PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “ANTITHROMBIN”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 847 records · Page 47Linked to original sources

Role of N- and C-terminal amino acids in antithrombin binding to pentasaccharide.

We have used a monoclonal antibody-based binding procedure to determine the dissociation constants of the interactions between the essential antithrombin-binding pentasaccharide and a series of 13 distinct N- and C-terminal antithrombin substitution mutation variants with defective binding interaction with heparin. The reduction in binding affinity of the pentasaccharide with the N-terminal variants (with substitution mutations Pro-41-->Leu, Arg-47-->Cys and His, Leu-99-->Val and Phe, Gln-118-->Pro, Arg-129-->Gln) compared to normal antithrombin, Kd 200 nM, ranged from 15-984-fold and was generally less than 150-fold. Reduced binding affinity is assumed to arise mostly by perturbation, direct or indirect, of the initial contact of pentasaccharide with basic residues of antithrombin. Surprisingly, the binding interaction of the pentasaccharide with the C-terminal variants (with substitution mutations in or near strand 1C/4B, Phe-402-->Leu, Cys, and Ser, Ala-404-->Thr, Pro-407-->Thr, Pro-429-->Leu) was more uniformly and yet substantially (135-482-fold) decreased, despite the spatial separation between the site of mutation and the proposed primary contact site of the pentasaccharide. These results demonstrate that strand 1C/4B region integrity is required for optimum interaction with the pentasaccharide, suggesting its involvement in transmission of the induced conformation change required for high affinity binding.

Amino Acids↗

[Automated simultaneous measurements of activity and antigenicity of plasma antithrombin III].

Plasma antithrombin III activity and concentration were measured simultaneously on COBAS MIRA-S by colorimetry using a synthetic substrate and by immunoturbidimetry, respectively, in normal subjects (n = 30), in patients with liver disease (n = 37), and in those with thrombosis (n = 76). The activity/concentration ratio of plasma antithrombin III, in which concentration was represented as the ratio to the mean concentration for normal, was evaluated in each group. Results showed that the ratio was significantly lower in patients with liver diseases (0.76 +/- 0.18, mean +/- SD, p < 0.01) and in thrombotic patients (0.89 +/- 0.18, p < 0.01) than that in normal (1.07 +/- 0.06), demonstrating the predominance of antithrombin III molecules with low activity in the former groups. This simple and rapid (< 10 min) method is applicable for detecting such the constitutional change in plasma antithrombin III.

Adult↗

Fibrinogen, D-dimer and thrombin-antithrombin complexes in a random population sample: relationships with other cardiovascular risk factors.

Fibrinogen is an independent risk factor for cardiovascular disease and both D-Dimer and Thrombin-Antithrombin complexes may be suitable as laboratory markers of deep venous thrombosis and are becoming more widespread in clinical practice. The aim of our study was to evaluate their normal range and to examine their correlation with various cardiovascular risk factors. Fibrinogen, D-Dimer and Thrombin-Antithrombin complexes were assessed in 516 normal subjects randomly selected from the National Health Service register of Trieste (Italy). In our community the mean value of fibrinogen was 283 +/- 71 mg/dl. Fibrinogen increases with age in males and was significantly higher in male smokers. In non-smokers, females had significantly higher fibrinogen values than males. The mean value of D-Dimer was 306 +/- 130 ng/ml. In females it is significantly higher. The fibrinogen and D-Dimer correlation coefficient was 0.20 (p < 0.001). The mean level of Thrombin-Antithrombin complexes was 6.25 +/- 6.8 ng/ml with a distribution markedly skewed towards the left; males had lower concentration than females (p = 0.047). Multiple regression analysis for fibrinogen as a dependent variable showed that D-Dimer, LDL-cholesterol, Body-Mass Index and Thrombin-Antithrombin complexes were poor predictors for fibrinogen plasma levels (R2 = 0.23) and that fibrinogen, ApoA1 and age can explain only about 10% of the observed variability in D-Dimer.

Adult↗

Identification of basic amino acid residues in thrombin essential for heparin-catalyzed inactivation by antithrombin III.

