组织因子与肿瘤靶向治疗

组织因子(tissue factor,TF)是一种分子量为47kD的跨膜糖蛋白,作为凝血因子Ⅶ的受体启动外源性凝血过程。近年来,人们发现组织因子在肿瘤血管生成和肿瘤细胞转移过程中也发挥重要作用,并且在针对组织因子的肿瘤靶向的治疗方面取得了一些重要进展。     

组织因子功能的多样性

组织因子（TF）是一个分子量为47kD的跨膜糖蛋白。作为凝血因子FⅦ／FⅧa的受体在引发凝血中起着重要的作用。近几年陆续发现TF还在肿瘤血管形成,肿瘤迁移,信号转导,炎症,动脉粥样经及胚胎发育等方面都有一定作用。但其机制仍知之甚少。有些是TF与凝血因子FⅦ／FⅦa结合后继发的效应,有些则是非FⅦ依赖性的。本文就TF的这些功能做一综述,并初步探讨了其机制及相应的治疗策略。     

代谢性炎症在代谢综合征中的作用

代谢综合征(metabolic syndrome,MS)是由代谢紊乱引发的一系列病理状况,如肥胖、2型糖尿病、动脉粥样硬化和非酒精性脂肪性肝病等.研究表明,代谢性炎症与胰岛素抵抗有着密切而复杂的联系,在MS的发生与发展中起到重要的作用.针对代谢性炎症信号通路进行研究,可为代谢性疾病的防治提供新思路.该文综述了代谢性炎症...     

两种剂量阿托伐他汀治疗老年急性冠脉综合征的疗效及影响炎症、凝血因子的研究

目的:探讨两种剂量阿托伐他汀治疗老年急性冠脉综合征的疗效及对炎症、凝血因子的影响。方法:选择我院2010年1月~2012年12月收治的120例老年急性冠脉综合征患者作为观察对象,根据住院号随机分为观察组和对照组,每组均60例,两组患者均采用阿托伐他汀治疗,对照组予以10 mg/d,观察组予以20 mg/d,比较两组的临床效果以及炎症因子、凝血因子的变化。结果:治疗后,两组血脂达标率均显著提高,观察组治疗后1个月的血脂达标率为33.3%,治疗后3个月的血脂达标率为46.7%,均显著高于对照组的15.0%、23.3%,差异均具有统计学意义(均P0.05);治疗后1个月和3个月所有患者血浆CRP和TF均显著下降,观察组治疗后1个月和3个月CRP和TF水平均显著低于对照组,差异均具有显著性(均P0.05);观察组治疗后3个月TFPI水平显著高于对照组,差异具有统计学意义(P0.05)。结论:大剂量阿托伐他汀治疗老年急性冠脉综合征患者临床疗效优于小剂量,对炎症因子和凝血因子的影响有利于预后的改善,值得临床进一步推广应用。     

代谢综合征——一个值得研究的新课题

近年来代谢综合征(Metabolic Syndrome,MS)受到广泛重视,这不仅是因为其患病率高,危害性大,更重要的是MS为一个多学科问题,不仅涉及心血管、内分泌代谢和肾脏疾病,还与某些消化、妇产和儿科疾病有关。国外学对MS先后有不同命名,其中影响较大的有“X综合征”、“胰岛素抵抗综合征”、“心血管代谢紊乱综合征”及“死亡四重奏”等。1999年WHO和2001年美国国家胆固醇教育委员会成人治疗组(NCEP-ATPIII)统一将其命名为MS。     

三氧化二砷对急性早幼粒细胞白血病细胞微粒数量及促凝活性的影响

目的:观察急性早幼粒细胞白血病(APL)细胞来源微粒(APL-MP)的促凝活性、表面组织因子(TF)表达情况、TF在其促凝活性中发挥的作用及分化治疗药物三氧化二砷(ATO)对上述指标有何影响。方法:选取3例初发APL患者,提取骨髓APL细胞,3名缺铁性贫血患者提取骨髓单个核细胞作为对照。分别用不同浓度ATO处理APL细胞24 h、48 h、72 h,收集细胞培养液提取微粒。采用流式细胞术对微粒进行定量分析并进行微粒表面TF表达情况检测;利用凝血实验比较不同组细胞释放微粒的促凝血活性;应用抗TF抗体抑制微粒促凝血活性实验检测TF在APL-MP的促凝血活性中发挥多大作用。结果:1.0μM及2.0μM ATO能显著促进APL细胞释放微粒。与正常骨髓来源单个核细胞释放的微粒相比,骨髓APL-MP的TF表达及促凝活性均显著增高,0.5μM及1.0μM ATO处理可以有效降低APL-MP的TF表达及促凝活性,且这一作用呈时间依赖性。各组APL-MP经抗TF抗体孵育后凝血时间显著延长。结论:APL-MP的TF表达和促凝学活性均显著增高,并且TF在APL-MP的促凝血活性中发挥着重要作用。ATO能显著促进APL细胞释放微粒,低浓度ATO可以有效降低APL-MP的TF表达及促凝血活性。     

