The fibrinogen molecule consists of two sets of Aalpha, Bbeta, and gamma chains assembled into a bilateral disulfide linked (Aalpha, Bbeta, gamma)2 structure. Cleavage of the two A-fibrinopeptides (FPA, Aalpha1-16) from normal Aalpha chains with arginine at position 16 (RFPA) by thrombin or the venom enzyme atroxin transforms fibrinogen into self-aggregating fibrin monomers (alpha, Bbeta, gamma)(2). Mutant Aalpha16R-->H fibrinopeptide (HFPA) cannot be cleaved from fibrinogen by atroxin. Many studies on heterozygous dysfibrinogenemias with this mutation suggested that incorporation of the mutant chains into the molecules was ordered in a manner yielding only (1) homodimeric normal (RFPARFPA) atroxin-coagulable molecules and (2) homodimeric abnormal (H(FPA)HFPA) atroxin-incoagulable molecules in equal quantities. Although heterodimeric molecules (RFPAHFPA) could not be found in studies on the intact protein, Meh et al. demonstrated their existence by showing that CNBr digests of fibrinogens from atroxin-treated Aalpha16R-->H heterozygotic dysfibrinogenemias consistently yielded N-terminal fragments (NDSKs) with partially resolved electrophoretic bands predominantly in between the NDSKs of fibrinogen and alpha-fibrin. An opportunity to confirm and better quantify the heterodimers arose with the recent development of a method (GPRphoresis) for identifying molecules lacking only one FPA, which is applied here in study of a newly presenting case of an Aalpha16R-->H dysfibrinogenemia, "fibrinogen Amarillo." GPRphoresis uses electrophoretic shifts, staged with GPRP-NH(2) to separate the self-aggregating fibrin monomers lacking both FPAs from weakly aggregating "semifibrin" molecules lacking one FPA An antifibrin alpha17-23 antibody is used to measure and differentiate the semifibrin from fibrinogen with FPA fully intact. Applying GPRphoresis to atroxin digests of fibrinogen Amarillo clearly demonstrated RFPARFPA, RFPAHFPA, and HFPAHFPA molecules in nearly perfect Mendelian 1:2:1 proportions. In turn, the high levels of the semifibrin in the terminal atroxin digests provide genetic phenotypic evidence supporting fidelity of the GPRphoresis method.
Many patients with thrombotic thrombocytopenic purpura (TTP) satisfactorily respond to plasma therapy (plasmapheresis and/or plasma infusion). Some, however, respond either not at all or only transiently and incompletely. Evidence indicates that platelets and endothelial cell‐derived unusually large von Willebrand factor (ULvWF) multimers, as well as the largest vWF multimers in plasma, form thrombi which are deposited in the microvascular circulation. Accordingly, platelet transfusions are avoided unless there is intra‐cranial or other life‐threatening hemorrhage. The largest plasma multimers of vWF are, however, replenished by the infusion of large volumes of whole plasma. We postulated that under conditions of massive plasma replacement, plasma depleted of the largest multimers of vWF might be preferable for the treatment of TTP episodes. The largest vWF multimers sediment in the cryoprecipitate, and the cryoprecipitate‐poor fraction of plasma (cryosupernatant) is depleted of these forms. Seven patients responding inadequately to intensive plasma therapy were switched to receive cryosupernatant in place of whole plasma. All patients improved quickly following this change in therapy, and the TTP syndrome resolved in all seven.
In this multidisciplinary review, health-care specialists present practical solutions to the dilemma of rising costs v the need for adequate medical care for all Americans. The United States is the only advanced industrial society that makes ability to pay a critical determinant in health care. As the costs of patient care and insurance coverage escalate, the public demands greater value in insurance coverage with enhanced access to adequate care, clinical trials, and experimental therapies. Greater cooperation is needed between third-party payers, business, and government to create a system that provides optimal care today while supporting innovation and emerging technology for the future.
Three murine plasma cell tumors were adapted to grow in cell culture. In vitro each plasmacytoma cell line secreted Immunoglobulin of the same type and same antigenic reactivity found in the parent tumor. During the observation period, which for 1 line was over 24 months, only the same types of light and heavy chains found initially were secreted. All 3 cell lines retained the ability to produce immunoglobulin-secreting plasma cell tumors when inoculated into BALB/c mice.
PROLIFERATING hybrid cell strains have been produced using Sendai virus to mediate fusion of a cloned, culture-adapted mouse plasmacytoma, MOPC 315 (my unpublished work with M. Potter), with the thymidine kinase deficient cell strain LM(TK−) C1 1D (ref. 1), referred to as C1 1D. Because the hybrid cell strains contained soluble enzymes with the electrophoretic mobility characteristic of the inbred strains of mice from which MOPC 315 and C1 1D were derived, at least part of both parental genomes was expressed (my unpublished work with H. G. Coon). Here I report an investigation of the synthesis of immunoglobulin by clones of these hybrid cell strains.