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PubMed1976

Factor VIII and human platelet aggregation. II. Characteristics of aggregation of human platelets by bovine factor VIII.

Bovine factor VIII aggregates human platelets either in a strong single wave at high concentration (10 mug/ml platelet suspension) or in two waves at low concentration (0.2-I mug/ml). The strong single wave of aggregation is not associated with release of [14C]serotonin or beta-glucuronidase; the high concentration does not induce retraction of reptilase-clotted platelet-rich plasma. Wtih the low concentration, relase of [14C]serotonin is observed just prior to the onset of the second wave of aggregation; release of beta-glucuronidase does not occur at any moment. The low concentration of bovine factor VIII induces moderate retraction of reptilase-clotted platelet-clotted platelet-rich plasma, which is inhibited by acetylsalicylic acid, indomethacin and apyrase, indicating that it is a consequence of release of platelet adenosine-5'-diphosphate. It has previously been suggested tht carbohydrate groups are involved in the human platelet-bovine factor VIII interaction, since galactose oxidase and periodate oxidation abolish the platelet aggregating activity of bovine factor VIII. The present study shows that these oxidizing substances also induce a degradation of bovine factor VIII, so that the exact role of carbohydrate groups in the aggregation process remains to be established.

Animals↗
PubMed1989

Factor VIII influences binding of factor IX and factor X to intact human platelets.

To investigate the influence of factor VIII on the binding of factors IX and X to the surface of intact human platelets, washed collagen-stimulated platelets were incubated with factor IX and factor X in the presence or absence of factor VIII. Platelets were then lysed and IX:Ag and X:Ag were determined in the platelet lysate. Platelet bound IX:Ag was higher after incubation of platelets with factor IX in the presence of native or activated factor VIII than after incubation of platelets with factor IX alone. Thrombin degraded factor VIII did not support binding of factor IX to stimulated platelets. Preactivation of factor IX enhanced binding to platelets; influence by factor VIII on binding to platelets was greater with native factor IX than with preactivated factor IX. Presence of native or activated factor VIII also increased binding of factor X to platelets. In contrast to factor IX, preactivation of factor X did not influence binding to platelets, but in the presence of factor VIII preactivation of factor X increased binding of factor X to platelets. Our data suggest that mediation of binding of factors IX and X to the surface of platelets is one of the mechanisms by that factor VIII exerts its cofactor function in the activation of factor X.

Blood Platelets↗
PubMed2003

Anti-heavy-chain monoclonal antibodies directed to the acidic regions of the factor VIII molecule inhibit the binding of factor VIII to phospholipids and von Willebrand factor.

Recent studies have shown that inhibitors develop against acidic regions of the FVIII molecule, which contain important functional sites. However, their mechanisms of inhibition are not well understood. In this study, two anti-human FVIII mouse monoclonal antibodies (MAbs), directed towards the exposed acidic regions of the FVIII molecule, were developed, characterised and their mechanisms of inhibition investigated. The two MAbs, F7B4 and F26F6, had inhibitory titres of 32 and 944 BU/mg respectively, had high affinities for the FVIII molecule (K(D) approximately nM range) and recognised sequences V(357)-F(360) on the acidic a1 region and E(724)-L(731) on the acidic a2 region of the FVIII heavy-chain (HC), respectively. F7B4 inhibited the rate of FXa generation by activated FVIII, whilst both antibodies inhibited FVIII activation by thrombin and blocked thrombin cleavage of FVIII. Furthermore, F7B4 and F26F6 inhibited FVIII binding to (a) phospholipids (IC(50): 77 nM and 40 nM respectively), and (b) VWF (IC(50): 93 nM and 267 nM respectively), despite both having HC specificity. Experiments with F(ab')(2) fragments confirmed the above findings. Taken together these data represent novel findings in that anti-acidic HC antibodies can inhibit FVIII function by a variety of mechanisms, in particular by interfering with the binding of FVIII to phospholipids & VWF.

