Thrombosis |
From the Department of Biochemistry and Molecular Biology, Royal Free and University College Medical Schools (Royal Free Campus), London, UK.
Correspondence to Camille Ettelaie, Department of Biochemistry and Molecular Biology, Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF, UK. E-mail Camille{at}RFHSM.AC.UK
| Abstract |
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Key Words: tissue factor ApoB100 tissue factor pathway inhibitor LDL oxidation lysine arginine inhibition
| Introduction |
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| Methods |
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Oxidation of LDL
LDLs (250 nmol/L protein=0.125 mg of protein/mL) were prepared
from 6 different normal, healthy donors. Minimally modified LDL were
prepared under sterile conditions from nLDLs (1 g of protein/L) by
exposure to air at room temperature.24 To prepare fully
oxidized LDLs, nLDLs were exposed to oxidation with 5 µmol/L
copper sulfate for 0, 1, 3, 6, 12, 18, and 24 hours at 37°C and
dialyzed against buffer, pH 7.4, containing 1 mmol/L EDTA.
Aliquots of nLDL containing 1 µmol/L DTPA were used as controls.
Lipid peroxide products were assayed by an iodometric
method.25 In addition, cumene hydroperoxide (Sigma
Chemical Company Ltd), 9-hydroperoxyoctadecadienoic acid, and
15-S-hydroperoxyeicosatetra-enoic acid (Cayman
Chemicals). were used to assess the effect of peroxides on tissue
factor activity.
Isolation of TFPI From Plasma and the Media of Human
Hepatocyte Carcinoma (Hep G2) Cells
Hep G2 cells were cultured in DMEM, containing 2 mmol/L
glutamine, supplemented with 10% FCS (Gibco Life Sciences) in 5%
CO2 at 37°C, until the cells became confluent.
The supernatant was removed and centrifuged at 1000g
for 10 minutes at 4°C to remove any cells and was used for isolation
of TFPI. Hep G-2 TFPI was almost entirely the full-length form (43 kDa)
as determined by 12% (wt/vol) denaturing polyacrylamide gel
electrophoresis.26 Citrated blood was obtained
from healthy volunteers and plasma prepared by
centrifugation. TFPI was isolated from human
plasma27 and the media of Hep G2 cells28 by
factor Xa-Sepharose affinity chromatography. The
affinity column was prepared by coupling human factor Xa to
p-nitrophenyl agarose29 (Sigma Chemical
Company Ltd). Human plasma TFPI was predominantly C-terminal truncated
(33 kDa).
Preparation of Full-Length Human Recombinant TFPI
Full-length TFPI cDNA was prepared by reverse transcription,
using the Superscript II enzyme (Gibco Life Sciences), according to
manufacturer's instructions and the DNA amplified by PCR, using
primers with nonidentical restriction sites. An enterokinase cleavage
site was also engineered preceding the full-length TFPI. The digested
DNA was ligated into the pinpoint Xa3 plasmid previously
digested with the same enzymes.
Competent Escherichia coli (JM109) cells were subsequently transfected and selected by growth in Terrific broth containing ampicillin (100 µg/mL). The cells were then grown in the presence of 100 µg/mL isopropyl-ß-thiogalactopyranoside (IPTG) and 5 µg/mL biotin, harvested, and the biotinylated protein isolated according to the manufacturer's instructions. A sample of the isolated TFPI was examined on a 12% (wt/vol) denaturing polyacrylamide gel and by immunoprecipitation, using anti-human TFPI antibodies (American Diagnostics). Recombinant full-length TFPI-fusion protein had a molecular mass of 47 kDa, which is in agreement with the calculated value for the recombinant TFPI-biotinylated tag construct. This TFPI preparation and those isolated from Hep G2 medium and plasma were all recognized by the anti-TFPI antibody.
Tissue Factor Inhibition Assay
To test for any inhibitory or procoagulant
effect, all samples or controls were incubated (in triplicate) with
1-mL aliquots of human recombinant tissue factor (DADE Innovin, Sysmex
UK Ltd) diluted 100 times (10 U/mL) at 37°C for up to 2 hours and the
tissue factor activity measured by means of the 1-stage prothrombin
time assay or the 2-stage chromogenic assay.30
The tissue factor stock was assumed to contain 1000 arbitrary units/mL.
