin, to identify mutations affecting regulatory regions with functional effect on its levels. We sequenced 15,375 bp of this gene, including the potential promoter region, in three groups of subjects: five healthy subjects with antithrombin levels in the lowest (75%) and highest (115%) ranges of our population, 14 patients with venous thrombosis and a moderate antithrombin deficiency as the single thrombophilic defect, and two families with type I antithrombin deficiency who had neither mutations affecting exons or flanking regions, nor gross gene deletions. Our study confirmed the low genetic variability of SERPINC1, particularly in the coding region, and its minor influence in the heterogeneity of antithrombin levels. Interestingly, in one family, we identified a g.2143 C>G transversion, located 170 bp upstream from the translation initiation codon. This mutation affected one of the four regions located in the minimal promoter that have potential regulatory activity according to previous DNase footprinting protection assays. Genotype-phenotype analysis in the affected family and reporter analysis in different hepatic cell lines demonstrated that this mutation significantly impaired, although it did not abolish, the downstream transcription. Therefore, this is the first mutation affecting a regulatory region of the SERPINC1 gene associated with antithrombin deficiency. Our results strongly sustain the inclusion of the promoter region of SERPINC1 in the molecular analysis of patients with antithrombin deficiency.
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10
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Kumar A, Bhandari A, Sarde SJ, Goswami C. Genetic variants and evolutionary analyses of heparin cofactor II. Immunobiology 2014; 219:713-28. [PMID: 24950623 DOI: 10.1016/j.imbio.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 04/13/2014] [Accepted: 05/19/2014] [Indexed: 11/25/2022]
Abstract
Heparin cofactor II (HCII) belongs to serpin superfamily and it acts as a thrombin inhibitor in the coagulation cascade, in a glycosaminoglycan-dependent pathway using the release of a sequestered hirudin-like N-terminal tail for interaction with thrombin. This serpin belongs to multiple member group V2 of vertebrate serpin classification. However, there is no comprehensive study illustrating the exact phylogenetic history of HCII, to date. Herein, we explored phylogenetic traits of HCII genes. Structures of HCII gene from selected ray-finned fishes and lamprey varied in exon I and II with insertions of novel introns of which one in core domain for ray-finned fishes in exon II at the position 241c. We found HCII remain nested in the largest intron of phosphatidylinositol (PI) 4-kinase (PIK4CA) gene (genetic variants of this gene cause schizophrenia) at the origin of vertebrates, dated about 500MY old. We found that sequence features such as two acidic repeats (AR1-II), GAG-binding helix-D, three serpin motifs and inhibitory reactive center loop (RCL) of HCII protein are highly conserved in 55 vertebrates analyzed. We identified 985 HCII variants by analysis of 1092 human genomes with top three variation classes belongs to SNPs (84.3%), insertion (7.1%) and deletion (5.0%). We identified 37 deleterious mutations in the human HCII protein and we have described these mutations in relation to HCII sequence-structure-function relationships. These understandings may have clinical and medical importance as well.
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Affiliation(s)
- Abhishek Kumar
- Department of Genetics & Molecular Biology in Botany, Institute of Botany, Christian-Albrechts-University at Kiel, Kiel, Germany.
| | - Anita Bhandari
- Molecular Physiology, Zoological Institute, Christian-Albrechts-University at Kiel, Kiel, Germany
| | - Sandeep J Sarde
- Department of Genetics & Molecular Biology in Botany, Institute of Botany, Christian-Albrechts-University at Kiel, Kiel, Germany; Master Program Agrigenomics, Christian-Albrechts-University at Kiel, Kiel, Germany
| | - Chandan Goswami
- National Institute of Science Education and Research, Bhubaneswar, Orissa, India
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11
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Abstract
Thrombin is the central protease in the blood coagulation network. It has multiple substrates and cofactors, and it appears that four serpins are responsible for inhibiting the thrombin produced in haemostasis and thrombosis. Structural studies conducted over the last 10 years have resolved how thrombin recognises these serpins with the aid of cofactors. Although antithrombin (AT), protein C inhibitor (PCI), heparin cofactor II (HCII) and protease nexin-1 (PN1) all share a common fold and mechanism of protease inhibition, they have evolved radically different mechanisms for cofactor-assisted thrombin recognition. This is likely to be due to the varied environments in which thrombin is found. In this review, I discuss the unusual structural features of thrombin that are involved in substrate and cofactor recognition, the serpin mechanism of protease inhibition and the fate of thrombin in the complex, and how the four thrombin-specific serpins exploit the special features of thrombin to accelerate complex formation.
