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¨x¯À(heparin)¬O¥Ñ³¡¥÷ÁD¤Æ¤§¥k±Û¸²µå¿}îÇ»Ä(D-glucuronic acid)¤Î¥k±ÛÓi°ò¸²µå¿}(D-glucosamine)²Õ¦¨ªº¤@ºØÖߦhÁÞÃþ(mucopolysaccharide)¡A

(Faham: Science, Volume 271(5252).February 23, 1996.pp 1116-1120)

¨ä¤T¯Åµ²ºc¤w³QMulloy µ¥¤H¸Ñ¥X(Mulloy,1993; PDB ID:1HPN)¡C

¨x¯À¤fªAµLªvÀø®ÄªG¡A¶·ÀR¯ß©Î²`¼h¥Ö¤Uª`®g¤~¦³®Ä(Hirsh, 1992)¡A±`¥Î©ó¤ßŦ¯ßºÞ¤â³N(cardiopulmonary bypass)«á¥Î§@§Ü¾®¾¯¡A¥H¨¾¤î¦å®ê§Î¦¨thrombosis(Bull et al., 1975)¡C¦b¤â³N¹L«á¡A¬°¤F¹w¨¾¦å®ê®ê¶ë¯e¯f(thromboembolic disease)®É©Î¦å²G³zªRµ¥±wªÌ¥ç¥i¨Ï¥Î¡C

    1. ²¸»Ä³½ºë³J¥Õªº§@¥Î
    2. ²¸»Ä³½ºë³J¥Õ(protamine sulphate)¡AÁ{§É¤W¥Î¨Ó¤¤©M¨x¯Àªº§Ü¾®¦å§@¥Î¡A¨ä¥»¨­Ói°ò»Ä§Ç¦C¦³65%¥H¤W¥Ñarginine²Õ¦¨¡A¨äÓi°ò»Ä§Ç¦C¦p¤U:

      Protamine : PR4S3RPVR5PRVSR6G2R4

      ¦bÅé¥~¹êÅç (in vitro)¤]·|»P¨x¯À¦³ºò±Kªºµ²¦X¡C·í²¸»Ä³½ºë³J¥Õ¦bÅ餺(in vivo)µ¹ÃÄ¡A¥¦·|»P¦å¤pªO(platelets)¡AÅÖºû³J¥Õ­ì(fibrinogen)¡A¤Î¨ä¥L¦å¼ß³J¥Õ(fibrinogen)²£¥Í¥æ¤¬§@¥Î(Gilman et al., 1990)¡A¦Ó¥B²¸»Ä³½ºë³J¥Õ¦bÅé¥~¹êÅç¤]¨ã¦³§Ü¾®¦åªº§@¥Î (Perkash,1980)¡A¥¦¯à©µªø¬¡¤Æ³¡¥÷¦¨®ê½è®É¶¡(Activated Partial Thromboplastin Time aPTT)©M«e¾®¦å®É¶¡¡C¤£¹L§Ü¾®¦å§@¥Î¸û¨x¯À(heparin)·L®z¡CÁ{§É¤Wª`®g²¸»Ä³½ºë³J¥Õµo²{¡A·í²¸»Ä³½ºë³J¥Õ¥Î¨Ó¤¤©M¨x¯Àµ¹ÃĹL¶q·|²£¥Í§Ü¾®¦å§@¥Î(Gilman et al.,1990)¡C

      §Ú­Ì¸ÕµÛ¥Hµ²ºc¥Íª«¾Çªº²´¥ú¡A³]­p¥XÂ÷Ói»Ä¥H(i,i+3©Mi,i+4)ªº¶¡¹j»P¨x¯À²£¥Í§@¥Î¡A¤¤©M¨x¯Àªº§Ü¾®¦å§@¥Î¡A§@¬°³]­pÃĪ«ªº²z©À¡C

    3. §Ü¾®¦å¾÷Âà

¤@¯ë¾®¦å¸ô®|¥i¤À¬°¨âºØ¡A¤@ºØ¬°¤º¦]©Ê¸ô®|(intrinsic pathway)¡A¥t¤@ºØ¬°¥~¦]©Ê¸ô®|(extrinsic pathway)(¦p¹Ï¤@)¡A°t¦XµÛPT,aPTT(¨£²Ä¤G³¹)ªº´ú¸Õ¡A¥i±oª¾¦óºØ¾®¦å¦]¤l¯Ê¥F©Î³Q§í¨î¡C

