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Previous Article | Table of Contents | Next Article 
Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3302-3308
Formation of the Human Fibrinogen Subclass Fib420:
Disulfide Bonds and Glycosylation in Its Unique ( E
Chain) Domains
By
Yiping Fu,
Jian-Zhong Zhang,
Colvin M. Redman, and
Gerd Grieninger
From the Lindsley F. Kimball Research Institute of the New York Blood
Center, New York, NY.
 |
ABSTRACT |
COS cell transfection has been used to monitor the assembly and
secretion of fibrinogen molecules, both those of the subclass containing the novel E chain and those of the more
abundant subclass whose chains lack E's globular
C-terminus. That region, referred to as the EC domain,
is closely related to the ends of and chains of fibrinogen
( C and C). Transfection of COS cells with E, ,
and cDNAs alone results in secretion of the symmetrical molecule
( E )2, also known as
Fib420. Cotransfection with cDNA for the shorter chain
yielded secretion of both (  )2 and
( E )2 but no mixed molecules of the
structure  E( )2. Exploiting the COS
cells' fidelity with regard to Fib420 production,
identification was made of the highly conserved Asn667 as the sole site
of N-linked glycosylation in the E chain. No evidence
from Cys Ser replacements was found for interchain disulfide
bridges involving the four cysteines of the EC domain.
However, for fibrinogen secretion, the E, , and subunits do exhibit different requirements for integrity of the two
intradomain disulfide bridges located at homologous positions in their
respective C-termini, indicating dissimilar structural roles in the
process of fibrinogen assembly.
© 1998 by The American Society of Hematology.
 |
INTRODUCTION |
FIBRINOGEN, THE protein that forms the
matrix of a blood clot, is a complex molecule composed of paired sets
of three subunits ( , , and ), each encoded by a separate gene.
A few years ago we identified a subclass of native fibrinogen molecules
based on subunit differences.1 Molecules of this
subclass are characterized by their greater mass (~420 kD) and lower
plasma levels relative to the more abundant form (~340 kD), and we
have coined the terms Fib420 and Fib340 to
distinguish between them. Whereas the novel Fib420
molecules' three subunits all end in globular domains that resemble
each other, those of the more commonly known subclass Fib340 have truncated subunits that lack such a domain.
Although Fib420 molecules represent only one of every 100 fibrinogen molecules in the blood of normal, healthy
adults,2 counterparts have been found throughout the
vertebrate kingdom.3,4 This implies an important function
for the novel subclass that is distinct from that of the more abundant
Fib340, but that is as yet undefined.
Discovery of Fib420 in our laboratory evolved from the
seminal finding that the complete sequence of the human gene encoding the subunit contains an additional exon (exon VI) undetected by
previous investigators.5,6 Alternative splicing to include exon VI gives rise to the isoform of the chain ( E)
with a globular carboxy-terminal extension. It is the 236 residues
encoded by exon VI (technically the EC domain, but often
referred to as the VI-domain) that are as similar to the sequences of
the C-terminal domains of the fibrinogen and chains ( C and
C) as the latter two are to each other (40% identity); the
truncated C-terminus of the common chain ( C) has a very
different character.
Early investigations with transfected COS cells seemed to suggest the
obligatory presence of common chains for the assembly and secretion
of recombinant E-containing fibrinogen.6 The subsequent unexpected finding that two E chains are
incorporated per molecule of Fib4201 prompted
the current investigation using batches of COS cells that more closely
resemble hepatic cells in their overall efficiency of fibrinogen
assembly. In this study, we show that such cells incorporate two
E subunits per molecule of fibrinogen, whether the
common isoform is present or not. Further use of the system to
explore the role of specific residues in Fib420 assembly
and secretion was undertaken based on an extensive series of studies showing an absolute requirement for particular sets of interchain and
intrachain disulfide bonds in assembly and secretion of the more
abundant Fib340,7-10 which has 29 disulfide
bonds in all and no free cysteine residues.11 In this
study, we examine the roles of the four additional cysteines and two
potential glycosylation sites contributed by each of the
EC domains unique to Fib420.
 |
MATERIALS AND METHODS |
The original , , and cDNAs of human fibrinogen were generous
gifts from Dominic Chung (University of Washington,
Seattle). Construction of vectors containing full-length cDNAs for the
E, , , and fibrinogen subunits has been
described.6,12 If not otherwise indicated, pED4-Neo vectors
(Genetics Institute, Cambridge, MA) were used.13 Cys
Ser mutations in the , , and chains were described
previously.7,9,10 The N-terminal and " C"-domain
mutations of E were derivatized from the mutants as
done previously.6 The mutations Cys Ser, Cys
Ala, and Asn Gln in the E chain's
VI-domain were generated by polymerase chain reaction (PCR)-directed
mutagenesis according to standard procedures. As before, all constructs
were verified by sequencing.