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Affiliation(s)
- J A Huntington
- Department of Haematology, University of Cambridge, Cambridge Institute for Medical Research, Cambridge, UK.
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12
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Lomas DA. Twenty Years of Polymers: A Personal Perspective on Alpha-1 Antitrypsin Deficiency. COPD 2013; 10 Suppl 1:17-25. [DOI: 10.3109/15412555.2013.764401] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Tang L, Wang HF, Lu X, Jian XR, Jin B, Zheng H, Li YQ, Wang QY, Wu TC, Guo H, Liu H, Guo T, Yu JM, Yang R, Yang Y, Hu Y. Common genetic risk factors for venous thrombosis in the Chinese population. Am J Hum Genet 2013; 92:177-87. [PMID: 23332921 DOI: 10.1016/j.ajhg.2012.12.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 10/23/2012] [Accepted: 12/20/2012] [Indexed: 12/21/2022] Open
Abstract
Venous thrombosis is a major medical disorder caused by both genetic and environmental factors. Little is known about the genetic background of venous thrombosis in the Chinese population. A total of 1,304 individuals diagnosed with a first venous thrombosis and 1,334 age- and sex-matched healthy participants were enrolled in this study. Resequencing of THBD (encoding thrombomodulin) in 60 individuals with venous thrombosis and 60 controls and a functional assay showed that a common variant, c.-151G>T (rs16984852), in the 5' UTR significantly reduced the gene expression and could cause a predisposition to venous thrombosis. Therefore, this variant was genotyped in a case-control study, and results indicated that heterozygotes had a 2.80-fold (95% confidence interval = 1.88-4.29) increased risk of venous thrombosis. The THBD c.-151G>T variant was further investigated in a family analysis involving 176 first-degree relatives from 38 index families. First-degree relatives with this variant had a 3.42-fold increased risk of venous thrombosis, and their probability of remaining thrombosis-free was significantly lower than that of relatives without the variant. In addition, five rare mutations that might be deleterious were also identified in thrombophilic individuals by sequencing. This study is the largest genetic investigation of venous thrombosis in the Chinese population. Further study on genetics of thrombosis should focus on resequencing of THBD and other hemostasis genes in different populations.
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14
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Martínez-Martínez I, Johnson DJD, Yamasaki M, Navarro-Fernández J, Ordóñez A, Vicente V, Huntington JA, Corral J. Type II antithrombin deficiency caused by a large in-frame insertion: structural, functional and pathological relevance. J Thromb Haemost 2012; 10:1859-66. [PMID: 22758787 DOI: 10.1111/j.1538-7836.2012.04839.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The metastable native conformation of serpins is required for their protease inhibition mechanism, but also renders them vulnerable to missense mutations that promote protein misfolding with pathological consequences. OBJECTIVE To characterize the first antithrombin deficiency caused by a large in-frame insertion. PATIENTS/METHODS Functional, biochemical and molecular analysis of the proband and relatives was performed. Recombinant antithrombin was expressed in HEK-EBNA cells. Plasma and recombinant antithrombins were purified and sequenced by Edman degradation. The stability was evaluated by calorimetry. Reactive centre loop (RCL) exposure was determined by thrombin cleavage. Mutant antithrombin was crystallized as a dimer with latent plasma antithrombin. RESULTS The patient, with a spontaneous pulmonary embolism, belongs to a family with significant thrombotic history. We identified a complex heterozygous in-frame insertion of 24 bp in SERPINC1, affecting strand 3 of β-sheet A, a region highly conserved in serpins. Surprisingly, the insertion resulted in a type II antithrombin deficiency with heparin binding defect. The mutant antithrombin, with a molecular weight of 59 kDa, had a proteolytic cleavage at W49 but maintained the N-terminal disulphide bonds, and was conformationally sensitive. The variant was non-inhibitory. Analysis of the crystal structure of the hyperstable recombinant protein showed that the inserted sequence annealed into β-sheet A as the fourth strand, and maintained a native RCL. CONCLUSIONS This is the first case of a large in frame-insertion that allows correct folding, glycosylation, and secretion of a serpin, resulting in a conformationally sensitive non-inhibitory variant, which acquires a hyperstable conformation with a native RCL.
