Kinetics Of Factor Viii Inhibitors In Three Non-Hemophiliac Patients

1981 ◽  
Author(s):  
S L McClellan ◽  
C V Hussey ◽  
J E Fobian ◽  
A V Pisciotta

Factor VIII (VIII) inhibitors were isolated from the gamma globulin fraction of the plasmas of three non-hemophilic patients. One of these patients is thought to have acquired the inhibitor secondary to Hodgkin’s disease while the other two were apparently drug-related. These patients presented without significant prior replacement therapy and showed elevated levels of von Willebrand factor (VIIIVW-R) as measured by Ristocetin aggregation of fixed washed platelets and elevated levels of antigenic VIII (VIIIAGN) using a CELIA technique. The procoagulant VIII (VIIIAHF) activities, however, ranged from 12-20% of normal activity (one-stage method) and the inhibitors were present in levels of 6-50 Bethesda Units/ml of plasma.The kinetics of the interaction between these inhibitors and VIII were studied to further characterize the inhibitors. In vitro inactivation of VIII by the inhibitors demonstrated a two-step kinetic model similar to that proposed by Biggs. Iii vivo neutralization of transfused VIII appeared to follow the same model. The high levels of VIIIAGN and VIIIVW-R in the presence of low levels of VIIIAHF suggest binding of the inhibitor to the procoagulant moiety. Further, two-step inactivation of the procoagulant activity suggests binding of more than one molecule of inhibitor near rather than at the active procoagulant site which results in increasing stearic inhibition of the active site. This is in contrast to simple direct binding of a single molecule of inhibitor as described with bimolecular second order kinetics.Finally, the presence of high levels of VIIIAGN with markedly attenuated VIIIAHF activities implies relatively slow clearance of the inhibitor-VIII complex.

1997 ◽  
Vol 77 (02) ◽  
pp. 383-386 ◽  
Author(s):  
S Bellucci ◽  
J P Girma ◽  
M Lozano ◽  
D Meyer ◽  
J P Caen

SummaryThe Bernard-Soulier syndrome (BSS) is characterized by thrombocytopenia with giant platelets, a prolonged bleeding time with defective platelet adhesion to the subendothelium related to a defect in platelet membrane glycoprotein lb (GPIb) and a decreased prothrombin consumption. The mechanism of the latter abnormality remains unknown. In this study, we showed that this defect was corrected by the addition of purified human factor VIII (FVIII) to blood from four patients with BSS. The correction of prothrombin consumption was almost complete at concentrations between 1.5 and 3 IU/ml of FVIII procoagulant activity (VIII.'C) and partially abolished by a monoclonal antibody which neutralizes VIII:C. This correction was specific for FVIII and was not observed after addition of purified human FIX. It was obtained, in the same magnitude range, with FVIII complexed to von Willebrand factor (vWF) but not with free vWF. These data provide a new insight into the knowledge of the physiological interaction between the platelet membrane and the vWF-FVIII complex facilitating plasma coagulation activation and may lead to helpful therapeutic advances.


Author(s):  
И.В. Куртов ◽  
Е.С. Фатенкова ◽  
Н.А. Юдина ◽  
А.М. Осадчук ◽  
И.Л. Давыдкин

Болезнь Виллебранда (БВ) может представлять определенные трудности у рожениц с данной патологией. Приведены 2 клинических примера использования у женщин с БВ фактора VIII свертывания крови с фактором Виллебранда, показана эффективность и безопасность их применения. У одной пациентки было также показано использование фактора свертывания крови VIII с фактором Виллебранда во время экстракорпорального оплодотворения. Von Willebrand disease presents a certain hemostatic problem among parturients. This article shows the effectiveness and safety of using coagulation factor VIII with von Willebrand factor for the prevention of bleeding in childbirth in 2 patients with type 3 von Willebrand disease. In one patient, the use of coagulation factor VIII with von Willebrand factor during in vitro fertilization was also shown.