The therapeutically important anticoagulant heparin catalyzes inactivation of thrombin by antithrombin III via formation of an intermediary ternary thrombin-heparin-antithrombin III complex that is subsequently converted to a stable thrombin-antithrombin III complex with the release of heparin. Point mutations at Arg-180, Arg-245, Lys-248, and Lys-252 in thrombin markedly reduced the efficiency of heparin catalysis by decreasing the stability of the ternary intermediate, whereas the inactivation of thrombin by antithrombin alone was not affected by these mutations. These results together with an analysis of the x-ray crystal structure of thrombin yielded a model for the thrombin-heparin interaction, wherein heparin forms salt linkages along a groove in thrombin defined by Lys-252, Lys-248, Arg-245, Arg-89, Arg-98, and Arg-180.

Amino Acid Sequence↗

Inhibition of dysthrombins Quick I and II by heparin cofactor II and antithrombin.

Heparin cofactor II and antithrombin are plasma serine proteinase inhibitors whose ability to inhibit alpha-thrombin is accelerated by glycosaminoglycans. Dysfunctional thrombin mutants Quick I (Arg67-->Cys) and Quick II (Gly226-->Val) were used to further compare heparin cofactor II and antithrombin interactions. Quick I, Quick II, and alpha-thrombin were eluted at the same salt concentration from heparin-Sepharose suggesting that the putative heparin-binding site (also termed anion binding exosite-II) is functional. Antithrombin yielded similar inhibition rates for Quick I and alpha-thrombin in the absence or presence of various amounts of heparin. Also, Quick I was inhibited similarly to alpha-thrombin by heparin cofactor II in the absence of glycosaminoglycan. In contrast, glycosaminoglycan-accelerated Quick I inhibition by heparin cofactor II was greatly reduced indicating that anion binding exosite-I (where the mutation occurs in Quick I) is critical for increased inhibition by heparin cofactor II. We also found that heparin cofactor II formed a SDS-resistant bimolecular complex with Quick II and alpha-thrombin at similar rates and the rate of complex formation was accelerated in the presence of glycosaminoglycans. A three-dimensional molecular model of the Quick II active site compared to alpha-thrombin suggested that the heparin cofactor II Leu-Ser-reactive site sequence (P1-P1') is a compatible "pseudosubstrate" in contrast to the Arg-Ser sequence found in antithrombin. The importance of heparin cofactor II as a thrombin regulator will depend upon its ability to interact with glycosaminoglycans and the functional availability of thrombin exosites.

Amino Acid Sequence↗

Mutagenesis of thrombin selectively modulates inhibition by serpins heparin cofactor II and antithrombin III. Interaction with the anion-binding exosite determines heparin cofactor II specificity.

Thrombin is a multifunctional serine protease that plays a critical role in hemostasis. Thrombin is inhibited by the serpins antithrombin III and heparin cofactor II in a reaction that is dramatically accelerated by glycosaminoglycans. The structural basis of the interaction with these inhibitors was investigated by introducing single amino acid substitutions into the anion-binding exosite (R68E, R70E) and unique insertion loops (K52E, K154A) of thrombin. The rate of inhibition of these recombinant thrombins by antithrombin III and heparin cofactor II was determined in the absence and presence of glycosaminoglycan. The second order rate constant (k2) for inhibition by antithrombin III without heparin was 3.7 x 10(5) M-1 min-1 for wild-type thrombin; rates for the mutant thrombins varied less than 2-fold. For inhibition by antithrombin III with heparin, the rate constant was 4.5 x 10(8) M-1 min-1 for wild-type thrombin with no significant differences between any of the recombinant thrombins. In contrast, the rate constant for inhibition by heparin cofactor II without glycosaminoglycan was 4.3 x 10(4) M-1 min-1 for wild-type thrombin; rates were 10-fold slower for thrombin K52E and 2- to 3-fold slower for thrombins R68E and R70E. The rate constants for inhibition of wild-type thrombin by HCII in the presence of heparin or dermatan sulfate were 9.2 x 10(8) M-1 min-1 and 9.0 x 10(8) M-1 min-1, respectively. Compared to wild-type thrombin, the rate of inhibition by HCII with glycosaminoglycan was 5- to 15-fold slower for thrombins K52E and R70E and 50- to over 100-fold slower for thrombin R68E. Thrombin K154A was inhibited by heparin cofactor II with rates similar to wild-type thrombin in all assays. These results suggest that heparin cofactor II interacts with residue Lys-52 in the proposed S1' subsite and with residues Arg-68 and Arg-70 in the anion-binding exosite of thrombin, and that these interactions contribute to the molecular basis of heparin cofactor II specificity for thrombin.

