Blood Coagulation Cascade Research Articles

ASSESSMENT OF PROTEOLYTIC ACTIVITY OF THE AQUEOUS LEAF EXTRACT OF Clerodendrum colebrookianum AND ITS EFFECT ON THE BLOOD COAGULATION CASCADE

Clerodendrum colebrookianum is a highly medicinal plant. Plant protease is one of the main components of analyzing the anticoagulant property of the plant. From the gelatin-agar plate, the technique confirms the presence of protease activity in Clerodendrum colebrookianum. Enzymatic activity and specific enzyme activity of the aqueous extract were determined using the caseinolytic method. It was seen that the enzyme activity (U) of Clerodendrum colebrookianum is 0.99±0.004 µmol of tyrosine released/ml/min. For the aqueous leaf extract of Clerodendrum colebrookianum the Clotting Time (CT), Prothrombin Time (PTT) and activated Partial Thromboplastin Time (aPTT) was determined and it was found that the plasma recalcification time increases the normal clotting time significantly at the dose of 1µG but not significant at dose 5 µg. The prothrombin time of the crude aqueous extracts of CC was observed to increase the prothrombin time significantly at the dose of 1µG. The activated partial thromboplastin time was seen to be insignificant in Clerodendrum colebrookianum. Even though Clerodendrum colebrookianum may act as a significant anticoagulant in the common and extrinsic pathways; on the intrinsic pathway of the blood coagulation cascade it may not have any effect.

Modified expi293 cell culture system using piggyBac transposon enables efficient production of human FVIII.

Human blood coagulation factor VIII (hFVIII) is used in hemostatic and prophylactic treatment of patients with hemophilia A. Biotechnological innovations have enabled purification of the culture medium of rodent or human cells harboring the hFVIII expression cassette. However, cell lines express hFVIII protein derived from an exogenous expression vector at a lower level than most other proteins. Here, we describe hFVIII production using piggyBac transposon and the human-derived expi293F cell line. Use of a drug selection protocol, rather than transient expression protocol, allowed cells harboring hFVIII expression cassettes to efficiently produce hFVIII. In heterogeneous drug-selected cells, the production level was maintained even after multiple passages. The specific activity of the produced hFVIII was comparable to that of the commercial product and hFVIII derived from baby hamster kidney cells. We also applied codon optimization to the hFVIII open reading frame sequences in the transgene, which increased production of full-length hFVIII, but decreased production of B-domain-deleted human FVIII (BDD-hFVIII). Low transcriptional abundance of the hF8 transgene was observed in cells harboring codon-optimized BDD-hFVIII expression cassettes, which might partially contribute to decreased hFVIII production. The mechanism underlying these distinct outcomes may offer clues to highly efficient hFVIII protein production.

Exploring the Complex Network of Heme-Triggered Effects on the Blood Coagulation System.

Excess labile heme, occurring under hemolytic conditions, displays a versatile modulator in the blood coagulation system. As such, heme provokes prothrombotic states, either by binding to plasma proteins or through interaction with participating cell types. However, despite several independent reports on these effects, apparently contradictory observations and significant knowledge gaps characterize this relationship, which hampers a complete understanding of heme-driven coagulopathies and the development of suitable and specific treatment options. Thus, the computational exploration of the complex network of heme-triggered effects in the blood coagulation system is presented herein. Combining hemostasis- and heme-specific terminology, the knowledge available thus far was curated and modeled in a mechanistic interactome. Further, these data were incorporated in the earlier established heme knowledge graph, “HemeKG”, to better comprehend the knowledge surrounding heme biology. Finally, a pathway enrichment analysis of these data provided deep insights into so far unknown links and novel experimental targets within the blood coagulation cascade and platelet activation pathways for further investigation of the prothrombotic nature of heme. In summary, this study allows, for the first time, a detailed network analysis of the effects of heme in the blood coagulation system.

