Studies with 131I-labelled antithrombin III in dogs

A simple, rapid, fairly pure preparation of dog antithrombin III (AT) is obtained by two passages through heparin-Sepharose. The AT is labelled with ¹³¹Iodine using lactoperoxidase, and unbound ¹³¹I and other contaminants are removed on a third heparin-Sepharose column. SDS-PAGE and isoelectric focussing show negligible differences between AT and ¹³¹I-AT while measurements of heparin cofactor and progressive antithrombin activities show at most loss of 5% activity by the ¹³¹I-AT. Comparisons of turnover behavior of “unscreened” and “screened” ¹³¹I-AT in dogs showed no significant differences. However, predictions from the plasma data using the standard kinetic model of plasma ¹³¹I-protein failed to fit the observed whole body ¹³¹I behavior. Fractional breakdown rate averaged .51, SD .056, and there was no difference between males and females. The approximate ratio of interstitial/plasma AT was 1.0, SD .13.     

Comparative study of antithrombin III.protease complex metabolism by fibroblasts and vascular endothelial cells

125I-labeled human antithrombin III (125I-AT III).protease complexes are specifically bound to both cultured human skin fibroblast (HSF) cells and adult bovine aortic endothelial (ABAE) cells; however, there is a significant difference in the rate and degree of metabolism of the complexes by these two cell types. HSF cells appear to internalize the complexes at a rate of about 2.5 pmole/1 X 10(6) cells/h and subsequently degrade them at a rate of 0.6 pmole/1 X 10(6) cells/h. ABAE cells internalize and degrade the complexes at rates approximately 100 and 30 times lower, respectively. Neither cell type interacts with free 125I-AT III but only with its combined form with either thrombin or trypsin. These data indicate the major role of HSF cells in the removal of AT III.protease complexes from extravascular spaces in the body, in contrast to the inert vascular surface with regard to AT III.protease complexes provided by the vascular endothelium.     

Antithrombin III: biodistribution in healthy volunteers

Five healthy volunteers were injected intravenously with 73-90 uCi purified human 131I-Antithrombin III (AT III), specific biological activity 5.6 U/mg. The tracer data were analysed using a three compartment model. The plasma radioactivity half life was 66.2 +/- 1.2 (sem) h, the fractional catabolic rate constant of the plasma pool was 0.025 +/- 0.002 (sem) h-1. These data were comparable with those described in the literature. Because of the difficulty in translating the mathematical analysis of various compartments into the biological model, biodistribution was monitored by a gamma camera linked to a DEC PDP 11/34 computer system. Dynamic and static images were obtained at fixed time intervals following the injection of 131I-AT III. Whole body scanning at intervals between the time of injection (t = 0) and t = 24.5 h showed 131I-AT III distribution over the heart, lungs, liver, spleen and great vessels. Dynamic scanning was performed over the heart, spleen and liver. Overlayed frames in the first ten minutes after the 131I-AT III injection showed the following radioactivity expressed as percentage of the injected dose; 5.9% +/- 0.3 (sem) over the heart, 10.6% +/- 0.9 (sem) over the liver and 1.1% +/- 0.1 (sem) over the spleen. A slower decline of the radioactivity between t = 0 and t = 24 h; (19%) was measured over the liver compared with the radioactivity disappearance over the heart region. This shows, in combination with the fact that the radioactivity disappearance over the heart was identical with the radioactivity decline measured in the plasma samples that retention of 131I-AT III occurred in the liver.(ABSTRACT TRUNCATED AT 250 WORDS)     

High molecular weight forms of antithrombin III complexes in blood

A double antibody competition radioimmunoassay was developed that allowed to detect specifically as little as 15 ng antithrombin III (AT III) per ml of the assayed material. In normal plasma examined by this assay, AT III concentration averaged 199 +/- 21 micrograms/ml. Complexes of AT III with thrombin or factor Xa crossreacted with free AT III in 87% and 95%, respectively. Molecular forms of AT III produced in plasma treated with coagulation enzymes, or in serum, were assessed by measuring immunoreactive AT III in fractions obtained by gel filtration chromatography on Sephadex G-200. AT III bound by thrombin in fibrinogen free-plasma ranged in molecular size from 160,000 to above 250,000. Similar aggregation occurred when monomeric complex of purified AT III and thrombin, of 90,000 Mr, was added to plasma. Presence of heparin intensified the degree of aggregation. In factor Xa-treated plasma AT III was converted into components with 160,000 Mr, or less. No complexes below 200,000 Mr were present in serum. They decreased in size to 160,000 Mr after affinity chromatography on heparin-Sepharose. These results indicated that blood represents a unique milieu conducive to aggregation of bound AT III. It appears, however, that AT II complexes present in blood may not only aggregate, but also associate with other serum proteins through unstable binding most likely caused by the enzyme component of the complex.     