组织因子膜外区融合蛋白基因的表达及产物的分离纯化与活性分析

 为构建表达组织因子 (TF)膜外区的融合载体 ,制备组织因子膜外区 ,抽提人胎盘组织的总RNA,通过 RT- PCR法扩增出 TF的 c DNA克隆至 p UC1 8并测定全序列 .然后以此为模板 ,再次PCR扩增出 TF膜外区 (soluble TF,s TF) c DNA,并将其插入到谷胱甘肽巯基转移酶融合表达载体 p GEX4T- 1 ,构建了 tac启动子控制下的 GST- s TF融合蛋白的表达载体 .表达的融合蛋白经亲和层析、凝血酶切得到纯化的 s TF.表达产物经 ELISA验证 ,能特异性地与 TF抗体结合 .重新脂化后 ,该产物具有较大凝血活性 .以上说明采用融合蛋白表达系统可以大量制备组织因子膜外区 ,为研制国产重组凝血活酶试剂和研究 s TF的结构和功能创造条件 .     

BTF2／TFⅡH的多功能与PolⅡ转录

BTF2,又称TFⅡH,为一多亚基蛋白质复合物,具有解链酶、依赖DNA的ATP酶及磷酸激酶活性,参与mRNA转录起始以及与转录偶联的核苷酸切除修复过程,在转录起始复合物形成过程中,BTF2/TFⅡH在有TFⅡE存在时,可使RNA聚合酶Ⅱ的羧端区域(CTD)、TBP及有关转录因子磷酸化.磷酸化反应可影响转录起始复合物中的蛋白质-蛋白质相互作用,调节转录起始,因此,BTF2/TFⅡH是一种重要的基本转录因子.     

可溶性组织因子突变体的基因构建、表达和性质

血浆中组织因子 (TF)的过量表达与许多病理过程密切相关。TF抑制物有可能防治这些疾病。设计了两种可溶性组织因子 (sTF)的突变体 (MCsTF和MFsTF) ,突变了协同催化的功能域 ,保留与因子VII/VIIa结合的功能域 ,使突变体竞争性抑制野生型TF的功能。用PCR的方法 ,对可溶性组织因子cDNA基因进行了点突变 ,并实现了在大肠杆菌中高效表达。rsTF、rMCsTF和rMFsTF的促凝活性研究表明 ,rMFsTF的激活X因子活性和促凝血作用相当于rsTF的 10 % ,而rMCsTF几乎完全失去了激活X因子活性和促凝血作用。rMCsTF和rMFsTF与VII/VIIa因子形成复合物对激活X因子的催化特异常数 (kcat/Km)分别是FVII/VIIa·rsTF的 2 .0 %和 3.7% ,也说明突变体与VII/VIIa形成的复合物对激活X因子催化活性显著降低。rMCsTF和rMFsTF对rsTF活性抑制动力学研究及体外活性研究表明 ,两种突变体均有抑制rsTF活性和抑制兔脑粉的促凝活性作用 ,抑制作用呈量效关系     

凝血因子Ⅷ

人凝血因子Ⅷ(抗血友病因子)是凝血内部级联途径(intrinsic clottingcascade)中起重要作用的血浆糖蛋白。A型血友病或称古典血友病是由于不正常的凝血因子Ⅷ引起的,10万名男性中发病率约为10—20人。近十年来,人们关于凝血因子Ⅷ,特别是它的基因和蛋白分子结构方面的知识日益增加。这篇综述总结了人凝血因子Ⅷ的结构和基因的分子克隆以及血友病的遗传诊断及治疗方面的新进展。     

Phospholipid-independent and -dependent interactions required for tissue factor receptor and cofactor function

