scholarly journals In vivo interaction of von Willebrand factor with platelets following cryoprecipitate transfusion in platelet-type von Willebrand's disease

Blood ◽  
1984 ◽  
Vol 63 (1) ◽  
pp. 226-230 ◽  
Author(s):  
JL Miller ◽  
BD Boselli ◽  
JM Kupinski
Keyword(s):  
Molecular Weight ◽  
Von Willebrand Factor ◽  
Platelet Rich Plasma ◽  
Platelet Factor ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract Previous studies performed in vitro have indicated that platelets from patients with platelet-type von Willebrand's disease (vWD) have receptors for von Willebrand factor (vWF) already exposed on their surfaces and that the addition of purified vWF or cryoprecipitate to patient platelet-rich plasma under stirring conditions is capable of inducing platelet aggregation and secretion. The present work reports the results of the transfusion of cryoprecipitate in a patient with platelet-type vWD. It is shown that, while factor VIII-related antigen and ristocetin cofactor activities maintain elevated levels for up to 12 hr following transfusion, the highest molecular weight vWF multimers decline rapidly. The platelet count also declines, followed in turn by a rise in the plasma level of platelet factor 4. Shortening of the bleeding time occurs only very transiently. The results of this study provide direct evidence that, in patients with platelet-type vWD, an abnormal interaction of their platelets with plasma vWF occurs in vivo, resulting in the absence of high molecular weight vWF multimers, low platelet counts, and impaired hemostasis that are characteristic of this disease.

scholarly journals In vivo interaction of von Willebrand factor with platelets following cryoprecipitate transfusion in platelet-type von Willebrand's disease

Blood ◽  
1984 ◽  
Vol 63 (1) ◽  
pp. 226-230
Author(s):  
JL Miller ◽  
BD Boselli ◽  
JM Kupinski
Keyword(s):  
Molecular Weight ◽  
Von Willebrand Factor ◽  
Platelet Rich Plasma ◽  
Platelet Factor ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Von Willebrand ◽  
Willebrand Factor

Previous studies performed in vitro have indicated that platelets from patients with platelet-type von Willebrand's disease (vWD) have receptors for von Willebrand factor (vWF) already exposed on their surfaces and that the addition of purified vWF or cryoprecipitate to patient platelet-rich plasma under stirring conditions is capable of inducing platelet aggregation and secretion. The present work reports the results of the transfusion of cryoprecipitate in a patient with platelet-type vWD. It is shown that, while factor VIII-related antigen and ristocetin cofactor activities maintain elevated levels for up to 12 hr following transfusion, the highest molecular weight vWF multimers decline rapidly. The platelet count also declines, followed in turn by a rise in the plasma level of platelet factor 4. Shortening of the bleeding time occurs only very transiently. The results of this study provide direct evidence that, in patients with platelet-type vWD, an abnormal interaction of their platelets with plasma vWF occurs in vivo, resulting in the absence of high molecular weight vWF multimers, low platelet counts, and impaired hemostasis that are characteristic of this disease.

Von Willebrand’s Disease caused by Compound Heterozygosity for a Substitution Mutation (T1156M) in the D3 Domain of the Von Willebrand Factor and a Stop Mutation (Q2470X)

