接触系统生物学意义的再认识

目前,凝血学说发放发生了概念性改变,认为体风凝血过程分为两个阶段?组织因子途径凝血过程的启动,以因子Ⅸ（ＦⅨ）为起点的内在途径凝血过程的放大,而接触系统并不参与体内凝血过程。已有资料表明,接触系统是一个重要的血管生物学调制 主要作用包括调整血管紧张度、抑制血小板活化、促进纤溶、抑制粘附以及促进炎病等。它的改变与败血症、血栓性疾病等病变过程密切相关。     

溃疡性结肠炎对凝血-纤溶系统激活现象的探讨

目的:通过对活动期和缓解期溃疡性结肠炎(UC)患者凝血和纤溶系统各指标的检测和对比,探讨肠炎对凝血-纤溶系统的激活作用。方法:以20名缓解期溃疡性结肠炎患者为对照,检测20名活动期溃疡性结肠炎患者体内凝血和纤溶系统各指标,包括血小板计数、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、凝血因子Ⅻ、Ⅺ、Ⅹ、Ⅸ、Ⅷ、Ⅶ、Ⅴ、Ⅱ,纤维蛋白原和D二聚体(D-D)。结果:活动期溃疡性结肠炎患者体内凝血因子Ⅺ、Ⅹ、Ⅸ、Ⅷ、Ⅴ、Ⅱ因子以及血浆纤维蛋白原、D-二聚体水平显著高于非活动期患者,其他指标没有显著差别。结论:活动期溃疡性结肠炎患者凝血-纤溶系统处于激活状态,提示肠炎可以激活凝血-纤溶系统。     

新鲜冰冻血浆的凝血活性

本文从基础理论上介绍了FFP的凝血活性。但应注意在临床治疗上,对于甲型及乙型血友病患者,最好应分别采用行之有效的因子Ⅷ和因子Ⅸ复合物制剂.     

血小板功能负性调控机制

在血液循环系统中,血小板在抑制因子的作用下,处于静息状态。当机体出血或外界因素刺激时,血小板活化,产生聚集、黏附和释放反应,释放出二磷酸腺苷(ADP)、花生四烯酸(AA)、血小板活化因子和5-羟色胺等物质,招募更多的血小板黏附于出血处,从而启动凝血过程,发挥止血作用。当止血反应完成后,血小板发生解聚,恢复到静息状态。然而,在病理条件下,血小板的内在解聚能力下降,形成过度活化的血小板,产生病理性血栓,导致急性缺血性心血管疾病的发生。临床使用抗血小板药物控制血小板的活化,治疗急性缺血性心血管疾病。然而,目前临床上常用的抗血小板药物发挥抗血小板活化作用的同时,影响了血小板正常的生理性止血作用,产生出血等副作用。因此,我们需要研发新型抗血小板药物,使其既能发挥抗血小板作用,又能减少出血等副作用。本文将对血小板负性调控机制进行综述,为进一步研究抗血小板药物提供思路。     

牛β-酪蛋白基因控制的人凝血Ⅸ因子基因在小鼠乳腺组织中的表达调控

构建牛β 酪蛋白基因控制的人凝血Ⅸ因子 (hFⅨ )乳腺组织特异性表达载体pCⅨm,pCiⅨ ,pCⅨ和报告基因 (LacZ)乳腺表达载体 pCiLacZ ,pCLacZ ,利用Stearylamine(SA)阳离子脂质体包埋 5种载体 ,通过尾静脉注射的方法直接转染哺乳期母鼠的活体组织 .在DNA ,mRNA以及蛋白质水平对实验小鼠的检测结果表明 :转染处理后hFⅨ基因和LacZ基因在小鼠乳腺获得表达 ,hFⅨ蛋白在乳汁中的最高分泌表达量为 80 .2 8ng/mL ,其中 85 %以上已经羧基化并具有生物学活性 ;对 5种载体表达调控的研究证实牛β_酪蛋白基因 5′端 2 .0kb的片段能够驱动人凝血Ⅸ因子基因在小鼠乳腺组织中分泌表达 ,β_酪蛋白基因内含子 1能够提高Ⅸ因子基因在乳腺组织中的表达水平 ,并能影响该基因表达的组织特异性 ;和hFⅨcDNA相比 ,hFⅨ基因自身的内含子 1能够提高该基因在活体乳腺组织中的表达水平 3倍以上     

