scholarly journals In Vivo hemostatic Significance of Activated Protein C in Factor VIIIa Regulation

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 93-93
Author(s):  
Amelia R. Wilhelm ◽  
Nicole A. Parsons ◽  
Charles T. Esmon ◽  
Rodney M. Camire ◽  
Lindsey A. George
Keyword(s):  
Blood Loss ◽  
Protein C ◽  
Activated Protein C ◽  
Enzyme Complex ◽  
Hemostatic Effect ◽  
Safety Considerations ◽  
A2 Domain ◽  
Tail Clip

Activated factor VIII (FVIIIa) is an essential cofactor in the intrinsic tenase (Xase) enzyme complex that generates factor Xa and propagates clot formation. The FVIIIa heterotrimer is comprised of a metal ion linked dimer (A1/A3-C1-C2 domains) that is associated with the A2 domain by weak non-covalent interactions. Regulation of FXa formation by the intrinsic Xase enzyme complex occurs by FIXa inhibition and mechanisms contributing to FVIIIa inactivation, including: 1) rapid A2 domain dissociation and 2) activated protein C (APC) cleavage of FVIIIa. While FVIIIa inactivation by APC is considered important, there are surprisingly no in vivo studies documenting the hemostatic role of APC in FVIIIa regulation. Further, published data demonstrate APC cleavage of FVIIIa at physiologic protein concentrations occurs over hours while A2 dissociation occurs rapidly over minutes. Thus, it is thought that the predominant mechanism of FVIIIa inactivation is A2 dissociation and APC likely plays a marginal role in FVIIIa regulation. Additionally, unlike described A2 mutations that enhance dissociation and cause hemophilia A (HA), there is no known disease state attributed to altered FVIIIa cleavage by APC. This is in contrast to FVIII's homologous protein, FVa, whereby resistance to APC cleavage is the most common inherited thrombophilia (FV-Leiden [FVL]). Understanding the physiologically relevant mechanisms of FVIIIa inactivation has immediate clinical applicability for understanding safety considerations in HA therapeutics that bypass FVIIIa regulation (FVIII mimetic antibodies, e.g. emicizumab). Further, as evidenced by successful hemophilia B gene therapy trials using a gain of function FIX variant (FIX-Padua), altering FVIIIa inactivation could be exploited for therapeutic benefit in the setting of gene transfer. We aimed to determine the in vivo hemostatic role of APC in FVIIIa regulation and pair these studies with purified system analysis. We introduced Arg to Gln mutations at FVIII APC cleavage sites (R336Q and R562Q, herein called FVIII-QQ) on a B-domain deleted FVIII (FVIII-WT) backbone and produced recombinant FVIII-QQ and FVIII-WT. Unlike FVIII-WT, western blot analysis of FVIII-QQ incubated with APC and phospholipids had no evidence of cleavage. Enzyme kinetic studies using purified components demonstrated no appreciable difference in the Km or Vmax for FX within the intrinsic Xase enzyme complex or A2 dissociation of FVIII-QQ relative to FVIII-WT. These data confirmed no unexpected differences in FVIII-QQ relative to FVIII-WT. To begin to evaluate the role of APC in FVIIIa regulation, we measured thrombin generation in murine and human HA plasma reconstituted with FVIII-QQ or FVIII-WT in the presence of increasing APC concentrations. The IC50 of APC was 2-3-fold higher for FVIII-QQ than FVIII-WT. To evaluate the in vivo hemostatic effect of APC in FVIIIa regulation, HA mice were infused with FVIII-QQ or FVIII-WT and evaluated by tail clip injury and 7.5% FeCl3 carotid artery occlusion models. Required doses of FVIII-QQ to normalize blood loss from a tail clip assay and time to vessel occlusion in a FeCl3 assay were 4-5 fold lower than necessary FVIII-WT doses; the superior hemostatic effect of FVIII-QQ supported the physiologic significance of APC in FVIIIa inactivation. To isolate the role of APC in FVIIIa regulation from APC inactivation of FVa, we backcrossed HA mice with FVL mice to create homozygous HA/FVL mice. HA/FVL mice were infused with FVIII-QQ or FVIII-WT and underwent tail clip assay analysis. Doses of FVIII-QQ required to normalize blood loss were again less than FVIII-WT. To further isolate the enhanced hemostatic effect of FVIII-QQ to APC resistance, we performed the tail clip assay in HA/FVL mice infused with FVIII-QQ or FVIII-WT in the presence or absence of MPC1609, an antibody that blocks murine APC function (Xu et al. J Thromb Haemost 2008). In the presence of MPC1609, the same dose of FVIII-WT and FVIII-QQ was required to normalize blood loss (Figure 1). Collectively, our in vitro and in vivo data support the physiologic significance of APC in FVIIIa regulation. To our knowledge these data are the first to demonstrate the in vivo hemostatic effect of APC in FVIIIa inactivation. Our data may be translated to rationally exploit APC regulation of FVIIIa to develop novel HA therapeutics or further delineate safety considerations in therapies that bypass FVIIIa regulation. Figure 1 Disclosures Camire: Pfizer: Research Funding. George:University of Pennyslvania: Employment; Pfizer: Consultancy; Avrobio: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Activated Protein C has a Regulatory Role in Factor VIII Function