2002 ◽  
Vol 88 (09) ◽  
pp. 421-426 ◽  
Author(s):  
Stefan Lethagen ◽  
Christina Isaksson ◽  
Charlotta Schaedel ◽  
Lars Holmberg
Keyword(s):  
Von Willebrand Factor ◽  
Null Allele ◽  
Dependent Manner ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Stop Mutation ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryHereditary defects of the von Willebrand factor (VWF) gene cause von Willebrand’s disease (VWD) which shows great variability dependent on the nature and location of the mutation. We here describe the characteristics of a substitution of methionine for threonine 1156 in the D3 domain of the VWF, i.e. the domain involved in the intracellular multimerization of pro-VWF dimers. A VWD patient with severe symptoms was a compound heterozygote for the T1156M mutation and a null allele (Q2470X) on the other chromosome. This led to marked reduction of plasma VWF concentration to about 0.05 U/ml and an abnormality of VWF multimers as in type 2A VWD. Expression in vitro of the mutation demonstrated that 1156M-VWF is secreted from COS-7 cells in a much reduced amount and lacking large multimers. When coexpressed with normal VWF 1156M-VWF decreased the secretion of normal VWF in a dose-dependent manner, the secreted VWF showing all the multimers. Two relatives of the propositus were single heterozygotes for the T1156M mutation and were either asymptomatic or had the manifestations of mild type 1 VWD. The expression data and studies of platelet VWF indicate that the T1156M mutation results in intracellular retention of VWF rather than impaired synthesis. Three other members of the family were heterozygotes for the Q2470X mutation and demonstrated the variable expressivity of a null allele.

scholarly journals Characterization of the defect of the factor VIII/von Willebrand factor protein in von Willebrand's disease

Blood ◽  
1982 ◽  
Vol 59 (3) ◽  
pp. 542-548 ◽  
Author(s):  
HR Gralnick ◽  
MC Cregger ◽  
SB Williams
Keyword(s):  
Sialic Acid ◽  
Factor Viii ◽  
Von Willebrand Factor ◽  
Platelet Rich Plasma ◽  
Molecular Forms ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Platelet Receptor ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract The factor VIII/von Willebrand factor (f.VIII/vWf) protein was purified from the plasma of a patient with von Willebrand's disease (vWd). The patient had all of the classic laboratory findings of vWd except for the ristocetin-induced platelet aggregation of his own platelet-rich plasma. The disease has been documented in three generations. Comparison of the purified normal and vWd f.VIIi/vWf protein revealed several abnormalities, including decreased concentration of f.VIII/vWf antigen; decreased specific vWf activity; absence of the larger molecular forms of the f.VIII/vWf protein; carbohydrate deficiencies affecting the sialic acid, penultimate galactose and N- acetylglucosamine moieties; and decreased binding of the f.VIII/vWf protein to its platelet receptor. These studies indicate the multiplicity of biochemical and functional abnormalities associated with the f.VIII/vWf protein in vWd. f.VIII/vWf protein to normal f.VIII/vWf protein that had been treated with 2-mercaptoethanol (2-ME) to reduce the multimer size and then treated with specific exoglycosidases to remove the sialic acid and penultimate galactose residues revealed similar biologic properties.

scholarly journals von Willebrand's disease characterized by increased ristocetin sensitivity and the presence of all von Willebrand factor multimers in plasma

Blood ◽  
1986 ◽  
Vol 68 (3) ◽  
pp. 668-672 ◽  
Author(s):  
L Holmberg ◽  
E Berntorp ◽  
M Donner ◽  
IM Nilsson
Keyword(s):  
Von Willebrand Factor ◽  
Platelet Rich Plasma ◽  
Severe Bleeding ◽  
Molecular Defect ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Coagulant Activity ◽  
The One ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract In eight members of one family, platelets in platelet-rich plasma aggregated at much lower ristocetin concentrations than normal. Ivy bleeding time was variously prolonged, and von Willebrand factor antigen (vWF:Ag), ristocetin cofactor activity, and factor VIII coagulant activity were decreased. Most of the affected members had had slight to rather severe bleeding symptoms. Platelet-type von Willebrand's disease (vWD) could be ruled out. All multimers of vWF:Ag were found in plasma as well as platelets. Administration of 1-desamino- 8-D-arginine vasopressin (DDAVP) to the propositus did not cause thrombocytopenia, and platelet-poor plasma obtained immediately after did not aggregate normal platelets. The molecular defect in this family, inherited as an autosomal dominant, resembles the one in type IIB because of the response to ristocetin but differs from IIB because all vWF:Ag multimers are present in plasma and the response to DDAVP is atypical. We conclude that this family has a new subtype of vWD and propose that structural as well as functional criteria should be used for a proper classification of vWD.