Membrane anchoring of tissue factor (TF), the cell receptor for coagulation factor VIIa (VIIa), exemplifies an effective mechanism to localize proteolysis at the cell surface. A recombinant TF mutant (TF1-219), deleted of membrane spanning and intracellular domains, was used to evaluate the role of phospholipid interactions for assembly of substrate with the catalytic TF.VIIa complex. TF1-219 was secreted by cells rather than expressed as a cell membrane protein. Unlike free VIIa, TF1-219 as well as the TF1-219.VIIa complex demonstrated no stable association with phospholipid. In the absence of lipid, kinetic evaluation of substrate factor X cleavage by free VIIa, TF.VIIa, and TF1-219.VIIa suggests that the catalytic function of VIIa rather than substrate recognition is enhanced by complex formation. Furthermore, compared with free factor X, factor X on phospholipid was preferentially cleaved as a substrate by TF1-219.VIIa. TF-dependent initiation of the coagulation protease cascades thus involves an enhancement of the activation of factor X on the cell surface by a crucial role of the TF transmembrane domain to membrane anchor the reaction, by the TF extracellular domain to provide protein-protein interactions with VIIa to enhance the activity of the catalytic domain of VIIa, and the preferential presentation of factor X as a substrate when associated with phospholipid surfaces.     

Role of zymogen and activated factor X as scaffolds for the inhibition of the blood coagulation factor VIIa-tissue factor complex by recombinant nematode anticoagulant protein c2

Recombinant nematode anticoagulant protein c2 (rNAPc2) is a potent, factor Xa (fXa)-dependent small protein inhibitor of factor VIIa-tissue factor (fVIIa.TF), which binds to a site on fXa that is distinct from the catalytic center (exo-site). In the present study, the role of other fX derivatives in presenting rNAPc2 to fVIIa.TF is investigated. Catalytically active and active site blocked fXa, as well as a plasma-derived and an activation-resistant mutant of zymogen fX bound to rNAPc2 with comparable affinities (K(D) = 1-10 nm), and similarly supported the inhibition of fVIIa.TF (K(i)* = approximately 10 pm). The roles of phospholipid membrane composition in the inhibition of fVIIa.TF by rNAPc2 were investigated using TF that was either detergent-solubilized (TF(S)), or reconstituted into membranes, containing phosphatidylcholine (TF(PC)) or a mixture of phosphatidylcholine and phosphatidylserine (TF(PCPS)). In the absence of the fX derivative, inhibition of fVIIa.TF was similar for all three conditions (K(i) approximately 1 microm), whereas the addition of the fX derivative increased the respective inhibition by 35-, 150-, or 100,000-fold for TF(S), TF(PC), and TF(PCPS). The removal of the gamma-carboxyglutamic acid-containing domain from the fX derivative did not affect the binding to rNAPc2, but abolished the effect of factor Xa as a scaffold for the inhibition of fVIIa.TF by rNAPc2. The overall anticoagulant potency of rNAPc2, therefore, results from a coordinated recognition of an exo-site on fX/fXa and of the active site of fVIIa, both of which are properly positioned in the ternary fVIIa.TF.fX(a) complex assembled on an appropriate phospholipid surface.     

Hinge bending within the cytokine receptor superfamily revealed by the 2.4 A crystal structure of the extracellular domain of rabbit tissue factor.

Tissue factor (TF), a member of the cytokine receptor superfamily, is the obligate cofactor of coagulation factor VIIa (FVIIa), and has a pivotal role in initiating the extrinsic pathway of blood coagulation through formation of the TF x FVIIa complex. The crystal structure of the extracellular portion of rabbit TF has been solved at 2.35 A resolution and refined to a crystallographic R-value of 19.1% (free R-value, 27.7%). Like the human homologue, the extracellular portion consists of two fibronectin type III domains connected by a short alpha-helical segment. Unexpectedly, the two molecules in the crystallographic asymmetric unit differ in their relative domain-domain orientation, revealing unsuspected hinge motion consisting of a rotation of about 12.7 degrees around an axis intersecting the linker segment at residue 106. Superposition of rabbit tissue factor with free and bound human tissue factor allows for the detection of an identical, albeit smaller, hinge motion in human TF induced upon binding of FVIIa. This raises the possibility that a very similar hinge axis may be present in other members of the cytokine receptor superfamily.     