Amino Acid Sequence↗
PubMedDate not supplied

Mechanism of factor VIII inactivation by human antibodies. III. Proteolytic cleavage of factor VIII:C and C antigen by thrombin.

Thrombin activation of factor VIII results in a marked, but transient, increase in factor VIII procoagulant activity. This proteolytic process has been examined by immobilizing factor VIII in a solid phase system using mouse monoclonal antibody specific for the factor VIII related antigen. These studies demonstrate that thrombin activation is the result of proteolytic cleavage from the factor VIII:C protein of a peptide fragment which contains both the factor VIII:C procoagulant and VIII:C antigen sites recognized by human antibodies.

Animals↗
PubMed1977

Stabilization of factor VIII in plasma by the von Willebrand factor. Studies on posttransfusion and dissociated factor VIII and in patients with von Willebrand's disease.

In normal plasma, the ratio of the procoagulant activity of factor VIII (VIII(AHF)) to that of the von Willebrand factor activity (ristocetin cofactor, VIII(VWF)) or factor VIII antigen (VIII(AGN)) is approximately 1, but ratios > 1 (e.g., VIII(AHF) > VIII(VWF) or VIII(AGN)) may be observed in some patients with von Willebrand's disease and in the "late" posttransfusion plasmas of patients with this disorder. The lability of VIII(AHF) was studied by incubating plasma, diluted 1:10 in imidazole buffer pH 7.1, for 6 h at 37 degrees C. With normal plasmas, 77+/-12% (SD) of the original VIII(AHF) activity remained after incubation. VIII(AHF) was labile (e.g., 35-55% residual activity) in the "late" posttransfusion plasmas (VIII(AHF) >> VIII(VWF)) of a patient with von Willebrand's disease, but not in the "early" posttransfusion plasmas (VIII(AHF) approximately VIII(VWF)). VIII(AHF) was also labile in the (base-line) plasmas of three patients with von Willebrand's disease in whom the ratios of VIII(AHF) to VIII(VWF) were 4.4 to 8.1, but not in the plasmas of four other patients in whom the ratio was approximately 1. The electrophoretic mobility of factor VIII antigen was increased in two of the three patients with labile VIII(AHF). In both of these patients, and in the late posttransfusion plasmas, labile VIII(AHF) activity could be stabilized by the addition of purified von Willebrand factor (lacking VIII(AHF) activity) or by hemophilic plasma, but not by plasmas of patients with severe von Willebrand's disease. Thus, VIII(VWF) may serve to stabilize VIII(AHF) and this might explain the posttransfusion findings in von Willebrand's disease.

Blood Coagulation Factors↗
PubMed1977

Inherited combined deficiency of factor V and factor VIII: report of a case with normal factor VIII antigen and ristocetin-induced platelet aggregation.

A patient with inherited combined deficiency of factor V and factor VIII is reported, who demonstrated normal levels of factor VIII antigen and plasma cofactor for ristocetin-induced platelet aggregation. The relationship of this condition to classical hemophilia and von Willebrand's disease is discussed. The data presented suggest that multiple loci on at least 2 chromosomes are necessary for the normal expression of factor VIII activity.

Adult↗
PubMed1980

Effects of neutral proteases from human leukocytes on structure and biological properties of human factor VIII.

Human factor VIII was purified from cryoprecipitate and incubated for up to 24 hours with four neutral proteases of human blood leukocytes, namely, with elastase-like protease (ELP), chymotrypsin-like protease (CLP), collagenase and gelatinase. Electrophoretic patterns showed a reproducible sequence of degradation of factor VIII and of its 230,000 molecular weight subunit by ELP and CLP. Intermediate products were similar but those resulting from exhaustive proteolysis by ELP and CLP differed distinctly from each other. Procoagulant activity of factor VIII was rapidly and completely destroyed by ELP and CLP before visible electrophoretic changes would be detected. No increase in this activity was observed prior to its destruction. Von Willebrand factor (ristocetin cofactor) activity was considerably more resistant to ELP and CLP and declined in rough relation to degradation of highly aggregated forms of factor VIII. ELP and CLP produced a pronounced progressive increase in the Laurell reaction antigen. Normal human plasma showed a high potency to inhibit ELP and CLP. Large doses of these enzymes (300 microgram per ml) produced in the plasma medium only a moderate fall in factor VIII procoagulant activity. Collagenase and gelatinase did neither degrade factor VIII nor change its biological properties.