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Affiliation(s)
- I Martínez-Martínez
- Centro Regional de Hemodonación, University of Murcia, Regional Campus of International Excellence Campus Mare Nostrum, Murcia, Spain
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15
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Roussel BD, Irving JA, Ekeowa UI, Belorgey D, Haq I, Ordóñez A, Kruppa AJ, Duvoix A, Rashid ST, Crowther DC, Marciniak SJ, Lomas DA. Unravelling the twists and turns of the serpinopathies. FEBS J 2011; 278:3859-67. [DOI: 10.1111/j.1742-4658.2011.08201.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Perlmutter DH, Silverman GA. Hepatic fibrosis and carcinogenesis in α1-antitrypsin deficiency: a prototype for chronic tissue damage in gain-of-function disorders. Cold Spring Harb Perspect Biol 2011; 3:cshperspect.a005801. [PMID: 21421920 DOI: 10.1101/cshperspect.a005801] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In α1-antitrypsin (AT) deficiency, a point mutation renders a hepatic secretory glycoprotein prone to misfolding and polymerization. The mutant protein accumulates in the endoplasmic reticulum of liver cells and causes hepatic fibrosis and hepatocellular carcinoma by a gain-of-function mechanism. Genetic and/or environmental modifiers determine whether an affected homozygote is susceptible to hepatic fibrosis/carcinoma. Two types of proteostasis mechanisms for such modifiers have been postulated: variation in the function of intracellular degradative mechanisms and/or variation in the signal transduction pathways that are activated to protect the cell from protein mislocalization and/or aggregation. In recent studies we found that carbamazepine, a drug that has been used safely as an anticonvulsant and mood stabilizer, reduces the hepatic load of mutant AT and hepatic fibrosis in a mouse model by enhancing autophagic disposal of this mutant protein. These results provide evidence that pharmacological manipulation of endogenous proteostasis mechanisms is an appealing strategy for chemoprophylaxis in disorders involving gain-of-function mechanisms.
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Affiliation(s)
- David H Perlmutter
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh and Magee-Womens Hospital of UPMC, Pennsylvania 15224, USA.
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Lin HY, Muller YA, Hammond GL. Molecular and structural basis of steroid hormone binding and release from corticosteroid-binding globulin. Mol Cell Endocrinol 2010; 316:3-12. [PMID: 19643161 DOI: 10.1016/j.mce.2009.06.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
Corticosteroid-binding globulin (CBG), a non-inhibitory member of the serine proteinase inhibitor (serpin) super-family, is the high-affinity transport protein for glucocorticoids in vertebrate blood. Plasma CBG is a glycoprotein with 30% of its mass represented by N-linked oligosaccharide chains. Its well-characterized steroid-binding properties represent a "bench-mark data set" used extensively for in silico studies of protein-ligand interactions and drug design. Recent crystal structure analyses of intact rat CBG and cleaved human CBG have revealed the precise topography of the steroid-binding site, and shown that cortisol-bound CBG displays a typical stressed (S) serpin conformation with the reactive center loop (RCL) fully exposed from the central beta-sheet A, while proteolytic cleavage of the RCL results in CBG adopting a relaxed (R) conformation with the cleaved RCL fully inserted within the protein core. These crystal structures have set the stage for mechanistic studies of CBG function which have so far shown that helix D plays a key role in coupling RCL movement and steroid-binding site integrity, and provided evidence for an allosteric mechanism that modulates steroid binding and release from CBG. These studies have also revealed how the irreversible release of steroids occurs after proteolysis and re-orientation of the RCL within the R conformation. This recent insight into the structure and function of CBG reveals how naturally occurring genetic CBG mutations affect steroid binding, and helps understand how proteolysis of CBG enhances the targeted delivery of biologically active steroids to their sites of action.
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Affiliation(s)
- Hai-Yan Lin
- State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China.
