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1
Department of Clinical Biochemistry, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
2
Laboratory of Clinical Biology, OCMW Hospitals, Antwerp,
Belgium.
a Author for correspondence. Fax 32-3-820.27.45; e-mail hendriks{at}uia.ua.ac.be
| Abstract |
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Methods: We developed an assay to determine the proCPU concentration in human plasma. The assay involved quantitative conversion of proCPU to active CPU by thrombin-thrombomodulin, a very efficient activator of proCPU, followed by determination of the enzymatic activity of CPU with the substrate hippuryl-L-arginine, using an HPLC-assisted determination of the released hippuric acid. Using this method, we established a reference interval based on 490 healthy individuals.
Results: The mean proCPU concentration, determined after activation of the zymogen in diluted plasma and expressed as CPU activity, was 964 U/L, with a SD of 155 U/L. The population showed a gaussian distribution. However, we noticed important differences related to age and the use of hormone preparations.
Conclusions: The sensitivity and precision of the method make it suitable for routine clinical determinations and as a reference procedure.© 1999 American Association for Clinical Chemistry
| Introduction |
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We first reported in 1988 on the presence of a labile carboxypeptidase
activity in fresh human serum that interfered with the assay of CPN(1)(2)(3). This novel carboxypeptidase activity was not
detectable in human plasma, but appeared after the coagulation of
blood. Because of the marked instability of this enzyme, we named it
CPU (where "U" indicates unstable) (3)(4).
Campbell and co-workers (5)(6) confirmed these
findings and called the enzyme carboxypeptidase R, where "R"
represents arginine. Eaton et al. (7) discovered it as a
contaminant during the purification of
2-antiplasmin, utilizing plasminogen-Sepharose
affinity chromatography. They cloned the CPU cDNA from human liver and
deduced the amino acid sequence of the proenzyme, designating it plasma
carboxypeptidase B because the active enzyme very much behaves like
pancreatic carboxypeptidase B in terms of enzyme activity(7)(8). This name, however, is rather confusing
because the term "plasma carboxypeptidase B" had long been used as
a synonym for plasma carboxypeptidase N (9). In addition,
pancreatic carboxypeptidase B, a pancreatic digestive carboxypeptidase,
can be detected in the plasma compartment of patients with acute
pancreatitis (10)(11). Wang et al.(12) confirmed the identity between proCPU and the protein
isolated by Eaton et al. (7). We localized the
subregional mapping of the human proCPU gene as locus q14.11 to
chromosome 13 (13).
Bajzar et al. (14) independently found this enzyme and showed that it can be activated by thrombin and that upon activation, it can inhibit fibrinolysis. Consequently, they named it thrombin-activatable fibrinolysis inhibitor.
Recently, much attention has been focused on the role of CPU in the
fibrinolytic system (Fig. 1
). It had been postulated that CPU, generated during
coagulation, dampens the fibrinolytic system by acting on fibrin that
has been partially degraded by plasmin(4)(15)(16)(17). This hypothesis was substantiated
when it was demonstrated that proCPU exhibits a strong affinity for
plasminogen and that it can be activated by plasmin and thrombin(7). The thrombin-thrombomodulin complex is the most likely
physiological activator because thrombomodulin increases the catalytic
efficiency of CPU activation by thrombin by a factor of 1250(18). Plasmin degradation of fibrin exposes C-terminal
lysine residues that are essential for the high-affinity binding of
plasminogen to fibrin and the subsequent activation of plasminogen to
plasmin (19)(20)(21). Thus CPU, activated locally through the
action of thrombin-thrombomodulin, is able to control the rate of
fibrinolysis by cleaving some of the generated C-terminal lysine
residues (15). This effect was demonstrated directly in
experiments involving confocal microscopy (22). Recent data
indicate that CPU indeed plays an important role in plasminogen
activation because it is able to delay tissue plasminogen
activator-induced clot lysis in vitro and since inhibition or depletion
of CPU enhances the rate of clot lysis(14)(15)(16)(18)(22)(23)(24). In vivo
evidence for a role of CPU in the fibrinolytic system is provided by
two studies. In a canine model of intracoronary thrombosis, it was
shown that CPU is formed in vivo and that increased CPU activity is
associated with prolonged time to reperfusion (17). In a
study using a thrombosis model in rabbits, inhibition of CPU enhanced
clot lysis (25).