Transient transfections of COS-1 cells were performed by the calcium
phosphate method used earlier.12 To achieve
E synthesis comparable to that of the other subunits, an
excess of E-cDNA was generally added, as indicated.
Qualitative evaluation of fibrinogen production was made by labeling
the cells for 2 hours with [35S]methionine in the
presence of 15 µg/mL heparin and 30 KIU aprotinin, then
immunoprecipitating fibrinogen from cell lysates or culture medium with
rabbit antibodies either to whole human fibrinogen (DAKO, Carpinteria,
CA) or to the VI-domain of
E.1,6,12 The intact fibrinogen species were
separated by sodium dodecyl sulfate (SDS)/4%PAGE under nonreducing
conditions; separation of the component subunits was achieved by
SDS/7.5% PAGE under reducing conditions. Signals were detected by
autoradiography. The results reported here were confirmed with several
different passages of COS cells.
 |
RESULTS |
COS cells transfected simultaneously with either the
E/ / or the E/ / / sets of
cDNAs synthesized all three or four fibrinogen subunits, respectively,
as shown by SDS-PAGE analysis of cell lysates immunoprecipitated with
antifibrinogen (Fig 1A). Predominantly E chains were immunoprecipitated by anti-VI, indicating
that most of the intracellular E subunits are not
assembled, ie, they exist as free polypeptides. Similar intracellular
pools of free E chains have been found in the human
hepatocarcinoma cell line HepG2 (Grieninger et al, in
preparation).

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| Fig 1.
Synthesis and secretion of E- and
-fibrinogen by transfected COS cells. Cells were transfected with
stoichiometric proportions of pBC-vectors containing fibrinogen subunit
cDNAs6,12 in combination as indicated below the lanes. When
all four subunit cDNAs were cotransfected, E cDNA was
included at a twofold excess. Fibrinogen was immunoprecipitated from
cell lysates (A) and culture medium (B) with either antifibrinogen (f)
or anti-VI (VI) as indicated above the lanes, and subunits were
separated under reducing conditions. Migration of the chain as a
doublet in cell extracts (see also Figs 5A and 6A) may reflect the
presence of the nonglycosylated precursor.
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Transfected COS cells secrete mostly fully assembled fibrinogen
hexamers.12 To identify E-containing
fibrinogen from among the other fibrinogen species, immunoprecipitation
of culture medium with two antibodies was used. Anti-VI
immunoprecipitated only those consisting of E, , and
, whereas antifibrinogen collected every fibrinogen species,
yielding a profile on reduced SDS-PAGE that included, when present, all
four fibrinogen subunits E, , , and (Fig 1B).
In immunoprecipitates of the medium of cells transfected with
E/ / cDNAs alone, the three fibrinogen subunits were detected at roughly similar molar ratios, irrespective of the
antibody used (anti-VI or antifibrinogen). Because anti-VI is highly
specific for the E chain (see Fig 1A, lanes 1 and 3; Fig 2, lane 3), immunoprecipitating or
only when bound to E, it follows that the bulk of
the E secreted by these cells is packaged in fully
assembled fibrinogen molecules. Cells transfected additionally with the
cDNA for common (the E/ / / -transfectants) secrete both -fibrinogen and E-fibrinogen as
indicated by the presence of E, , and chains in
the anti-VI immunoprecipitates and all four chains in the
antifibrinogen immunoprecipitates. Although
E/ / / -transfectants expressed significant
amounts of the common chain, none was found in their
anti-VI-immunoprecipitated culture medium, suggesting that no mixed
molecules of the structure  E( )2
were exported.

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| Fig 2.
Secretion of Fib420 by transfected COS cells
in the presence and absence of the common chain. Cells were
transfected with pED4-Neo-vectors containing fibrinogen subunit cDNAs
in combination as indicated below each lane; E cDNA was
included at a fivefold excess. Fibrinogen was immunoprecipitated from
culture medium with either antifibrinogen (f) or anti-VI (VI) as
indicated and run under nonreducing conditions. Traces of incompletely
assembled or single subunits could be seen in the lower part of the gel
only after overexposure of the film, confirming that most of the chains
detected in the medium upon reduction of the immunoprecipitates in Fig
1B were indeed components of hexameric fibrinogen molecules.