Tissue factor activity was calculated from appropriate standard curves
and the percentage inhibition in each sample was calculated against an
aliquot of tissue factor diluted 200 times (5 U/mL) as follows: % of
inhibition=100x[initial tissue factor activity (control)-residual
tissue factor activity]/initial tissue factor activity (control).
Chemical Modification of TFPI
Lysine residues were modified selectively either to preserve the
positive charge
(Lys+-modified)31 or to
neutralize the charge
(Lysneut-modified).31 To modify
lysine residues retaining the charge, samples of Hep G2 TFPI or BSA (2
to 10 mg) were dissolved in NaCl (0.15 mol/L), EDTA (0.01% wt/vol),
BaBH4 (0.3 mol/L), pH 9.0 (Sigma Chemical Company
Ltd) at 0°C; 1 µL of formaldehyde (37% wt/vol) was added
immediately and at 3-minute intervals up to 60 minutes. The proteins
were then dialyzed against NaCl (0.15 mol/L), EDTA (0.01% wt/vol), pH
7.0, and freeze-dried until use.
TFPI and BSA were acetylated to modify lysine residues, neutralizing the charge. The samples (10 mg) were dissolved in 3 mL of sodium phosphate (0.005 mol/L), KCl (0.1 mol/L), pH 7.4, on ice and 1 mL of N-acetylimidazole (0.91 mol/L) (Sigma Chemical Company Ltd) was added and mixed. The samples were kept on ice for 20 minutes and subsequently dialyzed and freeze-dried as above.
Arginine modification was performed as described by Stark.31 The protein samples (1 mg) were dissolved in 2 mL of Na2B4O7 (0.25 mol/L), 1,2-cyclohexanedione (0.15 mol/L), pH 9.0 (Sigma Chemical Company Ltd). The samples were incubated at 37°C for 2 hours, after which an equal volume of acetic acid (30% wt/vol) was added. The samples were then consecutively dialyzed against 15%, 7.5%, and 1% (wt/vol) acetic acid. The samples were then dialyzed and freeze-dried as above. After chemical modification, all samples were examined by denaturing gel electrophoresis.
Determination of Effects of Serum on Tissue Factor
Activity
Human venous blood was collected from 5 volunteers 20 to 30
years old, allowed to clot, and the sera decanted and
centrifuged to remove any cells. The ability of sera to inhibit
tissue factor (final concentration, 5 U/mL) activity was measured in
the presence of either anti-human ApoB100 antibodies (Immuno) (final
concentration, 73 µmol/L) or anti-human TFPI antibodies
(American Diagnostics) (final concentration, 7.5
µmol/L), and finally in the absence of any antibodies as before.
Moreover, the total amount of LDL within the sera was estimated by
using a turbimetric precipitation method with 10% (wt/vol) dextran
sulfate (T 500).32
Investigation of the Inhibitory Contributions of
ApoB100 and TFPI and the Influence of Oxidation
Samples of tissue factor (final concentration, 5 U/mL) were
incubated with either reconstituted LDL (final concentration, 250
nmol/L protein), samples of Hep G2, plasma and recombinant TFPI (final
concentration, 50 nmol/L), or combinations of LDL-r and TFPI.
Inhibitory activity of TFPI and LDL-r were assayed in the
presence of prothrombin complex (10 ng/mL) and
Ca2+ ions (0.5 mmol/L) and the residual
tissue factor activity. Moreover, similar samples exposed to oxidizing
conditions or chemical modifications were assessed in the same way.
| Results |
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Time Course of the Inhibition of Tissue Factor by Isolated
TFPI and ApoB100
Plasma TFPI (50 nmol/L), at 5 times its mean
physiological concentration, had a transient
inhibitory effect, reaching a maximum of inhibition at
15 minutes (Figure 2
). On the other
hand, both Hep G2 TFPI and recombinant TFPI inhibited tissue factor for
a longer period and to a greater extent than plasma TFPI (Figure 2
). Inhibition by LDL-r (250 nmol protein/L) took longer,
ultimately causing almost total inhibition of the tissue factor
procoagulant activity (Figure 2
). Furthermore, although the
inhibition by LDL-r was not affected by the presence of anti-TFPI
antibodies, the inhibition was suppressed in the presence of
anti-ApoB100 antibodies (not shown). Conversely, TFPI activity was only
suppressed by the presence of anti-TFPI antibodies (not shown).
