Intron-22-inversion patients express the entire Factor VIII (FVIII)-amino-acid sequence intracell... more Intron-22-inversion patients express the entire Factor VIII (FVIII)-amino-acid sequence intracellularly as 2 non-secreted polypeptides and have a positive "intracellular (I)-FVIII-CRM" status. Mutations conferring a positive I-FVIII-CRM status are associated with low inhibitor risk and are pharmacogenetically relevant because inhibitor risk may be affected by the nature of the therapeutic FVIII-protein (tFVIII), the affinity of any tFVIII-derived foreign peptide (tFVIII-fp) for any HLA class-II isomer (HLA-II) comprising individual major histocompatibility complex (MHC) repertoires, and the stability of any tFVIII-fp/HLA-II complex. We hypothesize that mutations conferring a completely or substantially negative I-FVIII-CRM status are pharmacogenetically irrelevant because inhibitor risk is high with any tFVIII and individual MHC repertoire.
The Registry was created in 1997 by Meirione Costa e Silva of Brasilia and Dr. Kasper for the Int... more The Registry was created in 1997 by Meirione Costa e Silva of Brasilia and Dr. Kasper for the International Society on Thrombosis and Haemostasis. Its purpose is to help medical personnel identify available concentrates and stay abreast of pharmaceutical company changes. This year, Mark Brooker, Public Policy Officer of WFH, helped update it.
Earlier studies with factor 1 X~~~~k~~l. i~~~~ (IXB~LE), a nonfunctional variant of factor IX, su... more Earlier studies with factor 1 X~~~~k~~l. i~~~~ (IXB~LE), a nonfunctional variant of factor IX, suggested that the defect in this protein may reside in the catalytic domain of the molecule (Usharani, P., Warn-Cramer, B. J., Kasper, C. K., and Bajaj, S. P. (1985) J. CZin. Invest. 75, 76-83). In this report, genomic DNA fragments from normal IX and IXBmLE alleles were cloned into phage xEMBL3 and the recombinant phage identified using normal IX cDNA and synthetic oligonucleotides. Exons VI, VII, and VI11 of normal IX and IXB~LE gene were also amplified using a newly developed primerdirected polymerase chain reaction method. All eight exons and flanking regions of the normal IX and IXB~LE gene were sequenced by the dideoxy chain termination method. Comparison of the normal IX and IXB~LY: sequences revealed a single base substitution (C 4 T) in the exon VI11 of the BmLE variant, which results in the replacement of Ala3" by Val in the variant molecule. Although this mutation is in the catalytic domain of the molecule, purified factor IXaBmLE is indistinguishable from normal IXa in its activity toward a small synthetic substrate, L-tosylarginine methyl ester. These data, coupled with the previous data, identify a region (around residue 390) in the normal factor IXa which appears to play a major role in the extended macromolecular substrate binding site.
Factor IX is a multidomain protein essential for hemostasis. We describe a mutation in a patient ... more Factor IX is a multidomain protein essential for hemostasis. We describe a mutation in a patient affecting the first epidermal growth factor (EGF)-like domain of the protein. All exons and the promoter region of the gene were amplified by the polymerase chain reaction method, and sequenced. Only a single mutation (C----G), that predicts the substitution of Pro55 by Ala in the first EGF domain was found in the…
We gave danazol (600 mg/day orally for 14 days) to eight adults with mild or moderate hemophilia ... more We gave danazol (600 mg/day orally for 14 days) to eight adults with mild or moderate hemophilia A, one with severe hemophilia A, and one with moderate hemophilia B. In the patient with severe hemophilia A, the levels of factor VIII two to four days after an infusion of factor VIII concentrate were higher than expected, suggesting a prolonged half- life. In one patient with mild hemophilia A, a questionable slight increase in factor VIII was noted at the end of the study. No change was seen in factor levels of other subjects. Therapy was terminated early, at eight days, in a patient who developed severe muscle cramps, and at ten days in a patient with a severe rash. Another patient developed hepatic dysfunction three days after completing the 14-day trial. In this trial, the side effects of danazol outweighed its meager and questionable benefits.
