The inactivation of human platelet factor Va by activated protein C (APC) was analyzed by functional assessment of cofactor activity and Western blotting analysis to visualize the factor Va fragments accompanying proteolysis. Platelets were treated with thrombin to facilitate both their activation as well as the release and further activation of platelet factor Va, followed by APC addition. The rates of inactivation were donor-dependent such that 15-60% of the initial cofactor activity was lost within 5 min of APC addition with as much as 10-20% of the activity still remaining after 2 h of incubation. Western blot analysis using a monoclonal antibody that recognizes an epitope between amino acid residues 307 and 506 of the factor V molecule suggested that the factor Va activity resistant to APC inactivation was due to residual heavy chain. Furthermore, in contrast to studies with normal plasma-derived factor Va, two possible cleavage mechanisms could explain the platelet factor Va fragments observed. APC can cleave platelet factor Va initially at Arg(506), with subsequent cleavages occurring at Ar-306 and Arg(679). Alternatively, APC can cleave at Arg(306) initially, with further cleavage at Arg(679) then at Arg(506) or at Arg(506) followed by cleavage at Arg(679). Similar results were obtained if platelets were removed from the inactivation mixtures and phospholipid vesicles were used to supply the membrane surface required for inactivation, suggesting that the order of platelet factor Va peptide bond cleavage or the amount of cofactor activity remaining was not altered by either of these surfaces. Thus, APC is unable to effect the complete inactivation of platelet factor Va, even though it would appear that the same cleavages which render the plasma cofactor inactive are occurring in the platelet cofactor. Analogous protocols were used to study an individual heterozygous for the Arg(506), Gln(506) mutation (Factor V Leiden, Factor V-R506Q). With respect to the mutant platelet factor Va in the presence of APC, >70% of the initial cofactor activity remained after 1 min, with 30% activity still remaining after 2 h. As seen in studies of the APC catalyzed inactivation of plasma factor Va(R506Q), proteolysis of the mutant platelet factor Va confirms that even though cleavage at Arg(306) will occur in the absence of cleavage at Arg(506), the rate of inactivation is slower. Collectively these data suggest that when compared to normal plasma factor Va, differences in normal platelet factor Va which define: 1) whether the heavy chain is susceptible to cleavage at Arg(306) Or Arg(506) and 2) the extent to which it is cleaved initially at Arg(306), in contrast to cleavage of Arg(506), will define both the extent and rate of inactivation.