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Samples of LDL-r were combined with each of the 3 preparations of TFPI
(50 nmol/L) and incubated at 37°C for 30 minutes, then incubated with
recombinant human tissue factor (final concentration, 5 U/mL) and
assayed at zero time and after 15 minutes. Preincubation of LDL-r with
C-terminal truncated plasma TFPI, before incubation with tissue factor,
had little effect on the inhibitory potential of either of
the 2 proteins (Table 1
). Conversely,
preincubation of LDL-r with either full-length Hep G2 TFPI or
recombinant TFPI resulted in a reduction in the activity of the sample,
compared with either LDL-r or TFPI alone (Table 1
).
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Time Course of Copper-Induced LDL Oxidation and the
Influence on Tissue Factor Activity
A steady rise in the concentration of lipid peroxides was detected
after incubation with CuSO4 to a maximum peroxide
concentration of 250 nmol/mg of LDL protein at 18 hours; no further
increase was apparent after 24 hours of incubation (Figure 3
). The ability of LDL to undergo
oxidation varied among the different preparations, because samples
prepared from various individuals differ in their susceptibility to
oxidation. nLDL (250 nmol/L protein) inhibited the tissue factor
activity by an average of 53±8% (n=6). As oxidation progressed, the
ability of LDL to inhibit tissue factor decreased, eventually enhancing
tissue factor activity by up to 40% (Figure 3
). The change in
the activity of tissue factor was most pronounced with LDL samples more
prone to oxidation.
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Effect of Low Levels of Oxidation on Tissue Factor
Activity
On exposure to air, the level of peroxides rose from 17 nmol/mg of
protein in the nLDL to mean values of 45 and 70 nmol/mg of protein in
the 24- and 48-hour treated LDL, respectively. The nLDL controls
retained most of their inhibitory effect on tissue factor
even after 24 and 48 hours (Table 2
). This inhibition decreased by
>50% after 24 hours of oxidation. After 48 hours of incubation, all
the inhibitory potential had been lost and tissue factor
activity was enhanced slightly by 10%.
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Addition of the lipid peroxides 9-hydroperoxyoctadecadienoic acid and 15-S-hydroperoxyeicosatetraenoic acid (products of LDL oxidation) or cumene hydroperoxide (0 to 20 µmol/L) to tissue factor (10 U/mL) had little effect on procoagulant activity at low concentrations (<4 µmol/L), but were inhibitory in the higher range (not shown). Therefore, although peroxide formation is an index of oxidation, they are not directly the cause of the enhancement of tissue factor activity.
Effect of Oxidation on TFPI-Bound LDL-r
Copper-mediated oxidation of TFPI-bound LDL has been shown to
suppress the inhibitory potential of the complex toward
tissue factor.21 The purpose of this part of the study was
to investigate the effects of mildly oxidized LDL on different forms of
TFPI. Aliquots of LDL-r, or lipids alone, were incubated with
recombinant TFPI, plasma TFPI, and Hep G-2 TFPI for 30 minutes before
mild oxidation by exposure to air as described in Methods. The samples
were then incubated with recombinant human tissue factor (final
concentration, 5 U/mL) for 15 minutes in the presence of prothrombin
complex (10 ng/mL) and Ca2+ ions (0.5
mmol/L). Mild oxidation of the plasma TFPI and LDL-r mixture slightly
reduced the combined inhibitory potential toward tissue
factor, whereas the inhibitory activity of the recombinant
TFPI or of Hep G2 TFPI combined with that of LDL-r was greatly reduced
by the oxidation (Table 3
). In all
samples, increases in peroxidation products (40 to 45 nmol/mg of
LDL protein) were detected after 24 hours, indicating that oxidation
had occurred.
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Effect of Chemical Modification of Lysine and Arginine Residues on
TFPI Activity
Oxidation of lipoproteins leads to formation of adducts between
lipid peroxidation products and lysine residues. The effects of
chemical modification of basic amino acids were therefore examined.