Properdin (factor P) as a new target cleaved by factor XIa: Intrinsic coagulation at the crossroads with inflammation

The complement system and blood coagulation cascade, in particular, the contact activation pathway, are functionally related and exhibit crossover activities. Deficiency or altered function of complement proteins are associated with thrombo‐inflammatory diseases. Factor XI (FXI), as part of the intrinsic pathway, is the zymogen, which can be activated to the plasma protease FXIa by FXIIa with the help of high molecular weight kininogen, and then continue to the downstream cascade of proteases that ultimately triggers the production of thrombin (FIIa).

Domain Evolution of Vertebrate Blood Coagulation Cascade Proteins

Vertebrate blood coagulation is controlled by a cascade containing more than 20 proteins. The cascade proteins are found in the blood in their zymogen forms and when the cascade is triggered by tissue damage, zymogens are activated and in turn activate their downstream proteins by serine protease activity. In this study, we examined proteomes of 21 chordates, of which 18 are vertebrates, to reveal the modular evolution of the blood coagulation cascade. Additionally, two Arthropoda species were used to compare domain arrangements of the proteins belonging to the hemolymph clotting and the blood coagulation cascades. Within the vertebrate coagulation protein set, almost half of the studied proteins are shared with jawless vertebrates. Domain similarity analyses revealed that there are multiple possible evolutionary trajectories for each coagulation protein. During the evolution of higher vertebrate clades, gene and genome duplications led to the formation of other coagulation cascade proteins.

The role of histotripsy pulsing rate on clot degradation when combined with thrombolytic drug

Histotripsy is a bubble-based focused ultrasound therapy under development for tissue ablation, including the treatment of venous thrombosis. Histotripsy is effective for lysing erythrocytes within the clot, but not its fibrin structures. Our prior work has demonstrated when combined with a standard-of-care thrombolytic drug, histotripsy can degrade both cellular and extracellular clot components. To date, only histotripsy pulsing rates of 20–40 Hz have been tested for this combination approach. Previous studies have shown the pulsing rate influences the bubble dynamics, and therefore treatment outcomes. The goal of this study was to determine the effect of pulsing rate on clot degradation. Human whole blood clots were exposed to thrombolytic drug and histotripsy pulses. The pulsing rate ranged from 5 to 500 Hz. Following treatment, metrics of clot degradation (change in clot mass, and markers of erythrocyte and fibrin degradation) were tabulated. An improvement in treatment outcomes was observed for the combination approach relative to histotripsy alone for the 50 Hz pulsing rate. At 500 Hz, the benefit of combining thrombolytic drug with histotripsy was not well defined. Overall, these results indicate the pulsing rate has a role in the ablative and drug delivery capacity of histotripsy.

Physiological and Biochemical Characteristics of Rainbow Trout with Severe, Moderate and Asymptomatic Course of Vibrio anguillarum Infection.