Antithrombin III↗

Protein C, protein S, and antithrombin III in acute ocular occlusive diseases.

Hereditary and acquired deficiencies of protein C, protein S, and antithrombin III are important risk factors of thrombosis, especially in peripheral veins. In a prospective study, concentrations of these factors were measured to determine the prevalence of deficiencies of these proteins in ocular vascular occlusive disease. A total of 167 patients with acute retinal arterial (28%) or venous occlusion (55%) or ischemic optic neuropathy (17%) were included. Exclusion criteria were anticoagulant therapy, renal insufficiency, and hepatic disease. The mean values obtained for all patients were in normal range (protein C, 102 +/- 25%; protein S, 109 +/- 22%; antithrombin III, 23.6 +/- 3.1 IU/ml). Antithrombin III was pathologically reduced in one patient with branch venous occlusion. Proteins C and S were severely altered in two patients with central venous occlusion, in one individual with ischemic optic neuropathy, and in one patient with branch arterial occlusion. Subnormal values were found in 21 patients for antithrombin III (16.1-19.9 IU/ml), in 7 patients for protein C (55-65%). Two of these five patients with pathologic findings showed severe vascular manifestations in the form of current deep-vein thrombosis and multiple retinal occlusions. Their age was 30 and 53 years, respectively, and differed considerably from the mean age of the entire group (65 +/- 12 years). This study suggests that these proteins were important factors for the development of ocular vascular occlusive diseases in single patients. Although the prevalence is low, measurement of these parameters in young patients may be useful in preventing other vascular complications.

Acute Disease↗

Antithrombotic effect of human recombinant tissue factor pathway inhibitor on endotoxin-induced intravascular coagulation in rats: concerted effect with antithrombin.

In our current study, we examined the antithrombotic effect of Chinese hamster ovary cell-derived human recombinant tissue factor pathway inhibitor (h-rTFPI) by intravenous injection of h-rTFPI with or without antithrombin into endotoxin-treated rats. An injection of h-rTFPI at a high dose (4 mg/kg of h-rTFPI or three doses of 1 mg/kg) significantly prevented the decrease of fibrinogen and factor VIII and the increase of fibrin/fibrinogen degradation products and glutamic-pyruvic transaminase in rats, while a single injection of 1 mg/kg of h-rTFPI or 250 U/kg of antithrombin did not significantly prevent intravascular coagulation. However, a simultaneous injection of 1 mg/kg of h-rTFPI and 250 U/kg of antithrombin did significantly prevent intravascular coagulation. From the studies on the clearance rate and immunohistochemical staining of injected h-rTFPI into normal rats, we found that most of the intravenously-injected h-rTFPI was localized on the central vein and sinusoids in the liver and catabolized via the proteoglycan-mediated pathway with a half-life of 48 min. These results suggest that h-rTFPI and antithrombin prevented endotoxin-induced intravascular coagulation in concert by binding to the vascular walls of the liver and by inhibiting fibrin formation on Kupffer cells in hepatic sinusoids.

Animals↗

The effect of levenogesterol (Norplant) contraception on coagulation as measured by antithrombin-III levels.

PURPOSE: To determine the effect of contraception given immediately postpartum on coagulation as measured by antithrombin III. STUDY DESIGN: In this prospective study, parturients (n = 85) self selected three means of postpartum contraception: levenorgesterol implants, oral contraceptives, or a barrier method. RESULTS: Baseline coagulation was assessed by antithrombin-III levels in each of the 85 women within 48 hours of delivery (100.35 +/- 1.61%) and at one (109.1 +/- 1.89%) and six (105.51 +/- 1.71%) weeks postpartum. There was a rise in antithrombin-III after delivery but there were no significant differences between the groups. CONCLUSION: The levenorgesterol implant system did not cause a decrease in antithrombin-III in normal parturients.

Antithrombin III↗

Effect of various estrogen treatment schedules on antithrombin III levels.

Antithrombin III levels were determined in 18 normal indiviuals of both sexes, 24 pregnant women (at term), 20 patients treated with oral contraceptives and 21 postmenopausal patients treated with Premarin. There was no sex difference in antithrombin III levels in the untreated control group. Pregnant women at term had the lowest levels of antithrombin III. The second lowest values were exhibited by women on oral contraceptives. Both of these groups differed significantly (p less than 0.05) from the controls. Premarin treated postmenopausal women had somewhat lower levels of antithrombin III than controls but these were statistically not significant.