¾®¦å¦]¤lXa(factor Xa)©M¾®¦å¦]¤lIXa(factor IXa)¬O¦å²G¤¤­«­nªºµ·¦w»ÄúB(serine protases)§í¨î¾¯¡A­Y¯Ê¥F§Ü¾®¦åúBIII (antithrombin III)·|¼W¥[®ê¶ëªº§Î¦¨¡C¨x¯À·|©M§Ü¾®¦åúBIIIµ²¦X²£¥Í§Ü¾®¦å§@¥Î(Hirsh, et al., 1994 ; Jin,L. et al.,1997; Davie, E.W. et al.,1991)¡C

(From: Hirsh: Circulation, Volume 89(3).Mar 1994.pp 1449-1468.)

  1. 4³]­p¥X»P¨x¯À(heparin)µ²¦Xªº¶§Â÷¤lú@úA

¦b1993¡A1994¦~(DeLuica ,A. et al.,1993;Wakefield,T.W. et al.,1994)¥H¤£¦PªºLys¨ú¥N²¸»Ä³½ºë³J¥Õ¤WªºArg¡A³o¨Ç±a¤£¦Pªº¹q²üªºÃþ³½ºë³J¥Õ¶§Â÷¤lú@úA(ploycationic protamione-like peptides)(¦p¹Ï¤G¶§Â÷)³o¨Çsynthetic protamine-like varient peptideÀHµÛ¹q²üªº¼W¥[·|¼W¥[°fÂà¨x¯Àªº§Ü¾®¦å§@¥Î(reversal of heparin anticoagulation)©M¬r©Ê(¦p¹Ï¤T¡B¹Ï¥|)¡A¬Û¤Ïªº¹q²ü¸û¤Öªº¬r©Ê¤p¦ý°fÂà¨x¯Àªº§Ü¾®¦å§@¥Îªº¯à¤O¤]¤ñ¸û¤p¡A³oµ¹§Ú­Ì¤@­Ó±Ò¥Ü¯à¤£¯à³]­p¤@±ø¥H¸û¤Ö¹q²üªº¶§Â÷¤lú@úA¥B¯à°÷»Pheparinµ²¦X?

¨x¯Àbiding protein³q±`§t¦³¦³«Ü¦hÆP©ÊÓi°ò»Ä,Cardinµ¥¤H(Cadin et al.,1989)´£¥X¨âºØgeneral typeªº ¡¨consensus sequence¡¨¤À§O¬°

X B B X B X

X B B X X B X

B¬°ÆP©Ê®ò°ò»Ä¡A¤£¹L·í®É¤ñ¸ûªºsequenceªº³J¥Õ½è¦³­­¡A¤§«áµo²{§ó¦h¯à»P¨x¯Àµ²¦XªºÓi°ò»Ä§Ç¦C(Michel et al.,1992¡AMargalit,H. et al.,1992)¡A¥H¤U´XÂI³]­p§Ú­Ì¦p¦ó³]­p¥X»P¨x¯Àµ²¦X¤§¶§Â÷¤lú@úAªººc«ä¡C

±q¤U¦C³J¥Õ½èªº§Ç¦C(sequences)¡A¶§Â÷¤l©ÊÓi°ò»Ä¦ü¥G¦³(I,I+3)(I,I+4)ªº¶¡¹j¦s¦b

ªí1-4-1

Protein

Sequence

Protein C inhibitor

1-15

HRHHPREMKKRRVEDL

Protein C inhibitor

263-276

EKTLRKWLKMFKKR

Antithrobin III

124-140

AKLNCRLYRKANKSSKL

ColV

349-357

GKPGPRGQRGP

94¦~Tyler-Cross,R.(Tyler-Cross,R. et.,1994)¥Hµ¥·Å¼ö¥d­p(isothermal titration calorimetry)¬ã¨santithrombin IIIªºheparin binding domain®Éµo²{¦bhigh affinity site¦³Ãþ¦ü(i,i+3©Mi,i+4)ªº¶¡¹j(¹Ï¤­¡B¹Ï¤»¡B¹Ï¤C)¡C

