The autosomal dominantly inherited east Texas bleeding disorder is linked to an A2440G variant in exon 13 of the F5 gene. Affected individuals have normal levels of coagulation factor V (FV) activity, but demonstrate inhibition of global coagulation tests. We demonstrated that the A2440G mutation causes upregulation of an alternatively spliced F5 transcript that results in an in-frame deletion of 702 amino acids of the large activation fragment, the B domain. The approximately 250-kDa FV isoform (FV-short), which can be fully activated by thrombin, is present in all A2440G carriers’ plasma (n = 16). FV-short inhibits coagulation through an indirect mechanism by forming a complex with tissue factor pathway inhibitor-α (TFPIα), resulting in an approximately 10-fold increase in plasma TFPIα, suggesting that the TFPIα:FV-short complexes are retained in circulation. The TFPIα:FV-short complexes efficiently inhibit thrombin generation of both intrinsic and extrinsic coagulation pathways. These data demonstrate that the east Texas bleeding disorder–associated F5A2440G leads to the formation of the TFPIα:FV-short complex, which inhibits activation and propagation of coagulation.
Authors
Lisa M. Vincent, Sinh Tran, Ruzica Livaja, Tracy A. Bensend, Dianna M. Milewicz, Björn Dahlbäck
(A–D) A pool of plasma from affected family members was subjected to either FV or TFPI depletion to analyze whether TFPI was specifically associated with FV-short. (A and B) Plasma (300 μl) was incubated with 900 μl Streptavidin-coated magnetic beads carrying biotinylated polyclonal antibodies against TFPI (AHTFPI-S). After 2 hours at 11°C, the mixture was centrifuged, the supernatant diluted 1:40 in sample preparation buffer, and 10 μl added for Western blot analysis using a monoclonal antibody against FV (A, AHV-5146) or an antibody against TFPI (B, ATFPI-5138 against Kunitz 1 domain). The beads were washed once in HNSBSA and bound TFPI eluted with 300 μl sample preparation buffer; 10 μl of a 1/20 dilution was loaded and analyzed with antibodies against FV (A) and TFPI (B). Aff, affected; sup, supernatant, ip, immunoprecipitate (C and D) Affected plasma (1 ml) was either loaded to a 1-ml HiTrap column with coupled MK30 against the FV B domain or a 1-ml HiTrap column with coupled polyclonal anti-FV IgG (#8806) (αFV). After 30 minutes incubation, the plasma was eluted and analyzed by Western blotting for FV (C) or TFPI (D). The lanes in C and D were run on the same gel but were noncontiguous. (E and F) Unaffected plasma (5 ml) was immunoprecipitated with 1 ml anti-TFPI magnetic beads, essentially as in A and B. The starting plasma and the supernatant (10 μl of 1/10 dilution) were analyzed with antibodies against FV (E, AHV-5146) or TFPI (F, ATFPI-5138). The beads were washed and eluted with 100 μl sample preparation buffer, and 10 μl undiluted sample was analyzed for FV (E) and TFPI (F).