Simple SummaryDuring the past decades, bacterial infections have been a serious problem in aquaculture that causes very large economic losses. Currently, antibiotics are the most common method of disease prevention and control. A combination of water quality monitoring, early detection of fish infections, and other preventive biosecurity measures in fish farms can help prevent the spread of infection. We investigated the natural bacterial infection in fish farms and characterized the parameters of the health status of rainbow trout Oncorhynchus mykiss (Walbaum, 1792) during disease. Depending on the course of the disease (severity of the pathology, leukocyte profile, and expression of immune-related genes), three subpopulations of fish with severe damage, a moderate course of the infectious process, and asymptomatic fish were characterized. An unexpected result was a small metabolic difference between fish with moderate symptoms and fish with weak signs of pathology. Thus, we have described the characteristics of a trout subpopulation with a mild course of infection which has potential for recovery after infection.This article describes the clinical manifestation of natural Vibrio anguillarum infection in rainbow trout (Oncorhynchus mykiss) during an outbreak on a fish farm. (i) Using an integrated approach, we characterized the pathogenesis of vibriosis from the morphological, hematological, and biochemical points of view. The molecular mechanisms associated with the host immune response were investigated using mass spectrometric analysis of trout plasma proteins. (ii) According to the severity of infection (the extent of tissue damage, the level of expression of pro-inflammatory genes, and changes in the leukocyte profile) three fish populations were identified among infected trout: fish with severe lesions (SL), fish with the moderate infectious process (IP) and asymptomatic fish (AS). (iii) Lymphopenia, granulocytosis, and splenomegaly were strong trends during the progression of infection and informative indicators of severe manifestation of disease, associated with hemorrhagic shock, metabolic acidosis, and massive tissue damage. (iv) As expected, pro-inflammatory interleukins, complement components, acute phase proteins, and antimicrobial peptides were implicated in the acute pathogenesis. Systemic coagulopathy was accompanied by increased antithrombotic reactions. (v) Reconstruction of metabolic pathways also revealed a high energy requirement for the immune response in severely affected fish. (vi) An unexpected result was a small difference between fish with moderate symptoms and fish with no or minor external signs of pathology (putatively resistant to infection). Increased production of antiproteases and enhanced blood coagulation cascade were observed in healthier fish, which may underlie the mechanisms of a controlled, non-self-damaging immune response to infection. (vii) Depending on the progression of the disease and the presence of the pathogen, a stepwise or linear change in the abundance of some plasma proteins was revealed. These proteins could be proposed as molecular markers for diagnosing the health and immune status of trout when cultured in fish farms.

Distinct gene expression patterns for CD14++ and CD16++ monocytes in preeclampsia

Preeclampsia (PE) is a serious gestational complication affecting the life of a mother and child. The immunophenotype and gene expression profile of isolated blood monocyte subpopulations of pregnant women with PE have not been studied before. In this work, we assessed changes in CD14++ and CD16++ monocyte subpopulations in PE and physiological pregnancy (n = 33). Immunophenotyping, immunomagnetic sorting of monocytes and analysis of the transcriptional profile of their genes were carried out. The percentage of classical monocytes was significantly lower, while the intermediate fraction of monocytes was significantly higher in late-onset PE compared to control. Transcriptome analysis of late-onset PE classical CD14++ monocytes revealed significant activation of inflammation mediated by chemokine and cytokine signalling pathways; apoptosis; regulation of transcription from RNA polymerase II promoter in response to stress and others. The most suppressed signalling pathways were associated with T cell activation and selection. In CD16++ monocytes of late-onset PE cases, positive regulation of cell–cell adhesion, integrin signalling pathway, blood coagulation cascade were the most activated ones. The inflammation mediated by chemokine and cytokine signalling pathway and p53 pathway were the most down-regulated in CD16++ monocytes. The obtained results indicate profound changes occurring to two most polar monocyte subpopulations in PE and their different roles in the pathogenesis of this disease.

Two Methods for the Implicit Integration of Stiff Reaction Systems

Abstract We present two methods for the implicit integration of nonlinear stiff systems. Direct application of the Newton method to backward Euler discretization of such systems may diverge. We observe that the solution is recovered by smoothing out certain eigenvalues in the Jacobian matrix. To this end, we introduce a solution-dependent matrix-weighted combination of backward and forward Euler methods. The weight is tuned on each Newton iteration to reproduce the solution with an exponential integrator, whereby a weight function for smoothing eigenvalues is obtained. We apply the proposed techniques, namely quasi-Newton backward Euler and matrix-weighted Euler, to several stiff systems, including Lotka–Volterra, Van der Pol’s, and a blood coagulation cascade.

Tissue factor in cancer-associated thromboembolism: possible mechanisms and clinical applications.