Blood ◽  
2021 ◽  
Author(s):  
Amelia R. Wilhelm ◽  
Nicole A. Parsons ◽  
Benjamin J Samelson-Jones ◽  
Robert J Davidson ◽  
Charles Esmon ◽  
...  
Keyword(s):  
Factor Viii ◽  
Protein C ◽  
Activated Protein C ◽  
Protein S ◽  
Inhibitory Antibody ◽  
Apc Resistance ◽  
Fv Leiden ◽  
A2 Domain ◽  
Tail Clip

Mechanisms thought to regulate activated factor VIII (FVIIIa) cofactor function include A2-domain dissociation and activated protein C (APC) cleavage. Unlike A2-domain dissociation, there is no known phenotype associated with altered APC cleavage of FVIII and biochemical studies suggest APC plays a marginal role in FVIIIa regulation. However, the in vivo contribution of FVIIIa inactivation by APC is unexplored. Here we compared wild-type B-domainless FVIII (FVIII-WT) recombinant protein to an APC resistant FVIII variant (FVIII-R336Q/R562Q; FVIII-QQ). FVIII-QQ demonstrated expected APC resistance without other changes in procoagulant function or A2-domain dissociation. In plasma-based studies, FVIII-WT/FVIIIa-WT demonstrated a dose-dependent sensitivity to APC with or without protein S, while FVIII-QQ/FVIIIa-QQ did not. Importantly, FVIII-QQ demonstrated approximately 5-fold increased procoagulant function relative to FVIII-WT in the tail clip and ferric chloride injury models in hemophilia A (HA) mice. To minimize the contribution of FV inactivation by APC in vivo, the tail clip assay was performed in homozygous HA/FV-Leiden mice infused with FVIII-QQ or FVIII-WT in the presence or absence of mAb1609, an antibody that blocks murine PC/APC hemostatic function. FVIII-QQ again demonstrated enhanced hemostatic function in HA/FV-Leiden mice; however, FVIII-QQ and FVIII-WT performed analogously in the presence of the PC/APC inhibitory antibody, supporting the increased hemostatic effect of FVIII-QQ was APC specific. Our data demonstrate APC contributes to the in vivo regulation of FVIIIa, which has the potential to be exploited to develop novel HA therapeutics.

scholarly journals ptFVa ( Pseudonaja Textilis Venom-Derived Factor Va) Retains Structural Integrity Following Proteolysis by Activated Protein C

2021 ◽  
Author(s):  
Mark Schreuder ◽  
Xiaosong Liu ◽  
Ka Lei Cheung ◽  
Pieter H. Reitsma ◽  
Gerry A.F. Nicolaes ◽  
...  
Keyword(s):  
Protein C ◽  
Structural Integrity ◽  
Noncovalent Interactions ◽  
Activated Protein C ◽  
Regulatory Mechanisms ◽  
Factor V ◽  
Factor Va ◽  
Dynamics Simulations ◽  
A2 Domain