Antithrombin III microheterogeneity in antithrombin III deficiency and in the antithrombin III abnormality, "antithrombin III Toyama"

Antithrombin III (AT III) microheterogeneity was investigated in 12 cases of congenital AT III deficiency and 2 cases of congenital AT III abnormality by isoelectric focusing (IEF) and immunofixation. In congenital AT III deficiency, IEF and immunofixation revealed AT III as 8 bands which was indistinguishable from normal control in terms of the number of bands and the isoelectric point (pI) of each band. In the proband of the congenital AT III abnormality, however, IEF and immunofixation showed AT III as 8 bands which shifted slightly but definitely to the acidic side compared to those of normal subjects. This change in pI of the abnormal AT III was considered to reflect the amino acid replacement in the polypeptide chain of the abnormal AT III molecule.     

A purified antithrombin III--heparin complex as a potent inhibitor of thrombin in porcine endotoxin shock

Inhibition of activated clotting factors is an important therapeutic approach in disseminated intravascular coagulation (DIC). We examined the possible protective effect of a purified complex of human antithrombin III (AT III) and heparin in endotoxin-induced DIC in pigs. Two groups of endotoxemic pigs were studied. AT III-heparin group pigs (n = 8) were pretreated with a bolus injection of 500 units AT III-heparin complex, followed by a continuous infusion of 1000 units of the complex for 6 hours given simultaneously with the infusion of 10 micrograms/kgh of S. abortus equi endotoxin. Controls (n = 9) were given saline in addition to the continuous infusion of endotoxin. AT III activity, prothrombin and soluble fibrin in plasma were determined by chromogenic substrate methods. Fibrinogen was measured turbidimetrically. Human AT III antigen in the treated group was 64 +/- 3% at 2 hours and increased to 84 +/- 4% until the end of the experiment. AT III activity in the AT III-heparin group was elevated throughout the whole observation period (greater than 100%), whereas it was significantly lower in the controls. Prothrombin decreased similarly in both groups by approximately 35% until the end of the experiment. AT III-heparin treatment significantly attenuated the endotoxin-induced consumption of fibrinogen and completely prevented the increase in soluble fibrin in plasma. However, no significant effect of AT III-heparin was observed on endotoxin-induced mortality and dysfunction in pulmonary gas exchange. Therefore we conclude that the purified AT III-heparin complex inhibits thrombin effects and prevents development of DIC, but fails to significantly influence clinical outcome in endotoxin shock of the pig.     

Prophylactic antithrombin III administration during pregnancy immediately reduces the thrombin hyperactivity of congenital antithrombin III deficiency by forming thrombin-antithrombin III complexes.

We examined the changes of haemostatic molecular markers after antithrombin III (AT III) administration in a 22-year-old woman with congenital AT III deficiency in the third trimester of pregnancy who did not have thrombosis. Various markers including fibrinopeptide A (FPA), thrombin-antithrombin III complex (TAT), prothrombin fragment F1 + 2 (F1 + 2), plasmin-alpha 2antiplasmin, D-dimer, beta-thromboglobulin, and platelet factor 4 were measured before and just after 3,000 U of AT III concentrate, which was given three times per week from the 34 week of pregnancy until delivery. Just after AT III administration, F1 + 2 and FPA levels decreased on most occasions, while TAT sometimes increased. Plasma FPA levels were markedly decreased on all 8 occasions when the plasma FPA levels was above 2.0 ng/ml before AT III administration. Plasma FPA levels were always greater than or equal to 6.4 ng/ml before AT III administration on the 4 occasions when TAT increased to above 115%. The changes of plasma F1 + 2 levels were significantly correlated with the AT III level. These results suggest that prophylactic AT III administration in the third trimester immediately inactivates intravascular thrombin to form TAT and reduce the plasma FPA level. Thus, the transient TAT elevation following AT III administration may not only be due to extraction of thrombin from the fibrin clots of thrombi but also to intravascular thrombin which is not attached to thrombi. FPA is the best molecular marker for thrombin hyperactivity and it should be monitored in AT III-deficient pregnant women in the third trimester.     