Venous and arterial thromboses, called as cancer-associated thromboembolism (CAT), are common complications in cancer patients that are associated with high mortality. The cell-surface glycoprotein tissue factor (TF) initiates the extrinsic blood coagulation cascade. TF is overexpressed in cancer cells and is a component of extracellular vesicles (EVs). Shedding of TF+EVs from cancer cells followed by association with coagulation factor VII (fVII) can trigger the blood coagulation cascade, followed by cancer-associated venous thromboembolism in some cancer types. Secretion of TF is controlled by multiple mechanisms of TF+EV biogenesis. The procoagulant function of TF is regulated via its conformational change. Thus, multiple steps participate in the elevation of plasma procoagulant activity. Whether cancer cell-derived TF is maximally active in the blood is unclear. Numerous mechanisms other than TF+EVs have been proposed as possible causes of CAT. In this review, we focused on a wide variety of regulatory and shedding mechanisms for TF, including the effect of SARS-CoV-2, to provide a broad overview for its role in CAT. Furthermore, we present the current technical issues in studying the relationship between CAT and TF.

Phospholipase A2 receptor is associated with hypercoagulable status in membranous nephropathy: a narrative review.

Background and ObjectiveMembranous nephropathy (MN) is the pathology type with the highest incidence of thrombotic events in nephrotic syndrome (NS). While patients with MN are prone to developing thromboembolic complications, the specific mechanism remains unclear. Many studies have shown a high titer of PLA2R antibody aggravates proteinuria and hypoalbuminemia and predicts a lower likelihood of clinical remission in patients with PLA2R-associated MN. Proteinuria and hypoalbuminemia also increase the risk of thrombotic events. In our previous review, we found secretory phospholipase A2 (sPLA2) may act as a ligand for PLA2R, and binding of sPLA2 to PLA2R results in damage to podocytes. sPLA2 can promote the release of AA from membrane phospholipids, and AA is closely related to blood lipid levels and coagulation cascades. The objective of this study is to explain the relationship between phospholipase A2 receptor (PLA2R) and blood hypercoagulability in MN patients and the new theory that secretory phospholipase A2 (sPLA2) and arachidonic acid (AA) may play a role in regulating blood lipid levels and the coagulation cascade in patients with PLA2R-positive MN.MethodsLiterature retrieval was conducted through China National Knowledge Infrastructure (CNKI) and PubMed. and Introduction information was then retrieved and the results from the literature searched, classified, and important information summarized. A conclusion was then reached, and a new standpoint put forward.Key Content and FindingsWe discussed the role of PLA2R antibody and sPLA2 in hypercoagulability in patients with MN and analyzed the following four possible mechanisms: sPLA2 can combine with PLA2R and induce podocyte apoptosis; sPLA2 may promote the production of anti-PLA2R antibodies; sPLA2 may promote the release of AA from membrane phospholipids; and AA induces platelet aggregation.ConclusionsPLA2R may exacerbate hypercoagulability in patients with PLA2R-related MN, and sPLA2 plays an important role in the process.

ALLOSTERIC REGULATION OF THE BLOOD CLOTTING CASCADE

Recognition of functional partners is a pivotal factor in the regulation of protein interactions. The areas of direct contact between complementary molecules that interact according to Koshland’s "key - lock" scheme deserve special attention. The relevance of the study of this kind of interactions is obvious. In the case of the simplest serine proteinases the increased affinity of the enzyme to a certain area of the target protein is ensured by the synchronous interaction of the binding and allosteric sub-sites with amino acid residues of the target protein, that are adequate by ligand specificity and placed in an optimal conformation. The purpose of this work is to clarify the compliance of the components of the blood clotting cascade with this rule. Comparison of the primary sequences of sites of activation cleavage, reactive centers of serpins and sites of proteolytic inactivation testifies in favor of this assumption.

Isolation of the Anticoagulant and Procoagulant Fractions of the Venom of Iranian Endemic Echis carinatus.

