Plasma proteins and Coagulation Factors

Abdul Salam M. Sofro Faculty of Medicine YARSI University Jakarta

Learning objectives
By the end of the lecture, students are expected to understand : various biochemical aspects of blood plasma Role and function of plasma factors in hemostasis
Reference: Murray K et al. 2000. Harpers Biochemistry, 25th ed.

Composition of Blood
Solid elements : RBC, WBC, Platelets Liquid medium : plasma consisting of water, electrolytes, metabolites, nutrients, proteins, hormones, etc. Water & electrolyte composition of plasma is practically the same as that of all extracellular fluids Once the blood has clotted (coagulated), the remaining liquid phase (called serum) lacks of the clotting factors (including fibrinogen)

Plasma proteins
Total plasma protein approx. 7.0-7.5 g/dl A complex mixture of simple & conjugated proteins such as glycoproteins & various types of lipoproteins, thousands of antibodies Can be separated
by sodium or ammonium sulfate into three major groups fibrinogen, albumin & globulins by electrophoresis using cellulose acetate into five bands albumin, 1, 2, & globulin

Composition of blood plasma

Component Water Proteins Salts Lipids Glucose (blood sugar) Percent ~92 68 0.8 0.6 0.1

Serum proteins

Cont.
Concentration of plasma protein is important in determining the distribution of fluid between blood & tissues Osmotic pressure (oncotic pressure) exerted by plasma protein is approx. 25 mm Hg.
Hydrostatic pressure in arterioles is approx. 37 mm Hg a net outward force of about 11 mm Hg drives fluid out into interstitial spaces. Hydrostatic pressure in venules is approx. 17 mm Hg a net force of about 9 mm Hg attracts water back into circulation

Cont.
The above pressures are often referred to as the Starling forces. If plasma protein concentration is markedly diminished (eg. due to severe protein malnutrition fluid is not attracted back into the intravascular compartment and accumulates in extravascular tissue spaces oedema

Cont.
Most plasma proteins are synthesized in the liver Plasma proteins are generally synthesized on membrane-bound polyribosomes Almost all plasma proteins are glycoproteins Many plasma proteins exhibit polymorphism Each plasma protein has a characteristic half-life in the circulation The level of certain protein in plasma protein increase during acute inflammatory states or secondary to certain types of tissue damage

Some functions of plasma proteins

Antiprotease (antichymotrypsin, a1 antitrypsin, 2 macroglobulin, antithrombin) Blood clotting (various coagulation factors, fibrinogen) Hormones Immune defence (Ig, complement proteins, 2-microgloblin) Involvement in inflammatory responses (acute phase response protein eg. C-reactive protein, 1-acid glycoprotein Oncofetal (1-fetoprotein = AFP)

Cont.
Transport or binding proteins albumin for bilirubin, FFA, ions, metals, metheme, steroids, other hormones, variety of drugs Ceruloplasmin contains Cu but albumin is more important in physiological transport of Cu Corticosteroid-binding globulin (transcortin) Haptoglobin binds extracorpuscular Hb

Cont.
Liproproteins (chylomicron, VLDL, LDL, HDL) Hemopexin Retinol-binding protein Sex hormone-binding globulin Thyroid-binding Transferrin Transthyretin (formerly pre-albumin, binds T4 & forms a complex with Retinol-binding protein)

Detail functions of some plasma protein

Albumin:
Major protein of human plasma (3.4-4.7 g/dL) Some 40% in plasma, 60% in extracellular space Synthesized in liver as preproprotein, depressed in a variety of diseases, particularly those of liver (decreases albumin/globulin ratio) Responsible for 75-80% of osmotic pressure of human plasma Ability to bind various ligands (include FFA, Ca, certain steroid hormones, bilirubin etc. Play an important role in transport of Cu, drugs

Cont.
Haptoglobin: A plasma glycoprotein that binds extracorpuscular Hb in a tight noncovalent Hb-Hp complex Prevent loss of free Hb into kidney Its plasma levels are of some diagnostic use low level in hemolytic anemias