Objective: The Australian snake ptFV ( Pseudonaja textilis venom-derived factor V) variant that retains cofactor function despite APC (activated protein C)-dependent proteolysis. Here, we aimed to unravel the mechanistic principles by determining the role of the absent Arg306 cleavage site that is required for the inactivation of Fva (mammalian factor Va). Approach and Results: Our findings show that in contrast to human FVa, APC-catalyzed proteolysis of ptFVa at Arg306 and Lys507 does not abrogate ptFVa cofactor function. Remarkably, the structural integrity of APC-proteolyzed ptFVa is maintained indicating that stable noncovalent interactions prevent A2-domain dissociation. Using Molecular Dynamics simulations, we uncovered key regions located in the A1 and A2 domain that may be at the basis of this remarkable characteristic. Conclusions: Taken together, we report a completely novel role for uniquely adapted regions in ptFVa that prevent A2 domain dissociation. As such, these results challenge our current understanding by which strict regulatory mechanisms control FVa activity.

Thrombomodulin mutant mice with a strongly reduced capacity to generate activated protein C have an unaltered pulmonary immune response to respiratory pathogens and lipopolysaccharide

Blood ◽  
2004 ◽  
Vol 103 (5) ◽  
pp. 1702-1709 ◽  
Author(s):  
Anita W. Rijneveld ◽  
Sebastiaan Weijer ◽  
Sandrine Florquin ◽  
Charles T. Esmon ◽  
Joost C. M. Meijers ◽  
...  
Keyword(s):  
Immune Response ◽  
Protein C ◽  
Activated Protein C ◽  
Protein S ◽  
Lavage Fluid ◽  
Respiratory Pathogens ◽  
Pulmonary Response ◽  
Inflammatory Infiltrates

AbstractThe thrombomodulin–protein C–protein S (TM-PC-PS) pathway exerts anticoagulant and anti-inflammatory effects. We investigated the role of TM in the pulmonary immune response in vivo by the use of mice with a mutation in the TM gene (TMpro/pro) that was earlier found to result in a minimal capacity for activated PC (APC) generation in the circulation. We here demonstrate that TMpro/pro mice also display a strongly reduced capacity to produce APC in the alveolar compartment upon intrapulmonary delivery of PC and thrombin. We monitored procoagulant and inflammatory changes in the lung during Gram-positive (Streptococcus pneumoniae) and Gram-negative (Klebsiella pneumoniae) pneumonia and after local administration of lipopolysaccharide (LPS). Bacterial pneumonia was associated with fibrin(ogen) depositions in the lung that colocalized with inflammatory infiltrates. LPS also induced a rise in thrombin-antithrombin complexes in bronchoalveolar lavage fluid. These pulmonary procoagulant responses were unaltered in TMpro/pro mice, except for enhanced fibrin(ogen) deposition during pneumococcal pneumonia. In addition, TMpro/pro mice displayed unchanged antibacterial defense, neutrophil recruitment, and cytokine/chemokine levels. These data suggest that the capacity of TM to generate APC does not play a role of importance in the pulmonary response to respiratory pathogens or LPS.

Interaction between Antiphospholipid Antibodies and Protein C Anticoagulant Pathway: A Narrative Review

2022 ◽  
Author(s):  
Vittorio Pengo
Keyword(s):  
Antiphospholipid Antibodies ◽  
Protein C ◽  
Activated Protein C ◽  
Severe Form ◽  
Protein C Deficiency ◽  
Small Vessels ◽  
Gray Area ◽  
Glycoprotein I

AbstractThrombotic antiphospholipid syndrome (APS) is a condition in which thrombosis in venous, arterial, and/or small vessels is ascribed to the presence of antiphospholipid antibodies (aPL). Among the various proposed pathogenic theories to explain thrombotic APS, those involving the interaction between aPL and the protein C system have gained much consensus. Indeed, robust data show an acquired activated protein C resistance (APC-R) in these patients. The role of aPL in this impairment is clear, but the mechanism of action is uncertain, as the type of aPL and to what extent aPL are involved remains a gray area. Lupus anticoagulant (LA) is often associated with APC-R, but antibodies generating LA comprise those directed to β2-glycoprotein I and antiphosphatidylserine/prothrombin. Moreover, the induction of APC-R by aPL requires the presence of phospholipids and is suppressed by the presence of an excess of phospholipids. How phospholipids exposed on the cell membranes work in the system in vivo is unknown. Interestingly, acquired APC-R due to aPL might explain the clinical phenotypes of thrombotic APS. Indeed, the literature reports cases of both venous and arterial thromboembolism as well as skin necrosis, the latter observed in the severe form of protein C deficiency and in catastrophic APS.