scholarly journals Subunit composition of plasma von Willebrand factor in patients with the myeloproliferative syndrome

Blood ◽  
1986 ◽  
Vol 68 (6) ◽  
pp. 1213-1217 ◽  
Author(s):  
U Budde ◽  
JA Dent ◽  
SD Berkowitz ◽  
ZM Ruggeri ◽  
TS Zimmerman
Keyword(s):  
Von Willebrand Factor ◽  
Bleeding Time ◽  
Polyacrylamide Gel Electrophoresis ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Prolonged Bleeding Time ◽  
Myeloproliferative Syndrome ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract In order to evaluate the role of proteolysis in acquired von Willebrand's disease (vWD) associated with the myeloproliferative syndrome, we have determined the relative quantity of von Willebrand factor (vWF) fragments as compared with the intact 225 kDa subunit in four patients. The plasma vWF of each individual lacked large multimers; each had a prolonged bleeding time; and both platelet and leukocyte counts were elevated. Plasma was obtained from blood drawn into 1 mmol/L leupeptin, 6 mmol/L N-ethylmaleimide, and 5 mmol/L EDTA to prevent in vitro proteolysis. vWF was isolated from plasma by immunoadsorbent chromatography, reduced, subjected to SDS-5% polyacrylamide gel electrophoresis, and immunoblotted with a mixture of 55 anti-vWF monoclonal antibodies. In three patients with essential thrombocytosis (ET) the 176 and 140 kDa fragments were increased in proportion to the intact 225 kDa subunit indicating increased proteolysis. Treatment of one ET patient with CCNU (Lomustine) decreased the platelet count and, to a lesser extent, the white blood cell count. This was associated with a correction of the bleeding time, a partial correction of the multimeric abnormality, and a lessening of vWF cleavage. In a patient with polycythemia rubra vera (PRV) the proportion of the 176 kDa fragment was increased to the upper limit of normal but there was no definite evidence of increased proteolysis. These studies provide evidence that proteolysis plays a role in the acquired von Willebrand's disease associated with the myeloproliferative syndrome. However, other mechanisms must also be considered.

Agglutination of Platelet-Type von Willebrand’s Disease Platelets by Bovine von Willebrand Factor

1985 ◽  
Vol 53 (02) ◽  
pp. 204-207
Author(s):  
Hoyu Takahashi ◽  
Akira Shibata
Keyword(s):  
Von Willebrand Factor ◽  
Binding Sites ◽  
Platelet Rich Plasma ◽  
Membrane Receptors ◽  
Von Willebrand's Disease ◽  
Washed Platelet ◽  
Platelet Receptors ◽  
Von Willebrand’S Disease ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryIt has been shown that platelets from patients with platelet- type von Willebrand’s disease (vWD) agglutinate upon the addition of human von Willebrand factor (vWF) in the absence of ristocetin or botrocetin, suggesting that platelet membrane receptors for human vWF is abnormal. The present work reports the platelet agglutinability on stimulation with bovine vWF in platelet-type vWD. Platelets in patient platelet-rich plasma or washed platelet suspensions and patient platelets treated with formalin agglutinated in the presence of markedly lower concentrations of bovine vWF than those required for normal platelets. This finding provides additional evidence that platelet-type vWD platelets have abnormal expression of binding sites for vWF on their surface, and supports that platelet receptors for bovine vWF are identical or very close to those for human vWF.

scholarly journals Heterogeneity of the Factor VIII/Von Willebrand Factor Protein in Von Willebrand’s Disease

1977 ◽  
Author(s):  
H. R. Gralnick ◽  
Y. Sultan ◽  
B. S. Coller
Keyword(s):  
Molecular Weight ◽  
Factor Viii ◽  
Von Willebrand Factor ◽  
Apparent Molecular Weight ◽  
Total Carbohydrate ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Parallel Reduction ◽  
Von Willebrand ◽  
Willebrand Factor