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The issue of mixed versus symmetrical molecules was explored further by
separating the secreted fibrinogen species under nonreducing conditions. As seen in Fig 2, E/ / -transfectants
secreted a high molecular weight species (Fib420) that is
significantly larger than that of the / / -transfectants
(Fib340). Most striking, however, is that only one
E-containing species is secreted when all four chains
are cotransfected ( E/ / / -transfectants); this product comigrates with Fib420. No mixed molecules,
containing E as well as and therefore migrating at a
position intermediate between Fib420 and
Fib340, were detected.
These findings with heterologous host cells support our earlier
hypothesis that formation of symmetrical fibrinogen molecules, ( E )2, is energetically favored over
that of the mixed molecules  E( )2,1 driven perhaps
by alternative disulfide bond configurations either between the two
E chains' VI-domains to form a fourth nodule
and/or connecting the VI-domains to N-terminal cysteines that
could belong, in principle, to any subunit chain, even E itself. The latter would serve to tether the VI-domains to the central
nodule, consistent with the tetranodular images observed in many
published electron micrographs of fibrinogen.14-16
To test this alternative disulfide bond hypothesis, we looked for
qualitative changes in the fibrinogen species secreted by COS cells
that had been transfected with subunit cDNAs coding for either
wild-type chains or chains in which specific cysteines were converted
to serines (or alanines) by site-directed mutagenesis. All four
cysteines in the VI-domain of human E were substituted, individually and in combination; changes in the N-terminus and in the
" C" region of the E chain were also introduced
(illustrated in Fig 3). In addition,
N-terminal substitution mutants at sites in the and chains
( 65S and 8S/9S) were evaluated for their potential contribution
to Fib420 formation.

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| Fig 3.
Schematic representation of targeted amino acid positions
in the E subunit for site-directed mutagenesis. Residues
are numbered as done previously.6 Arrows or simple vertical
lines indicate positions of those cysteines converted, either singly or
in combination, to serine or alanine by site-directed mutagenesis. (A)
The three regions of the E chain: the N-terminus (NT)
containing a large -helical segment, the so-called " C"
region, and the C-terminal globular VI-domain ( EC
domain); (B) the VI-domain, potential glycosylation sites in the
wild-type sequence at Asn667 and Asn812 are marked, respectively, with
closed and open diamonds. The glycosylation site at Asn791 introduced
by the Cys793 Ser change is marked with a striped diamond. Putative
loops connecting cysteines E613/644 as well as
E780/793 are drawn by analogy with the intrachain loops
formed by homologous cysteines in the C and C domains.
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To establish whether any of the above cysteine mutations per se
affected Fib420 secretion, they were initially examined in E/ / -transfectants, ie, in the absence of the major
chain (Fig 4). All mutant
fibrinogen subunits were expressed, as shown by analysis of cell
lysates (Fig 4A). Despite some variation in the amount of fibrinogen
secreted by the different mutants, it is clear that
E613S and E780S/793S substitutions
abolished secretion of Fib420 (Fig 4B). Although the double
mutation E613S/644S, which knocks out the putative first
loop in the VI-domain, has no discernable effect on Fib420
secretion, the single E613S mutant and its mutated
disulfide bond partner ( E644S;
Table 1) are inhibitory. In either of these
single mutations, a reactive thiol group introduced by an unpaired
cysteine appears to interfere nonspecifically with the assembly
and/or secretion process. Of note, the
E780S/793S mutation creates a neo-N-glycosylation site (NNS) at Asn791. That carbohydrate is attached to this site can be seen
from the upward mobility shift of E780S/793S in Fig 4A, lane 5. To test whether the extra carbohydrate chain is responsible for
blocking secretion, we changed Cys793 to alanine instead of serine in
mutant E780S/793A. This particular mutation also blocked secretion (Table 1), indicating that the missing (second) intrachain loop and not the carbohydrate attachment is responsible for lack of
Fib420 export in E780S/793S mutants.

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| Fig 4.