A Sensitive and Facile Assay for the Measurement of Activated Protein C Activity Levels in Vivo

1993 ◽  
Vol 69 (05) ◽  
pp. 441-447 ◽  
Author(s):  
Carolyn L Orthner ◽  
Billy Kolen ◽  
William N Drohan
Keyword(s):  
Protein C ◽  
Plasma Concentrations ◽  
Limited Proteolysis ◽  
Activated Protein C ◽  
Microtiter Plate ◽  
Reversible Inhibitor ◽  
Activity Levels ◽  
Standard Curve ◽  
Agarose Beads

SummaryActivated protein C (APC) is a serine protease which plays an important role as a naturally occurring antithrombotic enzyme. APC, which is formed by thrombin-catalyzed limited proteolysis of the zymogen protein C, functions as an anticoagulant by proteolytic inactivation of the coagulation cofactors VIIIa and Va. APC is inhibited by several members of the serpin family as well a by α2-macroglobulin. APC is being developed as a therapeutic for the prevention and treatment of thrombosis. We have developed an assay to quantify circulating levels of enzymatically active APC during its administration to patients, in healthy individuals, and in various disease states. This assay utilizes an EDTA-dependent anti-protein C monoclonal antibody (Mab) 7D7B10 to capture both APC and protein C from plasma, prepared from blood collected in an anticoagulant supplemented with the reversible inhibitor p-aminobenzamidine. Mab 7D7B10-derivatized agarose beads are added to the wells of a 96-well filtration plate, equilibrated with Tris-buffered saline, and incubated for 10 min with 200 μl of plasma. After washing, APC and protein C are eluted from the immunosorbent beads with a calcium-containing buffer into the wells of a 96-well microtiter plate containing antithrombin III (ATIII) and heparin. The amidolytic activity of APC is then measured on a kinetic plate reader following the addition of L-pyroglutamyl-L-prolyl-L-arginine-p-nitroanilide (S-2366) substrate.The rate of substrate hydrolysis was proportional to APC concentration over a 200-fold concentration range (5.0 to 1,000 ng/ml) when measured continuously over a 15 to 30 min time period. The coefficient of variation was 5.9% at 35 ng/ml and 8.8% at 350 ng/ml APC. The sensitivity of the assay could be increased by measuring the amount of color produced after longer incubation times in the endpoint mode. The measured APC activity levels were little affected by varying protein C or prothrombin over the extremes of 0 to 150% of normal plasma concentrations. By constructing the standard curve in protein C-deficient plasma, the concentration of APC activity in normal pooled plasma was determined to be 2.8 ng/ml (45 pM), which represents 0.08% of the protein C concentration. The assay was approximately 50-fold more sensitive than the identical assay, but using Mab-coated microtiter wells rather than immunosorbent beads as the capture step.

Protective role of activated protein C in lung and airway remodeling

2004 ◽  
Vol 32 (Supplement) ◽  
pp. S262-S265 ◽  
Author(s):  
Koji Suzuki ◽  
Esteban Cesar Gabazza ◽  
Tatsuya Hayashi ◽  
Haruhiko Kamada ◽  
Yukihiko Adachi ◽  
...  
Keyword(s):  
Protein C ◽  
Airway Remodeling ◽  
Activated Protein C ◽  
Protective Role

Improved hemostasis with superactive analogs of factor VIIa in a mouse model of hemophilia A