The recent advent of techniques to purify the factor VIII/von Willebrand factor (f.VIII/vWf) protein from plasma to quantitate the f.VIII/vWf protein and to measure the vWf (plasma ristocetin cofactor) have greatly added to our understanding of von Willebrand’s disease (vWd). The initial studies of antigen, procoagulant and vWf levels revealed a parallel reduction in all three activities in vWd suggesting a quantitative deficiency of the f. VIII/vWf protein and its biologic activities.Recent studies, however, have suggested three major forms of vWd. The first group of patients have a quantitative defect with a parallel reduction of the f.VIII/vWf protein and of the antigen, vWf and procoagulant activities. The second group of patients appear to have a qualitative defect of the f.VIII/vWf protein. These individuals have normal levels of the antigen and procoagulant activity; however, the vWf activity is reduced or absent. The third group of patients have a combination of a qualitative and quantitative deficiency. These variants resemble both previous groups in that there are reduced levels of the antigen, procoagulant and vWf activities but usually greater reduction of the vWf activity.Three major defects of the f.VIII/vWf protein have been recognized in vWd: 1) decreased plasma concentration of the f. VIII/vWf protein, 2) the apparent molecular weight of the protein is reduced and/or the largest molecular weight polymers are absent, and 3) there is a partial or total carbohydrate deficiency. For the f.VIII/vWf protein to express vWf activity, it must be of a minimal molecular size and have a specific carbohydrate content and/or sequence.

Current Knowledge of the AHF-Like Antigen

1975 ◽  
Author(s):  
Dominique Meyer
Keyword(s):  
Molecular Weight ◽  
Factor Viii ◽  
Von Willebrand Factor ◽  
Hemophilia A ◽  
Factor Activity ◽  
Factor Viii Activity ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Von Willebrand ◽  
Willebrand Factor

Factor VIII and von Willebrand Factor activities are associated with a high molecular weight protein which can be isolated from plasma and may be studied by immunological methods. Homologous antibodies to Factor VIII are directed towards the active site of the Factor VIII molecule; they do not neutralize Willebrand Factor activity and do not precipitate with normal plasma. The use of such antibodies has allowed the distinction between Hemophilia A+ and A-. Specific precipitation of Factor VIII antibodies using polyethylene glycol will be reported, allowing typing of heavy and light chains of purified antibodies. Heterologous antisera prepared in rabbits against purified human Factor VIII complex neutralize Factor VIII and von Willebrand Factor activities and precipitate with AHF-like antigen. Estimation of this antigen in plasma has allowed (1) the differenciation of the molecular abnormalities in Hemophilia A and classical von Willebrand’s disease; (2) the comparison between normal and Hemophilic AHF-like antigen; (3) the detection of carriers of Hemophilia A; (4) the study of variants of von Willebrand’s disease; (5) the demonstration of this antigen in platelets and in endothelial cells. Factor VIII activity and AHF-like antigen are probably separate entities, circulating as a complex in normal plasma, as suggested by the following experiments: transfusion studies in von Willebrand’s disease; immuno-adsorption studies; comparison of Factor VIII complex in cryoprecipitate and supernatant; and dissociation in high salt buffer, demonstrating that Factor VIII includes two biologically linked but distinct fragments, of high (HMW) and low (LMW) molecular weight. The non functional HMW subunit, controlled by an autosomal locus, is identified by the presence of AHF-like antigen and Willebrand Factor activity. The LMW subunit, product of an X-chromosome locus, does not contain AHF-like antigen, but it carries Factor VIII activity, as demonstrated by the following facts: inactivation by both human and rabbit antibodies to Factor VIII; transient activation by thrombin; obtention of antisera which specifically inactivate Factor VIII.

