title: Von Willebrand factor-cleaving protease and Upshaw-Schulman syndrome.
abstract: Vascular endothelial cell (EC)-produced plasma von Willebrand factor (vWF) plays a critical role in primary hemostasis through its action of anchoring platelets onto the injured denuded subendothelial matrices under high shear stress. Unusually large vWF multimers (UL-vWFMs), present in plasma immediately after release from ECs, are most biologically active, but they are soon cleaved and degraded into smaller vWFMs by a specific plasma protease, termed vWF-cleaving protease (vWF-CPase), in normal circulation. Recent studies on the relationship between UL-vWFMs and vWF-CPase, together with its autoantibody (inhibitor) have brought about a clear discrimination between thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Furthermore, a congenital deficiency of this enzyme activity has been shown to cause Upshaw-Schulman syndrome, a complex constitutional bleeding diathesis. Successful purification of vWF-CPase revealed that this enzyme is composed of a single polypeptide with a molecular mass of approximately 190 kd, and its complementary DNA cloning unambiguously indicated that it is uniquely produced in the liver and its gene is located on chromosome 9q34. The messenger RNA of vWF-CPase had a span of 4.6 kb, and its enzyme was designated ADAMTS 13. The predicted complete amino acid sequence of this enzyme consisted of 1427 residues, including a signal peptide, a short propeptide terminating in the sequence RQRR, a reprolysin-like metalloprotease domain, a disintegrin-like domain, a thrombospondin-1 repeat (TSP1), a cysteine-rich domain, an ADAMTS spacer, 7 additional TSP1 repeats, and 2 CUB domains.
authors.affiliation: Department of Blood Transfusion Medicine, Nara Medical University, Kashihara City, Japan. yfujimur@nmu-gw.cc.naramed-u.ac.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fujimura
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Yagi
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshioka
authors.forename: Taei
authors.initials: T
authors.lastname: Matsui
authors.forename: Koiti
authors.initials: K
authors.lastname: Titani
mesh_terms: D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; D000328:Adult; D000595:Amino Acid Sequence; D000745:Anemia, Hemolytic, Congenital / Q000201:enzymology / Q000235:genetics*; D001323:Autoantibodies / Q000276:immunology; D001704:Biopolymers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D002899:Chromosomes, Human, Pair 9 / Q000235:genetics; D018076:DNA, Complementary / Q000235:genetics; D003937:Diagnosis, Differential; D004792:Enzyme Precursors / Q000235:genetics / Q000378:metabolism; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis; D006474:Hemorrhagic Disorders / Q000201:enzymology / Q000235:genetics*; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000201:enzymology; D046911:Macromolecular Substances; D008297:Male; D008666:Metalloendopeptidases / Q000737:chemistry / Q000172:deficiency / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification / Q000502:physiology*; D008958:Models, Molecular; D008969:Molecular Sequence Data; D008970:Molecular Weight; D010375:Pedigree; D010974:Platelet Aggregation / Q000502:physiology; D011487:Protein Conformation; D017434:Protein Structure, Tertiary; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis; D012333:RNA, Messenger / Q000235:genetics; D013577:Syndrome; D013921:Thrombocytopenia / Q000201:enzymology / Q000235:genetics*; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D001323:Autoantibodies; D001704:Biopolymers; D018076:DNA, Complementary; D004792:Enzyme Precursors; D046911:Macromolecular Substances; D012333:RNA, Messenger; D014841:von Willebrand Factor; D051722:ADAM Proteins; D008666:Metalloendopeptidases; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human