Assessment of recombinant factor VIIa as an antidote for bleeding induced in the rabbit by low molecular weight heparin.

While protamine sulfate reverses the anticoagulant effect of standard heparin, there currently is no effective antidote for low molecular weight heparin (LMWH)-induced bleeding. Recently, recombinant activated factor VII (rFVIIa) was approved by the FDA for use in hemophilia patients with factor (F)VIII or FIX inhibitors. However, this new pro-hemostatic agent has potential utility in other clinical scenarios. In this study, we utilized a well-characterized rabbit ear puncture model to test the efficacy of rFVIIa to reverse LMWH-induced prolonged bleeding. Animals were first treated with bolus intravenous LMWH (1800 anti-FXa U kg(-1)) which increased the primary bleeding time approximately fourfold and raised the plasma anti-FXa activity immediately and continuously throughout the 90-min experiment. In a randomized and blinded fashion, animals then received either rFVIIa (400 microg kg(-1)) or placebo by bolus intravenous injection, following which the ear puncture bleeding times were measured, along with blood levels of heparin (anti-FXa activity) and FVII. FVII activity increased 5.3-fold over baseline in treated animals, decreasing by only 24% over the full observation period. The rFVIIa-treated animals showed a slight decrease in bleeding time immediately after injection, but there was no statistically significant difference in bleeding after rFVIIa or placebo administration. In this study using a rabbit ear bleeding model, rFVIIa was not an effective antidote to LMWH-induced bleeding. However, the bolus injection of LMWH produced a very high blood anti-FXa level, which may have precluded rFVIIa effectiveness.

Ascaris haemoglobin is a nitric oxide-activated 'deoxygenase'.

The parasitic nematode Ascaris lumbricoides infects one billion people worldwide. Its perienteric fluid contains an octameric haemoglobin that binds oxygen nearly 25,000 times more tightly than does human haemoglobin. Despite numerous investigations, the biological function of this molecule has remained elusive. The distal haem pocket contains a metal, oxygen and thiol, all of which are known to be reactive with nitric oxide. Here we show that Ascaris haemoglobin enzymatically consumes oxygen in a reaction driven by nitric oxide, thus keeping the perienteric fluid hypoxic. The mechanism of this reaction involves unprecedented chemistry of a haem group, a thiol and nitric oxide. We propose that Ascaris haemoglobin functions as a 'deoxygenase', using nitric oxide to detoxify oxygen. The structural and functional adaptations of Ascaris haemoglobin suggest that the molecular evolution of haemoglobin can be rationalized by its nitric oxide related functions.

Determinants of Ascaris hemoglobin octamer formation.

The oxygen-avid, homooctameric hemoglobin of Ascaris (AH) has an unusual structure. Each polypeptide consists of two tandem globin folds followed by a highly charged COOH-terminal tail that contains four direct repeats of His-Lys-Glu-Glu (HKEE). Deletion analysis of the AH tail determined that at least two of the four HKEE repeats are required for efficient octamer formation. Surprisingly, the first four residues of the tail (Glu-His-His-Glu) alone were moderately effective in promoting multimerization. The hemoglobin from Pseudoterranova decipiens (PH) also consists of two globin domains followed by a shorter COOH-terminal extension containing only one HKEE repeat. Interchanging the tails of AH and PH revealed that the PH tail is moderately effective in promoting octamer formation. Dissociation analysis of wild-type and mutant AH and PH revealed that the intact octamers are stabilized by interactions between residues within the globin folds, not the tail. Mutational and biochemical studies revealed that one key interaction is contributed by isoleucine 15, which lies in the unusually long AB loop of AH. We propose that the AH tail plays no role in stabilization of the quaternary structure once formed but rather functions as an intramolecular chaperone, aiding assembly of the nascent AH octamer.

Subunit interactions in Ascaris hemoglobin octamer formation.

The oxygen-avid, perienteric hemoglobin of Ascaris is a homooctamer. Each subunit contains two tandem globin domains that are highly homologous with the exception of a charged COOH-terminal extension. In solution, recombinant domain one (D1) exists as a monomer, whereas recombinant domain two with the COOH-terminal tail (D2) is primarily an octamer. To examine the role of the COOH-terminal extension in Ascaris hemoglobin multimer formation, we attached the tail to the monomeric, heme-containing proteins, myoglobin and D1; neither construct was capable of multimer formation. Additionally, we removed the tail from both full-length Ascaris hemoglobin and D2. This substantially decreased, but did not eliminate, multimerization. We further characterized subunit interactions by disrupting full-length hemoglobin multimers with the chaotropic salt, NaSCN, which yielded intermediate oligomers. In solution, D2 demonstrated a greater propensity to dissociate than full-length hemoglobin, indicating that D1 contributes to octamer stability. D1 formed a weak dimer in its crystal; thus, we analyzed interactions along the subunit interface. Hydrogen bonds as well as hydrophobic and electrostatic forces appeared to contribute to dimer formation. Amino acid substitutions along this interface in D2 are predicted to enhance subunit interactions for that domain. Our studies reveal that the COOH-terminal tail is necessary, but not sufficient, for efficient octamer formation. Other regions, possibly with the E- and F-helices and AB loops of both domains, appear to be important for Ascaris hemoglobin octamer formation.