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Prepublished online as a Blood First Edition Paper on August 7, 2003; DOI 10.1182/blood-2003-05-1560.

Submitted May 16, 2003
Accepted July 24, 2003
Heparin-induced substrate behavior of antithrombin Cambridge II
Alec Mushunje, Aiwu Zhou, Robin W Carrell, and James A Huntington*
Department of Haematology, University of Cambridge, Cambridge, United Kingdom
* Corresponding author; email: jah52{at}cam.ac.uk.
Cambridge II (A384S) is a highly prevalent antithrombin variant in the British population (1.14 per 1000), and predisposes carriers to a mild, but significant increased risk of thrombosis. To determine if the association of Cambridge II with thrombophilia is due to a perturbation of the antithrombin inhibitory mechanism, we expressed and characterised the variant. Antithrombin Cambridge II was found to be normal in its affinity for heparin, its ability to form SDS-stable complexes with factor Xa and thrombin, and its uncatalyzed stoichiometries and rates of inhibition. However, in the presence of full-length heparin there was a 3 and 7-fold increase in stoichiometry of inhibition of factor Xa and thrombin. The stoichiometries were not affected by pentasaccharides, indicating that the inhibitory mechanism of antithrombin Cambridge II is only perturbed in the presence of a bridging glycosaminoglycan. Thus, the vascular localisation of antithrombin Cambridge II would render the carrier slightly thrombophilic. The high occurrence of this mutation and its possible propagation from a few founders suggests an evolutionary advantage, perhaps in decreasing post-partum bleeding.

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