Cys Ser changes in the E, , and subunits: Negative and neutral effects on the secretion of
Fib420. Cys Ser changes were made in the fibrinogen
subunits at the positions indicated above the lanes. COS cells were
transfected with pED4-vectors containing E, , and (either wild-type or mutant) cDNAs as shown; E
constructs were included at a fivefold excess. Fibrinogen was
immunoprecipitated, from cell lysates (A) and culture medium (B), with
antifibrinogen and run under reducing conditions. The size of protein
markers (lane 1) is displayed in kD in the left margin.
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In addition to the VI-domain cysteines, we evaluated substitutions of
cysteines in other parts of the Fib420 molecule that might
be available for alternative disulfide bonding with the VI-domain,
reasoning that those cysteines were not found to be critical for export
of Fib340. The first pair of these was further upstream in
the E chain, Cys442 and Cys472, which correspond to
positions in the C region of the common chain known to form an
intrachain loop10; mutant E442S/472S had no
effect on Fib420 secretion in
E/ / -transfectants (Fig 4). Other candidate
cysteines that we evaluated, located in the N-termini of the
constituent fibrinogen chains ( E Cys28 and Cys36, Cys65, and Cys8 and Cys9), are involved in forming the symmetrical
disulfide bridges that hold the   trimers together; only one
out of the four symmetrical bonds is absolutely required for
Fib340 hexamer assembly and secretion.7,8,10
None of these mutations, E28S/36S, 65S, or
8S/9S, when cotransfected with complementary wild-type
chains, interfered with proper secretion of Fib420
molecules in the E/ / -transfectants (Fig 4).
Having established that Fib420 production was possible
despite substitution of particular residues, the same mutations were examined in E/ / / -transfectants. This test of
the alternative disulfide bond configuration hypothesis could be
expected to yield secretion of mixed molecules (containing both
E and ) whenever cysteines involved in bonds favoring
homodimer formation were replaced. For each set of mutations, it was
first shown that simultaneous transfection with all four cDNAs leads to
expression of all four subunits (Fig 5A)
and that for the subunits comprising Fib420, ie, the
E, , and chains, the levels of expression were
comparable to those of the E/ / -transfectants (Fig
4A). The medium of the transfected cells was then immunoprecipitated
with anti-VI for detection of secreted E-containing
fibrinogen (Fig 5B). Although secretion with mutated subunits was less
efficient, in no case were mixed molecules detectable as species
migrating faster than that of the
E/ / -transfectant. It follows that selective
incorporation of two E subunits in the presence of the
abundant chain is not dependent on disulfide bridges involving
cysteines in the VI-domain of E or on available cysteine
partners further upstream in the E chain itself or in
the other two subunits present in the central core of the fibrinogen
molecule. These results with recombinant molecules are consistent with
trypsin digests of  -fibrinogen,4 the lamprey
equivalent of Fib420, which appears to be a similarly symmetrical molecule but which has E-like chains derived
from a separate  gene17 instead of being
alternatively spliced gene products as in higher
vertebrates.3,6

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| Fig 5.
Effect of E, , and subunit
mutations on Fib420 secretion in presence of the wild-type
subunit: No secretion of mixed molecules. Cys Ser changes were
made in the fibrinogen subunits at the positions indicated above the
lanes. COS cells were transfected with either wild-type or mutant
E, , and cDNAs together with wild-type cDNA
in the combinations shown; E constructs were included at
a fivefold excess. Fibrinogen was immunoprecipitated from cell lysates
(A) with antifibrinogen and run under reducing conditions; from the
culture medium (B), fibrinogen was immunoprecipitated with anti-VI and
run under nonreducing conditions. As described previously,1
due to the differential proteolytic susceptibility of and
E subunits in cell lysates, a proteolytic fragment
derived only from the chain, not from E, appears as
a band migrating below the chain doublet in panel A (compare also
Fig 1A).
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In contrast to the predominant human chain, which has no
carbohydrate, human E is N-glycosylated.1 We
knocked out each of the two potential glycosylation sites,
E667 and E812, by changing asparagines to
glutamines. These mutated E chains showed a mobility
shift comparable in magnitude to that fortuitously generated in mutant
E780S/793S with its second active glycosylation site.
Examination of lysates of E/ / -transfectants in
Fig 6 revealed that the mutant
E812Q comigrates with wild-type E, whereas E667Q migrates faster, suggesting that normally
carbohydrate is attached to Asn667 and not to Asn812.
E780S/793S, as noted above, is larger than wild-type
E because of an additional carbohydrate moiety at
Asn791. Thus, the stepwise increase in molecular weight of
E667Q, E812Q, and
E780S/793S reflects the attachment of zero, one, and two
carbohydrate chains, respectively.