Adolescent↗

[Antithrombin III in various conditions in internal medicine].

In a group of 993 patients with serious medical diseases an important deficiency of antithrombin III was found in patients with hepatic insufficiency, pulmonary embolism and with disseminated intravascular coagulation. Acquired antithrombin III deficiency in these conditions develops when the antithrombin production in the liver is low and also in patients with shock syndrome and disseminated intravascular coagulation. Assessment of antithrombin III is of diagnostic and prognostic value in thrombotic and prethrombotic conditions and its results is decisive for adequate substitution. Adequate AT III substitution without concurrent heparin administration in patients with septicaemia and manifestations of DIC improves the prognosis of patients with an increased endothelial resistance.

Antithrombin III Deficiency↗

Assessment of interference by heparin cofactor II in the DuPont aca antithrombin-III assay.

Hereditary deficiency of antithrombin-III (AT-III), the major heparin cofactor in human plasma, is a well-established cause of recurrent venous thrombosis. Cross-reactivity of heparin cofactor II (HC II) in assays of AT-III may, in some cases, interfere with the ability to diagnose hereditary deficiency of AT-III. For that reason, we have evaluated the interference by HC II in the new DuPont aca antithrombin assay. Response of the assay to purified AT-III and HC II was compared. Inhibition of the bovine thrombin in the assay was sixfold less per molecule of HC II than of AT-III. This level of selectivity should be adequate to prevent misdiagnosis of patients. Analysis of patient samples showed close correlation (r = 0.91) of values from the automated aca assay with those of a manual assay (Coatest antithrombin, Helena Laboratories).

Antithrombin III↗

Two novel antithrombin variants, Asn187Asp and Asn187Lys, indicate a functional role for asparagine 187.

Three unrelated families have been identified with mutations involving asparagine 187. Two of these families are asymptomatic and were identified during the screening of random blood donors, whilst the third has a history of recurrent thromboembolic disease. In two families the mutation (6460 AAC-->GAC) results in an asparagine to aspartate substitution and is associated with normal immunological levels of antithrombin but a reduction in functional activity. In the third family the mutation (6462 AAC-->AAA) results in an asparagine to lysine substitution at residue 187 and is associated with a parallel reduction in both immunological and functional antithrombin levels. Asparagine 187 is located in the middle of the F helix of antithrombin and forms the major link between the F helix and strand 3 of the A sheet. The F helix is seen to overlie the A sheet of the molecule and moves with strands 2 and 3 of this sheet as they open to allow entry of the reactive site loop to form strand 4. Substitutions of asparagine 187 are, therefore, likely to disrupt this sliding movement leading to a loss of inhibitory activity.

Adult↗

Anticoagulant therapy in a congenital antithrombin III (ATIII)-deficient patient with chronic renal failure undergoing regular hemodialysis.

We describe a 43-year-old male patient with congenital antithrombin III deficiency requiring hemodialysis due to extension of venous thrombus from recurrent deep vein thrombosis. During dialysis with adequate heparinization, the patient often revealed clot formation in the extracorporeal circuit resulting in unexpected discontinuation of dialysis. When either a combination of antithrombin III concentrate + heparin or the newly developed synthetic antithrombin preparation, MD805, was administered during dialysis, he could be uneventfully dialyzed with either of the two regimens.

Adult↗

[Clinical study of the therapeutic value of Kybernin in the treatment of antithrombin III deficiency].

Together with a detailed presentation of the physiological role of antithrombin III and a description of the pathological states in which it's acquired deficiency requires substitutional therapy with an antithrombin preparation, this report contains the results of a clinical trial of such a preparation which is in use under the name of Kybernin. Patients with severe diseases and traumas, of a septic nature mostly, were included in the trial. The experimental group includes 20 such patients treated with Kybernin, and the control group had 12 patients who did not receive this preparation. The level of antithrombin III at the time of entering the study was an average of 40.1% in the experimental group, and 53.2% in the control group. The mortality of the treated group was 45%, and in the control group it was 66.7%. Clinical and laboratory results point to a favorable effect of Kybernin therapy in the suppression of disseminated intravascular coagulation.

Adolescent↗

Protein C, protein S and antithrombin III deficiencies in retinal vein occlusion.