1977 ◽  
Author(s):  
Patrick A. McKee

Factor VIII (FVIII) procoagulant activity was initially thought to be a glycoprotein with a molecular weight (MW) >1 million and composed of disulfide-1inked ~200,000 MW subunits. A protein with similar properties, except lacking procoagulant activity, is in hemophilic plasma; it was identical to normal FVIII by SDS-gel analyses, isoelectric focusing, and PAS staining. Subsequently it was shown that the FVIII glycoprotein also has von Willebrand factor (vWF) activity, suggesting that both FVIII and vWF activities might be properties of the same molecule. When the FVIII/vWF protein(s) is rechromatographed on 4% agarose and 0.25 M CaCl2, virtually all the protein and vWF activity elute in the void volume, but most of the FVIII procoagulant activity elutes much later. The extent of separation of the two activities depends on the amount of protein applied to the column. Also, exposure of the FVIII/vWF to thrombin before gel filtration strikingly accentuates separation of the two activities. The reduced SDS-gel pattern of the void volume protein peak showed the 200,000 MW subunit while that of the procoagulant peak contained several subunit bands which ranged from ~30,000–100,000 MW. Removal of sialic acid from FVIII/vWF is associated with reduced ristocetin induced platelet aggregation and causes a 50-fold increase in the rate of clearance of protein from the circulation by the hepatocyte. Currently, our data suggest that FVIII procoagulant and vWF activities are properties of a single molecule composed of disulfide-bound identical subunits. Cleavage by thrombin then results in FVIII procoagulant activity. Additional cleavages, to which the molecule appears very sensitive, results in FVIII inactivation. The vWF activity is very stable—even to proteolysis—and it appears to be a function of the carbohydrate side chains of the molecule.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1415-1415
Author(s):  
Hanspeter Rottensteiner ◽  
Katalin Varadi ◽  
Susanne Vejda ◽  
Hartmut J. Ehrlich ◽  
Friedrich Scheiflinger ◽  
...  

Abstract Abstract 1415 A recombinant human CHO-expressed von Willebrand factor (rVWF) consisting of ultra-high molecular weight (UHMW) multimers resembles the VWF stored in Weibel-Palade bodies of endothelial cells. Once secreted into plasma, UHMW multimers are rapidly cleaved by ADAMTS13 and are usually missing in plasma-derived VWF (pdVWF). Here we analyzed in vitro whether the kinetics of cleavage of rVWF by ADAMTS13 is similar to that of pdVWF. The kinetics of ADAMTS13-mediated proteolysis of rVWF were explored under denaturing conditions (1.5 M urea) or under shear stress so as to expose the ADAMTS13 cleavage site of VWF. Multiple assays showed that rVWF was efficiently cleaved by ADAMTS13. UHMW multimers disappeared within seconds at physiological concentrations of ADAMTS13. Using lower concentrations of ADAMTS13 (10-30 mU/ml, equivalent to 1–3% of normal human plasma), UHMW were cleaved within 30 minutes. The typical satellite bands appeared very early in an ADAMTS13 dose-dependent manner. Virtually the same results were obtained when human plasma was used as a source for ADAMTS13. Although pdVWF differs from rVWF in its multimeric structure, the decrease in activity was similar for rVWF and pdVWF. Finally, the extent of ADAMTS13 cleavage was similar for rVWF and pdVWF when exposed to shear stress using a cone-plate viscometer. Our data clearly indicate that rVWF is a good substrate for ADAMTS13. Ongoing phase 1 studies demonstrated that rVWF is indeed processed by the protease when administered in humans with severe VWD. Disclosures: Rottensteiner: Baxter Innovations GmbH: Employment. Varadi:Baxter Innovations GmbH: Employment. Vejda:Baxter Innovations GmbH: Employment. Ehrlich:Baxter Innovations GmbH: Employment. Scheiflinger:Baxter Innovations GmbH: Employment. Schwarz:Baxter Innovations GmbH: Employment. Turecek:Baxter Innovations GmbH: Employment.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1414-1414
Author(s):  
Eva-Maria Muchitsch ◽  
Barbara Dietrich ◽  
Hanspeter Rottensteiner ◽  
Herbert Gritsch ◽  
Hartmut J. Ehrlich ◽  
...  