Ins405AsnPro Mutation in the von Willebrand Factor Propeptide in Recessive Type 2A (IIC) von Willebrand’s Disease

1998 ◽  
Vol 79 (04) ◽  
pp. 718-722 ◽  
Author(s):  
D. Karpman ◽  
C. Isaksson ◽  
A. C. Kristoffersson ◽  
S. Lethagen ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
De Novo ◽  
Duplication Event ◽  
Von Willebrand Disease ◽  
In Vitro Mutagenesis ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Von Willebrand ◽  
Willebrand Factor

SummaryThe molecular defects of the von Willebrand factor (vWF) have been studied in the patient in whom the von Willebrand disease phenotype IIC was originally described. A six nucleotide insert, AATCCC, was found in exon 11 of the vWF gene, predicting the insertion of the amino acids asparagine and proline between phenylala-nine 404 and threonine 405 of the vWF propeptide. The mutation was present in one allele. Analysis of amplification products derived from platelet vWF mRNA showed the other allele to be silent. The patient is thus a compound heterozygote for a null allele and the IIC allele, in accord with the recessive mode of inheritance of the IIC phenotype. Family studies indicated the IIC mutation to have occurred de novo, possibly as a result of a duplication event. In vitro mutagenesis and expression in COS-7 cells confirmed the detrimental effect of the mutation on vWF multimer assembly. Taken together with those of earlier studies the present findings suggest that the IIC phenotype may well be exclusively caused by mutations which result in changes of the amino acid sequence in certain regions of the vWF propeptide. Although in the recently revised classification of von Willebrand’s disease variants, the IIC type is included in the 2A category, obviously it constitutes a very distinct subtype.

scholarly journals The heterogeneity of type IIA von Willebrand's disease: studies with protease inhibitors

Blood ◽  
1986 ◽  
Vol 68 (6) ◽  
pp. 1207-1212 ◽  
Author(s):  
J Batlle ◽  
MF Lopez Fernandez ◽  
M Campos ◽  
B Justica ◽  
C Berges ◽  
...  
Keyword(s):  
Bleeding Time ◽  
Relative Proportion ◽  
Clinical Expression ◽  
Von Willebrand's Disease ◽  
Von Willebrand’S Disease ◽  
Time Correction ◽  
Von Willebrand ◽  
Willebrand Factor

The absence of large von Willebrand factor (vWF) multimers from plasma is a characteristic of Type IIA von Willebrand's disease (vWD) and is thought to contribute to the clinical expression of this disorder. Recently, three IIA patients have been reported in whom intermediate and large multimers could be restored if blood were collected in 5 mm EDTA, 6 mmol/L N-ethylmaleimide, and 1 mmol/L leupeptin. This suggested that absence of large multimers resulted from in vitro proteolysis. We have now collected blood from ten Type IIA vWD patients in these inhibitors but were not able to detect large multimers in the plasma of any of them. In addition, intermediate-sized multimers were reduced or completely absent in all. The inclusion of inhibitors in the citrate anticoagulant, as compared to citrate alone, was found to increase the relative proportion of intermediate multimers in some patients but had no effect in others, and in none did it restore large multimers to plasma. The results with platelet vWF were more varied. Four patients showed an absence or decrease of large multimers, whereas in seven patients large multimers were present. When compared with citrate anticoagulant alone, the inclusion of inhibitors in the anticoagulant had little or no effect on the platelet multimeric pattern. 1-Deamino-8- D-Arginine Vasopressin (DDAVP) was administered to six patients from five families. Two patients from one family showed complete correction and a third patient showed almost complete correction of her bleeding time. Two patients showed minimal correction and one showed no detectable correction. An increase in multimer size after DDAVP tended to be associated with correction of the bleeding time. However, in no case did the largest multimers appear in plasma even in patients with complete bleeding time correction. The presence or absence of inhibitors in the anticoagulant had little or no effect on the multimeric pattern after DDAVP. These results indicate that Type IIA vWD is a heterogeneous disorder in which absence of largest and intermediate multimers is an in vivo phenomenon.

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