Elimination of antithrombin III concentrate in healthy pregnant and preeclamptic women with an acquired antithrombin III deficiency

The activity elimination half-life of heat-treated antithrombin III (AT III) concentrate was studied in 5 healthy pregnant and 5 preeclamptic women with a documented AT III deficiency. Healthy pregnant women received 1500 units over 20 minutes. Serial blood specimens were obtained over the next 12 hours. The mean (+/- SEM) activity elimination half-life of AT III was 29.4h +/- 3.4h. Preeclamptic subjects had a mean baseline AT III activity of 70.5 +/- 2% (range 61 to 75%). Their activity eliminator half-life after 3000 units of AT III concentrate was 8.5 +/- 1.2h. There was a direct relationship between the pre-concentrate AT III activity level and the AT III activity elimination half-life (r = 0.79, p = 0.01) for all subjects. Based upon parameters calculated from the first infusion, the AT III activity of preeclamptic subjects was maintained by a constant infusion at approximately 100% for 96h. At the conclusion of the infusion, the activity elimination half-life was again measured. A dramatic increase in the activity elimination half-life was demonstrated (433.6h). We conclude that the activity elimination half-life of AT III concentrate is increased during normal pregnancy and further increased in preeclamptic women with an acquired deficiency.     

Further characterization of a pathological isoantithrombin with no affinity for heparin (antithrombin III Roma)

A molecular antithrombin III variant (Antithrombin III Roma) with an abnormal pattern of crossed immunoelectrofocusing was further investigated in order to identify the pathological isoforms. AT III crossed immunoelectrofocusing of the whole plasma from the affected patients showed a loop overlapping the peak normally present at pH 4.8-4.6. Affinity chromatography demonstrated the presence of an AT III fraction totally lacking in heparin affinity. Crossed immunoelectrophoresis on heparin-agarose (H-CIE) and crossed immunoelectrofocusing (CIEF) runs performed on the fractions obtained by heparin-agarose affinity chromatography confirmed that the functional defect was exclusively related to the pathological isoantithrombin (pH 4.8-4.6), which was also devoid of any progressive activity. The AT III fraction with normal affinity to heparin displayed H-CIE and CIEF patterns identical to the control AT III.     

Comparison between the effect of pentosan polysulphate heparin and antithrombin III injections in antithrombin III deficient patients

Pentosan polysulphate is an heparin analogue which acts via an antithrombin III (AT III) independent pathway. We compared the effect of this drug to that of heparin and AT III infusions in AT III deficient patients. Four patients with AT III congenital deficiency received on three different occasions: (i) an infusion of human AT III concentrate (20 U/kg or 40 U/kg), (ii) an intramuscular injection of pentosan polysulphate (2 mg/kg), (iii) a subcutaneous calcium heparin injection (100 U/kg). AT III infusion inhibits the excessive thrombin generation (46% of inhibition) observed in the plasma of AT III deficient patients during at least 12 hours, but does not modify the factor Xa formation. On the contrary, pentosan polysulphate has a marked effect on both thrombin (62% of inhibition) and factor Xa generation (57% of inhibition) still present 8 hours after injection. Heparin injection has the same effect, more prolonged, as pentosan polysulphate on thrombin generation but is not so effective on impairing factor Xa generation (27% of inhibition). The marked effect of pentosan polysulphate on thrombin and factor Xa generation in these patients is due to its AT III independent mechanism of action.     

Isolation and partial characterization of two distinct types of antithrombin III from rabbit

Heparin-Sepharose chromatography of rabbit plasma or serum yields two fractions of free antithrombin III (AT). The first of these elutes at a lower salt concentration, represents about 90% of the AT in plasma, and has an approximately 2000 dalton higher molecular weight by SDS polyacrylamide electrophoresis. An antibody to the lower affinity species reacts with the second form. The higher affinity AT is not formed from the lower affinity type during blood coagulation as demonstrated by approximately equal levels in plasma and serum, and lack of conversion of ¹²⁵I-labelled lower affinity AT to the higher affinity form during blood coagulation. Heparin cofactor and progressive AT activities of the two forms are essentially identical when assayed by chromogenic substrates. The forms are separable by crossed immunoelectrophoresis.     