Substitution of the Gla domain in factor X with that of protein C impairs its interaction with factor VIIa/tissue factor: lack of comparable effect by similar substitution in factor IX

We previously reported that the first epidermal growth factor-like (EGF1) domain in factor X (FX) or factor IX (FIX) plays an important role in the factor VIIa/tissue factor (FVIIa/TF)-induced coagulation. To assess the role of gamma-carboxyglutamic acid (Gla) domains of FX and FIX in FVIIa/TF induced coagulation, we studied four new and two previously described replacement mutants: FX(PCGla) and FIX(PCGla) (Gla domain replaced with that of protein C), FX(PCEGF1) and FIX(PCEGF1) (EGF1 domain replaced with that of protein C), as well as FX(PCGla/EGF1) and FIX(PCGla/EGF1) (both Gla and EGF1 domains replaced with those of protein C). FVIIa/TF activation of each FX mutant and the corresponding reciprocal activation of FVII/TF by each FXa mutant were impaired. In contrast, FVIIa/TF activation of FIX(PCGla) was minimally affected, and the reciprocal activation of FVII/TF by FIXa(PCGla) was normal; however, both reactions were impaired for the FIX(PCEGF1) and FIX(PCGla/EGF1) mutants. Predictably, FXIa activation of FIX(PCEGF1) was normal, whereas it was impaired for the FIX(PCGla) and FIX(PCGla/EGF1) mutants. Molecular models reveal that alternate interactions exist for the Gla domain of protein C such that it is comparable with FIX but not FX in its binding to FVIIa/TF. Further, additional interactions exist for the EGF1 domain of FX, which are not possible for FIX. Importantly, a seven-residue insertion in the EGF1 domain of protein C prevents its interaction with FVIIa/TF. Cumulatively, our data provide a molecular framework demonstrating that the Gla and EGF1 domains of FX interact more strongly with FVIIa/TF than the corresponding domains in FIX.     

Mechanical Stretch Inhibits Lipopolysaccharide-induced Keratinocyte-derived Chemokine and Tissue Factor Expression While Increasing Procoagulant Activity in Murine Lung Epithelial Cells

Previous studies have shown that the innate immune stimulant LPS augments mechanical ventilation-induced pulmonary coagulation and inflammation. Whether these effects are mediated by alveolar epithelial cells is unclear. The alveolar epithelium is a key regulator of the innate immune reaction to pathogens and can modulate both intra-alveolar inflammation and coagulation through up-regulation of proinflammatory cytokines and tissue factor (TF), the principal initiator of the extrinsic coagulation pathway. We hypothesized that cyclic mechanical stretch (MS) potentiates LPS-mediated alveolar epithelial cell (MLE-12) expression of the chemokine keratinocyte-derived cytokine (KC) and TF. Contrary to our hypothesis, MS significantly decreased LPS-induced KC and TF mRNA and protein expression. Investigation into potential mechanisms showed that stretch significantly reduced LPS-induced surface expression of TLR4 that was not a result of increased degradation. Decreased cell surface TLR4 expression was concomitant with reduced LPS-mediated NF-κB activation. Immunofluorescence staining showed that cyclic MS markedly altered LPS-induced organization of actin filaments. In contrast to expression, MS significantly increased LPS-induced cell surface TF activity independent of calcium signaling. These findings suggest that cyclic MS of lung epithelial cells down-regulates LPS-mediated inflammatory and procoagulant expression by modulating actin organization and reducing cell surface TLR4 expression and signaling. However, because LPS-induced surface TF activity was enhanced by stretch, these data demonstrate differential pathways regulating TF expression and activity. Ultimately, loss of LPS responsiveness in the epithelium induced by MS could result in increased susceptibility of the lung to bacterial infections in the setting of mechanical ventilation.     

Efficacy of transfer factor in treating patients with recurrent ocular herpes infections

Recurrent ocular herpes is an insoluble problem for the clinician. As cellular immunity plays an important role in controlling herpes relapses, and other studies have shown the efficacy of HSV-specific transfer factor (TF) for the treatment of herpes patients, an open clinical trial was undertaken in 134 patients (71 keratitis, 29 kerato-uveitis, 34 uveitis) suffering from recurrent ocular herpetic infections. The mean duration of the treatment was 358 days, and the entire follow-up period 189121 before, and 64062 days after TF treatment. The cell-mediated immune response to the viral antigens, evaluated by the lymphocyte stimulation test (LST) and the leucocyte migration test (LMT) (P<0.001), was significantly increased by the TF treatment. The total number of relapses was decreased significantly during/after TF treatment, dropping from 832 before, to 89 after treatment, whereas the cumulative relapse index (RI) dropped, during the same period, from 13.2 to 4.17 (P<0.0001). No side effects were observed. It is concluded that patients with relapsing ocular herpes can benefit from treatment with HSV-specific TF.     