We utilized a kaolin-activated partial thromboplastin time (APTT) using rabbit brain phospholipid... more We utilized a kaolin-activated partial thromboplastin time (APTT) using rabbit brain phospholipid, in which the capacity of a fourfold increased “high” phospholipid concentration (PC) to normalize the abnormal “standard” PC-APTT in patients with lupus anticoagulants is assessed. This system was also used to measure factors VIIIC, IX, and XI. The tissue thromboplastin inhibition test (TTI), a prothrombin time system in which the activity of a lupus anticoagulant is unmasked by the use of dilute thromboplastin, was simultaneously evaluated. Test sensitivity was defined by results on 31 consecutive patients with standard PC-APTT inhibitors and no bleeding tendency. Specificity was based on 94 patients with various other coagulopathies, including coagulation factor inhibitors, severe congenital factor deficiencies, hepatic insufficiency, and warfarin and heparin treatment. Twenty-one patients with lupus erythematosus and standard PC-APTT results within normal limits were also tested. Se...
SummaryFactor XI deficiency is an uncommon bleeding disorder usually manifested by excessive blee... more SummaryFactor XI deficiency is an uncommon bleeding disorder usually manifested by excessive bleeding after surgery or trauma. Until recently the only effective therapy has been fresh-frozen plasma (FFP) infusion. We describe the efficacy and safety of a new factor XI concentrate produced from human donor plasma by a modification of the method used for antithrombin III concentrate. The mean recovery of factor XI in the circulation measured on 62 occasions was approximately 91% of the injected dose, and the mean half-disappearance-time was 52 h. The concentrate was used for 31 invasive procedures in 30 patients, including 16 patients who had a definite bleeding tendency on previous occasions, with normal haemostasis being achieved in all but 1. Only 1 patient (previously experiencing allergy to FFP) experienced adverse effects during infusion. Monitoring of liver function tests and viral antibody status in suitable patients has shown no evidence of transmission of hepatitis viruses, ...
Variations of the partial thromboplastin time (PTT) were tested to determine the best screening m... more Variations of the partial thromboplastin time (PTT) were tested to determine the best screening method for detection of inhibitors of factor VIII. Variables tested included the duration of preincubation of a mixture of patient plasma and factor VIII source (normal plasma), the ratio of the patient plasma to the normal plasma, and the duration of incubation of the normal plasma-patient plasma mixture with kaolin- cephalin suspension prior to recalcification. The following conclusions were reached: (1) The PTT performed on a mixture of equal amounts of patient and normal plasma without preincubation of the mixture was inadequate to detect many factor VIII inhibitors. (2) Factor VIII inhibitors of more than 0.5 Bethesda units could be detected if the PTT was performed on a mixture of four parts patient plasma and one part normal plasma, with preincubation of the mixture for 60 min at 37 degrees C. (3) Factor VIII inhibitors as weak as 0.1 Bethesda units could be detected if the PTT was...
Previously, from the plasma of unrelated haemophilia-B patients, we isolated two non-functional F... more Previously, from the plasma of unrelated haemophilia-B patients, we isolated two non-functional Factor IX variants, namely Los Angeles (IXLA) and Long Beach (IXLB). Both variants could be cleaved to yield Factor IXa-like molecules, but were defective in catalysing the cleavage of Factor X (macromolecular substrate) and in binding to antithrombin III (macromolecular inhibitor). In the present study we have identified the mutation of IXLA by amplifying the exons (including flanking regions) as well as the 5′ end of the gene by polymerase-chain-reaction (PCR) method and sequencing the amplified DNA by the dideoxy chain-termination method. Comparison of the normal IX and IXLA sequences revealed only one base substitution (T----C) in exon VIII of IXLA, with a predicted replacement of Ile-397 to Thr in the mature protein. This mutation is the same as found recently for IXLB. The observation that IXLB and IXLA have the same mutation is an unexpected finding, since, on the basis of their ox...