Reduction of factor FVIIa activity during heparin therapy. Evidence for assay interactions with tissue factor pathway inhibitor and antithrombin

Heparin is known to exert its antithrombotic effects by accelerating the effect of antithrombin (AT) and by mobilizing tissue factor pathway inhibitor (TFPI) into the circulation from vascular endothelium. Heparin treatment has been reported to decrease FVIIa activity by 40%; this was suggested as a new antithrombotic action of heparins. The present study was conducted to investigate whether the apparent reduction in FVIIa activity induced by unfractionated heparin (UFH) infusion in vivo is due to interactions between AT and TFPI with the FVIIa assay or due to an actual decrease in FVIIa. Blocking plasma TFPI in affinity purified anti-TFPI IgG caused a 25% increase in plasma FVIIa activity (Staclot VII - rTF, Diagnostica Stago, Aswiéres-sur-Seine, France). In vitro heparinization of plasma caused a dose-dependent decrease in FVIIa (up to 56 +/- 8%) at high heparin concentrations (1.0-5.0 IU/mL UFH), a reduction abolished by Hexadimethine Bromide (HDB) to neutralize heparin-induced activation of AT. Thus, heparin-induced activation of AT is apparently responsible for decreased FVIIa under in vitro conditions. Bolus injection followed by continuous infusion of heparin to healthy volunteers was accompanied by a prompt 50% reduction in FVIIa activity, which was sustained throughout heparin infusion and normalized within 24 hours after discontinuation of treatment. Addition of anti-TFPI IgG to postheparin plasma reversed the heparin-induced reduction in FVIIa by approximately 50%, and combined pretreatment of postheparin plasma with anti-TFPI IgG and HDB brought FVIIa to preheparin levels. The present study shows that the FVIIa assay is sensitive to TFPI and AT, especially during heparin treatment, and thereby indicates that the heparin-induced decrease in FVIIa is affected by interactions between TFPI and AT with the FVIIa assay.     

Antithrombin III Avranches, a new variant with defective serine-protease inhibition--comparison with antithrombin III Charleville

A decreased plasma antithrombin activity in presence or in absence of heparin was discovered in a 47-year-old patient presenting with recurrent venous thromboembolism. The immunoreactive material (AT III-IR) was normal. The same biological abnormalities were found in two relatives of the patient, leading to the diagnosis of hereditary qualitative AT III deficiency. The propositus' AT III was coeluted with normal AT III from an heparin-sepharose column. An additional step of ion-exchange chromatography on a Mono Q column using a FPLC system (Pharmacia, St-Quentin en Yvelines, France) allowed the purification of a protein which was homogenous in SDS-10% polyacrylamide electrophoresis gel (PAGE). AT III purified from propositus' plasma, normal plasma and the plasma of the patient known to have an AT III variant with defective protease binding (AT III Charleville) were compared. The specific activities measured as heparin cofactor antithrombin or factor Xa inhibition in absence of heparin were decreased to half the normal value. Kinetic studies confirmed a decreased rate of thrombin inhibition for both abnormal AT III preparations. SDS-PAGE experiments performed in purified system and immunoblots obtained from plasma showed that the two variants have different behaviour: in the case of AT III Charleville thrombin induced an apparent 5 k delta increase in molecular mass, probably due to a conformational change. AT III Avranches did not form stoechiometric complexes with thrombin, but was unmodified by the protease.     

Association of proteins undergoing slow axonal transport with goldfish visual system myelin.

[3H]Proline derived radioactivity which is slowly transported in the goldfish optic nerve has been isolated in association with purified preparations of optic tectal myelin. Acrylamide gel analysis reveals that most of the slowly transported radioactivity is distributed among the high molecular weight myelin proteins with a major peak comigrating with a band (approximately 42,000 daltons) which is prominent in goldfish brain myelin. A similar peak is not seen in gels of whole synaptosome protein. Relatively small but measureable amounts of radioactivity comigrate with the basic and proteolipid proteins. A low density myelin subfraction is 3-5 fold lower in specific radioactivity (disint./min/mug protein) than a corresponding high density fraction and shows particularly low specific radioactivities in the basic and proteolipid bands. The results are discussed with reference to the possible adherence of specific axonal membrane fragments as well as other potential sources of myelin label.     

Heparin cofactor II deficiency in the elderly: comparison with antithrombin III.