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18
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Sutherland JS, Bhakta V, Sheffield WP. Investigating serpin-enzyme complex formation and stability via single and multiple residue reactive centre loop substitutions in heparin cofactor II. Thromb Res 2009; 117:447-61. [PMID: 15869786 DOI: 10.1016/j.thromres.2005.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 03/04/2005] [Accepted: 03/20/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Following thrombin cleavage of the reactive centre (P1-P1'; L444-S445) of the serpin heparin cofactor II (HCII), HCII traps thrombin (IIa) in a stable inhibitory complex. To compare HCII to other serpins we substituted: the P13-P5' residues of HCII with those of alpha(1)-proteinase inhibitor (alpha(1)-PI), alpha(1)-PI (M358R), or antithrombin (AT); the P4-P1, P3-P1, and P2-P1 residues of HCII with those of AT; and made L444A/H/K/M or R point mutations. We also combined L444R with changes in the glycosaminoglycan binding domain collectively termed MutD. MATERIALS AND METHODS Variants were made by site-directed mutagenesis, expressed in bacteria, purified and characterized electrophoretically and kinetically. RESULTS AND CONCLUSIONS Of the P13-P5' mutants, only the alpha(1)-PI-loop variant retained anti-IIa activity, but less than the corresponding L444M. Heparin-catalyzed rate constants for IIa inhibition were reduced vs. wild-type (WT) by at most three-fold for all P1 mutants save L444A (reduced 20-fold). L444R and L444K inhibited IIa>50- and >6-fold more rapidly than WT in heparin-free reactions, but stoichiometries of inhibition were increased for all variants. HCII-IIa complexes of all P1 variants were stable in the absence of heparin, but those of the L444K and L444R variants released active IIa over time with heparin. Limited proteolysis of these two groups of HCII-IIa complexes produced different fragmentation patterns consistent with conformational differences. The combination of either substituted AT residues at P2, P3, and P4, or the MutD mutations with L444R resulted in complex instability with or without heparin. This is the first description of HCII-IIa complexes of transient stability forming in the absence of heparin, and may explain the extent to which the reactive centre loop of HCII differs from that of AT.
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Gooptu B, Lomas DA. Conformational pathology of the serpins: themes, variations, and therapeutic strategies. Annu Rev Biochem 2009; 78:147-76. [PMID: 19245336 DOI: 10.1146/annurev.biochem.78.082107.133320] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Point mutations cause members of the serine protease inhibitor (serpin) superfamily to undergo a novel conformational transition, forming ordered polymers. These polymers characterize a group of diseases termed the serpinopathies. The formation of polymers underlies the retention of alpha(1)-antitrypsin within hepatocytes and of neuroserpin within neurons to cause cirrhosis and dementia, respectively. Point mutations of antithrombin, C1 inhibitor, alpha(1)-antichymotrypsin, and heparin cofactor II cause a similar conformational transition, resulting in a plasma deficiency that is associated with thrombosis, angioedema, and emphysema. Polymers of serpins can also form in extracellular tissues where they activate inflammatory cascades. This is best described for the Z variant of alpha(1)-antitrypsin in which the proinflammatory properties of polymers provide an explanation for both progressive emphysema and the selective advantage of this mutant allele. Therapeutic strategies are now being developed to block the aberrant conformational transitions and so treat the serpinopathies.
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Affiliation(s)
- Bibek Gooptu
- School of Crystallography, Birkbeck College, University of London, London, UK.
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20
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α1-Antitrypsin deficiency, chronic obstructive pulmonary disease and the serpinopathies. Clin Sci (Lond) 2009; 116:837-50. [DOI: 10.1042/cs20080484] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
α1-Antitrypsin is the prototypical member of the serine proteinase inhibitor or serpin superfamily of proteins. The family includes α1-antichymotrypsin, C1 inhibitor, antithrombin and neuroserpin, which are all linked by a common molecular structure and the same suicidal mechanism for inhibiting their target enzymes. Point mutations result in an aberrant conformational transition and the formation of polymers that are retained within the cell of synthesis. The intracellular accumulation of polymers of mutant α1-antitrypsin and neuroserpin results in a toxic gain-of-function phenotype associated with cirrhosis and dementia respectively. The lack of important inhibitors results in overactivity of proteolytic cascades and diseases such as COPD (chronic obstructive pulmonary disease) (α1-antitrypsin and α1-antichymotrypsin), thrombosis (antithrombin) and angio-oedema (C1 inhibitor). We have grouped these conditions that share the same underlying disease mechanism together as the serpinopathies. In the present review, the molecular and pathophysiological basis of α1-antitrypsin deficiency and other serpinopathies are considered, and we show how understanding this unusual mechanism of disease has resulted in the development of novel therapeutic strategies.