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The aim of our present study was to design an assay to determine proCPU concentrations in human plasma by quantitatively converting proCPU to CPU by means of a standardized activation with the thrombin-thrombomodulin complex. Subsequently, the activity of the generated CPU would be measured by an HPLC-assisted method. Because a recent report shows that the proCPU concentration in human plasma is a major determinant of the clot lysis time (26) and because no reference values for proCPU concentrations are known, we determined proCPU concentrations in a healthy population to establish a reference interval for this potential new marker of fibrinolytic capacity.
| Materials and Methods |
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Blood was collected into buffered 32 g/L sodium citrate anticoagulant (0.109 mol/L sodium citrate), using an evacuated tube system with a final ratio of nine parts blood to one part buffered citrate, by volume. Plasma was prepared by centrifugation at 3000g for 15 min at room temperature and was stored at -70 °C until analysis.
Control plasma was obtained by pooling citrated plasma from 10 healthy volunteers. Aliquots were stored at -70 °C.
Inactivated serumserum in which neither activatable proCPU nor basic carboxypeptidase activity could be detectedwas prepared by incubating human serum for 12 h at 56 °C.
chemicals
Hippuryl-L-arginine (Hip-Arg) was obtained from Bachem
Feinchemicalien. Hippuric acid was obtained from Fluka.
o-Methylhippuric acid was synthesized from glycine and
o-methylbenzoylchloride (UCB) by a procedure analogous to
that used for the synthesis of hippuric acid (27). Human
thrombin was obtained from Sigma. Rabbit lung thrombomodulin was
obtained from American Diagnostica. The thrombin inhibitor
D-phenylalanyl-L-prolylarginyl
chloromethyl ketone (PPACK) was obtained from Alexis Biochemicals.
Aprotinin was obtained from Bayer. HEPES was purchased from Calbiochem.
All other reagents used were of high purity grade and were from Merck.
instruments
The HPLC system consisted of a model 302 pump, a model 303 solvent
delivery system, a model 802 C manometric module, a model 401 dilutor,
and a model 231 autosampling injector (all from Gilson), a model 450
ultraviolet detector (Waters Associates), and a 150 x 4.6 mm
(i.d.) Spherisorb ODS-2, 5 µm, column (Alltech). All chromatography
steps were performed on a Waters 650 Advanced Protein Purification
System (Millipore). Columns and chromatography media were from
Pharmacia. The materials used for electrophoresis were purchased from
Bio-Rad Laboratories. An Eppendorf centrifuge 5417, with a fixed-angle
F 45-24-11 rotor, or an Heraeus Megafuge 1.0 R centrifuge, with a
bucket 2252 rotor, was used. For the evaporation of samples, a Savant
Speedvac SC 100 (Savant Instruments) was used.
methods
Purification of human proCPU.
Human citrated plasma was
diluted 1:1 with 50 mmol/L phosphate buffer, pH 7.5. Aprotinin was
added to a final concentration of 14 mg/L. The plasma was then depleted
of plasminogen by chromatography on lysine-Sepharose as described
previously (28). All buffers used for the lysine-Sepharose
column contained aprotinin in a final concentration of 1.4 mg/L. The
eluate of the lysine-Sepharose column was used for further purification
of proCPU, based on the method of Bajzar et al. (14). The
purification yielded a single protein band at a molecular mass of 60
kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis
(SDS-PAGE). The enzyme was purified an average 24 000-fold with a
specific activity of 300 kU/g.
Protein concentrations were measured with the bicinchoninic acid detection reagent (Pierce Chemicals) or with Coomassie Brilliant Blue G-250, according to the method by Bradford (29).