人体抗血友病因子Ⅸ的分子克隆

因子Ⅸ的功能性缺陷能导致一种称为Chrstimas病或血友病B的出血失常症,这种因子Ⅸ是血液凝决中的凝集因子之一。血友病B和A(因子Ⅷ(C)缺陷)都是Ⅹ染色体连锁的,在男性中大约以一万分之一的频率而出现。血友病B中,因子Ⅸ的功能性改变的分子基础尚不太清楚。     

人凝血Ⅸ因子cDNA在培养细胞中和转基因小鼠内的表达特性

将由ＳＶ４０早期启动子和小鼠金属硫蛋白基因启动子所控制的人凝血Ⅸ因子ｃＤＮＡ的重组基因分别导入培养的小鼠成纤维细胞,发现它们都能被表达。进而将它们分别导入小鼠受精卵雄原核,作成相应的转基因小鼠,则发现它们都失去了表达特性,结果分析表明,在人凝血Ⅸ因子ｃＤＮＡ中可能存在着决定其在活体内表达的顺式调节元件。     

重组腺相关病毒(rAAV)介导的人凝血因子Ⅸ高活性突变衍生物在血友病B基因治疗研究中的应用

采用定点诱变技术, 将R338A点突变引入人凝血因子Ⅸ基因, 并构建于AAV载体上, 以rHSV/AAV杂合辅助病毒系统介导制备rAAV-hFIX重组病毒, 然后, 经肌肉注射对血友病B小鼠进行治疗实验, 观察该突变基因在小鼠体内的表达、活性以及机体对该突变衍生物的免疫反应与治疗效果. 结果显示: (i)治疗小鼠体内可检测到hFIX-R338A突变衍生物的存在, 并持续15周以上; (ii)突变衍生物hFIX-R338A在小鼠血浆中的凝血活性达(34.2±5.23)%, 显著高于野生型Ⅸ因子凝血活性((14.27±3.4)%); (iii)治疗小鼠体内未检测到抗Ⅸ因子突变衍生物抗体的存在; (iv)未发现与治疗相关的局部及全身性毒副作用. 提示: 以AAV介导人凝血因子Ⅸ高活性突变衍生物hFIX-R338A基因治疗可能成为替代野生型Ⅸ因子进行血友病B基因治疗的一个更为有效的途径.     

双耳条件下超前声对人分辨滞后声强度的影响

在复杂声环境中,对声音强度的分辨是听觉系统对声音信号精确处理的重要功能之一.到目前为止,有关人对声音强度分辨的研究都是在单耳条件下进行的,然而,正常条件下人都是利用双耳感知强度和方位变化的声音.以人对声刺激强度的最小可察觉差异(just noticeable difference,JND)为强度分辨阈值的指标,观察双耳条件下超前声对人分辨滞后声强度的影响.实验在封闭声场中进行,声刺激强度和空间方位的控制是通过改变双耳平均声压(average binaural level,ABL)和双耳声压差(interaural level difference,ILD)来模拟的.实验结果表明,与安静条件下人对声刺激强度的分辨阈值相比,低强度的超前声对人分辨滞后声强度的阈值无显著影响,而中等及以上强度(ABL大于或等于40 dB)的超前声可提高人分辨滞后声强度的阈值,阈值的提高随超前声强度的增加呈单调增大的趋势.当超前声强度一定时,超前声对人分辨滞后声强度的影响随滞后声强度的增加而衰减,对分辨较高强度的滞后声的阈值影响不显著,该结果与单耳的研究结果有明显差异.实验未发现超前声和滞后声ILD的相对改变对人探测滞后声强度变化的阈值有显著影响.     

重组腺相关病毒(rAAV)介导的人凝血因子IX高活性突变衍生物在血友病B基因治疗研究中的应用

采用定点诱变技术,将R338A点突变引入人凝血因子Ⅸ基因,并构建于AAV载体上,以rHSV/AAV杂合辅助病毒系统介导制备rAAV-hFIX重组病毒,然后,经肌肉注射对血友病B小鼠进行治疗实验,观察该突变基因在小鼠体内的表达、活性以及机体对该突变衍生物的免疫反应与治疗效果.结果显示:(i)治疗小鼠体内可检测到hFIX-R338A突变衍生物的存在,并持续15周以上;(ii)突变衍生物hFIX-R338A在小鼠血浆中的凝血活性达(34.2±5.23)%,显著高于野生型Ⅸ因子凝血活性((14.27±3.4)%);(iii)治疗小鼠体内未检测到抗Ⅸ因子突变衍生物抗体的存在;(iv)未发现与治疗相关的局部及全身性毒副作用.提示:以AAV介导人凝血因子Ⅸ高活性突变衍生物hFLX-R338A基因治疗可能成为替代野生型Ⅸ因子进行血友病B基因治疗的一个更为有效的途径.     

