Human Protein C (hPC) is a vitamin K-dependent serine protease that has a critical role in the naturally-occurring anticoagulant pathway. Upon activation of the zymogen by thrombin at the endothelial cell surface, the active form of hPC has anticoagulant activity in hemostasis due to its ability to inactivate factors Va and VIIIa. For biological activity, hPC requires several post-translational modifications including proteolytic cleavage, disulfide bond formation, b-hydroxylation, g-carboxylation, and N-linked glycosylation. Plants have the eukaryotic protein modifying mechanisms required for many human proteins and may provide a safe, cost-effective system for producing hPC on a large-scale basis. Tobacco (Nicotiana tabacum L.) is particularly well suited for use as a bioreactor for high-value recombinant proteins. Tobacco is one of the easiest plants to transform, it is an excellent biomass producer and can produce up to a million seeds from a single genetically engineered plant. Previous attempts to produce hPC in tobacco were limited by expression levels. The overall goal of the research was to develop transgenic plants that express hPC at higher levels. A cDNA encoding hPC was fused to an enhanced constitutive 35S promoter (35SDE ) and introduced into a plant transformation vector. The hPC construct was introduced into tobacco leaf disks using Agrobacterium tumefaciens-mediated transformation, and 30 transgenic plants were generated. Stable integration of the hPC gene construct into the tobacco genome and transgene copy number were determined by genomic Southern hybridization and segregation analyses. The majority of transgenic plants expressed the hPC transgene based on RNA analyses by northern hybridization. Plants utilizing the enhanced 35S promoter had equivalent levels of expression to previously generated hPC-containing plants. A variety of polyclonal and monoclonal antibodies raised against hPC were tested for detection of hPC standards and tobacco-synthesized hPC by western immunoblotting. Novel proteins in the size range of hPC heavy chain cross-reacted with anti-heavy chain hPC antibodies in 35SDE:hPC plants. Thus, plants may be capable of synthesizing hPC and proteolytically processing it to light and heavy chains. Although further experiments will be required to confirm the identity of these putative hPC proteins in tobacco, these result suggest that analyses of hPC expressed in plants have been limited by effective tools for detecting the hPC gene product rather than expression levels determined by the transgene promoter. / Master of Science

This thesis was about the relationship of the Factor V Leiden mutation and activated protein C resistance. I looked up patients with Leiden mutation and activated protein C resistance. I monitored the frequency of thromboembolism and miscarriages in the personal and family case history of patients. Subsequently, I looked up if other risk factors which affect clinical manifestations in patients with this mutation can be found.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Vor dem Hintergrund der steigenden Inzidenz und der nahezu unverändert hohen Letalität der schweren Sepsis wurden in den letzten Jahren beeindruckende Fortschritte auf dem Gebiet der Diagnostik und v.a. der Therapie der Sepsis erlangt. Ziel der vorliegenden Arbeit war es, den Einfluss des neuen Medikaments Drotrecogin alpha (aktiviert) auf Patienten mit septischem Schock bzgl. Mortalität zu prüfen und Kriterien, die auf eventuellen Erfolg bzw. Misserfolg hinweisen, zu identifizieren. Hierzu wurden die Akten von 63 Patienten mit septischem Schock, die zwischen Oktober 2002 und September 2006 auf der internistischen Intensivstation der Medizinischen Klinik und Poliklinik I des Universitätsklinikums Würzburg betreut wurden, ausgewertet. Die ermittelten Daten wurden in Bezug auf neuere Literatur analysiert. Alle Patienten (44 Männer, 19 Frauen, Durchschnittsalter 53,4 ± 13,7 Jahre) wurden zusätzlich zur Standardsepsistherapie mit DrotAA (24 µg/kg KG/h) für eine Gesamtzeit von max. 96 h behandelt. Jedem Patienten mussten zur Kreislaufstabilisierung Katecholamine verabreicht werden, folglich befanden sich per definitionem alle Studienteilnehmer im septischen Schock. Der durchschnittliche Apache II-Score lag bei 36 und die mittlere Anzahl an Organversagen war 4,4 (100 % der Patienten erlitten ein Kreislaufversagen, 94 % hatten ein Lungenversagen, 78 % ein Nierenversagen, 68 % eine metabolische Azidose, 64 % eine DIC, 35 % ein Leberversagen). Insgesamt verstarben 30 der 63 Patienten (47,6 %) innerhalb von 30 d nach Beginn der Applikation von DrotAA. 