SDS-PAGE was performed at 200 V in 10% gels according to the method by Laemmli (30). Gels (10%) were prepared on the day of electrophoresis, following the Bio-Rad protocol. Proteins were visualized by silver staining.
After SDS-PAGE, the purified proenzyme was electroblotted (1 h at 150 mA) to a PVDF membrane. The membrane was subjected to Edman degradation in an automated sequencer (Applied Biosystems Model 470 A). NH2-terminal sequencing reveal the sequence FQSGQVLAALPRTSRQVQVL, which confirmed its identity as plasma carboxypeptidase B (7).
Determination of carboxypeptidase activity.
The
carboxypeptidase activities were measured with an HPLC-assisted assay
using the substrate Hip-Arg as described elsewhere(12)(31). The procedure was as follows. For the
chromatographic assay, 10 µL of enzyme solution was added to 40 µL
of substrate solution (30 mmol/L Hip-Arg, 50 mmol/L HEPES, pH 8.0).
This mixture was incubated for 30 min at 37 °C; the reaction was
then stopped by the addition of 50 µL of 1 mol/L HCl. After the
addition of 10 µL of internal standard (o-methylhippuric
acid), hippuric acid and o-methylhippuric acid were
extracted from the acidified solution into 300 µL of ethyl acetate by
vortex-mixing for 30 s. The mixture was centrifuged for 2 min at
20 000g in an Eppendorf centrifuge. A 200-µL aliquot of
the supernatant ethyl acetate layer was removed and evaporated to
dryness. The dry residue was redissolved in 150 µL of the
chromatographic mobile phase, and 15 µL was injected onto the column
(the described volumes were used for determination of CPU in diluted
plasma after activation). The mobile phase used was a mixture of 850 mL
of 10 mmol/L potassium phosphate buffer, pH 3.5, and 150 mL of
acetonitrile. The separation of hippuric acid from the substrate was
obtained within 3 min by reversed-phase HPLC.
Each batch of substrate was checked for the presence of free hippuric acid by assaying a sample blank (10 µL of distilled water added to 40 µL of substrate). A stock solution of the internal standard was prepared by dissolving 291 mg of o-methylhippuric acid in 25 mL of ethanol and diluting to 100 mL with distilled water. For the determination of CPU in diluted plasma (after activation), a 1:6 dilution of the internal standard stock solution in 250 mL/L ethanol was used. Duplicate determinations were performed for all enzyme assays.
For the calibration procedure, four 1000-µL aliquots of the hippuric acid calibrator solution (22.5 µmol/L in ethyl acetate) were evaporated to dryness. Substrate (40 µL) was added to each tube, and the assay procedure was performed as described above, beginning with the addition of 10 µL of distilled water.
For the assay, one unit of enzyme activity was defined as the amount of enzyme required to hydrolyze 1 µmol of substrate per minute at 37 °C under the conditions described. The carboxypeptidase activity (U/L) was calculated using the mean ratio of the peak heights of hippuric acid and the peak heights of the internal standard of the sample, blank, and calibrator.
Determination of optimal conditions for activation of proCPU.
The activation of purified proCPU with thrombin in the presence of
thrombomodulin was performed at room temperature and at 37 °C in the
presence and absence of 5 mmol/L CaCl2. Different
concentrations of thrombin-thrombomodulin were tested. The following
protocol was used. To 5 µL of purified proCPU (from different batches
with a corresponding CPU activity of 900-2650 U/L), 10 µL of
thrombin-thrombomodulin in 20 mmol/L HEPES, 5 mmol/L
CaCl2, 0.1 mL/L Tween 80, pH 7.4, was added.
After the mixture was incubated for time intervals of 1120 min, the
activation was stopped by the addition of 5 µL of 20 µmol/L PPACK.
Subsequently, 5 µL of inactivated serum was added.