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| Fig 6.
Mutation of potential N-glycosylation sites in the
E VI-domain: Determination of carbohydrate attachment
site. The VI-domain's two potential glycosylation sites, at Asn667 and
Asn812, were changed to Gln; a new site at Asn791 had been introduced
by the Cys793 Ser change. COS cells were transfected with either
wild-type or these mutant E cDNAs together with the and subunit cDNAs. Fibrinogen was immunoprecipitated from cell
lysates and culture medium with antifibrinogen and run under reducing
conditions. Upon overexposure of the film, Fib420 subunits
are clearly detectable in the culture medium of the Q667 mutant.
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In mutant E667Q, secretion of Fib420 is
reduced to less than 20% of wild-type levels (Fig 6; upon overexposure
of the film the subunits are clearly detectable), suggesting possible
involvement of carbohydrate attachment at this site in secretion.
However, from an earlier finding that Fib420 secretion was
not appreciably inhibited when tunicamycin blocked N-glycosylation in
HepG2 cells,1 it is apparent that reduced secretion of
E667Q mutant Fib420 results not from the
absence of sugar but rather from a conformational change introduced by
replacing Asn with Gln.
 |
DISCUSSION |
This study shows, in transfected COS cells, that formation of secreted
E-containing fibrinogen hexamers is possible with the
E, , and subunit building blocks alone.
Importantly, the predominant secreted species of
E-containing fibrinogen is the homodimeric
( E )2, even in the presence of the
common chain (ie, in E/ / / -transfectants);
no mixed molecules of the composition  E( )2 are observed (Figs 1 and 2).
In other words, the heterologous COS cell system mimics the hepatic
Fib420 assembly process as evaluated in the cell line
HepG2, where E-homodimeric fibrinogen molecules are
formed preferentially in the presence of an abundant supply of chains, the E: chain ratio being roughly
1:20.1
This investigation of human E-containing fibrinogen
contradicts prior notions regarding the obligatory presence of common chains for assembly and secretion.6 Inability of cells
used in previous COS experiments to match the performance of hepatoma cells (HepG2), which assemble E and chains into
fibrinogen with equal efficiency, may account for the anomalous earlier
findings. Exploiting the current COS cells' fidelity with regard to
Fib420 synthesis and secretion, studies were extended to
analyze the molecule's glycosylation sites as well as the requirement
for specific cysteines in connection with its secretion.
Of the two potential glycosylation sites in the Fib420's
unique EC domain, the tripeptide at Asn667 is conserved
in all vertebrates, including lamprey, whereas the one at Asn812 is
conserved only in mammals.3,17 By substituting Gln for Asn
we have now shown that it is the highly conserved Asn667 site that has
carbohydrate attached in the E chain of human
Fib420 (Fig 6). Thus, Fib420 has a
total of six carbohydrate moieties among its six component chains. All
of the sites have the consensus tripeptide sequence NXT, with X being a
positively charged residue: arginine in and , lysine in .
Whereas the chain bears carbohydrate in a more upstream region of
the chain, both E and chains use sites in the
C-terminal region. Although the EC and C attachment sites do not align with each other, they are both located between the
homologous first and second disulfide loops.
With its four extra cysteines per EC domain,
Fib420 has the potential to form 33 disulfide bonds. The
positions of the four cysteines in EC are invariant
among E homologs throughout vertebrate evolution and
align precisely with cysteines in the C and C domains,3,6,17 each of which has two intrachain disulfide bridges. The results from substituting serine or alanine residues for
the VI-domain cysteines (Figs 4 and 5, Table 1) are consistent with the
existence of similar bonds between the cysteine pairs at
E613/ E644 and at
E780/ E793. The finding that the
individual E613S and E644S mutations
block secretion but not the double mutation E613S/644S
strongly suggests that there is an intrachain loop formed by Cys613 and
Cys644. Fib420 secretion is prevented by double mutation of
the cysteines presumably forming the domain's second disulfide loop
( E780/793), indicating a vital role for them, and not
those of the potential first loop, in Fib420 export from
the cell.
