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Factor IXa-factor VIIIa-cell surface complex does not contribute to the
basal activation of the coagulation mechanism in vivo
KA Bauer, PM Mannucci, A Gringeri, F Tradati, S Barzegar, BL Kass, H ten Cate, AS Kestin, DB Brettler and RD Rosenberg
Department of Medicine, Beth Israel Hospital, Boston, MA 02215.
We have infused recombinant factor VIIa into patients with hereditary
factor VII deficiency with marked reductions in plasma concentrations of
factor IX activation peptide (FIXP), factor X activation peptide (FXP), and
prothrombin activation fragment F1+2. These investigations show substantial
elevations in these markers of coagulation activation and thereby
demonstrate that the factor VII-tissue factor pathway is largely
responsible for the activation of factor IX as well as factor X in the
basal state (ie, the absence of thrombosis or provocative stimuli). We have
administered a monoclonal antibody purified factor IX concentrate to
individuals with hemophilia B. These studies show an increase in the plasma
levels of FIXP that were initially greatly decreased, but no change in FXP
or F1+2. We have also infused highly purified factor VIII concentrate into
patients with hemophilia A. The data demonstrate no significant changes in
the plasma concentrations of FXP and F1+2. The above observations indicate
that factor IXa generated by the factor VII-tissue factor pathway is unable
to activate factor X under basal conditions. Based upon the above findings,
we outline a model of blood coagulation system function under basal
conditions, and suggest a process by which the generation of factor Xa and
thrombin might be accelerated during normal hemostasis and in the setting
of thrombotic disorders.
Volume 79,
Issue 8,
pp. 2039-2047,
04/15/1992
Copyright © 1992 by The American Society of Hematology

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