Blood ◽  
2003 ◽  
Vol 102 (10) ◽  
pp. 3615-3620 ◽  
Author(s):  
Mikael Tranholm ◽  
Kim Kristensen ◽  
Annemarie T. Kristensen ◽  
Charles Pyke ◽  
Rasmus Røjkjær ◽  
...  
Keyword(s):  
Blood Loss ◽  
Bleeding Time ◽  
Hemophilia A ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Intrinsic Activity ◽  
Hemostatic Effect ◽  
Therapeutic Doses ◽  
Hemostatic Effects

AbstractIt is currently debated whether the mechanism of action of therapeutic doses of recombinant factor VIIa (rFVIIa, Novo-Seven) relies on the tissue factor (TF)-independent activity of the enzyme. The present study was conducted to investigate the in vivo hemostatic effects of rFVIIa and 3 analogs thereof with superior intrinsic activity (FVIIaIIa, K337A-FVIIaIia, and M298Q-FVIIa) in mice with antibody-induced hemophilia A. A highly significant dose response was observed for the bleeding time and blood loss for each of the rFVIIa variants. The bleeding time and blood loss were normalized after administration of 10 mg/kg rFVIIa, 3 mg/kg K337A-FVIIaIia, and 3 mg/kg M298Q-FVIIa, indicating a potency of these FVIIa analogs 3-4 times above that of rFVIIa in FVIII-depleted mice. The different in vivo potencies of the various forms of FVIIa could not be explained by the pharmacokinetics. Histopathological evaluation of kidneys revealed no signs of treatment-related pathological changes even after treatment with the superactive variants. The fact that FVIIa analogs with enhanced intrinsic activity are more efficacious in the murine hemophilia A model strongly suggests that the TF-independent procoagulant activity of FVIIa contributes to its clinical hemostatic effect. (Blood. 2003; 102:3615-3620)

Systemic hemostatic and hemostasiological effects of fibrin monomer in low dose under warfarin action in experiment

2019 ◽  
Author(s):  
В.М. Вдовин ◽  
А.П. Момот ◽  
Д.А. Орехов ◽  
И.Г. Толстокоров ◽  
В.О. Шевченко ◽  
...  
Keyword(s):  
Liver Injury ◽  
Blood Loss ◽  
Prothrombin Complex Concentrate ◽  
Coagulation Factors ◽  
International Normalized Ratio ◽  
Blood Coagulation Factors ◽  
Circulating Blood Volume ◽  
Hemostatic Effect ◽  
Blood Loss Volume