Blood clot formation under flow: the importance of factor XI depends strongly on platelet count

A previously validated mathematical model of intravascular platelet deposition and tissue factor (TF)-initiated coagulation under flow is extended and used to assess the influence on thrombin production of the activation of factor XI (fXI) by thrombin and of the activation of factor IX (fIX) by fXIa. It is found that the importance of the thrombin-fXIa-fIXa feedback loop to robust thrombin production depends on the concentration of platelets in the blood near the injury. At a near-wall platelet concentration of ~250,000/μL, typical in vessels in which the shear rate is <200 s(-1), thrombin activation of fXI makes a significant difference only at low densities of exposed TF. If the near-wall platelet concentration is significantly higher than this, either because of a higher systemic platelet count or because of the redistribution of platelets toward the vessel walls at high shear rates, then thrombin activation of fXI makes a major difference even for relatively high densities of exposed TF. The model predicts that the effect of a severe fXI deficiency depends on the platelet count, and that fXI becomes more important at high platelet counts.     

Inhibition of platelet-surface-bound proteins during coagulation under flow I: TFPI

Blood coagulation is a self-repair process regulated by activated platelet surfaces, clotting factors, and inhibitors. Tissue factor pathway inhibitor (TFPI) is one such inhibitor, well known for its inhibitory action on the active enzyme complex comprising tissue factor (TF) and activated clotting factor VII. This complex forms when TF embedded in the blood vessel wall is exposed by injury and initiates coagulation. A different role for TFPI, independent of TF:VIIa, has recently been discovered whereby TFPI binds a partially cleaved form of clotting factor V (FV-h) and impedes thrombin generation on activated platelet surfaces. We hypothesized that this TF-independent inhibitory mechanism on platelet surfaces would be a more effective platform for TFPI than the TF-dependent one. We examined the effects of this mechanism on thrombin generation by including the relevant biochemical reactions into our previously validated mathematical model. Additionally, we included the ability of TFPI to bind directly to and inhibit platelet-bound FXa. The new model was sensitive to TFPI levels and, under some conditions, TFPI could completely shut down thrombin generation. This sensitivity was due entirely to the surface-mediated inhibitory reactions. The addition of the new TFPI reactions increased the threshold level of TF needed to elicit a strong thrombin response under flow, but the concentration of thrombin achieved, if there was a response, was unchanged. Interestingly, we found that direct binding of TFPI to platelet-bound FXa had a greater anticoagulant effect than did TFPI binding to FV-h alone, but that the greatest effects occurred if both reactions were at play. The model includes activated platelets’ release of FV species, and we explored the impact of varying the FV/FV-h composition of the releasate. We found that reducing the zymogen FV fraction of this pool, and thus increasing the fraction that is FV-h, led to acceleration of thrombin generation.     

Surface-mediated control of blood coagulation: the role of binding site densities and platelet deposition

A mathematical model of the extrinsic or tissue factor (TF) pathway of blood coagulation is formulated and results from a computational study of its behavior are presented. The model takes into account plasma-phase and surface-bound enzymes and zymogens, coagulation inhibitors, and activated and unactivated platelets. It includes both plasma-phase and membrane-phase reactions, and accounts for chemical and cellular transport by flow and diffusion, albeit in a simplified manner by assuming the existence of a thin, well-mixed fluid layer, near the surface, whose thickness depends on flow. There are three main conclusions from these studies. (i) The model system responds in a threshold manner to changes in the availability of particular surface binding sites; an increase in TF binding sites, as would occur with vascular injury, changes the system's production of thrombin dramatically. (ii) The model suggests that platelets adhering to and covering the subendothelium, rather than chemical inhibitors, may play the dominant role in blocking the activity of the TF:VIIa enzyme complex. This, in turn, suggests that a role of the IXa-tenase pathway for activating factor X to Xa is to continue factor Xa production after platelets have covered the TF:VIIa complexes on the subendothelium. (iii) The model gives a kinetic explanation of the reduced thrombin production in hemophilias A and B.     