PURPOSE: The role of decreased levels of protein C, protein S and antithrombin III were investigated in patients with branch and central retinal vein occlusion. METHODS: Forty-five patients with retinal vein occlusion and 20 healthy subjects as a control group was studied. Fourteen patients (31%) had central retinal vein occlusion and 31 (69%) had branch retinal vein occlusion. The concentrations of protein C, protein S and antithrombin III were measured. RESULTS: Plasma levels of protein C, protein S and antithrombin III were not reduced in the control group. Six of the 14 central retinal vein occlusion cases and 3 of the 31 retinal branch vein occlusion cases had decreased levels of protein C. One of the 14 central retinal vein occlusion cases and 1 of the 31 retinal branch vein occlusion cases had decreased levels of protein S. Antithrombin III was reduced in 1 patient of the 31 retinal branch vein occlusions. We found statistically significant differences for number of cases with protein C deficiency between the central retinal vein occlusion cases and the branch retinal vein occlusion cases (p<0.05). CONCLUSION: Deficiency of anticoagulant proteins, especially protein C, may play a role in the etiology of retinal vein occlusion. Measurement of these parameters may be useful in preventing venous thrombosis elsewhere in the body.

Biomarkers↗

[Type I antithrombin deficiency as a cause of arterial and venous thrombosis in a family with severe thrombophilia].

INTRODUCTION: In rare cases of thromboembolic diseases developing in young age, venous and arterial thromboembolism can occur simultaneously. AIMS: To detect the venous and the arterial risk factors in a severe thrombophilic family. A 47-years-old female with severe atherosclerosis and recurrent deep vein thrombosis, and 6 members of her family were analysed. METHODS: The following haemostatic and molecular genetic investigations were performed: besides the rutin haemostatic parameters, risk factors for venous thrombembolic disease, risk factors for venous and arterial thrombosis (plasma homocysteine level, MTHFR C677T polymorphism) were determined. This panel was completed with the measurement of lipoprotein (a), von Willebrand factor, plasminogen activator inhibitor-1 antigen, serum total cholesterin, HDL cholesterin, C reactive protein and PIA2 variant. The propositus was proven to have type I antithrombin deficiency, elevated homocysteine level, homozygous MTHFR C677T polymorphism, elevated Lp(a), vWF:Ag, and PAI-1:Ag levels. RESULTS: All family members had a combination of cardiovascular risk factors (in 4 cases elevated homocysteine level, in 3 cases elevated Lp(a), in 2 cases elevated vWF:Ag, in 4 cases increased PAI-1 level). These risk factors were combined in three cases with type I antithrombin deficiency. Despite of the presence of atherosclerotic risk factors in the family, arterial thrombotic disease could be detected only in two patients with antithrombin deficiency. CONCLUSIONS: The results of the investigated family indicate that in case of combination of venous and arterial thromboembolic risk factors, antithrombin deficiency may contribute to the manifestation of arterial thromboembolic diseases.

Adult↗

Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: report of a case.

Nephrotic syndrome frequently causes venous thromboembolic complications. Arterial thrombosis has rarely been reported and is mainly observed in children. Only six cases of lower extremity arterial thrombosis in adults have been reported in the literature. The outcome in these cases was unsatisfactory because of the high rates of limb loss and recurrence of thrombosis. We report successful treatment of a 39-year-old man who suffered from right lower extremity arterial thrombosis associated with decreased levels of serum antithrombin III. He was admitted to our hospital with severe pain in his right foot. No pulse was palpable in his right dorsalis pedis or posterior tibial arteries. His right foot was cold and mottled, with a reduced sensation and motor activity. The laboratory data revealed a serum total protein concentration of 3.9g/dl and an albumin concentration of 1.5 g/dl. The coagulation profile showed a fibrinogen level of 879 mg/dl and antithrombin III value of 9.5%. Right lower extremity arteriography showed a complete occlusion of the right deep femoral artery and popliteal artery, and a filling defect in the common femoral artery. An emergency thrombectomy was performed under general anesthesia. The patient was treated successfully, and surgical treatment was followed by anticoagulant therapy with 1,000 units of antithrombin III. A renal biopsy revealed histologic evidence of minimal change of glomerulonephritis. He was discharged 3 months later, and no recurrence of thrombosis has yet been observed.

Acute Disease↗