In citrated plasma samples, CPU was determined after activation of the zymogen, proCPU, using a similar protocol. Optimal concentrations of thrombin-thrombomodulin were determined. The following protocol was used. Citrated plasma samples were diluted 20-fold in 20 mmol/L HEPES, pH 7.4. The thrombin-thrombomodulin complex was prepared in the same buffer as described above and mixed with an equal amount of 80 mmol/L CaCl2 in 20 mmol/L HEPES, pH 7.4. A 20-µL aliquot of this mixture was added to 20 µL of plasma diluted 1:20 and incubated at room temperature. The activation of proCPU in plasma was stopped by the addition of 10 µL of 20 µmol/L PPACK, and the activity was measured with Hip-Arg and analyzed by HPLC. To determine CPN activity, similar measurements were performed without the addition of thrombin-thrombomodulin. The CPU activity was the difference in the value obtained after activation minus the value obtained without activation; this activity was used as a measure for the proCPU concentration in plasma.
The effect of sodium ions on the activation of purified proCPU and proCPU in diluted plasma was evaluated in the presence or absence of 150 mmol/L NaCl.
Reference values of proCPU, determined after activation with
thrombin-thrombomodulin.
Citrated plasma from 490 healthy adults
was analyzed in duplicate as follows. Plasma samples, stored at
-70 °C, were thawed quickly at 37 °C until they had just thawed.
To 20 µL of a plasma sample diluted 1:20 in 20 mmol/L HEPES, pH 7.4,
was added 20 µL of a 1:1 mixture of thrombin-thrombomodulin and 80
mmol/L CaCl2 in 20 mmol/L HEPES, pH 7.4. The
final concentrations of thrombin and thrombomodulin during activation
were 0.4 kU/L and 16 nmol/L, respectively. After incubation for 10 min
at room temperature, the activation was stopped with 10 µL of 20
µmol/L PPACK. Activity was measured with the substrate Hip-Arg, and
the released hippuric acid was determined by HPLC. Statistical analysis
was performed with SigmaStat, Ver. 1.
| Results |
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Similar results were obtained for proCPU in plasma. Maximum activity
was obtained with a concentration of 0.4 kU/L thrombin and 16 nmol/L
thrombomodulin (Table 2
), with activation times not exceeding 15 min.
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For purified proCPU and for proCPU in plasma, lower activities were obtained when activation was performed in the presence of sodium ions. This result is similar to the one observed for protein C and is explained by the fact that the activity and specificity of thrombin are controlled in an allosteric fashion by the binding of Na+ to a single site. The Na+-bound state is the fast form, whereas the Na+-free state is the slow form (33). This may imply that for the activation of proCPU, the slow form of thrombin, i.e., the Na+-free form, is important.
In all additional experiments, purified proCPU was activated as follows: 10 µL of 0.3 kU/L thrombin-24 nmol/L thrombomodulin (the final concentration of thrombin was 0.2 kU/L, and the final concentration of thrombomodulin was 16 nmol/L) in 20 mmol/L HEPES, 5 mmol/L CaCl2, 0.1 mL/L Tween 80, pH 7.4, was added to 5 µL of purified proCPU. The activation was stopped after a 10-min incubation at room temperature by the addition of 5 µL of 20 µmol/L PPACK. Subsequently, 5 µL of inactivated serum was added and the carboxypeptidase activity was measured.
The protocol for determining proCPU in plasma is described in Materials and Methods. The proCPU concentration, expressed as CPU activity in U/L after activation with thrombin-thrombomodulin, was obtained by subtracting the carboxypeptidase activity present in a sample without activation from the total carboxypeptidase activity obtained after activation.
linearity
To study the linearity as a function of CPU activity, purified
proCPU was added to control plasma. Dilutions were made in inactivated
serum. Activation was as described above, and activity was measured.
The linearity of the assay could be demonstrated by assaying serially
diluted plasma with added proCPU (total CPU activity, 7885 U/L). Linear
regression analysis gave r = 0.999 for dilutions of
1:128, 1:64, 1:32, 1:16, 1:8, 1:4, and 1:1 and undiluted proCPU
(activity, 627885 U/L).