Electrophoresis, Polyacrylamide Gel↗
PubMed2003

Factor VIII--Baxter: rAHF-PFM, recombinant anti-haemophilic factor--protein-free method, recombinant factor VIII--protein-free.

Baxter Healthcare is developing a next-generation recombinant factor VIII for the treatment of haemophilia A that is produced using a totally protein-free manufacturing process. By excluding proteins or raw materials derived from human or animal sources in the final product, the risk of transmission of potentially infectious agents is removed. All of the recombinant factor VIII products currently on the market incorporate proteins or raw materials derived from either human or animal sources, as part of the nutrients required for the cells to produce the protein. Baxter has exclusive rights to Quadrant Healthcare's factor VIII stabilisation technology. Quadrant received 1 million US dollars under the agreement, and was to receive milestone payments in excess of 2 million US dollars, together with royalties on sales should a new factor VIII product using Quadrant's technology reach the market. In December 2000, Quadrant Healthcare was acquired by Elan Drug Delivery (Elan Corporation), which continued to develop the proprietary formulation and stabilisation technologies of Quadrant. In July 2003, the newly formed company Quadrant Technologies acquired Elan Drug Delivery from Elan Corporation and renamed it Quadrant Drug Delivery. In July 2003, the US FDA approved the use of ADVATE for the prevention and control of bleeding episodes in people with haemophilia A. At the Bear Stearns 16th Annual Healthcare Conference held in September 2003, Baxter reported that ADVATE was launched in August 2003 in the US. A pivotal phase III clinical trial of this recombinant factor VIII therapy, initiated in 89 previously untreated patients with haemophilia A, has been completed at sites in the US, UK, Sweden, France, Belgium, Germany, Denmark and Italy. This trial compared the pharmacokinetics, tolerability and immunogenicity of this therapy with Baxter's currently marketed recombinant factor VIII preparation, Recombinate trade mark. The first clinical data that were presented on this agent at the XXV International Congress of the World Federation of Hemophilia meeting indicate that Baxter's next-generation recombinant factor VIII is bioequivalant with Recombinate trade mark. The two agents should have comparable efficacy. A Marketing Authorisation Application (MAA) was submitted to the EU EMEA and regulatory filings were made in Canada in September 2002. The submission was made via the centralised procedure. Should the new-generation product reach the market, Baxter will continue to offer Recombinate trade mark as well as plasma-derived factor VIII products. Preliminary study results announced in July 2003 show that factor VIII therapy was effective in controlling bleeding episodes in patients with severe and moderately severe haemophilia A who were previously treated, or had undergone surgery.

Clinical Trials as Topic↗
PubMed1987

Monoclonal antibodies to factor VIII: their application in immunoblotting for the visualization of factor VIII in therapeutic concentrates and plasma.

Two monoclonal antibodies (McAb) termed 12A4 and 19C1 have been raised against human factor VIII. In immunoassays 12A4 bound to factor VIII antigen (VIII:Ag) in plasma but not serum whilst 19C1 bound to VIII:Ag in both plasma and serum. Both McAb were shown by immunoblotting to react with the carboxy (C) terminal polypeptide of factor VIII which appeared as a doublet with a molecular weight (Mr) of 77,000/75,000. The C terminal factor VIII polypeptide was detectable by immunoblotting in each of 12 therapeutic factor VIII concentrates, from six different manufacturers, although its level was variable. Factor VIII was visualized in plasma by immunoblotting following its immunoadsorption and elution from agarose-bound monoclonal antibodies. No Mr 77,000/75,000 bands were detectable in plasma obtained from 13 unrelated CRM- haemophiliacs whilst 11 CRM+ haemophilic plasmas from seven kindred were shown to have a C terminal factor VIII polypeptide of normal molecular size.