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21
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Aihara KI, Azuma H, Akaike M, Kurobe H, Takamori N, Ikeda Y, Sumitomo Y, Yoshida S, Yagi S, Iwase T, Ishikawa K, Sata M, Kitagawa T, Matsumoto T. Heparin cofactor II is an independent protective factor against peripheral arterial disease in elderly subjects with cardiovascular risk factors. J Atheroscler Thromb 2009; 16:127-34. [PMID: 19403987 DOI: 10.5551/jat.e695] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Heparin cofactor II (HCII) specifically inactivates thrombin action at the injured vascular wall. We have reported that HCII is a protective factor against coronary in-stent restenosis and carotid atherosclerosis; however, it is unclear whether there is any correlation between plasma HCII levels and the development of peripheral arterial disease (PAD). METHODS Plasma HCII activity and the ankle brachial pressure index (ABI) were determined in 494 elderly subjects with cardiovascular risk factors. PAD was diagnosed by ABI below 0.9, and 62 subjects were diagnosed with PAD. The relationship between factors that affect cardiovascular events and the prevalence of PAD was statistically evaluated. RESULTS Mean HCII activity in PAD subjects was significantly lower than in non-PAD subjects (87.5+/-19.7% v.s. 94.6+/-17.8%, p=0.009). Multivariate logistic regression analysis showed that age (odds ratio [OR]: 1.062, p=0.0016), current smoking (OR 3.028, p=0.002) and diabetes mellitus (OR 2.656, p=0.008) were independent and progressive determinants of PAD. In contrast, HCII was an independent inhibitory factor of PAD (OR: 0.982, p=0.048). CONCLUSIONS Plasma HCII activity is inversely related to the prevalence of PAD. HCII may function as the sole protective factor against PAD in elderly people with cardiovascular risk factors.
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Affiliation(s)
- Ken-ichi Aihara
- Department of Medicine and Bioregulatory Sciences, University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
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22
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Bühler R, Mattle HP. Hematological diseases and stroke. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:887-934. [PMID: 18804686 DOI: 10.1016/s0072-9752(08)93045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Robert Bühler
- Department of Neurology, Iselspital, University of Bern, Bern, Switzerland
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23
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Lin HY, Underhill C, Gardill BR, Muller YA, Hammond GL. Residues in the human corticosteroid-binding globulin reactive center loop that influence steroid binding before and after elastase cleavage. J Biol Chem 2008; 284:884-96. [PMID: 19011238 DOI: 10.1074/jbc.m807376200] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Corticosteroid-binding globulin (CBG) is a non-inhibitory serine proteinase inhibitor (serpin) that transports cortisol and progesterone in blood. Crystal structures of rat CBG and a thrombin-cleaved human CBG:anti-trypsin (Pittsburgh) chimera show how structural transitions after proteolytic cleavage of the CBG reactive center loop (RCL) could disrupt steroid binding. This ligand release mechanism is assumed to involve insertion of the cleaved RCL into the beta-sheet A of the serpin structure. We have, therefore, examined how amino acid substitutions in the human CBG RCL influence steroid binding before and after its cleavage by neutrophil elastase. Elastase-cleaved wild-type CBG or variants with substitutions at P15 and/or P16 (E334G/G335N or E334A) lost steroid binding completely, whereas deletion of Glu-334 resulted in no loss of steroid binding after RCL cleavage, presumably because this prevents its insertion into beta-sheet A. Similarly, the steroid binding properties of CBG variants with substitutions at P15 (G335P), P14 (V336R), or P12 (T338P) in the RCL hinge were largely unaffected after elastase cleavage, most likely because the re-orientation and/or insertion of the cleaved RCL was blocked. Substitutions at P10 (G340P, G340S) or P8 (T342P, T342N) resulted in a partial loss of steroid binding after proteolysis which we attribute to incomplete insertion of the cleaved RCL. Remarkably, several substitutions (E334A, V336R, G340S, and T342P) increased the steroid binding affinities of human CBG even before elastase cleavage, consistent with the concept that CBG normally toggles between a high affinity ligand binding state where the RCL is fully exposed and a lower affinity state in which the RCL is partly inserted into beta-sheet A.
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Affiliation(s)
- Hai-Yan Lin
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia V5Z 4H4, Canada
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24
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Gooptu B, Lomas DA. Polymers and inflammation: disease mechanisms of the serpinopathies. ACTA ACUST UNITED AC 2008; 205:1529-34. [PMID: 18591408 PMCID: PMC2442629 DOI: 10.1084/jem.20072080] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Members of the serpin (serine proteinase inhibitor) superfamily play a central role in the control of inflammatory, coagulation, and fibrinolytic cascades. Point mutations that cause abnormal conformational transitions in these proteins can trigger disease. Recent work has defined three pathways by which these conformers cause tissue damage. Here, we describe how these three mechanisms can be integrated into a new model of the pathogenesis of emphysema caused by mutations in the serpin α1-antitrypsin.