We investigated heparin cofactor II (HC II) levels and their relationship to other haemostatic factors in the elderly in comparison with antithrombin III (AT III). We measured plasma HC II activity levels in 166 subjects aged from 61 to 99 years using a chromogenic method. HC II levels (94.4 +/- 18.5%) in the healthy elderly subjects were significantly (p less than 0.001) lower than in 40 healthy adult controls under 60 years of age (mean age: 51.5 years; 111.6 +/- 21.2%). HC II levels in the elderly subjects decreased further with age (r = 0.308, p less than 0.001) and the extent of the decrease was more marked than that for AT III (r = 0.179, p less than 0.05). There was no significant sex difference in HC II levels in the elderly. HC II levels correlated significantly with AT III levels and with acute phase reactants including sialic acid, fibrinogen, and PAI-1. HC II levels also correlated with factor VII, plasminogen, alpha 2-plasmin inhibitor, serum lipid, pseudocholinesterase, and albumin levels. These correlations were also found for AT III except active PAI-1 and tPA-PAI-1 complexes, but the correlations with acute phase reactants were stronger for HC II than AT III. We divided 154 elderly subjects into 4 groups by their pseudocholinesterase and albumin levels to estimate the effect of nutritional status on antithrombin activity in the elderly. HC II levels were normal in the elderly subjects with a good nutritional state (103 +/- 18%), but were significantly decreased in those with malnutrition (85 +/- 15%, p less than 0.001). AT III levels also showed the same tendency. These results indicate a decrease in the reserve capacity to inhibit thrombin generation at sites of atherosclerosis in response to trigger events. The deficiency of two major antithrombin factors in the elderly may indicate a tendency to thrombosis, especially in individuals with malnutrition. When considering the clinical significance of HC II, several other parameters, including age, nutritional status, hepatic synthetic ability, and the presence or absence of acute phase reaction should also be assessed.     

Studies of the effects of estradiol, progesterone, cortisol, thrombophlebitis, and typhoid vaccine on synthesis and catabolism of antithrombin III in the dog

Effects of estradiol, progesterone, cortisol, thrombophlebitis and typhoid vaccine on the synthesis and catabolism of antithrombin III (AT) in dogs were studied, using I-125-labeled AT (I-125-AT) as a tracer. Five dogs were used for each study. A single intramuscular injection of 20 mg estradiol caused a 20% decrease of plasma AT concentration in 6 days without appreciable changes in the plasma half-lives of I-125-AT but with a significant decrease in the fractional catabolic rate of I-125-AT(j3u). A single intramuscular injection of 250 mg progesterone did not produce any appreciable changes of plasma AT concentration, the plasma half-lives of I-125-AT or j3u. On the other hand, intravenous and intramuscular injections of a total of 750 mg cortisol caused a 17% increase of plasma AT concentration in a day after the injections without alterations of the plasma half-lives of I-125-AT or j3u. Next, thrombophlebitis was produced in dogs by a single intravenous injection of 1 ml 90% phenol into a leg vein occluded for 1 min by a gauze tourniquet and the effects of thrombophlebitis were studied. The results indicated that it did not cause appreciable changes of plasma AT concentration, the plasma half-lives of I-125-AT or j3u. However, studies of the effects of a single intravenous injection of 3 ml typhoid vaccine showed a 25% decrease of plasma AT concentration in a day after the injection with a moderate acceleration of the decline rate of plasma I-125-AT and a 14% increase in j3u values. Further studies in heparinized dogs showed similar effects with typhoid vaccine. These results indicate that estradiol causes a decreased rate of AT synthesis, that progesterone has no appreciable effects on AT metabolism, that cortisol increases the rate of AT synthesis, that localized thrombophlebitis has no appreciable effects on AT metabolism and that typhoid vaccine causes an increased j3u by unknown mechanisms which is not an accelerated coagulation process.     

The transneuronal transport of proline within the mouse visual system: Some characteristics of the [H]-proline containing material

Following the intraocular injection of tritiated proline in the mouse, the progressive transport of radioactivity in the brain and the nature of the cortical material(s) to which the label is bound was examined. About 35–40% of the radioactivity that was present in the cerebral cortex at four weeks post-injection was extractable with either distilled water or various buffers. By using 0.1% SDS this value can be increased up to 94%. Polyacrylamide gel electrophoresis of the extracted proteins showed that a major part of the radioactivity is accumulated in one band of proteins. This heavily labeled band could not be identified in the homolateral parietooccipital cortex or in the frontal cortex. Similarly, SDS electrophoresis of the SDS-extracted proteins also demonstrated the presence of a major band of proteins whose molecular weight was estimated at approximately 68,000 daltons. The protein was purified by ammonium sulfate precipitation and DEAE-Sephadex separation.     