A number of protein sequences have been identified that bear C-terminal
domains homologous to EC, C, and C. In this family of fibrinogen-related domains (FREDs),18 which contains at
least 14 unique members at latest count, the cysteines of the first and
second disulfide loops are preserved. With only one
exception,19 the 12 residues of the second loop are highly
conserved; those of the first loop, varying in number from 24 to 30, constitute the sequence with the lowest conservation in the entire
family of FREDs. In the context of our findings regarding
Fib420 secretion, the second loop's higher degree of
conservation may reflect a more critical role in secretion of the
parent molecule.
It should be mentioned that the C-terminal region of the chain
actually has three intrachain disulfide bonds. In the large loop formed
by cyteines 201/286, which is essential for secretion,10 only Cys286 is part of the C domain proper.6
Although the loop is conserved among all vertebrate fibrinogen chains, there is no cysteine corresponding to Cys286 in any other
member of the FRED family, implying a highly specific function.
Structurally, the E chain differs significantly from the
and chains by virtue of the large " C" region
(identical to the truncated C-terminus of the common chain) that
tethers the subunit's globular C-terminus ( EC) to its
-helical N-terminus. Overall, the " C" tether, encoded by
exon V of the gene, is poorly conserved among the fibrinogens of
higher vertebrates.20 However, the disulfide loop it
contains, homologous to the human cysteines at positions 442/472, is
highly conserved, although it does not play a role in either
Fib340 or Fib420 secretion10 (Figs
4 and 5). An apparent conformational change in Fib420
occurs in the E442S/472S mutant as a result of
eliminating a disulfide-bridged loop, and it is reflected, even in this
high-molecular-weight range, in distinctly slower migration on SDS-PAGE
relative to all the other species that were generated (Fig 5). This is
consistent with the slower migration noted previously of the
442S/472S mutant relative to wild-type chains under nonreducing
SDS-PAGE conditions10 and gives credence to the hypothesis
that the loops in the " C"-region of E make the
Fib420 molecule more compact. It remains to be seen whether
the 442S/472S Fib420 mutant displays neoepitopes and/or is more susceptible to proteolytic attack.
Based on sequence comparison,6 the globular fold of the
EC domain is expected to be very similar to the folds of
the C and C domains, which were recently determined at atomic
resolution and which were found to be virtually
superimposable.21-23 However, the dependence of secretion
on the integrity of the two homologous intradomain disulfide bridges is
distinctly different for each subunit. In the C region, only the
first loop is required; in the EC region, it is the
second loop; and in the C region both loops play a critical part.
These observations support different structural roles for the subunits
in the process of fibrinogen assembly, a notion put forward more than a
decade ago.24,25
The mechanism that favors formation of the symmetrical
Fib420 molecule over that of a mixed
E/ -containing molecule in the presence of excess chains is not known at present. We previously speculated that
alternative disulfide bridges, either between the VI-domains
and/or the VI-domain and the center of the molecule, might
provide the impetus for homodimer formation. Without directly determining disulfide bridges between particular cysteines, the experiments using E/ / / -transfectants (Fig 5) do
not support that hypothesis; specific mutations in E's
VI-domain and the N-termini of all the E, , and chains, designed to remove cysteines potentially available for
alternative disulfide bridges, failed to reduce production of
( E )2 in favor of mixed
 E( )2 molecules. Thus, a different
mechanism based on noncovalent interactions must be advanced to explain
symmetrical incorporation of E chains into
Fib420 against all stoichiometric odds. Given the high
negative charge borne by each EC domain,6 it
is conceivable that chaperone proteins associated with nascent
fibrinogen26,27 may play a critical role in balancing the
spatial charge distribution.
 |
NOTE ADDED IN PROOF |
As this report was being processed for publication, the assignments of
bound cysteine pairs and carbohydrate attachment site in the
EC domain were confirmed by x-ray crystallographic
analysis of a recombinant version of the domain.28
 |
FOOTNOTES |
Submitted April 28, 1998;
accepted July 6, 1998.
Supported in part by the National Institutes of Health through grants
to G.G. (HL 51050) and C.M.R. (HL 37457) and by the American Heart
Association through a grant to G.G.
Address reprint requests to Gerd Grieninger, PhD, New York Blood
Center, 310 E 67th St, New York, NY 10021; e-mail:
ggrien{at}server.nybc.org.
The publication costs of this article were defrayed in part by page charge payment. This article must therefore be hereby marked "advertisement" is accordance with 18 U.S.C. section 1734 solely to indicate this fact.
 |
ACKNOWLEDGMENT |
We thank our colleague K.M. Hertzberg for many valuable contributions
to the manuscript.
 |
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