Abstract Abstract 1414 Von Willebrand factor (VWF) is cleaved by the plasma metalloprotease ADAMTS13 that regulates the hemostatic activity of VWF by limiting its multimeric size in the human system. We showed previously by in vitro and ex vivo studies that human recombinant VWF (rVWF) is virtually resistant to the proteolytic activity of murine and rat ADAMTS13, whereas ADAMTS13 from rabbits and cynomolgus monkeys is able to cleave human rVWF. Here we tested the pharmacological behavior of human rVWF in rabbits and cynomolgus monkeys. The animals were infused once with different doses of human rVWF. VWF antigen rose sharply in a dose-dependent manner (∼25 IU/ml VWF:Ag for the highest dose, 15 min after injection) and then declined gradually (∼7 IU/ml VWF:Ag for the highest dose, 18 hours after injection). By contrast, the ADAMTS13 activity did not show relevant changes throughout the entire test period in the rabbit or in the monkey samples, indicating that an excess of intravenously administered rVWF as the substrate does not exhaust its enzyme ADAMTS13. Most importantly, neither rabbits nor cynomolgus monkeys showed any exaggerated pharmacological or toxic effects upon rVWF administration. Even the administration of 14 daily doses of rVWF to cynomolgus monkeys did not lead to any toxicological effect. Our data indicate that rabbits and cynomolgus monkeys, two species with a sufficient rVWF cleavage capacity by endogenous ADAMTS13, are appropriate animal models for a meaningful preclinical evaluation of the rVWF product, which allows the therapeutic safety margins for human patients to be determined. Disclosures: Muchitsch: Baxter Innovations GmbH: Employment. Dietrich:Baxter Innovations GmbH: Employment. Rottensteiner:Baxter Innovations GmbH: Employment. Gritsch:Baxter Innovations GmbH: Employment. Ehrlich:Baxter Innovations GmbH: Employment. Turecek:Baxter Innovations GmbH: Employment. Schwarz:Baxter Innovations GmbH: Employment.


Blood ◽  
2000 ◽  
Vol 95 (10) ◽  
pp. 3139-3145 ◽  
Author(s):  
Sylvie Jorieux ◽  
Edith Fressinaud ◽  
Jenny Goudemand ◽  
Christine Gaucher ◽  
Dominique Meyer ◽  
...  

We report 2 new mutations identified in 3 patients and characterized by the markedly decreased affinity of von Willebrand factor (vWF) for factor VIII (FVIII). Patients 2 and 3, who have a typical type 2N phenotype, were found to be compound heterozygous for Arg91Gln and Cys25Tyr or Cys95Phe, respectively. Patient 1, who is the first cousin of patient 2, had an FVIII binding defect of vWF, low levels of vWF, and multimeric impairment. She was found to be compound heterozygous for the mutations Cys25Tyr and a stop codon (D93ter) in exon 4. Transient expression of recombinant vWF (rvWF) containing either Cys25Tyr or Cys95Phe mutations resulted in mutated rvWF with markedly reduced FVIII binding ability, multimeric structure impairment, and a significant decrease in the vWF expression level. Moreover, the use of anti-vWF monoclonal antibodies that inhibit the FVIII binding showed that these 2 mutations likely induce a conformational change in the D′ domain. These results show that the native conformation of the D′ domain of vWF is not only required for FVIII binding but also for normal multimerization and optimal secretion.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 214-214
Author(s):  
Henriet Meems ◽  
Carmen van der Zwaan ◽  
Koen Mertens ◽  
Alexander Meijer

