This project will explore the mechanism(s) responsible for decreased ristocetin-von Willebrand factor (VWF) interactions due to mutations and polymorphisms in the VWF A1 domain, the region of VWF most critical for interaction with platelet glycoprotein Ib (GPIb). The functional implications of these polymorphisms will be tested in the absence of ristocetin in order to determine their effect on VWF function. In addition, the role of factor VIII (FVIII) release following VWF-platelet binding will be investigated. The objective of this application is to determine the in vivo relevance of A1 domain polymorphisms that lead to decreased VWF activity on functional testing with ristocetin, to ensure that patients are not misdiagnosed with von Willebrand disease (VWD) on the basis of spurious laboratory testing results.
Specific aim 1 will elicit the mechanism(s) behind the decrease in ristocetin-induced VWF-platelet interactions associated with A1 domain mutations through direct binding assays and surface plasmon resonance. Binding strength will be assessed with optical tweezers.
Specific aim 2 will evaluate the effect(s) of key A1 domain mutations on platelet GPIb interactions independent of VWF as well as the mutations'effects on other aspects of VWF function. Both static and flow conditions will be assessed for VWF-collagen and VWF-platelet binding.
Specific aim 3 will determine the impact of factor VIII (FVIII) release in clot formation following VWF-platelet interactions through measurement of FVIII activity and thrombin generation after ligand binding. Clot formation will be examined with in vivo thrombosis models. Bob Montgomery, MD, an experienced researcher in VWF biology, will serve as the primary mentor for this project, along with a committee of research scientists established for the purpose of enhancing the applicant's scientific knowledge and research career growth. This project will utilize the resources of the Medical College of Wisconsin and the Blood Research Institute of the Blood Center of Wisconsin to further the applicant's understanding of coagulation biology and scientific methods for examining coagulation factor function in vitro and in vivo. The applicant will also draw on the resources of a comprehensive clinic for patients with bleeding disorders for better understanding of the clinical behavior of VWF in patients. This environment provides a unique setting for training clinician scientists in the field of coagulation. The ultimate goal of this project is translation and application of these research findings to improve care for patients with VWD and other disorders of coagulation and to further an academic research career for the principal investigator.

Public Health Relevance

Von Willebrand disease (VWD) is a common bleeding disorder, but laboratory testing for this condition is complicated, due in part to use of a non-physiologic agonist, ristocetin, to stimulate von Willebrand factor (VWF)-platelet interactions. This project will explore the effect of polymorphisms in VWF on ristocetin binding and on VWF-platelet interactions independent of ristocetin, with the ultimate goal of improving diagnosis of VWD. Further work will investigate the role of VWF as a carrier protein for factor VIII in clot formation.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Clinical Investigator Award (CIA) (K08)
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Special Emphasis Panel (ZHL1-CSR-U (F1))
Program Officer
Sarkar, Rita
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Medical College of Wisconsin
Schools of Medicine
United States
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Flood, Veronica H; Abshire, Thomas C; Christopherson, Pamela A et al. (2018) Von Willebrand disease in the United States: perspective from the Zimmerman program. Ann Blood 3:
Doruelo, A L; Haberichter, S L; Christopherson, P A et al. (2017) Clinical and laboratory phenotype variability in type 2M von Willebrand disease. J Thromb Haemost 15:1559-1566
Flood, Veronica H; Christopherson, Pamela A; Gill, Joan Cox et al. (2016) Clinical and laboratory variability in a cohort of patients diagnosed with type 1 VWD in the United States. Blood 127:2481-8
Cooper, Scott; Sell, Shawn; Nelson, Luke et al. (2016) Von Willebrand factor is reversibly decreased during torpor in 13-lined ground squirrels. J Comp Physiol B 186:131-9
Flood, Veronica H; Schlauderaff, Abraham C; Haberichter, Sandra L et al. (2015) Crucial role for the VWF A1 domain in binding to type IV collagen. Blood 125:2297-304
Flood, Veronica H (2014) New insights into genotype and phenotype of VWD. Hematology Am Soc Hematol Educ Program 2014:531-5
Flood, Veronica H (2014) Perils, problems, and progress in laboratory diagnosis of von Willebrand disease. Semin Thromb Hemost 40:41-8
Flood, Veronica H; Gill, Joan Cox; Friedman, Kenneth D et al. (2013) Collagen binding provides a sensitive screen for variant von Willebrand disease. Clin Chem 59:684-91
Franzblau, Emily B; Punzalan, Rowena C; Friedman, Kenneth D et al. (2013) Use of purified fibrinogen concentrate for dysfibrinogenemia and importance of laboratory fibrinogen activity measurement. Pediatr Blood Cancer 60:500-2
Flood, Veronica H; Friedman, Kenneth D; Gill, Joan Cox et al. (2013) No increase in bleeding identified in type 1 VWD subjects with D1472H sequence variation. Blood 121:3742-4

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