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Affiliation(s)
- Bibek Gooptu
- School of Crystallography, Birkbeck College, University of London, London WC1E 7HX, England, UK
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25
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Aihara KI, Azuma H, Akaike M, Ikeda Y, Sata M, Takamori N, Yagi S, Iwase T, Sumitomo Y, Kawano H, Yamada T, Fukuda T, Matsumoto T, Sekine K, Sato T, Nakamichi Y, Yamamoto Y, Yoshimura K, Watanabe T, Nakamura T, Oomizu A, Tsukada M, Hayashi H, Sudo T, Kato S, Matsumoto T. Strain-dependent embryonic lethality and exaggerated vascular remodeling in heparin cofactor II-deficient mice. J Clin Invest 2007; 117:1514-26. [PMID: 17549254 PMCID: PMC1878511 DOI: 10.1172/jci27095] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 03/27/2007] [Indexed: 01/04/2023] Open
Abstract
Heparin cofactor II (HCII) specifically inhibits thrombin action at sites of injured arterial wall, and patients with HCII deficiency exhibit advanced atherosclerosis. However, the in vivo effects and the molecular mechanism underlying the action of HCII during vascular remodeling remain elusive. To clarify the role of HCII in vascular remodeling, we generated HCII-deficient mice by gene targeting. In contrast to a previous report, HCII(-/-) mice were embryonically lethal. In HCII(+/-) mice, prominent intimal hyperplasia with increased cellular proliferation was observed after tube cuff and wire vascular injury. The number of protease-activated receptor-1-positive (PAR-1-positive) cells was increased in the thickened vascular wall of HCII(+/-) mice, suggesting enhanced thrombin action in this region. Cuff injury also increased the expression levels of inflammatory cytokines and chemokines in the vascular wall of HCII(+/-) mice. The intimal hyperplasia in HCII(+/-) mice with vascular injury was abrogated by human HCII supplementation. Furthermore, HCII deficiency caused acceleration of aortic plaque formation with increased PAR-1 expression and oxidative stress in apoE-KO mice. These results demonstrate that HCII protects against thrombin-induced remodeling of an injured vascular wall by inhibiting thrombin action and suggest that HCII is potentially therapeutic against atherosclerosis without causing coagulatory disturbance.
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Affiliation(s)
- Ken-ichi Aihara
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Hiroyuki Azuma
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Masashi Akaike
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Yasumasa Ikeda
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Masataka Sata
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Nobuyuki Takamori
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Shusuke Yagi
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Takashi Iwase
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Yuka Sumitomo
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Hirotaka Kawano
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Takashi Yamada
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Toru Fukuda
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Takahiro Matsumoto
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Keisuke Sekine
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Takashi Sato
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Yuko Nakamichi
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Yoko Yamamoto
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Kimihiro Yoshimura
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Tomoyuki Watanabe
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Takashi Nakamura
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Akimasa Oomizu
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Minoru Tsukada
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Hideki Hayashi
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Toshiki Sudo
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Shigeaki Kato
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
| | - Toshio Matsumoto
- Department of Medicine and Bioregulatory Sciences and
21st Century Center of Excellence Program, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Institute of Molecular and Cellular Biosciences and
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
ERATO, Japan Science and Technology Agency, Saitama, Japan.
Benesis Corp., Osaka, Japan.
First Institute of New Drug Discovery, Otsuka Pharmaceutical Co., Tokushima, Japan
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26
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Corral J, González-Conejero R, Hernández-Espinosa D, Vicente V. Protein Z/Z-dependent protease inhibitor (PZ/ZPI) anticoagulant system and thrombosis. Br J Haematol 2007; 137:99-108. [PMID: 17391489 DOI: 10.1111/j.1365-2141.2007.06548.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A new anticoagulant system involving a serpin has been recently characterised. The protein Z/Z-dependent protease inhibitor (PZ/ZPI) system inhibits activated factors X, XI and IX by different mechanisms. By homology with other anticoagulant systems (antithrombin or the protein C/protein S), deficiency of the serpin (ZPI) or its cofactor (PZ) might imbalance the haemostatic system with thrombotic consequences. Evidence supports the in vivo anticoagulant role of this complex and the thrombotic consequences of its deficiency. Non-sense variations of the ZPI (W303X and R67X) have been associated with increased risk of venous thrombosis. Moreover, PZ deficient mice carrying the FV Leiden have a thrombotic phenotype. Finally, some reports suggest that PZ deficiency might increase the risk of thrombosis. However, other studies question the thrombotic relevance of both ZPI and PZ deficiencies. This system could play a redundant role in haemostasis that explains the conflicting results on its thrombotic potential, which might be exacerbated in combination with other prothrombotic factors.
