Familial thrombophilia: Clinical and molecular analysis of Swedish families with inherited resistance to activated protein C or protein S deficiency

1996 ◽  
Vol 56 (sup226) ◽  
pp. 19-46 ◽  
Author(s):  
Bengt Zöller
Blood ◽  
2015 ◽  
Vol 126 (19) ◽  
pp. 2247-2253 ◽  
Author(s):  
Fumiaki Banno ◽  
Toshiyuki Kita ◽  
José A. Fernández ◽  
Hiroji Yanamoto ◽  
Yuko Tashima ◽  
...  

Key Points A protein S-K196E mutation reduced its activated protein C cofactor activity in recombinant murine protein S-K196E and in K196E mutant mice. Mice carrying a protein S-K196E mutation or heterozygous protein S deficiency were more vulnerable to venous thrombosis than wild-type mice.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3186-3186
Author(s):  
Rinku Majumder

Abstract 3186 Poster Board III-123 Thrombosis is a serious problem in the United States. The overall estimated incidence (annual occurrence) of deep venous thrombosis is 1 episode for every 1000 persons. Protein S, a vitamin K-dependent protein, is one of the natural anticoagulants found in the blood. Deficiency of protein S is most common protein deficiencies associated with familial venous thrombosis There are studies that suggest an association between arterial thrombosis (stroke, heart attack) in patients with protein S deficiency. At this time, the exact role of protein S deficiency and its relative importance in arterial disease is still being explored by physicians and scientists. Protein S is known as a non-enzymatic cofactor of activated Protein C in the inactivation of factors Va and VIIIa, as part of a negative feedback loop to regulate blood coagulation. Plasma coagulation assays in the absence of activated protein C suggest that Protein S may have other anticoagulant role(s). For example, it has been suggested that Protein S down-regulates thrombin generation by stimulating FXa inhibition by the tissue factor pathway inhibitor (Rosing, J., et al., Thromb Res, 2008. 122 Suppl 1: p. S60-3). It has also been proposed that protein S can directly inhibit the intrinsic Xase complex (Takeyama, M., et al.. Br J Haematol, 2008. 143(3): p. 409-20). But the exact mechanism of how Protein S exerts its anticoagulant effect on factor IXa/VIIIa complex is still unclear. In order to determine the role of Protein S as an anticoagulant in the intrinsic Xase Complex, we have used C6PS (a small six carbon chain synthetic Phosphatidylserine (PS) molecule) that does not occur in vivo, but has been used as a powerful tool in demonstrating the regulation of both factors Xa and Va by binding of molecular PS. Soluble lipid binding can offer invaluable insights into events that would be next to impossible to document on a membrane surface which is complicated as it has surface condensation effect and allosteric effects of different factors. We focus here on the conformation changes of the proteins by using C6PS as a tool. We have determined the binding of Protein S with C6PS by using tryptophan fluorescence and observed a stoichiometric Kd of ∼180 μM.We checked for micelles formation under each experimental condition. We have also determined the direct binding of factor IXa with Protein S by using DEGR-IXa ((5-(dimethylamino)1-naphthalenesulfonyl]-glutamylglycylarginyl chloromethyl ketone) in the presence and absence of C6PS. Our results show that the affinity of binding of DEGR-IXa to Protein S in the presence of C6PS is ∼22 fold tighter (Kd ∼15 nM compared to 324 nM) than without C6PS. We also measured the rate of factor X activation by factor IXa with the addition of increasing concentration of C6PS in the presence and absence of Protein S. We observed that Protein S decreased factor IXa mediated factor X activation by 14 fold. We had previously shown that apparent Kd of factor IXa binding to C6PS during factor X activation was ∼125 μM. But addition of Protein S had an effect on the apparent Kd as it increased to 700 μM indicating the affinity of factor IXa towards C6PS was decreased with the addition of Protein S during factor X activation. From these data we can speculate that Protein S induces a conformational change in factor IXa in the presence of C6PS which may affect the interaction of factor IXa with factor VIIIa, thus affecting the intrinsic Xase complex. Using this useful tool (C6PS), we will characterize the anticoagulant role of Protein S in the intrinsic Xase complex which in turn will give us some insights into this important protein which is a crucial target for therapeutic drugs for venous thrombosis. Disclosures No relevant conflicts of interest to declare.


