Characterization and structural impact of five novel PROS1 mutations in eleven protein S-deficient families.

Heterozygozity for four novel missense mutations (W108C, W342R. E349K and L485S) and one novel 4 bp deletion (ACdelAAAG affecting codons 632-633) was identified in PROS1 of unrelated thrombosis prone Danish families with protein S type I or III deficiency. The 4 bp deletion results in a frameshift leading to replacement of the coding sequence for the 3 C-terminal amino acids by an abnormal extended sequence that codes for 9 amino acids. The E349K substitution was found in 7 families. Haplotype analysis using 7 microsatellite markers flanking PROS1 was consistent with a common founder for this mutation. The mutations reported here are most likely the cause of the protein S deficiency. Firstly, the four missense mutations cosegregate with the abnormal plasma protein S phenotype and lead to the loss of highly conserved amino acids. Secondly, computer analysis of structural models of protein S predicts that the substitutions could affect proper protein folding and/or stability. Analysis of platelet mRNA from subjects with the W108C, E349K, L485S mutation or the 4 bp deletion showed that mutated mRNA was expressed in significant amounts suggesting that mutated molecules are synthesized. Our results are compatible with defective protein folding/unstable molecules, impaired secretion and intracellular degradation of mutated protein, which appear to be the major molecular disease mechanisms for missense mutations and certain other mutations found in genetic disorders.

Two mutations in exon XII of the protein S alpha gene in four thrombophilic families resulting in premature stop codons and depressed levels of mutated mRNA.

Sixteen Danish unrelated thrombophilic families with plasma protein S deficiency of type 1 (or III) are currently under investigation in our laboratory for defects in the protein S alpha gene. The present paper describes a part of this work, which deals with the identification and phenotypical presentation of two unique mutations in exon XII of the protein S alpha gene in four of these families. The mutations were identified by SSCP screening followed by nucleotide sequence analysis or by direct nucleotide sequence analysis. The mutation found in one family (D) is a novel deletion of an A in either the codon for Gly448 (GGA) or Ile449 (ATI) resulting in a frameshift and a premature stop codon at position 454. The other mutation shared by three families (F, G and J) is a previously reported C-->T transition within a hypermutable CG dinucleotide sequence converting Arg410 (CGA) to Stop (TGA). All affected individuals are heterozygotes for their mutation and in each family the protein S genotype, the plasma protein S phenotype (not shown for Family J) and the clinical phenotype cosegregate. The two mutations can fully explain the abnormal protein S phenotype since premature stop codons are known to disrupt gene function of the mutated allele. Analysis of protein S mRNA from platelets showed that both mutations result in a marked reduction in the amount of protein S mRNA from the mutated alleles indicating that the mutations exert their deleterious effects on gene expression at the transcriptional level. The Arg410-->Stop mutation in Families F, G and J is in all instances linked to a G at the site of a common neutral dimorphism in the codon for Pro626 (CCA/G) in exon XV. This indicates that the mutation in these families could have arisen in a common ancestor. The Arg410 (CGA)-->Stop (TGA) mutation is also seen in exon XII of the normal protein S alpha gene. This gives rise to the speculation as to whether the mutation in the protein S alpha gene is the result of an interaction with the protein S beta gene leading to double homologous unequal crossing-over or gene conversion of a short DNA sequence. However, this is unlikely since none of the 7 other protein S beta-specific nucleotides are present in the mutated exon XII sequence of the protein S alpha gene. The common Arg506-->Gln Leiden mutation in coagulation factor V is not an additional risk factor for thrombosis in any of the four families studied.

Latex allergy: an unfamiliar cause of intra-operative cardiovascular collapse.

We describe severe latex allergy in an 8-year-old girl undergoing elective orthopaedic surgery and anaesthesia. Sudden, profound cardiorespiratory collapse occurred 40 min after induction. During the 1 h period of resuscitation the child required a total of 14.5 ml adrenaline 1 in 10,000. A subsequent latex radioallergosorbent test was very strongly positive. Two weeks later the child presented again for surgery. Neoprene surgical gloves were used and all latex products eliminated from the anaesthetic equipment. Latex contact was strictly avoided during drug preparation and administration. This time the intra-operative course was uneventful.

Protein-ligand interactions in the lysine-binding site of plasminogen kringle 4 are different in crystal and solution. Electrostatic interactions studied by site-directed mutagenesis exclude Lys35 as an important acceptor in solution.

Three amino acid residues previously reported to establish the interactions between lysine-like derivatives and plasminogen kringle 4 have been replaced by other residue types using the methods of site-directed mutagenesis. The effect of these modifications on the binding constant have been measured. The residues are Lys35, Asp57, and Arg71, according to the sequence numbering scheme adapted from the plasminogen kringle 5 domain. The plasminogen kringle 4 derivatives where Lys35 of the native molecule is replaced with isoleucine and methionine residues, respectively, were seen to bind the ligands, respectively, with association constants similar to those of the unmodified recombinant kringle 4 domain. The modification of Asp57 to asparagine was shown to eliminate the ability to bind to the lysine affinity column used to purify the protein. Similarly the site-directed mutagenesis for Arg71 to glutamine resulted in a 12-19-fold decrease in binding of each of the two ligands. In addition, the effect of ionic strength on the binding of 6-aminohexanoic acid to the recombinant plasminogen kringle 4 and the three single substituted derivatives was examined. For the unmodified kringle domain as well as for the two derivatives modified only at the position of Lys35, an ionic strength of 0.5 M reduced the binding constant by a factor of 3 to 0.12 x 10(5) M-1. The derivative modified at the position of Arg71 was not effected by the ionic strength and maintained a rather low binding constant of 0.02 x 10(5) M-1. The observations suggest that the carboxylate of Asp57 and the guanidino group of Arg71 provide the electrostatic interaction in the binding site for the epsilon-amino group and the alpha-carboxylate of a C-terminal lysine residue.(ABSTRACT TRUNCATED AT 250 WORDS)