The venom of Echis carinatus contains both procoagulant and anticoagulant components that can either promote or block the blood coagulation cascade, and some of these components affect platelet function in different ways. The present study focuses on setting up a procedure for the purification of crude venom and designing appropriate clotting tests in order to characterize the procoagulant and anticoagulant fractions of E. carinatus venom. Chromatographic methods, including gel filtration, ion-exchange chromatography, and reverse-phase high-performance liquid chromatography (HPLC), were applied for purifying these fractions. Coagulant activity testing, prothrombin time (PT), and activated partial thromboplastin time (APTT) were used to determine procoagulant and anticoagulant properties. For measuring molecular weight, 15% SDS-PAGE electrophoresis with a molecular weight standard ranging from 6.5 to 200 kDa was used. We obtained five fractions named F1, F2, F3, F4, and F5. The F1 and F2 fractions showed procoagulant activity, and the F5 fraction had anticoagulant activity. The molecular weight of F2.4.2 from fraction F2 and F5.1 from fraction F5 were analyzed by SDS-PAGE electrophoresis under the reducing condition. These factors were identified as a single protein band at the end of purification. The molecular weights of these purified fractions were estimated to be 7.5 kDa and 38 kDa for F5.1(b) and F2.4.2(b), respectively. Our findings suggest an efficient and suitable procedure for the identification and purification of the procoagulant and anticoagulant factors of the venom of Iranian E. carinatus using the PT and APTT assays.

Anti-MRSA and clot lysis activities of Pestalotiopsis microspora isolated from Dillenia pentagyna Roxb.

There is an urgent call to search for novel natural compounds against developing multidrug-resistant microorganisms. The present work focuses on the characterization of a plant-associated fungus having bioactivity against methicillin-resistant Staphylococcus aureus (MRSA) strains. A fungal strain P31 was isolated from bark of Dillenia pentagyna and identified as Pestalotiopsis microspora. The maximum anti-MRSA activity was observed from extract of P31 grown in sabouraud dextrose broth. The minimum inhibitory concentrations(MIC) values of P31 extract were 14 μg/ml for methicillin-sensitive S. aureus (MSSA) and 32 μg/ml for MRSA strain, respectively. A crude P31 extract showed strong bactericidal activity by killing all treated MRSA cells within 24 h of treatment at their respective MIC value. A scanning electron microscopic study visualized morphological damage of MRSA cells. The membrane permeability of P31 extract-treated MRSA cells gradually increased which caused release of internal cytoplasmic nucleic acids, proteins and potassium ions (K+ ) from cells suggesting cell lysis or leakage from cells. A very low concentration of P31 extract was able to inhibit biofilm formed by MRSA cells. Thin layer chromatographic separation followed by gas chromatography-mass spectrometry analysis of the P31 extract revealed a number of antimicrobial compounds along with an anti-MRSA compound 2,4-di-tert-butylphenol. In addition, the P31 extract also showed in-vitro human blood clot lysis activity at various concentrations. The clot lysis activity of P31 extract was found maximum at 500 µg/ml. These findings suggest that fungal isolate P31 has potential as a source of anti-MRSA compounds useful in staph infections.

Role of Vitamin K in Selected Malignant Neoplasms in Women.

The main function of vitamin K in the human organism is its activity in the blood clotting cascade. Epidemiological studies suggest that reduced intake of vitamin K may contribute to an increased risk of geriatric diseases such as atherosclerosis, dementia, osteoporosis, and osteoarthritis. A growing number of studies also indicate that vitamin K may be involved not only in preventing the development of certain cancers but it may also support classical cancer chemotherapy. This review article summarizes the results of studies on the anticancer effects of vitamin K on selected female malignancies, i.e., breast, cervical, and ovarian cancer, published over the past 20 years. The promising effects of vitamin K on cancer cells observed so far indicate its great potential, but also the need for expansion of our knowledge in this area by conducting extensive research, including clinical trials.

A Kunitz-type inhibitor from tick salivary glands: A promising novel antitumor drug candidate.