2017 ◽  
Vol 142 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Elena Maryamchik ◽  
Matthew W. Rosenbaum ◽  
Elizabeth M. Van Cott

Context.— Rivaroxaban causes a false increase in activated protein C resistance (APCR) ratios and protein S activity. Objective.— To investigate whether this increase masks a diagnosis of factor V Leiden (FVL) or protein S deficiency in a “real-world” population of patients undergoing rivaroxaban treatment and hypercoagulation testing. Design.— During a 2.5-year period, we compared 4 groups of patients (n = 60): FVL heterozygous (FVL-HET)/taking rivaroxaban, wild-type/taking rivaroxaban, FVL-HET/no rivaroxaban, and normal APCR/no rivaroxaban. Patients taking rivaroxaban were tested for protein S functional activity and free antigen (n = 32). Results.— The FVL-HET patients taking rivaroxaban had lower APCR ratios than wild-type patients (P < .001). For FVL-HET patients taking rivaroxaban, mean APCR was 1.75 ± 0.12, versus 1.64 ± 0.3 in FVL-HET patients not taking rivaroxaban (P = .005). Activated protein C resistance in FVL-HET patients fell more than 3 SDs below the cutoff of 2.2 at which the laboratory reflexes FVL DNA testing. No cases of FVL were missed despite rivaroxaban. In contrast, rivaroxaban falsely elevated functional protein S activity, regardless of the presence or absence of FVL (P < .001). A total of 4 of 32 patients (12.5%) had low free protein S antigen (range, 58%–67%), whereas their functional protein S activity appeared normal (range 75%–130%). Rivaroxaban would have caused a missed diagnosis of all cases of protein S deficiency during the study if testing relied on the protein S activity assay alone. Conclusions.— Despite rivaroxaban treatment, APCR testing can distinguish FVL-HET from normal patients, rendering indiscriminate FVL DNA testing of all patients on rivaroxaban unnecessary. Free protein S should be tested in patients taking rivaroxaban to exclude hereditary protein S deficiency.


Blood ◽  
1993 ◽  
Vol 82 (7) ◽  
pp. 1989-1993 ◽  
Author(s):  
JH Griffin ◽  
B Evatt ◽  
C Wideman ◽  
JA Fernandez

Abstract A defect involving poor anticoagulant response to activated protein C (APC), an anticoagulant serine protease known to inactivate factors Va and VIIIa in plasma, was recently reported and the existence of a novel APC cofactor was suggested. To define the frequency of this defect among 25 venous thrombophilic patients with no identifiable laboratory test abnormality and among 22 patients previously identified with heterozygous protein C or protein S deficiency, the APC-induced prolongation of the activated partial thromboplastin time assay for these patients was compared with results for 35 normal subjects. The results show that this new defect in anticoagulant response to APC is surprisingly present in 52% to 64% of the 25 patients, ie, in the majority of previously undiagnosed thrombophilia cases, but is not present in 20 of 22 heterozygous protein C or protein S deficient patients, suggesting that the new factor is a risk factor independent of protein C or protein S deficiency. The results demonstrate that abnormalities in the anticoagulant protein C pathway are present in the majority of thrombophilic patients.


Blood ◽  
1993 ◽  
Vol 82 (7) ◽  
pp. 1989-1993 ◽  
Author(s):  
JH Griffin ◽  
B Evatt ◽  
C Wideman ◽  
JA Fernandez

A defect involving poor anticoagulant response to activated protein C (APC), an anticoagulant serine protease known to inactivate factors Va and VIIIa in plasma, was recently reported and the existence of a novel APC cofactor was suggested. To define the frequency of this defect among 25 venous thrombophilic patients with no identifiable laboratory test abnormality and among 22 patients previously identified with heterozygous protein C or protein S deficiency, the APC-induced prolongation of the activated partial thromboplastin time assay for these patients was compared with results for 35 normal subjects. The results show that this new defect in anticoagulant response to APC is surprisingly present in 52% to 64% of the 25 patients, ie, in the majority of previously undiagnosed thrombophilia cases, but is not present in 20 of 22 heterozygous protein C or protein S deficient patients, suggesting that the new factor is a risk factor independent of protein C or protein S deficiency. The results demonstrate that abnormalities in the anticoagulant protein C pathway are present in the majority of thrombophilic patients.


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