Selective attenuation of the extrinsic limb of the tissue factor-driven coagulation protease cascade by occupancy of a novel peptidyl docking site on tissue factor

Tissue factor (TF), the receptor and cofactor for factor VIIa (VIIa) for cellular initiation of the coagulation protease cascade, drives thrombogenesis, inflammation, tumor cell metastasis, and the lethality of severe sepsis. To identify TF surface loci that can selectively inhibit substrate zymogen association and activation, TF(1-218), the extracellular domain, was used as the target for the phage display search. This resulted in selection of 59 clones from a phage gpVIII surface protein-expressed library of constrained combinatorial peptides. Of these, one encoding the peptide Glu-Cys-Leu-Arg-Ser-Val-Val-Thr-Cys on gpVIII most avidly bound TF(1-218), as did the synthetic peptide. Inhibition of binding was selective with an IC(50) of 30 nM for proteolytic activation of factor X by the TF(1-218)-VIIa complex. In contrast, there was no inhibition of factor IX activation. The selective inhibition of only factor X association with TF(1-218) will spare the intrinsic hemostatic pathway while attenuating the extrinsic thrombogenic pathway. This and related peptidyl structures provide the potential for the more precise identification of TF surface loci that mediate selective functional properties of the protein as well as a structural basis for the design of novel molecules for selectively attenuating initiation of the extrinsic limb of the coagulation protease cascade and other functions of TF.     

Tissue factor-dependent chemokine production aggravates experimental colitis

Tissue factor (TF) is traditionally known as the initiator of blood coagulation, but TF also plays an important role in inflammatory processes. Considering the pivotal role of coagulation in inflammatory bowel disease, we assessed whether genetic ablation of TF limits experimental colitis. To this end, wild-type and TF-deficient (TFlow) mice were treated with 1.5% dextran sulfate sodium (DSS) for 7 d, and effects on disease severity, cytokine production and leukocyte recruitment were examined. Clinical and histological parameters showed that the severity of colitis was reduced in both heterozygous and homozygous TFlow mice compared with controls. Most notably, edema, granulocyte numbers at the site of inflammation and cytokine levels were reduced in TFlow mice. Although anticoagulant treatment with dalteparin of wild-type mice reduced local fibrin production and cytokine levels to a similar extent as in TFlow mice, it did not affect clinical and histological parameters of experimental colitis. Mechanistic studies revealed that TF expression did not influence the intrinsic capacity of granulocytes to migrate. Instead, TF enhanced granulocyte migration into the colon by inducing high levels of the granulocyte chemoattractant keratinocyte-derived chemokine (KC). Taken together, our data indicate that TF plays a detrimental role in experimental colitis by signal transduction-dependent KC production in colon epithelial cells, thereby provoking granulocyte influx with subsequent inflammation and organ damage.     

Novel interactions of large P3 moiety and small P4 moiety in the binding of the peptide mimetic factor VIIa inhibitor

Selective factor VIIa-tissue factor complex (FVIIa/TF) inhibition is seen as a promising target for developing new anticoagulant drugs. A novel peptide mimetic factor VIIa inhibitor, ethylsulfonamide-d-biphenylalanine-Gln-p-aminobenzamidine, shows 100-fold selectivity against thrombin in spite of its large P3 moiety, unlike previously reported FVIIa/TF selective inhibitors. X-ray crystal structure analysis reveals that the large P3 moiety, d-biphenylalanine, and the small P4 moiety, ethylsulfonamide, make novel interactions with the 170-loop and Lys192 of FVIIa/TF, respectively, accompanying ligand-induced conformational changes of the 170-loop, Gln217, and Lys192. Structural comparisons of FVIIa with thrombin and amino acid sequence comparisons among coagulation serine proteases suggest that these interactions play an important role in achieving selective inhibition for FVIIa/TF.