The linearity as a function of incubation time was checked by measuring the activity at regular time intervals ranging from 10 to 120 min. Linear regression analysis gave r = 0.999 (time, 050 min). Linearity diminished after incubation time exceeded 70 min. Although the half-life of CPU at 37 °C is short (t1/2 = 10 min)(2)(32), a stabilizing effect of the substrate during assay was observed. This is in accordance with our previous results (3)(4).
reproducibility of the proCPU ASSAY
We evaluated the within- and between-day precision of a control
plasma. The mean value of a control plasma, measured on different days
(n = 11) was 1040 ± 48 U/L (between-day CV, 4.6%). The mean
value of a control plasma, measured several times on the same day
(n = 10) was 1034 ± 31 U/L (within-day CV, 3.0%)
sensitivity
The HPLC method described is able to detect enzyme activities as
low as 1 U/L. For the measurement of very low carboxypeptidase
activities, a slightly modified procedure (longer incubation time and
different volume ratio of substrate to sample ) was used. If a dilution
value of 20 (dilution of the plasma sample) x 2.5 (dilution upon
activation) is used for the measurement of CPU in diluted plasma, an
activity of 50 U/L plasma can be detected.
reference values
Reference values of proCPU (expressed as CPU activity in U/L after
activation with thrombin-thrombomodulin) from a population of 216 men
and 274 women were determined. The mean values, SDs, and minimums and
maximums of the different groups, expressed in U/L, are presented in
Table 3
. All groups displayed a gaussian distribution except for women
in the 3039 age group receiving hormone therapy. Statistical analysis
was performed using the Student t-test or the MannWhitney
rank-sum test. The overall population of 490 healthy volunteers had a
mean proCPU concentration corresponding to a CPU activity of 964 U/L
(SD, 155 U/L). No statistical difference was observed between men (961
U/L; SD, 153 U/L) and women (966 U/L; SD, 156 U/L), although there was
a significant difference between women receiving hormonal therapy (1006
U/L; SD, 152 U/L) and women not receiving hormonal therapy (930 U/L;
SD, 152 U/L; P <0.0001).
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In men, there was a positive correlation between the proCPU concentration and age (r = 0.2865; P <0.001), with a significant increase in activity starting with the 4049 age group (P = 0.0024). Women not receiving hormonal therapy had a considerable increase in proCPU concentration in the 5060 age group (P <0.0001). Under the age of 50 years, similar values were observed in women not receiving hormone therapy as in men under 40 years of age. In women receiving hormonal therapy, no age-related differences were observed. Increased proCPU concentrations were obtained in women receiving hormonal therapy in comparison with women not receiving hormonal therapy [P = 0.0002 (age group, 3039 years); P = 0.0007 (age group, 4049 years)]. In the 5061 age groups, no difference could be observed between the groups.
| Discussion |
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Recently, much attention has been focused on the role of CPU in
fibrinolysis (Fig. 1
). proCPU exhibits a strong affinity for
plasminogen and can be activated by plasmin and thrombin(7), but is activated most efficiently by the
thrombin-thrombomodulin complex (18). The potential role of
the proCPU/CPU system in controlling fibrinolysis is further
demonstrated by a study of Mosnier et al. (26), which
revealed a positive correlation between the proCPU antigen
concentration and the time to clot lysis. This indicates that an
increased proCPU concentration in plasma signifies a retardation of
clot lysis and thus could parallel increased thrombo-embolic risk. In
this respect, the proCPU concentrations we measured in the different
age and sex groups and in relation to the use of hormonal therapy seem
very interesting. Indeed, we noticed increases in proCPU concentrations
in relation to age for men, increases for women in the 5061 age
groups and increases in women taking oral contraceptives.
Further studies on patient groups with increased thrombo-embolic risk need to be undertaken to determine whether a high proCPU concentration is a risk factor for thrombo-embolic disease.
| Acknowledgments |
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| Footnotes |
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| References |
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