46 % unserer Patienten sind innerhalb von 24 h nach Aufnahme auf die ITS mit DrotAA behandelt wurden. In der statistischen Analyse zeigte sich der Beginn der Therapie mit DrotAA innerhalb von 24 h jedoch nicht als signifikanter Prädiktor für die 30 d-Mortalität (HR: 0,87; 95 % CI: 0,422 – 1,791; p = 0,705). Die unabhängigen Prädiktoren des 30 d-Mortalitätsrisikos waren die Anzahl an Organversagen (HR je Organ: 1,51; 95 % CI: 1,14 – 1,99; p = 0,004), die Anzahl an verabreichten Antibiotika (HR je Medikament: 0,57; 95 % CI: 0,42 – 0,79; p = 0,001), das Ansteigen des Noradrenalinbedarfs (HR: 2,884; 95 % CI: 1,156 – 7,195; p = 0,023), das Ansteigen des CRP-Wertes (HR: 1,453; 95 % CI: 0,970 – 2,177; p = 0,070), sowie das Abfallen des Quick- (HR: 0,520; 95 % CI: 0,283 – 0,953; p = 0,034) bzw. des pH-Wertes (HR:0,428; 95 % CI: 0,188 – 0,973; p = 0,043). Verglichen mit der Literatur [45], war eine Behandlung mit DrotAA bei Patienten mit einem Apache II-Score ≥ 25 mit einem reduzierten Mortalitätsrisiko assoziiert. Signifikant war diese Differenz bei Patienten mit einem Apache II-Score von 35 – 44. Bei keinem der 63 Patienten traten während der Gabe von DrotAA intrakranielle Blutungen oder Blutungen, die die Gabe von mehr als drei Blutkonserven notwendig machten, auf. Mit den Daten dieser hier vorliegenden Untersuchung konnte gezeigt werden, dass eine DrotAA-Behandlung bei Patienten mit septischen Schock und höchsten Mortalitätsrisiken mit einem besseren Outcome assoziiert ist, als es entsprechend des Apache II-Scores zu erwarten wäre. / Introduction: Against the background of increasing incidence and high lethality of severe sepsis, substantial progress in diagnostic and therapy was achieved in the last years. Activated drotrecogin alpha (DrotAA) is a new medication for severe sepsis. As a recombinant form of human activated protein C it has anti-thrombotic, anti-inflammatory and profibrinolytic properties. According to large trials the use of DrotAA should be restricted to patients with severe sepsis and highest risk of death. While these studies suffered from major exclusion criteria, this case-series presents the experience with DrotAA in “real world“ patients with septic shock and multi-organ failure. Methods: Between October 2002 and September 2006 63 patients with septic shock were treated with DrotAA (24 µg/kg/hr for up to 96 hours) in addition to standard care at the intensive care unit of the University Hospital Würzburg. The patient files were analysed retrospectively with regard to mortality in order to find criteria indicating a potential success or failure of the therapy. Results: All patients (44 men, 19 women, mean age 53.4±13.7 years) were treated with DrotAA (24 µg/kg/hr) in addition to standard sepsis therapy. 100% of the patients were in septic shock determined by the requirement of vasopressor therapy. The average APACHE II score was 36 and the average number of failed organs was 4.4 (100% cardiovascular failure, 94% lung failure, 78% kidney failure, 68% metabolic acidosis, 64% DIC, 35% liver failure). 30 of 63 patients (47.6%) died within 30 days after the start of the DrotAA-therapy. 46% of the patients were treated with DrotAA within 24 hours after arrival to the ICU. However, the start of the DrotAA therapy within 24 hours was no significant predictor of 30-day mortality risk (HR: 0.87; 95% CI: 0.422-1.791; p=0.705). Independent predictors of 30-day mortality risk were the number of failing organs (HR per organ: 1.51; 95% CI: 1.14-1.99; p=0.004), the number of applied antibiotics (HR per drug: 0.57; 95% CI: 0.42-0.79; p=0.001), the increasing requirement of norepinephrine (HR: 2.884; 95% CI: 1.156-7.195; p=0.023), the increase of CRP (HR: 1.453; 95% CI: 0.970-2.177; p=0.070), the decrease of thromboplastin time (HR: 0.520; 95% CI: 0.283-0.953; p=0.034) and pH value (HR 0.428; 95% CI: 0.188-0.973; p=0.043). In patients with APACHE II score ≥ 25 treatment with DrotAA was associated with a reduced mortality risk. This difference was significant in patients with an APACHE II score of 35-44. During the treatment with DrotAA no patient suffered from intracranial hemorrhage or bleedings requiring the application of three or more erythrocyte concentrates. Conclusion: Targeting treatment with DrotAA to patients with septic shock, multi-organ failure and high risk of death is associated with better survival than anticipated from baseline APACHE II scores although mortality risk remains still very high.