Influence of cysteine proteinase inhibitors on platelet and plasma components of blood coagulation system

Factor XIIIa plays an important role in stabilization of formed fibrin clot during blood coagulation. Recent studies proved that factor XIIIa affects formation of coated platelets, which are highly procoagulant and characterized by a high level of alpha-granular proteins on their surface and expose surface phosphatidylserine after platelet activation. The ability of newly found cysteine proteinase inhibitors (CPIs) from plants to affect thiol group of the factor XIIIa active centre was recently discovered. Here, the effect of CPIs on the formation of coated platelets and activity of plasma components during blood coagulation process was investigated. It was found that CPIs dose-dependently decreased the fraction of coated platelets in the total platelet population during platelet activation and decreased endogenous thrombin potential (ETP) by 40% for thrombin generation in platelet-rich as well as in platelet-poor plasma. Such decrease of ETP could not be explained by the CPIs influence on factor XIIIa. Investigation of the effects of these inhibitors on factor Xa and thrombin activity has shown that CPIs dose-dependently inhibited their activity and might cause an ETP decrease. Thus, the obtained data indicated that CPIs affected both platelet and plasma components of blood coagulation system.     

Spatial Distribution of Factor Xa,Thrombin, and Fibrin(ogen) on Thrombi at Venous Shear

Background

The generation of thrombin is a critical process in the formation of venous thrombi. In isolated plasma under static conditions, phosphatidylserine (PS)-exposing platelets support coagulation factor activation and thrombin generation; however, their role in supporting coagulation factor binding under shear conditions remains unclear. We sought to determine where activated factor X (FXa), (pro)thrombin, and fibrin(ogen) are localized in thrombi formed under venous shear.

Methodology/Principal Findings

Fluorescence microscopy was used to study the accumulation of platelets, FXa, (pro)thrombin, and fibrin(ogen) in thrombi formed in vitro and in vivo. Co-perfusion of human blood with tissue factor resulted in formation of visible fibrin at low, but not at high shear rate. At low shear, platelets demonstrated increased Ca²⁺ signaling and PS exposure, and supported binding of FXa and prothrombin. However, once cleaved, (pro)thrombin was observed on fibrin fibers, covering the whole thrombus. In vivo, wild-type mice were injected with fluorescently labeled coagulation factors and venous thrombus formation was monitored in mesenteric veins treated with FeCl₃. Thrombi formed in vivo consisted of platelet aggregates, focal spots of platelets binding FXa, and large areas binding (pro)thrombin and fibrin(ogen).

Conclusions/Significance

FXa bound in a punctate manner to thrombi under shear, while thrombin and fibrin(ogen) distributed ubiquitously over platelet-fibrin thrombi. During thrombus formation under venous shear, thrombin may relocate from focal sites of formation (on FXa-binding platelets) to dispersed sites of action (on fibrin fibers).     

Inhibition of platelet-surface-bound proteins during coagulation under flow II: Antithrombin and heparin

Blood coagulation is a self-repair process regulated by activated platelet surfaces, clotting factors, and inhibitors. Antithrombin (AT) is one such inhibitor that impedes coagulation by targeting and inactivating several key coagulation enzymes. The effect of AT is greatly enhanced in the presence of heparin, a common anticoagulant drug. When heparin binds to AT, it either bridges with the target enzyme or induces allosteric changes in AT leading to more favorable binding with the target enzyme. AT inhibition of fluid-phase enzymes caused little suppression of thrombin generation in our previous mathematical models of blood coagulation under flow. This is because in that model, flow itself was a greater inhibitor of the fluid-phase enzymes than AT. From clinical observations, it is clear that AT and heparin should have strong inhibitory effects on thrombin generation, and thus we hypothesized that AT could be inhibiting enzymes bound to activated platelet surfaces that are not subject to being washed away by flow. We extended our mathematical model to include the relevant reactions of AT inhibition at the activated platelet surfaces as well as those for unfractionated heparin and a low molecular weight heparin. Our results show that AT alone is only an effective inhibitor at low tissue factor densities, but in the presence of heparin, it can greatly alter, and in some cases shut down, thrombin generation. Additionally, we studied each target enzyme separately and found that inactivation of no single enzyme could substantially suppress thrombin generation.     

