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H Fukue, K Anderson, P McPhedran, L Clyne and J McDonagh
Department of Pathology, Charles A. Dana Research Institute, Beth Israel
Hospital, Boston, MA 02215.
An 81-year-old woman, who presented with sudden episodes of spontaneous
bleeding, was found to have a specific inhibitor of factor XIII. Her fibrin
clots had approximately 70% gamma-gamma and no alpha polymer formation,
under conditions where normal fibrin was fully cross-linked; the patient's
clots were soluble in urea or monochloroacetic acid. Factor XIII activity
in her plasma was 24%, measured by the dansylcadaverine incorporation
assay. When mixed with normal plasma, the patient's plasma inhibited fibrin
cross-linking; however, in mixtures of patient and normal plasma, there was
no inhibition of factor XIII activity when assayed by the incorporation of
dansylcadaverine into casein. Thus, this inhibitor was active against
fibrin cross-linking but not against ligation of small molecules to casein.
Consequently, gel electrophoresis of reduced, sodium dodecyl
sulfate-solubilized fibrin clots was a simple, quantitative method that was
used to measure inhibitor activity. This inhibitor is unique and has been
designated inhibitor New Haven. It was neutralized by anti-IgG and
anti-kappa. It did not inhibit the activation of factor XIII but did
inhibit fibrin cross-linking. There was complex formation between the
inhibitor and activated factor XIII (A', A*) but not between A2 or
fibrinogen. Only A', A* and the 56-Kd fragment bound to affinity columns
made with this IgG. The inhibitor significantly decreased the binding of
A', A* to fibrin clots. These data indicate that the epitope for this
inhibitor is in a fibrin binding site. It is hidden in the zymogen and
expressed on A' and A*, indicating that the conformational change occurring
with the cleavage of the activation peptide is sufficient to expose the
fibrin binding site.
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