A concentrate containing plasma clotting factors II, VII, IX and X was used to secure hemostasis ... more A concentrate containing plasma clotting factors II, VII, IX and X was used to secure hemostasis for a herniorrhaphy, an osteotomy of a femur, a cup arthroplasty of a hip, and a tonsillectomy in patients with factor IX deficiency. After single infusions of concentrate, the net increase in plasma factor IX activity was 0.7 to 1.0 percent for each in-vitro unit of factor IX infused per kilogram of body weight. After large infusions of concentrate in two patients, the disappearance pattern of factor IX had two phases: a first component with half-disappearance times of 4.4 and 6 hours, and a second component with half-disappearance times of 26 and 32.6 hours.
Page 1. Session 1 : Epidemiology Vox Sang 1994;67(suppl 1):24-28 James W. Mosley a Marek J. Nowic... more Page 1. Session 1 : Epidemiology Vox Sang 1994;67(suppl 1):24-28 James W. Mosley a Marek J. Nowickia Carol K Kaspera Elizabeth Donegan Louis M. Aledort Margaret W. Hilgartnerd Eva A. Operskalskia The Transfusion Safety Study Groupe ...
In view of the physical as well as biochemical heterogeneity of the subcellular particles of poly... more In view of the physical as well as biochemical heterogeneity of the subcellular particles of polymorphonuclear leukocytes, we examined other cells under identical conditions to compare the distributions of particles and the associated enzyme activities. As shown in Fig. 3, the particles comparable to peak III particles of polymorphonuclear leukocytes were entirely absent from macrophages and liver cells. However, peaks physically comparable to peak II of the polymorphonuclear particles were found in both macrophage and liver cell homogenates. The unstimulated normal lung macrophages and BCG-stimulated macrophages showed practically similar distribution patterns.
Proceedings of the National Academy of Sciences, 1991
In this report, we describe an approach to detect the presence of abnormal alleles in those genet... more In this report, we describe an approach to detect the presence of abnormal alleles in those genetic diseases in which frequency of occurrence of the same mutation is high (e.g., cystic fibrosis and sickle cell disease), and in others in which multiple mutations cause the disease and the sequence variation in an affected member of a given family is known (e.g., hemophilia B). Initially, from each subject, the DNA fragment containing the putative mutation site is amplified by the polymerase chain reaction. For each fragment two reaction mixtures are then prepared. Each contains the amplified fragment, a primer (18-mer or longer) whose sequence is identical to the coding sequence of the normal gene immediately flanking the 5' end of the mutation site, and either an alpha-32P-labeled nucleotide corresponding to the normal coding sequence at the mutation site or an alpha-32P-labeled nucleotide corresponding to the mutant sequence. Single nucleotide primer extensions are then carried ...
Proceedings of the National Academy of Sciences, 1985
Epitopes for 22 alloantibodies that inhibit factor VIII procoagulant protein (FVIII) from multitr... more Epitopes for 22 alloantibodies that inhibit factor VIII procoagulant protein (FVIII) from multitransfused individuals with severe hemophilia A and three autoantibodies from nonhemophilic individuals appeared to be restricted to two specific regions of the FVIII molecule. Immunoblotting of purified FVIII and purified thrombin-degraded FVIII, followed by reaction with inhibitor plasma samples, monoclonal anti-human IgG3 and IgG4 antibodies, and radiolabeled affinity-purified rabbit anti-mouse IgG, revealed that inhibitor epitopes could be localized to the Mr 72,000 and Mr 44,000 thrombin fragments of FVIII. These two chains are located at the carboxyl terminus and near the amino terminus of the FVIII molecule, respectively. The pattern of reactivity of the inhibitor alloantibodies could be divided into three types: 10 reacted with the Mr 72,000 chain, 3 reacted with the Mr 44,000 chain, and 9 reacted with both of these chains. Among the 3 inhibitor autoantibodies, 1 of each type was f...
