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Activation of factor VII during alimentary lipemia occurs in healthy adults
and patients with congenital factor XII or factor XI deficiency, but not in
patients with factor IX deficiency
GJ Miller, JC Martin, KA Mitropoulos, MP Esnouf, JA Cooper, JH Morrissey, DJ Howarth and EG Tuddenham
Medical Research Council Epidemiology and Medical Care Unit, Medical
College of St Bartholomew's Hospital, London.
Factor VII activity (FVIIc), a risk marker for coronary heart disease, is
increased during postprandial lipemia. Factor VII activation accompanies
lipolysis of triglyceride-rich lipoproteins, but the nature of this
association and whether it is causal remain uncertain. To explore this
issue, four patients with homozygous factor XII deficiency, four with
complete factor XI deficiency, six with factor IX deficiency, and their
respective age- and sex-matched controls were given two isocaloric dietary
regimens, one providing on average 136 g fat and the other 19 g fat. Blood
was taken before breakfast, immediately before lunch at 195 minutes, and at
completion of the study at 390 minutes. All samples for each subject and
matched control were assayed as one batch for FVIIc, activated factor VII,
and factor VII antigen (FVIIag). Activation of factor VII was observed with
the high- fat regimen but not with the low-fat regimen in all controls,
factor XII-deficient patients, and factor XI-deficient patients. No factor
VII activation was observed during either regimen in factor IX-deficient
patients, but a normal postprandial responsiveness of factor VII to dietary
fat was restored in one patient who replicated the study after factor IX
therapy. Plasma FVIIag was not altered postprandially in either regimen in
any group of patients or controls. Factor IX apparently plays an obligatory
role in the postprandial activation of factor VII, although the mechanism
remains to be determined.
Volume 87,
Issue 10,
pp. 4187-4196,
05/15/1996
Copyright © 1996 by The American Society of Hematology
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