Введение. Ранее было показано, что фибринмономер (ФМ) в низких дозировках обладает системным гемостатическим действием в условиях дозированной травмы. Авторами выдвинута гипотеза, согласно которой ФМ способен оказывать регулирующее гемостатическое действие in vivo на фоне сниженного гемостатического потенциала. Цель исследования: изучение системных гемостатических и гемостазиологических эффектов ФМ на фоне дозированной травмы печени при гипокоагуляции, обусловленной приемом варфарина. Материалы и методы. В работе использовали 40 кроликов породы Шиншилла. Для индукции кумаринобусловленной гипокоагуляции животным per os вводили варфарин в дозе 0,4 0,5 мг/кг 14 дней до достижения международного нормализованного отношения (МНО) более 2,0. Далее животным в краевую вену уха вводили концентрат факторов протромбино вого комплекса (КФПК) в дозе 40 ЕД/кг, ФМ в дозе 0,25 мг/кг или плацебо. Через 1 ч после введения препаратов наносили травму печени и оценивали кровопотерю (в процентах от объема циркулирующей крови). Исследовали число тромбоцитов, активированное парциальное тромбопластиновое время, МНО, содержание фибриногена и Ддимера, оценивали результаты тромбоэластографии крови. Результаты. Объем кровопотери в группах животных после внутривенного введения ФМ и КФПК на фоне приема варфарина был в 9,1 раза и 6,7 раза меньше, соответственно, по сравнению с группой плацебо, получавшей тот же антикоагулянт. Вместе с тем ФМ не влиял на параметры коагулограммы (отсутствие видимого гемостазиологического эффекта) и тромбоэластограммы, тогда как применение КФПК в качестве антидота варфарина сопровождалось нормализацией параметров тромбоэластометрии и коррекцией гипокоагуляционного сдвига по МНО. Заключение. Установлено, что ФМ способен проявлять свое системное гемостатическое действие в условиях сниженного тромбинообразования, обусловленного нарушением синтеза витамин Кзависимых факторов свертывания крови. Данное действие реализуется без признаков восстановления гемостатического равновесия. Introduction. It was shown earlier that fibrinmonomer (FM) in low doses had a systemic hemostatic effect in a controlled injury condition. The authors suggest that FM is able to exert a regulating hemostatic effect in vivo under reduced hemostatic potential. Aim: to study the systemic hemostatic and hemostasiological effects of FM under controlled liver injury during hypocoagulation caused by warfarin administration. Materials and methods. In this study 40 Chinchilla rabbits were used. For the induction of coumarinmediated hypocoagulation, animals were administered per os warfarin at a dose of 0.4 0.5 mg/kg for 14 days, until an international normalized ratio (INR) was more than 2.0. Subsequently, a prothrombin complex concentrate (PCC) at a dose of 40 U/kg, FM at a dose of 0.25 mg/kg or placebo were administered into the marginal ear vein of the animals. An hour later, a liver injury was inflicted and blood loss was assessed (in percents of the circulating blood volume). The number of platelets, activated partial thromboplastin time, INR, levels of fibrinogen and Ddimer were studied and the results of blood thromboelastography were evaluated. Results. Blood loss volume in animals groups after intravenous administration of FM and PPC, under warfarin reception, was 9.1 times and 6.7 times less, respectively, compared to the placebo group receiving the same anticoagulant. However, FM did not affect on coagulogram parameters (no visible hemostasiological effect) and thromboelastogram, whereas the use of PPC as warfarin antidote was accompanied by the normalization of thromboelastometry parameters and hypocoagulation shift correction according to INR. Conclusion. It was found that FM able to manifest its systemic hemostatic effect in conditions of reduced thrombin formation caused by impaired synthesis of vitamin Kdependent blood coagulation factors. This effect is implemented without any signs of recovery of hemostatic balance.

A reactive center loop–based prediction platform to enhance the design of therapeutic SERPINs

2021 ◽  
Vol 118 (45) ◽  
pp. e2108458118
Author(s):  
Wariya Sanrattana ◽  
Thibaud Sefiane ◽  
Simone Smits ◽  
Nadine D. van Kleef ◽  
Marcel H. Fens ◽  
...  
Keyword(s):  
Cleavage Site ◽  
Serine Proteases ◽  
Protein C ◽  
Activated Protein C ◽  
Reactive Center Loop ◽  
Physiological Processes ◽  
Naturally Occurring ◽  
Reactive Center ◽  
Insight Into

Serine proteases are essential for many physiological processes and require tight regulation by serine protease inhibitors (SERPINs). A disturbed SERPIN–protease balance may result in disease. The reactive center loop (RCL) contains an enzymatic cleavage site between the P1 through P1’ residues that controls SERPIN specificity. This RCL can be modified to improve SERPIN function; however, a lack of insight into sequence–function relationships limits SERPIN development. This is complicated by more than 25 billion mutants needed to screen the entire P4 to P4’ region. Here, we developed a platform to predict the effects of RCL mutagenesis by using α1-antitrypsin as a model SERPIN. We generated variants for each of the residues in P4 to P4’ region, mutating them into each of the 20 naturally occurring amino acids. Subsequently, we profiled the reactivity of the resulting 160 variants against seven proteases involved in coagulation. These profiles formed the basis of an in silico prediction platform for SERPIN inhibitory behavior with combined P4 to P4’ RCL mutations, which were validated experimentally. This prediction platform accurately predicted SERPIN behavior against five out of the seven screened proteases, one of which was activated protein C (APC). Using these findings, a next-generation APC-inhibiting α1-antitrypsin variant was designed (KMPR/RIRA; / indicates the cleavage site). This variant attenuates blood loss in an in vivo hemophilia A model at a lower dosage than the previously developed variant AIKR/KIPP because of improved potency and specificity. We propose that this SERPIN-based RCL mutagenesis approach improves our understanding of SERPIN behavior and will facilitate the design of therapeutic SERPINs.

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