Cont.
Transferrin: a 1-globulin, a glycoprotein, synthesized in liver Plays an important role in the bodys metabolism of iron (two mol of Fe3+ per mole of transferrin) diminishes potential toxicity of free iron Plasma concentration is approx. 300 mg/dL can bind 300 g of iron per dL (Total Iron Binding Capacity of plasma)

 Ceruloplasmin (Cp) 2-globulin Binds copper (Cu) Exhibits a copper-dependent oxidase activity Low levels of Cp are associated with Wilson disease Tissue levels of Cu & certain other metals are regulated in part by metallomethionins (small protein found in the cytosol of cells particularly liver, kidney & intestine)

 1-Antiproteinase (1-antitrypsin) Synthesized by hepatocytes & macrophages Principal serine protease inhibitor of human plasma inhibits trypsin, elastase & certain other proteases Deficiency of this protein has a role in certain cases (approx. 5%) of emphysema

 2-Macroglobulin A large plasma glycoprotein Comprises 8-10% of the total plasma protein in human Synthesized by a variety of cell types, including monocytes, hepatocytes & astrocytes. Binds many proteinases (an important panproteinase inhibitor) Binds many cytokines

 Immunoglobulin Play a major role in the bodys defence mechanism Synthesized by B lymphocytes

Immunoglobulin (Ig)
A group of proteins involved in mediating immune response in higher organisms In gamma globulin fraction of serum Very heterogeneous Similar in different species 106 different antibodies may be produced in human adult

Ig structure
Tetramer : * a pair of light chains (two identical =kappa or =lambda chains) * a pair of heavy chains (two identical =alpha, =gamma, =delta, =epsilon or =mu chains) Light chain has one variable region (VL) & one constant region (CL) Heavy chain has one variable region (VH) and three (, , ) or four (, ) constant regions

Immunoglobulin (antibody) molecule

Ig class
IgG
IgA

Mol. Struct

Carbohydr

22
22

22
22

4 %
10 %

IgM
IgD IgE

22
2 2 22

22
22 22

15 %
18 % 18 %

Ig functional groups
N terminal of H & L chains (VL/VH & CL /CH1) => antigen binding fragment C terminal of L chain (CL) => interchain disulphide bond C terminal of H chain (CH) particularly C 2 & C 3 and C 4 of IgM & IgE) constitute the Fc fragment responsible for class specific effector function => complement fixation or placental transfer, cell surface binding etc

Schematic models of an antibody molecule and a Fab fragment

Hemostasis and thrombosis

 Hemostasis is the cessation of bleeding from a

cut or severed vessel, whereas thrombosis occurs when the endothelium lining blood vessels is damaged or removed (eg. upon rupture of an atherosclerotic plaque) Hemostasis & thrombosis share three phases: Formation of a loose & temporary platelet aggregate at the site of injury Formation of fibrin mesh that binds to the platelet aggregate, forming a more stable hemostatic plug or thrombus Partial or complete dissolution of the hemostatic plug or thrombus by plasmin

Thrombi

Three types of thrombi: White thrombus Red thrombus Disseminated fibrin deposit in very small blood vessels or capillaries

Intrinsic and Extrinsic pathway of blood coagulation

Two pathways lead to fibrin clot formation These pathways are not independent Initiation of fibrin clot in response to tissue injury is carried out by extrinsic pathway, but how intrinsic pathway is activated in vivo is unclear (but it involves a negatively charged surface) Intrinsic & extrinsic pathways converge in a final common pathway

 Involves many different proteins can be classified into 5 types: (1) zymogens of serine dependent proteases which become activated during the process of coagulation (2) cofactors (3) fibrinogen (4) a transglutaminase, which stabilizes fibrin clot (5) regulatory & other proteins

Blood clotting factors

FI : Fibrinogen F II : Prothrombin F III : Tissue factor F IV : Ca2+ FV : Proaccelerin, labile factor, accelerator (Ac-) globulin F VII : Proconvertin, serum prothrombin conversion accelerator (SPCA), cothromboplastin

Blood clotting factors

F VIII : Antihemophilic factor A, antihemophilic globulin (AHG) F IX : Antihemophilic factor B, Christmas factor, plasma thromboplastin component (PTC) F X : Stuart Prower Factor F XI : Plsm thromboplastin antecedent (PTA) F XII : Hageman factor F XIII : Fibrin stabilizing factor (FSF), fibrinoligase

Intrinsic pathway
Involves factors XII, XI, IX, VIII, & X as well as prekallikrein, HMW kininogen, Ca2+ & platelet phospholipids results in the production of factor Xa. Commences with the contact phase in which prekallikrein, HMW kininogen, F XII & F XI are exposed to a negatively charged activating surface.