Blood Coagulation

The process of tissue factor initiated blood coagulation is discussed. Reactions of the blood coagulation cascade are propagated by complex enzymes containing a vitamin K-dependent serine protease and an accessory cofactor protein that are assembled on a membrane surface in a calcium-dependent manner.These complexes are 10⁵ 10⁹-fold more efficient in proteolyses of their natural substrates than enzymes alone. Based upon data acquired using several in vitro models of blood coagulation, tissue factor initiated thrombin generation can be divided into two phases: an initiation phase and a propagation phase. The initiation phase is characterized by the generation of nanomolar amounts of thrombin, femto- to picomolar amounts of factors VIIa, IXa, Xa, and XIa, partial activation of platelets, and almost quantitative activation of procofactors, factors V and VIII. The duration of this phase is primarily influenced by concentrations of tissue factor and TFPI. The characteristic features of the propagation phase are: almost quantitative prothrombin activation at a high rate, completion of platelet activation, and solid clot formation. This phase is primarily regulated by antithrombin III and the protein C system. Thrombin generation during the propagation phase is remarkably suppressed in the absence of factor VIII and IX (hemophilia A and B, respectively) and at platelet counts <5% of mean plasma concentration. The majority of data accumulated in in vitro models and discussed in this review are in good agreement with the results of in vivo observations.     

Activated platelets but not endothelial cells participate in the initiation of the consolidation phase of blood coagulation

To address the question of whether initiation of the consolidation phase of coagulation occurs on platelets or on endothelium, we have examined the interaction of coagulation factor XI with human umbilical vein endothelial cells (HUVEC) and with platelets. In microtiter wells factor XI binds to more sites in the absence of HUVEC (1.8 x 10(10) sites/well, K(D) = 2.6 nm) than in their presence (1.3 x 10(10) sites/well, K(D) = 12 nm) when high molecular weight kininogen (HK) and zinc are present. Binding was volume-dependent and abrogated by HUVEC or Chinese hamster ovary cells and was a function of nonspecific binding of HK to the artificial plastic surface. Factor XI did not bind to HUVEC or to HEK293 cell monolayers anchored to microcarrier beads. Activation of HUVEC resulted in von Willebrand's factor secretion, but factor XI binding was not observed. Only activated platelets supported factor XI binding in the presence of HK and zinc (K(D) = 8 nm, B(max) = 1319 sites/cell). Activation of factor XI was observed in plasma in the presence of platelets activated by the thrombin receptor activation peptide but not with activated HUVEC. These results support the concept that activated platelets, but not endothelial cells, expose a procoagulant surface for binding and activating factor XI, thereby initiating the consolidation phase of coagulation.     

Platelet activation as a marker for in vivo prothrombotic activity: detection by flow cytometry

Circulating platelets play a pivotal role in hemostasis. The platelet hemostatic function involves the direct interaction with damaged vessel walls, and circulating coagulation factors, primarily thrombin resulting in platelet activation, aggregation and formation of hemostatic plug. Flow cytometry is a useful technique for the study of platelet activation in circulating blood. Platelet activation markers for ex vivo analysis may include a) activation-dependent epitopes of the membrane glycoprotein (GP) IIb/IIIa (CD41a) receptor, as demonstrated by the binding of activation-specific monoclonal antibodies (MoAbs) PAC1, anti-LIBS1 and anti-RIBS); b) the expression of P-selectin (CD62p), the alpha-granule GP translocated to the platelet surface following release reaction; and c) platelet procoagulant activity, as demonstrated by the binding of i) annexin V protein to the prothrombinase-complex (prothrombin, activated factor X (Xa) and V (Va)) binding sites on the surface of activated platelets, and of ii) MoAbs against activated coagulation factors V and X bound to the surface of activated platelets. Using this method, platelet activation as a marker for in vivo prothrombotic activity can be demonstrated in various clinical conditions including coronary angioplasty, orthostatic challenge in primary depression, sickle cell disease in clinical remission and during pain episode, and in pregnancy-related hypertension with marked increase during preeclampsia. The finding of platelet procoagulant activity is corroborated by increased levels of plasma markers for thrombin generation and fibrinolytic activity.     

Coagulation proteases and human cancer

Tumours are capable of activating blood coagulation through the expression of procoagulant molecules such as tissue factor, cancer procoagulant and hepsin. Initiation of the clotting cascade results in the generation of the activated serine proteases factor VIIa, factor Xa and thrombin. These proteases act via protease-activated receptors and tissue factor to alter gene expression, thereby modulating tumour cell growth, invasion, metastasis and angiogenesis.