Antibodies, Monoclonal↗
PubMed2000

Mapping factor VIII inhibitor epitopes using hybrid human/porcine factor VIII molecules.

Four epitopes in the factor VIII (FVIII) molecule have been identified that constitute the targets for antibodies in most inhibitor plasmas. These epitopes are located in the A2, A3 and C2 domains and in the activation peptide (ar3 region) of the FVIII light chain. We have developed a method for mapping FVIII epitopes using recombinant hybrid human/porcine FVIII molecules. Ongoing studies continue to provide higher resolution maps of these epitopes. The manipulation of inhibitor epitopes using recombinant DNA technology may lead to improved forms of FVIII that have lower antigenicity and/or lower immunogenicity.

Animals↗
PubMed1992

Biological regulation of factor VIII activity.

Factor VIII, the plasma protein deficient in hemophilia A, is a crucial cofactor for regulation of hemostasis. Our understanding of factor VIII increased tremendously once it became possible to isolate homogeneous preparations of this protein from plasma. In addition, the isolation of the factor VIII gene has provided new means of exploring the structure and function of factor VIII. This increasing knowledge also sheds light on the genetic alterations resulting in hemophilia as well as in thrombophilia. This chapter summarizes our current understanding of the regulation of factor VIII function and raises questions to be answered in the years to come.

Factor VIII↗
PubMed1998

Familial clustering of factor VIII and von Willebrand factor levels.

Recently, we found that high levels of clotting factor VIII (>150 IU/dl) are common and make an important contribution to thrombotic risk. The determinants of high factor VIII:C are unclear and might be partly genetic. Therefore, we tested the influence of age, blood group and von Willebrand factor (VWF) levels on factor VIII:C levels, and investigated whether factor VIII:C levels are genetically determined. We performed an analysis of 564 female relatives of hemophilia A patients, who had visited our center for genetic counseling. In univariate analysis, AB0 blood group, age and VWF antigen (VWF:Ag) levels all influenced factor VIII:C levels. After adjustment for the effect of VWF:Ag levels, both blood group and age still had an effect on factor VIII:C levels. In sister pairs, the Pearson correlation coefficient between factor VIII:C levels was 0.17 (p = 0.024) and this correlation remained positive (0.15, p = 0.046) after correction for the influence of VWF:Ag. In mother-daughter pairs, no correlation of factor VIII:C levels was found. The correlation of VWF:Ag levels in sisterpairs was 0.41 (p <0.001) and in mother-daughter pairs 0.44 (p <0.001), in line with the assumption that VWF:Ag levels are under control of autosomal genes. Familial influence on plasma factor VIII:C and VWF:Ag levels was investigated with a recently developed familial aggregation test. This test verifies whether familial aggregation of a particular parameter exists in a set of pedigrees. In 435 women from 168 families, factor VIII:C as well as VWF:Ag levels correlated significantly within families, which suggests a familial influence. The familial aggregation was more prominent for VWF:Ag levels than for factor VIII:C levels, possibly because the genetic effect on VWF:Ag levels is larger than on factor VIII:C levels. Our results support the presence of a familial influence on factor VIII:C as well as on VWF:Ag levels.

Adult↗
PubMedDate not supplied

Preparation of cryoprecipitated factor VIII concentrates.

Factors affecting the yield of factor VIII in cryoprecipitate have been investigated in the context of a blood component program. Both in vitro and in vivo measurements were used to assess the effects of critical variables on the yield of factor VIII activity. Variables such as anticoagulant, plastic bag, mixing during collection, and platelet contamination had no significant effect on yield of factor VIII activity in cryoprecipitate. Among the most critical factors affecting yield were storage time of whole blood and procedures for freezing, thawing, and reconstitution. The following procedures were found to assure a 60 per cent recovery of factor VIII in cryoprecipitate: 1)processing of whole blood within six hours of collection; 2)use of a technique to freeze plasma within 30 minutes either in a -70 C ethanol bath or -85 C freezer; 3)rapid thawing (1 1/2 hour or less) in a 4 C circulating water bath; 4)centrifugation at 4,500 X g for 10 minutes at 4 C followed by draining of the supernatant in a 4 C cold room; 5) storage of the precipitate at -20 C until ready for use; 6) thawing in a 37 C water bath for at least 15 minutes followed by addition of 20 ml of 0.15 M saline for a 20 minute period at room temperature, and gentle mixing before pooling units for transfusion. The recovery of factor VIII in cryoprecipitate appears to be limited to about 65 per cent by its solubility in plasma at 4 C. Therefore, further effort to increase the amount available for treatment should involve improving the supply of plasma for its preparation and decreasing the cost of processing.