Le choc septique est la principale cause de mortalité dans les services de réanimation. Les glucocorticoïdes (GC) et la protéine C activée (APC) sont deux traitements adjuvants recommandés au cours du choc septique. Ce travail a pour objectif d'évaluer l'impact de la combinaison d'APC et des GC sur les paramètres hémodynamiques et la survie. Le sepsis expérimental se caractérise par une hypotension artérielle avec acidose lactique et une hyporéactivité vasculaire. L'administration de Dexa et/ou d'APC permet de diminuer les taux de lactates, d'interleukines et de nitrate/nitrite. Chez les groupes traités, la contraction est améliorée ainsi que la relaxation vasculaire des aortes et des artères mésentériques. L'administration d'APC et de Dexa, seul ou en association, entraine une diminution de l'expression induite d'iNOS et la restauration de la voie Akt. La combinaison APC et Dexa améliore le temps de survie de façon synergique. Nos résultats suggèrent que l'APC et les GC devraient être réévalués en association dans le traitement du choc septique / Sepsis remains the major cause of death in intensive care units. International guidelines for management of severe sepsis and septic shock recommend both stress-dose steroid therapy and recombinant activated protein C (APC). The aims of the present study were to compare the effects of APC and dexamethasone (Dexa) alone as well as in combination in resuscitated septic shock on survival, hemodynamics, and vascular reactivity. Sepsis was associated with a decrease in mean arterial pressure, elevation in plasma lactate and nitrite/nitrate concentration. Administration of APC, Dexa, and their combination improve arterial pressure and decrease lactate and nitrite/nitrate concentration. Both APC and Dexa improved arterial contractility and endothelial dysfunction resulting from septic shock in rats. The expression of iNOS was significantly reduced by the administration of Dexa, APC, and combination therapy. All treatments restore the Akt pathway. Moreover, their combination increased the length of survival. These findings suggest that APC and glucocorticoids should be further re-evaluated in combination in septic shock

<p>The aim of this study was to examine the expression of Thrombomodulin, Tissue Factor, Tissue Factor Pathway Inhibitor and Endothelial Protein C Receptor in placenta throughout the three phases of the third trimester in the normal placenta and in IUGR placenta from full term.</p><p>Twenty-five normal placenta samples and twenty-five IUGR placenta samples were obtained and each sample was stained by immunohistochemistry using monoclonal antibodies. Each antibody was optimised for antigen retrieval method and for optimal dilution, before been applied to the test tissue.</p><p>The results showed that each of the antibodies mentioned was expressed in normal placenta and in IUGR placenta.</p><p>No significant difference could be established concerning the expression of each antibody mentioned between normal and IUGR placenta.</p>

The aim of this study was to examine the expression of Thrombomodulin, Tissue Factor, Tissue Factor Pathway Inhibitor and Endothelial Protein C Receptor in placenta throughout the three phases of the third trimester in the normal placenta and in IUGR placenta from full term. Twenty-five normal placenta samples and twenty-five IUGR placenta samples were obtained and each sample was stained by immunohistochemistry using monoclonal antibodies. Each antibody was optimised for antigen retrieval method and for optimal dilution, before been applied to the test tissue. The results showed that each of the antibodies mentioned was expressed in normal placenta and in IUGR placenta. No significant difference could be established concerning the expression of each antibody mentioned between normal and IUGR placenta.