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Affiliation(s)
- Javier Corral
- Universidad de Murcia, Centro Regional de Hemodonación, Murcia, Spain.
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27
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Vicente V, Corral J. Trombofilia hereditaria: lecciones aprendidas y deberes pendientes. Med Clin (Barc) 2007; 128:657-9. [PMID: 17537364 DOI: 10.1157/13102056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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28
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Abstract
Glycosaminoglycans (GAGs) are the most abundant group of heteropolysaccharides found in the body. These long unbranched molecules contain a repeating disaccharide unit. GAGs are located primarily in the extracellular matrix or on the surface of cells. These molecules serve as lubricants in the joints while at the same time providing structural rigidity to cells. Sulodexide is a highly purified glycosaminoglycan composed of a fast mobility heparin fraction as well as dermatan sulfate. Sulodexide differs from other glycosaminoglycans, like heparin, by having a longer half-life and a reduced effect on systemic clotting and bleeding. In addition, sulodexide demonstrates a lipolytic activity that is increased in comparison to heparin. Oral administration of sulodexide results in the release of tissue plasminogen activator and an increase in fibrinolytic activities. An increasing body of research has demonstrated the safety and efficacy of sulodexide in a wide range of vascular pathologies.
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Affiliation(s)
- D Adam Lauver
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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29
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Belorgey D, Hägglöf P, Karlsson-Li S, Lomas DA. Protein misfolding and the serpinopathies. Prion 2007; 1:15-20. [PMID: 19164889 DOI: 10.4161/pri.1.1.3974] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The serpins are the largest superfamily of protease inhibitors. They are found in almost all branches of life including viruses, prokaryotes and eukaryotes. They inhibit their target protease by a unique mechanism that involves a large conformational transition and the translocation of the enzyme from the upper to the lower pole of the protein. This complex mechanism, and the involvement of serpins in important biological regulatory processes, makes them prone to mutation-related diseases. For example the polymerization of mutant alpha(1)-antitrypsin leads to the accumulation of ordered polymers within the endoplasmic reticulum of hepatocytes in association with cirrhosis. An identical process in the neuron specific serpin, neuroserpin, results in the accumulation of polymers in neurons and the dementia FENIB. In both cases there is a clear correlation between the molecular instability, the rate of polymer formation and the severity of disease. A similar process underlies the hepatic retention and plasma deficiency of antithrombin, C1 inhibitor, alpha(1)-antichymotrypsin and heparin co-factor II. The common mechanism of polymerization has allowed us to group these conditions together as a novel class of disease, the serpinopathies.
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Affiliation(s)
- Didier Belorgey
- Department of Medicine, University of Cambridge, Cambridge Institute for Medical Research, Cambridge, United Kingdom
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30
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Lomas DA. Parker B. Francis lectureship. Antitrypsin deficiency, the serpinopathies, and chronic obstructive pulmonary disease. Ann Am Thorac Soc 2006; 3:499-501. [PMID: 16921127 PMCID: PMC2643219 DOI: 10.1513/pats.200603-069ms] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
alpha(1)-Antitrypsin deficiency is the only genetic factor that is widely recognized to predispose smokers to chronic obstructive pulmonary disease. We have shown that the plasma deficiency results from point mutations perturbing the structure of the protein to favor sequential linkage between the reactive center loop of one molecule and beta-sheet A of another. These polymers are retained within the liver to form the periodic acid-Schiff-positive inclusions that are characteristic of the disease. Intracellular polymerization also explains the retention of mutants of other members of the serine proteinase inhibitor (or serpin) superfamily to cause diseases as diverse as thrombosis, angio-edema, and dementia. In view of the common mechanism, we have grouped these conditions together as the serpinopathies. Intrapulmonary Z alpha(1)-antitrypsin similarly forms polymers within the alveolar space. These polymers are inactive as a proteinase inhibitor and act as a chemoattractant for neutrophils. This conformational transition may explain the excessive inflammation that underlies the progressive emphysema associated with Z alpha(1)-antitrypsin deficiency.
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Affiliation(s)
- David A Lomas
- Department of Medicine, Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, University of Cambridge, Hills Road, Cambridge CB2 2XY, UK.