Blood Cell Count↗
PubMed1976

Immunologic studies on human factor VIII (anti-hemophilic factor A, AHF) components produced by low-ionic-strength dialysis.

Since dialysis of human factor VIII against buffers of low ionic strength yielded two distinct components, and since the factor VIII fraction isolated from normal plasma showed von Willebrand factor activity as defined by the corrective effect on abnormal platelet retention and ristocetin aggregation in von Willebrand's disease, the present studies were performed to determine if the correcting activities could be attributed to one or both of the components. Dialysis of factor VIII against buffers of low ionic strength led, however, to a decrease in factor VIII procoagulant activity and the reduction of the correcting activities, which suggested that the intact aggregate was required for procoagulant activity and for von Willebrand factor activity. In this respect dialysis of factor VIII at low ionic strength differed from dissociation at high salt concentrations. The two low ionic strength components were identified by the use of a rabbit antiserum against factor VIII, and could be distinguished on the basis of specific antigenic structures. Dialysis of factor VIII at low ionic strength led to a decrease in antigenic determinants closely related to factor VIII function. Specific antibodies to the low ionic strength components inhibited factor VIII activity in normal plasma, but the residual factor VIII was higher than that after inhibition with antibodies against intact factor VIII. Both antibodies interfered with von Willebrand factor activity.

Antibody Specificity↗
PubMed2004

Sequence of the rat factor VIII cDNA.

Factor VIII acts as an essential compound of the tenase complex of the coagulation system. Herein we report the cDNA of the rat factor VIII. The rat cDNA comprises 6777 nucleotides and encodes a protein of 2258 amino acids, 61 amino acids less than mouse and 92 amino acids less than human factor VIII. The over-all identity compared to human cDNA is 61% on the cDNA and 51% on the amino acid level. In cDNA, highest levels of sequence identity can be observed in the A and C domains (ranging between 68% and 73%), whereas B domain and the small acidic regions are more divergent (34% - 49%). Compared to mouse and human most sites for posttranslational modifications such as sulfatation and glycosylation as well as thrombin and protein C cleavage sites are conserved in rat. Alternative transcripts lacking exon 17 and/or comprising additional 26 bp due to alternative splicing of exon 20 were found. Furthermore, 13 polymorphisms (seven in exon 14, one in exon 20, 23, 24, and 25, two in the 3' UTR) three of which lead to an amino acid exchange could be detected. Our findings might provide new insights into the structure-function analysis of the factor VIII protein and might prove useful for future animal models addressing the function of factor VIII.

5' Untranslated Regions↗
PubMed1981

Changes in factor VIII complex activities during the production of a clinical intermediate purity factor VIII concentrate.

Samples taken at various stages of preparation of intermediate purity factor VIII concentrate were assayed for factor VIII coagulant activity (VIII:C), factor VIII coagulant antigen (VIIIC:Ag) and factor VIII related antigen (VIIIR:Ag). The antigen results were used to assess mechanical loss during fractionation as these markers are relatively stable. In contrast VIII:C is sensitive to both mechanical and inactivation losses. The major loss of factor VIII occurred during the cryoprecipitation and extraction step and was due to both mechanical loss and inactivation. Losses before and after this step were largely due to inactivation of the factor VIII. Assay of VIIIR:Ag in concentrates presented problems and a modified technique is suggested.

Antigens↗