Intrinsic pathway (cont.)

When the components of the contact phase assemble on the activating surface, F XII is activated to F XIIa upon proteolysis by kallikrein. This F XIIa attacks prekallikrein to generate more kallikrein, setting up a reciprocal activation F XIIa once formed, activates F XI to F XIa and also release bradykinin from HMW kininogen

Intrinsic pathway (cont.)

F XIa in the presence of Ca2+ activates F IX. This in turn cleaves an Arg-Ile bond in F X to produce F Xa

Intrinsic pathway PK HK XII XIIa HK XI Extrinsic pathway VII

Ca 2+

XIa VIIa/Tissue factor

IX VIII

Ca 2+ VIIIa

IXa Ca 2+ PL Xa Va Ca 2+ PL Thrombin X

X V

Prothrombin

Prothrombin

Thrombin XIII

Fibrinogen XIIIa Fibrin monomer

Fibrin polymer

Cross-linked Fibrin polymer

Extrinsic pathway
Also leads to activation of F X but by different mechanism. Involves tissue factor, F VII, F X & Ca2+ and results in the production of F Xa It is initiated at the site of tissue injury with the expression of tissue factor on endothelial cells

Extrinsic pathway (cont.)

Tissue factor interacts with & activates F VII. Tissue factor acts as a cofactor for F VIIa, enhancing its enzymatic activity to activate F X Activation of F X provides an important link between those two pathways

Final common pathway

Involves activation of prothrombin to thrombin F Xa produced by either intrinsic or extrinsic pathway, activates prothrombin (F II) to thrombin (F IIa) Activation of prothrombin, like that of factor X, occur on the surface of activated platelets & requires the assembly of a prothrombinase complex, consisting of platelet anionic phospholipid, Ca2+, F Va, F Xa, & prothrombin

Final common pathway (cont.)

Conversion of fibrinogen to fibrin is catalyzed by thrombin (thrombin also converts F XIII to F XIIIa, a factor highly specific transglutaminase that covalently cross-links fibrin molecules by forming peptide bonds between the amide groups of glutamine & the e-amino groups of lysine recidues, yielding a more stable fibrin clot with increased resistance to proteolysis

Overview of hemostasis. a activated form of clotting factor V, VII, VIII, IX, X; ADP, adenosine diphosphate; Epi, epinephrine; TXA2, thromboxane; vWF, von Willebrand factor.

Some notes
Levels of circulating thrombin must be carefully controlled achieved in 2 ways: Feedback mechanism through a cascade of enzymatic reactions for the conversion of prothrombin to thrombin Inactivation of any thrombin formed by circulating inhibitors (the most important of which is antithrombin III)

Some notes(cont.)
Endogenous activity of antithrombin III is greatly potentiated by the presence of heparin Coumarin anticoagulants (eg. Warfarin) inhibit vit.K-dependent carboxylation of F II, VII. IX & X Fibrin clots are dissolved by plasmin (circulates in plasma in the form of its inactive zymogen, plasminogen)

Some notes(cont.)
Activators of plasminogen are found in most body tissues e.g.
tissue plasminogen activator (alteplase, tPA) is a serine protease that is released into circulation from vascular endothelium under condition of injury or stress & is catalytically inactive unless bound to fibrin (recombinant t-PA is used therapeutically as a fibrinolytic agent as is Streptokinase Urokinase (precursor: prourokinase)

Some notes(cont.)
Hemophilia A is due to deficiency of F VIII Hemophilia B is due to deficiency of F IX Endothelial cells synthesize prostacyclin (potent inhibitor of platelet aggregation)& other compounds that affect clotting & thrombosis Aspirin is an effective antiplatelet drug Some laboratory tests measure coagulation & thrombolysis