Samples of Lys+-modified TFPI,
Lysneut-modified TFPI, and Arg-modified TFPI
(final concentration, 50 nmol/L) and the 3 controls
Lys+-modified BSA,
Lysneut-modified BSA, and Arg-modified BSA were
incubated with recombinant human tissue factor (final concentration, 5
U/mL) for 15 minutes and assayed as described in Methods. All samples
remained intact (full-length TFPI) after chemical modification (Figure 4
). The ability of TFPI to inhibit tissue
factor was reduced by modification of either lysine or arginine
residues (Table 4
). However, a greater
suppression of the inhibitory potential of TFPI toward
tissue factor was achieved when the positive charges of the lysine
residues within TFPI were neutralized (Table 4
). Modification of
arginine residues or lysine residues, conserving the positive charge,
were less effective in neutralizing TFPI activity, respectively. As a
control, it was shown that BSA, in its native form or after
modification of lysine or arginine residues, had no significant effect
on the overall activity of tissue factor.
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| Discussion |
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The inhibitory action of nLDL against tissue factor was
abrogated by oxidation. Recently, we have demonstrated that the
inhibitory action of purified ApoB100 derives from
lysine-rich peptide within its receptor-binding
domain.35 36 The residues in this region may react with
the aldehydic products of lipid peroxidation. However, mild
oxidation of LDL does not result in a significant increase in the
electrophoretic mobility of LDL.37 This domain is within a
region of ApoB100 capable of local structural alterations that changes
even at low levels of LDL oxidation.20 Moreover, the
oxidation of lipids alone (Table 2
), or the addition of pure
lipid peroxides, did not enhance the tissue factor activity, but rather
inhibited it slightly, concurring with our previous report that the
enhancement of tissue factor activity by oxidized LDL arises from the
modification of ApoB100.7
The inactivation of TFPI as a result of oxidation of lipoprotein has been demonstrated previously.21 In the present study, the effect of LDL oxidation on the 2 forms of TFPI found in vivo was examined. The full-length TFPI contains the C-terminal domain required for direct interactions with ApoB100.14 38 Therefore, only the full-length TFPI was influenced by LDL oxidation losing its anticoagulant function, probably because of its ability to associate with LDL. The oxidation of lipids may also mask lysine and possibly arginine residues within Kunitz 1 and 2 of TFPI. That truncated (plasma) LDL is not influenced by oxidation may be because of its inability to associate with LDL. The aldehydes that form adducts with lysine residues on proteins remain with the LDL and may not be able to influence the truncated TFPI.
This study indicates that ApoB100 within LDL is capable of inhibiting the procoagulant activity of tissue factor via a different and independent mechanism than that of TFPI and other tissue factor inhibitors. In addition, the rate at which the inhibition by ApoB100 is brought about is slower, but stronger, than that by TFPI at prevailing physiological concentrations. We propose that LDL may play an important role in the physiological functioning of tissue factor, in vivo. Both full-length and truncated TFPI have been detected in vivo. Moreover, full-length TFPI may be partially degraded in blood to the C-terminal truncated form, as observed in the comparison between Hep G2 and plasma TFPI carried out here. The purpose of TFPI degradation and the role in its interaction with LDL is not understood. However, our data are in agreement with others16 17 38 39 40 41 that the C-terminal of this protein is required for the interaction that occurs with ApoB100 as well as cell surface glycosaminoglycans. When associated with LDL, the oxidation of TFPILDL complex may result in the partial inactivation of TFPI, as well as giving rise to a procoagulant form of LDL. Such alterations may severely compromise correct control of hemostasis, especially in conditions associated with the risk of tissue factormediated coagulation such as atherosclerosis, and endotoxic shock. Because neither LDL nor LDL-associated TFPI would be capable of suppressing the procoagulant function of tissue factor and because the procoagulant activity of released tissue factor is augmented by the oxidized complex, the oxidation of LDL may contribute to potentially fatal thrombotic episodes especially those associated with coronary heart disease. Failure to inhibit tissue factor may also have other consequences, unrelated to thrombosis, namely, the formation of neointima through smooth muscle cell proliferation and angiogenesis.42
| Acknowledgments |
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Received September 15, 1998; accepted December 23, 1998.
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