©ó¬O§Ú­Ì³]­p¤F¤@±ø»P¨x¯Àµ²¦Xªº¶§Â÷¤lú@úA

K34: skaqkaqakqakqaqkaqkaqaKqakqy-Nh2

³]­p²z¥Ñ¦p¤U

1.°Ñ¦Òªí1-4-1¥H(i,i+3©Mi,i+4)ªºÂ÷Ói»Ä(lysine)¶¡¹j¡C

°£¤FÂ÷Ói»Ä¶¡¹j¥H¥~¡AÂ÷Ói»Ä¾Fªñ«D±a¹qÓi°ò»Ä¤]·|¼vÅTú@úA»P¨x¯À(heparin)µ²¦X«á¤G¯Åµ²ºcªºÅܤÆ(Stone,A.K. et al.,1977)¡A©ó¬O¦A°Ñ¦Ò¹L¥hÓi°ò»Ä¦bú@úA(peptides)¦b¬ÛÃöÁ³±Û§Î¦¨¶É¦V (helix-forming propensities) (Lyu,1990; O¡¦Neill & DeGrado,1990)°µ¨ä¥L¦ì¸mªº¶ñ¸É¡A¥HAlanine¶ñ¸É¨ä¥L¦ì¸mªº­ì¦]¡A¬O¦]¬°Alanine¸g±`¥X²{¦ba Á³±Ûµ²ºc(a -helix)¡A¥BAlanine¥X²{¦³Ã­©wµuÃ쪺a Á³±Ûú@úAªº§@¥Î(Lyu et al., 1990;Chakrabartty,A.,1994)¡A³¡¥÷¥Hglutamine¨ú¥N¬O¨¾¤îalanine©Mlysine§Î¦¨amphipiphilicªºµ²ºc¡A¾É­P¨â­ÓK34§Î¦¨dimer¡C

2.¥HNH2¨ú¥NCOOH¬O¦]¬°marcohelix dipole·|¼W¥[helixity©M

í©w helix(Shoemaker,K.R. et al.,1987;Lockhart&Kim,1992,

1993)¡C

(Bryson: Science, Volume 270(5238).November 10, 1995.pp 935-941.)

3.¦bNºÝ¥Hµ·¦w»Ä(Serine)¶}ÀY¬O¬°¤F²£¥Ícapping boxªº§@¥Î¨Ï

Á³±Û´Ý°ò(helical residue)ªº²Ä¤@­Ó°¼Ãì»P²Ä¥|­ÓÁ³±Û´Ý°òªº

°©Ãì(backbone)§Î¦¨²BÁä¡A¬Û¹ïªº²Ä¥|­Ó´Ý°òªº°¼Ãì©M²Ä¤@­Ó´Ý

°òªº°©Ãì§Î¦¨²BÁä¡A¶i¦Óí©wa Á³±Ûµ²ºc¡C(Lyu,1993 et

al.,1993;Petukhov,M. et al.,1996; Seale,J.W. et al.,1994)¡C

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¦AÂǥѤ@³s¦êK34©Mprotamine»Plow molecular weight Heparin

ªº¦UºØ§@¥Î(¦p¤U¹Ï)¡A¯à¹ï³J¥Õ½è©Îú@úA»P¨x¯À¤§¶¡ªº§@¥Î¤O¦³§ó¶i¤@¨Bªº¤F¸Ñ¡C

(From: Hirsh: Circulation, Volume 89(3).Mar 1994.pp 1449-1468.)

Molecular weight distributions of low molecular weight heparins and heparin. LMWH indicates low molecular weight hepari

The molecular weight of heparin ranges from 3000 to 30 000, with a mean of 15 000 (approximately 50 monosaccharide chains)

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±N¬Á¼þ¹LÂoº|¤æ¡B¿i¤fÀˤƲ~¡B¶ì½¦ºÞ»PAspirator ²Õ¦X¨Ã¶}¤ô©â®ð¡A±N¬Á¼þÂ÷¤ßºÞ¤ºªºreagent K©M¾ð¯×²V©M²G­Ë¤J¹LÂoº|¤æ¤¤¡A¦Ó´Ý¦s¦bÂ÷¤ßºÞ¤ºªº¾ð¯×¥ÎTFA¦A²M¬~¡A¤@¨Ö­Ë¤J¹LÂoº|¤æ¤º¡C

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¹LÂo¦b¿i¤fÀˤƲ~¤ºªº²GÅé­Ë¤J¥t¤@§t¦³Ether ªºÂ÷¤ßºÞ¤º¡A¥i¨£ºÞ¾À©³³¡¦³¥Õ¦â¨H¾ý(§Yµõ±q¾ð¯×¤W¤Á¤Uªºú@úA)¡C

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¨ú¤Ö¶q¯Â¤Æ«áªºú@úA(< 1mg)§@½èÃлö¤ÀªR¡A´ú¨ä¤À¤l¶q»P²z½×­È¬O§_²Å¦X¡C

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