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31
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Corral J, González-Conejero R, Soria JM, González-Porras JR, Pérez-Ceballos E, Lecumberri R, Roldán V, Souto JC, Miñano A, Hernández-Espinosa D, Alberca I, Fontcuberta J, Vicente V. A nonsense polymorphism in the protein Z-dependent protease inhibitor increases the risk for venous thrombosis. Blood 2006; 108:177-83. [PMID: 16527896 PMCID: PMC1895831 DOI: 10.1182/blood-2005-08-3249] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The protein Z-dependent protease inhibitor (ZPI) is a hemostatic serpin with anticoagulant activity. As for antithrombin, deficiency of ZPI could have relevant thrombotic consequences. We have studied 6 genetic modifications affecting the ZPI gene, identifying 5 haplotypes. Haplotype H5 is featured by a stop codon at position 67. The relevance of these genetic modifications and haplotypes in venous thrombosis was evaluated in a case-control study including 1018 patients and 1018 age- and sex-matched controls. Surprisingly, the H5 haplotype was found in 0.9% of controls, supporting that the Arg67Stop change is a low frequency nonsense polymorphism. The prevalence of this haplotype increased significantly in patients (3.0%), one of whom was in a homozygous state. Multivariate analysis confirms that carriers have a 3.3-fold risk of developing venous thrombosis (P = .002; 95% CI: 1.5-7.1). Moreover, we observed a significant association of this polymorphism with familial history of thrombosis (P < .001). Our study supports that the ZPI Arg67Stop nonsense polymorphism might be an independent genetic risk factor for venous thrombosis. This polymorphism has slightly lower prevalence but similar thrombotic risk than the FV Leiden or prothrombin 20210A. Although further studies are required, all available data support that the ZPI is a candidate to play a significant role in thrombosis and should be evaluated in thrombophilic studies.
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Affiliation(s)
- Javier Corral
- Centro Regional de Hemodonación, Universidad de Murcia, Murcia, Spain.
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32
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Abstract
Blood coagulation is essential to maintain hemostasis in organisms with a vascular network. Formation of a fibrin-rich clot at a site of vessel injury is a highly complex process that is orchestrated by the coagulation protease cascade. This cascade is regulated by 3 major anticoagulant pathways. Removal of a clot is mediated by the fibrinolytic system. Defects in the regulation of clot formation lead to either hemorrhage or thrombosis. Tissue factor, the primary cellular initiator of blood coagulation, is a transmembrane receptor that is expressed in a tissue-specific manner. The 3 major anticoagulants are tissue factor pathway inhibitor, antithrombin, and protein C, the latter requiring a transmembrane receptor called thrombomodulin for its activation. Tissue factor pathway inhibitor and thrombomodulin are expressed by endothelial cells in a tissue-specific manner, whereas antithrombin and protein C circulate in the plasma. Fibrinolysis requires the activation of plasminogen to plasmin, which is mediated by tissue-type plasminogen activator and urokinase-type plasminogen activator. Interestingly, tissue-type plasminogen activator is expressed by a subset of endothelial cells of discrete size and location. These observations, together with the phenotypes of mice that have defects in the procoagulant, anticoagulant, and fibrinolytic pathways, indicate that hemostasis is regulated in a tissue-specific manner.
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Affiliation(s)
- Nigel Mackman
- Department of Immunology, Scripps Research Institute, La Jolla, CA 92037, USA.
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33
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Lomas DA, Belorgey D, Mallya M, Miranda E, Kinghorn KJ, Sharp LK, Phillips RL, Page R, Robertson AS, Crowther DC. Molecular mousetraps and the serpinopathies1. Biochem Soc Trans 2005; 33:321-30. [PMID: 15787598 DOI: 10.1042/bst0330321] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Members of the serine proteinase inhibitor or serpin superfamily inhibit their target proteinases by a remarkable conformational transition that involves the enzyme being translocated more than 70 Å (1 Å=10−10 m) from the upper to the lower pole of the inhibitor. This elegant mechanism is subverted by point mutations to form ordered polymers that are retained within the endoplasmic reticulum of secretory cells. The accumulation of polymers underlies the retention of mutants of α1-antitrypsin and neuroserpin within hepatocytes and neurons to cause cirrhosis and dementia respectively. The formation of polymers results in the failure to secrete mutants of other members of the serpin superfamily: antithrombin, C1 inhibitor and α1-antichymotrypsin, to cause a plasma deficiency that results in the clinical syndromes of thrombosis, angio-oedema and emphysema respectively. Understanding the common mechanism underlying the retention and deficiency of mutants of the serpins has allowed us to group these conditions as the serpinopathies. We review in this paper the molecular and structural basis of the serpinopathies and show how this has allowed the development of specific agents to block the polymerization that underlies disease.
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Affiliation(s)
- D A Lomas
- Department of Medicine, University of Cambridge, Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Hills Road, Cambridge CB2 2XY, UK.
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