A major aim is the identification of the cause(s) of the antithrombin III (ATIII) abnormalities observed in hemophilic patients' plasma following intravenous treatment with various therapeutic concentrates of the vitamin-K dependent proteins (factor IX concentrates or prothrombin complex concentrates). The consistent finding of a cathodal shift in electrophoretic mobility of ATIII antigen suggested that ATIII complexes were present in the post-infusion plasmas or that a new or modified ATIII fraction had appeared. Attempts to characterize this putative variant and/or complexed ATIII will employ several complementary biochemical and immunologic techniques to study ATIII in plasma, including analytic isoelectric focusing in agarose, crossed immunoelectrofocusing, and immunoblotting following SDS-polyacrylamide gel electrophoresis. Other studies will be directed at isolating ATIII from plasma by either immunoprecipitation with anti-ATIII or affinity chromatography on heparin-agarose, followed by elution and analysis. A newly described normal variant of ATIII (ATIII-Beta) will be purified and used for comparison with ATIII fractions in post-infusion plasmas. ATIII-Beta, protein C, and heparin cofactor II in pre- and post-infusion plasmas will also be measured. A second major aim is the study of the biologic activity and fate of infused factors VII and VIIa following factor IX concentrate therapy, since infused factors VII/VIIa may have thrombogenic or hemostatic potential. Studies will include radioimmunoassay of factor VII in hemophilic plasmas, inactivation studies of factor VIIa with ATIII-Alpha, ATIII-Beta and heparin cofactor II in vitro, and quantitation of the rates of thrombin generation and inactivation in hemophilic plasma, after addition of factor VIIa and/or tissue factor. The observation that patients with hyperlipidemia and increased risk of arteriosclerotic disease have elevated factor VII levels is the basis for proposed studies to test whether factor VIIa is increased in such patients.
A third aim i s the characterization of the contents and effects of the new heat-treated factor IX concentrates on post-infusion AT III activity and antigen characteristics, factor VIIa recovery and survival, and immunologic suppression associated with concentrate therapy.
The aims of this proposal are directly pertinent to the clinical management of patients with hemophilia and may enhance the understanding of thrombotic disorders and transfusion-related immunosuppression.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
2R01HL024893-07
Application #
3337880
Study Section
Hematology Subcommittee 2 (HEM)
Project Start
1983-09-30
Project End
1988-09-29
Budget Start
1986-09-30
Budget End
1987-09-29
Support Year
7
Fiscal Year
1986
Total Cost
Indirect Cost
Name
State University New York Stony Brook
Department
Type
Schools of Medicine
DUNS #
804878247
City
Stony Brook
State
NY
Country
United States
Zip Code
11794
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Hoffman, C J; Miller, R H; Lawson, W E et al. (1989) Elevation of factor VII activity and mass in young adults at risk of ischemic heart disease. J Am Coll Cardiol 14:941-6
Hultin, M B; Dattwyler, R J; Lipton, R A (1989) Controlled prospective study of factor IX concentrate therapy and immunodeficiency. Am J Hematol 31:71-2
Hultin, M B; McKay, J; Abildgaard, U (1988) Antithrombin Oslo: type Ib classification of the first reported antithrombin-deficient family, with a review of hereditary antithrombin variants. Thromb Haemost 59:468-73
Hoffman, C; Shah, A; Sodums, M et al. (1988) Factor VII activity state in coronary artery disease. J Lab Clin Med 111:475-81
Hultin, M B; Abildgaard, U (1987) Antithrombin antigen of high molecular weight associated with neoantigen in hemophilic plasma after factor IX concentrate therapy. Thromb Res 45:175-82
Miller, N; Hultin, M B; Gounder, M et al. (1986) Hereditary antithrombin III deficiency: case report and review of recent therapeutic advances. Am J Hematol 21:215-21
Hoffman, C; Hultin, M B (1986) Factor IX concentrate therapy and thrombosis: relation to changes in plasma antithrombin III. Thromb Res 43:143-51
Hultin, M B (1985) Modulation of thrombin-mediated activation of factor VIII:C by calcium ions, phospholipid, and platelets. Blood 66:53-8
Miller, B C; Hultin, M B; Jesty, J (1985) Altered factor VII activity in hemophilia. Blood 65:845-9