Salivary glands are vital structures responsible for successful tick feeding. The saliva of ticks contains numerous active molecules that participate in several physiological processes. A Kunitz-type factor Xa (FXa) inhibitor, similar to the tissue factor pathway inhibitor (TFPI) precursor, was identified in the salivary gland transcriptome of Amblyomma sculptum ticks. The recombinant mature form of this Kunitz-type inhibitor, named Amblyomin-X, displayed anticoagulant, antiangiogenic, and antitumor properties. Amblyomin-X is a protein that inhibits FXa in the blood coagulation cascade and acts via non-hemostatic mechanisms, such as proteasome inhibition. Amblyomin-X selectively induces apoptosis in cancer cells and promotes tumor regression through these mechanisms. Notably, the cytotoxicity of Amblyomin-X seems to be restricted to tumor cells and does not affect non-tumorigenic cells, tissues, and organs, making this recombinant protein an attractive molecule for anticancer therapy. The cytotoxic activity of Amblyomin-X on tumor cells has led to vast exploration into this protein. Here, we summarize the function, action mechanisms, structural features, pharmacokinetics, and biodistribution of this tick Kunitz-type inhibitor recombinant protein as a promising novel antitumor drug candidate.

Effect of Biofunctional Green Synthesized MgO-Nanoparticles on Oxidative-Stress-Induced Tissue Damage and Thrombosis.

The present study describes the green biofunctional synthesis of magnesium oxide (MgO) nanoparticles using the aqueous Tarenna asiatica fruit extract. The characterization of Tarenna asiatica fruit extract MgO nanoparticles (TAFEMgO NPs) was achieved by X-ray powder diffraction, UV-Vis spectroscopy, FTIR, TEM, SEM, and energy-dispersive X-ray diffraction. TAFEMgO NPs scavenged the DPPH free radicals with an IC50 value of 55.95 μg/μL, and it was highly significant compared to the standard. To authenticate the observed antioxidant potential of TAFEMgO NPs, oxidative stress was induced in red blood cells (RBC) using sodium nitrite (NaNO2). Interestingly, TAFEMgO NPs ameliorated the RBC damage from oxidative stress by significantly restoring the stress parameters, such as the protein carbonyl content (PCC), lipid peroxidation (LPO), total thiol (TT), super-oxide dismutase (SOD), and catalase (CAT). Furthermore, oxidative stress was induced in-vivo in Sprague Dawley female rats using diclofenac (DFC). TAFEMgO NPs normalized the stress parameters in-vivo and minimized the oxidative damage in tissues. Most importantly, TAFEMgO NPs restored the function and architecture of the damaged livers, kidneys, and small intestines by regulating biochemical parameters. TAFEMgO NPs exhibited an anticoagulant effect by increasing the clotting time from 193 s in the control to 885 s in the platelet rich plasma. TAFEMgO NPs prolonged the formation of the clot process in the activated partial thromboplastin time and the prothrombin time, suggest the effective involvement in both intrinsic and extrinsic clotting pathways of the blood coagulation cascade. TAFEMgO NPs inhibited adenosine di-phosphate (ADP)-induced platelet aggregation. TAFEMgO NPs did not show hemolytic, hemorrhagic, and edema-inducing properties at the tested concentration of 100 mg/kgbody weight, suggesting its non-toxic property. In conclusion, TAFEMgO NPs mitigates the sodium nitrite (NaNO2)- and diclofenac (DFC)-induced stress due to oxidative damage in both in vitro and in vivo experimental models.

Evaluation of Novel Guanidino-Containing Isonipecotamide Inhibitors of Blood Coagulation Factors against SARS-CoV-2 Virus Infection.