Intron-22-inversion patients express the entire Factor VIII (FVIII)-amino-acid sequence intracell... more Intron-22-inversion patients express the entire Factor VIII (FVIII)-amino-acid sequence intracellularly as 2 non-secreted polypeptides and have a positive "intracellular (I)-FVIII-CRM" status. Mutations conferring a positive I-FVIII-CRM status are associated with low inhibitor risk and are pharmacogenetically relevant because inhibitor risk may be affected by the nature of the therapeutic FVIII-protein (tFVIII), the affinity of any tFVIII-derived foreign peptide (tFVIII-fp) for any HLA class-II isomer (HLA-II) comprising individual major histocompatibility complex (MHC) repertoires, and the stability of any tFVIII-fp/HLA-II complex. We hypothesize that mutations conferring a completely or substantially negative I-FVIII-CRM status are pharmacogenetically irrelevant because inhibitor risk is high with any tFVIII and individual MHC repertoire.
The Registry was created in 1997 by Meirione Costa e Silva of Brasilia and Dr. Kasper for the Int... more The Registry was created in 1997 by Meirione Costa e Silva of Brasilia and Dr. Kasper for the International Society on Thrombosis and Haemostasis. Its purpose is to help medical personnel identify available concentrates and stay abreast of pharmaceutical company changes. This year, Mark Brooker, Public Policy Officer of WFH, helped update it.
Earlier studies with factor 1 X~~~~k~~l. i~~~~ (IXB~LE), a nonfunctional variant of factor IX, su... more Earlier studies with factor 1 X~~~~k~~l. i~~~~ (IXB~LE), a nonfunctional variant of factor IX, suggested that the defect in this protein may reside in the catalytic domain of the molecule (Usharani, P., Warn-Cramer, B. J., Kasper, C. K., and Bajaj, S. P. (1985) J. CZin. Invest. 75, 76-83). In this report, genomic DNA fragments from normal IX and IXBmLE alleles were cloned into phage xEMBL3 and the recombinant phage identified using normal IX cDNA and synthetic oligonucleotides. Exons VI, VII, and VI11 of normal IX and IXB~LE gene were also amplified using a newly developed primerdirected polymerase chain reaction method. All eight exons and flanking regions of the normal IX and IXB~LE gene were sequenced by the dideoxy chain termination method. Comparison of the normal IX and IXB~LY: sequences revealed a single base substitution (C 4 T) in the exon VI11 of the BmLE variant, which results in the replacement of Ala3" by Val in the variant molecule. Although this mutation is in the catalytic domain of the molecule, purified factor IXaBmLE is indistinguishable from normal IXa in its activity toward a small synthetic substrate, L-tosylarginine methyl ester. These data, coupled with the previous data, identify a region (around residue 390) in the normal factor IXa which appears to play a major role in the extended macromolecular substrate binding site.
Factor IX is a multidomain protein essential for hemostasis. We describe a mutation in a patient ... more Factor IX is a multidomain protein essential for hemostasis. We describe a mutation in a patient affecting the first epidermal growth factor (EGF)-like domain of the protein. All exons and the promoter region of the gene were amplified by the polymerase chain reaction method, and sequenced. Only a single mutation (C----G), that predicts the substitution of Pro55 by Ala in the first EGF domain was found in the…
We gave danazol (600 mg/day orally for 14 days) to eight adults with mild or moderate hemophilia ... more We gave danazol (600 mg/day orally for 14 days) to eight adults with mild or moderate hemophilia A, one with severe hemophilia A, and one with moderate hemophilia B. In the patient with severe hemophilia A, the levels of factor VIII two to four days after an infusion of factor VIII concentrate were higher than expected, suggesting a prolonged half- life. In one patient with mild hemophilia A, a questionable slight increase in factor VIII was noted at the end of the study. No change was seen in factor levels of other subjects. Therapy was terminated early, at eight days, in a patient who developed severe muscle cramps, and at ten days in a patient with a severe rash. Another patient developed hepatic dysfunction three days after completing the 14-day trial. In this trial, the side effects of danazol outweighed its meager and questionable benefits.