Introduction: The extraocular muscles (EOMs) are considered a separate class of skeletal muscle, allotype. Myosin is the major contractile protein in muscle. The myosin heavy chain (MyHC) isoforms are the best molecular markers of functional heterogeneity of muscle fibers. The relaxation rate, reflects the rate at which Ca2+ is transported back into the sarcoplasmic reticulum (SR) mostly by SR Ca2+ATPase (SERCA). Myosin binding protein C (MyBP-C), plays a physiological role in regulating contraction. The laminins (Ln) are the major non-collagenous components of the basement membrane (BM) surrounding muscle fibers and are important for muscle fiber integrity. Methods: Adult human EOMs were studied with SDS-PAGE, immunoblots and immunocytochemistry, the latter with antibodies against six MyHC, 2 SERCA, 2 MyBP-C and 8 laminin chain isoforms. The capillary density was also determined. Results: Most fibers contained a mixture of MyHC isoforms. Three major groups of fibers could be distinguished. Fast fibers that stained with anti-MyHCIIa, slow fibers that stained with anti-MyHCI and MyHCeompos/MyHCIIaneg-fibers that stained with neither of these antibodies but with anti-MyHCI+IIa+eom and anti-MyHCeom. A majority of the fibers contained both SERCA1 and 2 whereas 1% were unstained with both antibodies. Biochemically SERCA2 was more abundant than SERCA1. MyBP-Cfast was not present in the EOMs and MyBP-Cslow was only detected immunocytochemically. The extrasynaptical BM of the EOM muscle fibers contained Lna2, b1, b2, g1, a4 and a5 chains. The capillary density in the EOMs was very high (1050 +/-190 capillaries/mm2) and significantly (p&lt;0.05) higher in the orbital than in the global layer. Conclusions: The co-existence of complex mixtures of several crucial protein isoforms provide the human EOMs with a unique molecular portfolio that a) allows a highly specific fine-tuning regime of contraction and relaxation, and b) imparts structural properties that are likely to contribute to protection against certain neuromuscular diseases.

Biomarker validation remains one of the most important constraints to development of new clinical diagnostic assays. To address this challenge, an immuno-mass spectrometric assay known as SISCAPA has been developed for quantitation of protein biomarkers in human blood. The SISCAPA assay overcomes the sensitivity barrier facing most mass spectrometric approaches by utilizing high affinity antibodies for enrichment of specific surrogate peptide analytes from complex mixtures such as trypsin-digested human plasma. However, several technological barriers remain before the SISCAPA technology gains widespread use for biomarker validation. Improvements are required in areas such as selection of high affinity anti-peptide antibodies, peptide detection sensitivity and increasing sample throughput to allow biomarker validation on large sample sets. The work presented in this dissertation describes the development of new methods for antibody selection and for high-throughput application of SISCAPA technology to biomarker measurement in human plasma. Specifically, two technological developments are described: 1) an assay called MiSCREEN was developed, which allows high-throughput screening of anti-peptide antibodies, enabling selection of high affinity reagents for de novo SISCAPA assays and 2) a liquid chromatography (LC)-free SISCAPA assay was developed that enables quantitation of surrogate peptides using both MALDI-TOF and RapidFire/MS platforms. Taken together, these technological advances provide a meaningful solution to the biomarker validation dilemma and allow a unified system for biomarker qualification, verification, validation and development of clinical assays for diagnosis and monitoring of a variety of diseases. To demonstrate the utility of the unified SISCAPA system for biomarker measurement, an assay was developed for protein C inhibitor (PCI) as a marker for prediction of biochemical recurrence in prostate cancer patients. The PCI-specific analyte was shown to predict biochemical recurrence of prostate cancer after radiation/hormone treatment. Early stage detection of recurrence was achieved, when compared to the ‘gold standard’ marker for prostate cancer, prostate specific antigen (PSA). Two-dimensional gel electrophoresis studies on PCI, revealed unique protein spots in a serum sample from a biochemically recurrent patient. Studying such alterations at the protein level may enable understanding of the molecular mechanisms by which PCI is involved in prostate cancer progression. / Graduate