Coagulation factor Xa (fXa) and thrombin (thr) are widely expressed in pulmonary tissues, where they may catalyze, together with the transmembrane serine protease 2 (TMPRSS2), the coronaviruses spike protein (SP) cleavage and activation, thus enhancing the SP binding to ACE2 and cell infection. In this study, we evaluate in vitro the ability of approved (i.e., dabigatran and rivaroxaban) and newly synthesized isonipecotamide-based reversible inhibitors of fXa/thr (cmpds 1–3) to hinder the SARS-CoV-2 infectivity of VERO cells. Nafamostat, which is a guanidine/amidine antithrombin and antiplasmin agent, disclosed as a covalent inhibitor of TMPRSS2, was also evaluated. While dabigatran and rivaroxaban at 100 μM concentration did not show any effect on SARS-CoV-2 infection, the virus preincubation with new guanidino-containing fXa-selective inhibitors 1 and 3 did decrease viral infectivity of VERO cells at subtoxic doses. When the cells were pre-incubated with 3, a reversible nanomolar inhibitor of fXa (Ki = 15 nM) showing the best in silico docking score toward TMPRSS2 (pdb 7MEQ), the SARS-CoV-2 infectivity was completely inhibited at 100 μM (p < 0.0001), where the cytopathic effect was just about 10%. The inhibitory effects of 3 on SARS-CoV-2 infection was evident (ca. 30%) at lower concentrations (3–50 μM). The covalent TMPRSS2 and the selective inhibitor nafamostat mesylate, although showing some effect (15–20% inhibition), did not achieve statistically significant activity against SARS-CoV-2 infection in the whole range of test concentrations (3–100 μM). These findings suggest that direct inhibitors of the main serine proteases of the blood coagulation cascade may have potential in SARS-CoV-2 drug discovery. Furthermore, they prove that basic amidino-containing fXa inhibitors with a higher docking score towards TMPRSS2 may be considered hits for optimizing novel small molecules protecting guest cells from SARS-CoV-2 infection.

A Case of Disseminated Intravascular Coagulation Syndrome following a Twenty Week Missed Abortion

Disseminated Intravascular Coagulation Syndrome (DIC) is defined as the pathological disruption of the balanced process of hemostasis that is characterized by systemic activation of the blood coagulation cascade, which results in generation and deposition of fibrin . This leads to formation of microvascular thrombi in small blood vessels and activation of plasmin causing fibrinolysis. This process combined leads to multiple organ dysfunction due to depleted platelets and clotting factors that are needed for hemostasis, thus presenting as excessive bleeding . While DIC in pregnancy is rare, only accounting for approximately 1-5% of all DIC cases in the general population, it occurs in 0.3-3.5% of delivery hospitalizations. The process itself can stem from a multitude of sources during pregnancy including, but not limited to, placental abruption, postpartum hemorrhage, Preeclampsia, Eclampsia, HELLP syndrome, acute fatty liver, amniotic fluid embolism, and pregnancy-related sepsis. Each individual diagnosis has distinct features and treatment regimens to prevent progression to DisseminatedIntravascular Coagulation Syndrome. DIC is a major contributor to maternal mortality with approximately 20-25%of maternal deaths being related to hemorrhage, amniotic fluid embolism, or hypertensive disorders, all of which can be related to coagulopathies. Distinguishing features of hemodynamically stable and unstable patients guide the managementand determine how quickly the team must react when actively managing Disseminated Intravascular Coagulation Syndromein the pregnant population. The objective of this case study is to review a unique patient presentation that is consistent witha benign diagnosis that quickly progressed to a potentially life-threatening condition. By reviewing this case study, I intend to discuss the initial disease presentation, diagnosis, and treatment options of DIC in pregnancy.

New insights into the hemolymph coagulation cascade of horseshoe crabs initiated by autocatalytic activation of a lipopolysaccharide-sensitive zymogen

The concept of a chain reaction of proteolytic activation of multiple protease zymogens was first proposed to explain the blood clotting system in mammals as an enzyme cascade. In multicellular organisms, similar enzyme cascades are widely present in signal transduction and amplification systems. The initiation step of the blood coagulation cascade often consists of autocatalytic activation of the corresponding zymogens located on the surfaces of host- or foreign-derived substances at injured sites. However, the molecular mechanism underlying the concept of autocatalytic activation remains speculative. In this review, we will focus on the autocatalytic activation of prochelicerase C on the surface of lipopolysaccharide as a potential initiator of hemolymph coagulation in horseshoe crabs. Prochelicerase C is presumed to have evolved from a common complement factor in Chelicerata; thus, evolutionary insights into the hemolymph coagulation and complement systems in horseshoe crabs will also be discussed.