We utilized a kaolin-activated partial thromboplastin time (APTT) using rabbit brain phospholipid... more We utilized a kaolin-activated partial thromboplastin time (APTT) using rabbit brain phospholipid, in which the capacity of a fourfold increased “high” phospholipid concentration (PC) to normalize the abnormal “standard” PC-APTT in patients with lupus anticoagulants is assessed. This system was also used to measure factors VIIIC, IX, and XI. The tissue thromboplastin inhibition test (TTI), a prothrombin time system in which the activity of a lupus anticoagulant is unmasked by the use of dilute thromboplastin, was simultaneously evaluated. Test sensitivity was defined by results on 31 consecutive patients with standard PC-APTT inhibitors and no bleeding tendency. Specificity was based on 94 patients with various other coagulopathies, including coagulation factor inhibitors, severe congenital factor deficiencies, hepatic insufficiency, and warfarin and heparin treatment. Twenty-one patients with lupus erythematosus and standard PC-APTT results within normal limits were also tested. Se...
SummaryFactor XI deficiency is an uncommon bleeding disorder usually manifested by excessive blee... more SummaryFactor XI deficiency is an uncommon bleeding disorder usually manifested by excessive bleeding after surgery or trauma. Until recently the only effective therapy has been fresh-frozen plasma (FFP) infusion. We describe the efficacy and safety of a new factor XI concentrate produced from human donor plasma by a modification of the method used for antithrombin III concentrate. The mean recovery of factor XI in the circulation measured on 62 occasions was approximately 91% of the injected dose, and the mean half-disappearance-time was 52 h. The concentrate was used for 31 invasive procedures in 30 patients, including 16 patients who had a definite bleeding tendency on previous occasions, with normal haemostasis being achieved in all but 1. Only 1 patient (previously experiencing allergy to FFP) experienced adverse effects during infusion. Monitoring of liver function tests and viral antibody status in suitable patients has shown no evidence of transmission of hepatitis viruses, ...
Variations of the partial thromboplastin time (PTT) were tested to determine the best screening m... more Variations of the partial thromboplastin time (PTT) were tested to determine the best screening method for detection of inhibitors of factor VIII. Variables tested included the duration of preincubation of a mixture of patient plasma and factor VIII source (normal plasma), the ratio of the patient plasma to the normal plasma, and the duration of incubation of the normal plasma-patient plasma mixture with kaolin- cephalin suspension prior to recalcification. The following conclusions were reached: (1) The PTT performed on a mixture of equal amounts of patient and normal plasma without preincubation of the mixture was inadequate to detect many factor VIII inhibitors. (2) Factor VIII inhibitors of more than 0.5 Bethesda units could be detected if the PTT was performed on a mixture of four parts patient plasma and one part normal plasma, with preincubation of the mixture for 60 min at 37 degrees C. (3) Factor VIII inhibitors as weak as 0.1 Bethesda units could be detected if the PTT was...
Previously, from the plasma of unrelated haemophilia-B patients, we isolated two non-functional F... more Previously, from the plasma of unrelated haemophilia-B patients, we isolated two non-functional Factor IX variants, namely Los Angeles (IXLA) and Long Beach (IXLB). Both variants could be cleaved to yield Factor IXa-like molecules, but were defective in catalysing the cleavage of Factor X (macromolecular substrate) and in binding to antithrombin III (macromolecular inhibitor). In the present study we have identified the mutation of IXLA by amplifying the exons (including flanking regions) as well as the 5′ end of the gene by polymerase-chain-reaction (PCR) method and sequencing the amplified DNA by the dideoxy chain-termination method. Comparison of the normal IX and IXLA sequences revealed only one base substitution (T----C) in exon VIII of IXLA, with a predicted replacement of Ile-397 to Thr in the mature protein. This mutation is the same as found recently for IXLB. The observation that IXLB and IXLA have the same mutation is an unexpected finding, since, on the basis of their ox...