Abstract Blood coagulation factor VIII is internalized and degraded by cellular systems via an endocytic mechanism that involves low-density lipoprotein receptor-related protein (LRP). Factor VIII's chaperone protein von Willebrand factor (VWF) has a dual role in this uptake mechanism. Under conditions of low shear stress VWF is particularly effective in blocking LRP-dependent endocytosis of factor VIII, whereas VWF itself mediates the uptake of factor VIII under high shear stress conditions. This study addresses the poorly understood uptake mechanism of factor VIII and the role therein of VWF in the absence of shear stress. LRP binds its ligands via ligand-binding domains that are clustered in four regions. Cluster II, III and IV have each been demonstrated to bind factor VIII. However, one of the poorly understood aspects of the LRP dependent endocytosis of factor VIII is that the affinity of LRP for factor VIII is an order of magnitude lower compared to the affinity of LRP for other ligands like, for instance, alpha-2-macroglobulin (α2M). We and others have previously hypothesized that, in contrast to α2M, factor VIII may first require pre-concentration on the cell surface before it is transferred to LRP for effective endocytosis. Direct evidence for the existence of this two-step mechanism of endocytosis is, however, still lacking. In the present study, we compared the endocytic uptake mechanism of fluorescent labeled α2M and a factor VIII GFP variant employing a confocal microscopy study. To this end, U87MG cells were employed, which are particularly effective in internalizing ligands via the LRP-dependent pathway. The role of vWF in the LRP-mediated endocytosis of factor VIII was assessed as well. The confocal microscopy studies surprisingly showed that factor VIII traffics to early endosomes irrespective of the presence of α2M. Co-incubation of factor VIII and α2M, revealed that both proteins end up in the same endocytic compartment of the cells. This finding can be explained if LRP can simultaneously bind and endocytose both factor VIII and α2M. Taking maximal advantage of this phenomenon, factor VIII and α2M were together incubated with the cells to accurately assess whether or not there is any difference in the rate of endocytosis of these proteins. The results demonstrated that α2M was present at the cell surface after 2 minutes of incubation. After 5 minutes, α2M was distributed in a punctate pattern over the cells indicating that α2M has been internalized by the cells. Interestingly, a 15 minutes incubation of factor VIII with the cells was required before factor VIII could be detected at the cell surface and inside the cells. This finding implies that the uptake of factor VIII is delayed compared to the rate of endocytosis of α2M. This is in agreement with the hypothesis that factor VIII may first require a cell surface binding step prior to LRP mediated endocytosis. These observations also imply that the cell surface binding step is rate-limiting in the endocytic uptake mechanism of factor VIII. Compelling evidence of the two-step endocytic model was obtained when factor VIII was incubated with the cells in the presence of receptor-associated-protein (RAP), which prevents direct binding of ligands to LRP. The results of these studies showed a striated fluorescent pattern that was localized at the borders of the cells. Notably, in the presence of VWF, no factor VIII was observed on or within the cells at all. These findings imply that VWF blocks cell surface binding of factor VIII. Based on our findings, we propose that the ligand-binding clusters of LRP can mediate the binding of more than one ligand to LRP. The combined results further convincingly show that factor VIII endocytosis includes an initial cell surface binding step which is rate limiting in the uptake mechanism of factor VIII. The observations also explain why VWF is particularly effective in blocking the endocytosis of factor VIII. VWF may not only block the direct binding of factor VIII to LRP but also the rate limiting cell surface binding step prior to LRP mediated endocytosis. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
1996 ◽  
Vol 87 (5) ◽  
pp. 1809-1816 ◽  
Author(s):  
AJ Vlot ◽  
SJ Koppelman ◽  
JC Meijers ◽  
C Dama ◽  
HM van den Berg ◽  
...  

The binding of factor VIII to von Willebrand factor (vWF) is essential for the protection of factor VIII against proteolytic degradation in plasma. We have characterized the binding kinetics of human factor VIII with vWF using a centrifugation binding assay. Purified or plasma vWF was immobilized with a monoclonal antibody (MoAb RU1) covalently linked to Sepharose (Pharmacia LKB Biotechnology, Uppsala, Sweden). Factor VIII was incubated with vWF-RU1-Sepharose and unbound factor VIII was separated from bound factor VIII by centrifugation. The amount of bound factor VIII was determined from the decrease of factor VIII activity in the supernatant. Factor VIII binding to vWF-RU1-Sepharose conformed to the Langmuir model for independent binding sites with a Kd of 0.46 +/- 0.12 nmol/L, and a stoichiometry of 1.3 factor VIII molecules per vWF monomer at saturation, suggesting that each vWF subunit contains a binding site for factor VIII. Competition experiments were performed with a recombinant vWF (deltaA2-rvWF), lacking residues 730 to 910 which contain the epitope for MoAB RU1. DeltaA2-rvWF effectively displaced previously bound factor VIII, confirming that factor VIII binding to vWF-RU1-Sepharose was reversible. To determine the association rate constant (k(on)) and the dissociation rate constant (k(off)), factor VIII was incubated with vWF-RU1-Sepharose for various time intervals. The observed association kinetics conformed to a simple bimolecular association reaction with k(on) = 5.9 +/- 1.9 x 10(6) M(-1) s(-1) and k(off) = 1.6 +/- 1.2 x 10(-3) s(-1) (mean +/- SD). Similar values were obtained from the dissociation kinetics measured after dilution of preformed factor VIII-vWF-RU1-Sepharose complexes. Identical rate constants were obtained for factor VIII binding to vWF from normal pooled plasma and to vWF from plasma of patients with hemophilia A. The kinetic parameters in this report allow estimation of the time needed for complex formation in vivo in healthy individuals and in patients with hemophilia A, in which monoclonally purified or recombinant factor VIII associates with endogenous vWF. Using the plasma concentration of vWF (50 nmol/L in monomers) and the obtained values for K(on) and K(off), the time needed to bind 50% of factor VIII is approximately 2 seconds.


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