Molecular basis and thrombotic manifestations of antithrombin deficiency in 15 unrelated Chinese patients

Introduction

Antithrombin (AT) deficiency is associated with an increasing risk of thrombosis.

Materials and methods

15 unrelated patients with AT deficiency defined by thrombophilic assays were recruited and detailed clinical information about patients, focusing on the personal and family history of thromboembolism (TE), were recorded. Mutation analysis was performed by direct sequencing of an AT gene (SERPINC1) in the patients and their family members.

Results

A total of 15 heterozygous causative mutations, each being identified in one family, were identified. Five mutations (33.3%) were reported here for the first time, including three null mutations (Ser36X, Lys70X and Try307X) and two missense mutations (Phe123Cys and Leu340Phe) probably impairing the structural integrity and stability of protein based on the AT structural analysis. Of the 15 patients, 33.3% (5/15) had additional risk factors and only one patient presented with additional genetic alteration causing an early onset of thrombosis. Fourteen patients (93.9%) suffered from multisite recurrent thrombotic episodes after a first episode of thrombosis. 93.3% of the patients experienced deep vein thrombosis (DVT) and 40.0% presented with mesenteric venous thrombosis (MVT). In addition, both venous and arterial thrombosis was present in two unrelated patients. 51.0% subjects with AT deficiency in the 15 unrelated pedigrees experienced TE events.

Conclusions

Prophylactic anticoagulation may be suggested in AT-deficient patients to avoid the recurrent and multisite thrombosis. The association of primary MVT and AT deficiency is highlighted.     

Molecular basis of antithrombin deficiency

Antithrombin (AT) is the most important physiological inhibitor of coagulation proteases. It is activated by glycosaminoglycans such as heparin. Hereditary antithrombin deficiency is a rare disease that is mainly associated with venous thromboembolism. So far, more than 200 different mutations in the antithrombin gene (SERPINC1) have been described. The aim of our study was to characterise the molecular background in a large cohort of patients with AT deficiency. Mutation analysis was performed by direct sequencing of SERPINC1 in 272 AT-deficient patients. Large deletions were identified by multiplex PCR coupled with liquid chromatography or multiplex ligation-dependent probe amplification (MLPA) analysis. To predict the effect of SERPINC1 sequence variations on the pathogenesis of AT deficiency, in silico assessments, multiple sequence alignment, and molecular graphic imaging were performed. The mutation profile consisted of 59% missense, 10% nonsense, 8% splice site mutations, 15% small deletions/insertions/duplications, and 8% large deletions. Altogether 87 different mutations, including 42 novel mutations (22 missense and 20 null mutations), were identified. Of the novel missense mutations, nine are suspected to impair the conformational changes that are needed for AT activation, two to affect the central reactive loop or the heparin binding site, and six to impair the structural integrity of the molecule. Despite the heterogeneous background of AT deficiency, 10 AT variants occurred in multiple index patients. Characterisation of the SERPINC1 mutation profile in large cohorts of patients may help to further elucidate the pathogenesis of AT deficiency and to establish genotype-phenotype associations.     

Homozygous variant of antithrombin III that lacks affinity for heparin, AT III Kumamoto

Abnormal antithrombin III (AT III) was found in the plasma of a 31-year-old female who suffered from recurrent thrombotic episodes. Heparin cofactor activity was 28% of normal and undetectable when measured by inhibition of thrombin and factor Xa (F.Xa), while both progressive antithrombin and antifactor Xa activities were normal. The concentration of plasma AT III antigen was 37 mg/dl. Analysis by crossed-immunoelectrophoresis (CIE) in the presence of heparin and affinity chromatography on heparin-Sepharose revealed that the propositus' AT III did not bind to heparin. When heparin cofactor II (HC II) was removed from propositus' plasma, heparin cofactor activity of AT III was not detected. Thus, HC II seemed to account for the plasma heparin cofactor activity found in the presence of thrombin. The patient's parents and three of her brothers demonstrated qualitative abnormality of AT III; heparin cofactor activity was 30-50% of normal levels in the presence of both thrombin and F.Xa. These findings indicate that the propositus' AT III lacks affinity for heparin and the mode of its inheritance seems to be autosomal dominant and, hence, the propositus would be a homozygote. For this variant, the name of AT III Kumamoto is proposed.