A concentrate containing plasma clotting factors II, VII, IX and X was used to secure hemostasis ... more A concentrate containing plasma clotting factors II, VII, IX and X was used to secure hemostasis for a herniorrhaphy, an osteotomy of a femur, a cup arthroplasty of a hip, and a tonsillectomy in patients with factor IX deficiency. After single infusions of concentrate, the net increase in plasma factor IX activity was 0.7 to 1.0 percent for each in-vitro unit of factor IX infused per kilogram of body weight. After large infusions of concentrate in two patients, the disappearance pattern of factor IX had two phases: a first component with half-disappearance times of 4.4 and 6 hours, and a second component with half-disappearance times of 26 and 32.6 hours.
Page 1. Session 1 : Epidemiology Vox Sang 1994;67(suppl 1):24-28 James W. Mosley a Marek J. Nowic... more Page 1. Session 1 : Epidemiology Vox Sang 1994;67(suppl 1):24-28 James W. Mosley a Marek J. Nowickia Carol K Kaspera Elizabeth Donegan Louis M. Aledort Margaret W. Hilgartnerd Eva A. Operskalskia The Transfusion Safety Study Groupe ...
In view of the physical as well as biochemical heterogeneity of the subcellular particles of poly... more In view of the physical as well as biochemical heterogeneity of the subcellular particles of polymorphonuclear leukocytes, we examined other cells under identical conditions to compare the distributions of particles and the associated enzyme activities. As shown in Fig. 3, the particles comparable to peak III particles of polymorphonuclear leukocytes were entirely absent from macrophages and liver cells. However, peaks physically comparable to peak II of the polymorphonuclear particles were found in both macrophage and liver cell homogenates. The unstimulated normal lung macrophages and BCG-stimulated macrophages showed practically similar distribution patterns.
Proceedings of the National Academy of Sciences, 1991
In this report, we describe an approach to detect the presence of abnormal alleles in those genet... more In this report, we describe an approach to detect the presence of abnormal alleles in those genetic diseases in which frequency of occurrence of the same mutation is high (e.g., cystic fibrosis and sickle cell disease), and in others in which multiple mutations cause the disease and the sequence variation in an affected member of a given family is known (e.g., hemophilia B). Initially, from each subject, the DNA fragment containing the putative mutation site is amplified by the polymerase chain reaction. For each fragment two reaction mixtures are then prepared. Each contains the amplified fragment, a primer (18-mer or longer) whose sequence is identical to the coding sequence of the normal gene immediately flanking the 5' end of the mutation site, and either an alpha-32P-labeled nucleotide corresponding to the normal coding sequence at the mutation site or an alpha-32P-labeled nucleotide corresponding to the mutant sequence. Single nucleotide primer extensions are then carried ...
Proceedings of the National Academy of Sciences, 1985
Epitopes for 22 alloantibodies that inhibit factor VIII procoagulant protein (FVIII) from multitr... more Epitopes for 22 alloantibodies that inhibit factor VIII procoagulant protein (FVIII) from multitransfused individuals with severe hemophilia A and three autoantibodies from nonhemophilic individuals appeared to be restricted to two specific regions of the FVIII molecule. Immunoblotting of purified FVIII and purified thrombin-degraded FVIII, followed by reaction with inhibitor plasma samples, monoclonal anti-human IgG3 and IgG4 antibodies, and radiolabeled affinity-purified rabbit anti-mouse IgG, revealed that inhibitor epitopes could be localized to the Mr 72,000 and Mr 44,000 thrombin fragments of FVIII. These two chains are located at the carboxyl terminus and near the amino terminus of the FVIII molecule, respectively. The pattern of reactivity of the inhibitor alloantibodies could be divided into three types: 10 reacted with the Mr 72,000 chain, 3 reacted with the Mr 44,000 chain, and 9 reacted with both of these chains. Among the 3 inhibitor autoantibodies, 1 of each type was f...
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