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Thromb Haemost
DOI: 10.1055/a-2569-6439
Stroke, Systemic or Venous Thromboembolism

Asn384Ser Mutation in Protein C is Associated with Multiple-Site Thrombosis in a Young Heterozygous Male

Junwei Yuan‡   *
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
2   College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Shijie Zhou  ‡   *
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Xi Wu‡   *
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Fang Li
3   State Key Laboratory of Microbial Metabolism & Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
,
Zhe Lai
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Qiulan Ding
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Wenman Wu
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Xuefeng Wang
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Jing Dai
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Xiaobo Hu
4   Shanghai Center for Clinical Laboratory, Shanghai, China
,
Yeling Lu
1   Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
› Author Affiliations Funding This study was supported by Shanghai Natural Science Foundation Program (22ZR1439500), and the General Program of National Natural Science Foundation of China (81870107) to YL; Young Talent Support Program of College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine (YX20230015) to XW; the General Program of National Natural Science Foundation of China (82070137) to XW; and the General Program of National Natural Science Foundation of China (81970127) to JD.
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Abstract

Background

Protein C (PC) is an important physiological anticoagulant factor in humans. Activated protein C (APC) is generated from the PC zymogen through proteolytic activation by thrombin. APC inhibits thrombin generation by inactivating activated factors V and VIII via limited proteolysis. In addition to its anticoagulant function, APC also exhibits potent cytoprotective and anti-inflammatory properties. We have identified a young male with multiple-site thrombosis, who carries a heterozygous mutation c.1151A > G,p.Asn384Ser(N384S) in PC. Although this mutation has been previously documented, limited functional research has been conducted to elucidate its pathogenesis.

Objective

To elucidate the functional alternations of the N384S mutant protein C and delineate the molecular mechanism underlying thrombosis in the patient carrying this mutation.

Methods

We expressed the recombinant PC-N384S in mammalian cells and characterized its properties in established coagulation and anti-inflammatory assay systems.

Results

The expression level of the PC-N384S was reduced to approximately 7% of that observed for PC-WT. The activation of PC-N384S by thrombin or thrombin–thrombomodulin (TM) complex was significantly impaired, although the addition of TM exhibited a slight enhancement in the activation process. In terms of cleaving a chromogenic substrate, the catalytic efficiency reduced to approximately 50% of that observed in the wild type. In addition, in comparison with APC-WT, APC-N384S demonstrated a pronounced decline in amidolytic activity following an extended incubation period at 37°C. APC-N384S exhibited slightly impaired anticoagulant activity in either FVa inhibition assay or plasma-based assay systems. Furthermore, anti-inflammatory activity of APC-N384S was dramatically impaired as determined by evaluating the barrier-protective effect.

Conclusion

The Asn384Ser mutation impairs both the anticoagulant and barrier-protective activities of protein C, thereby increasing the thrombosis risk in the heterozygous young male.

Keywords

protein C - mutation - thrombosis - anticoagulant

Authors' Contribution

J.Y. performed the research and wrote the manuscript; X.W. performed genetic analysis and coagulation assays of the subjects' plasma; F.L. performed structural analyses; S.Z. and Z.L. performed research; Q.D., W.W., and X.W. collected and provided clinical data; J.D. and X.H. supervised studies; and L.Y. designed experiments, analyzed data, supervised the project, and revised the manuscript. All authors approved the final version of this manuscript.


* These authors contributed equally to this work.




Publication History

Received: 17 December 2024

Accepted: 30 March 2025

Article published online:
18 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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