ADAMTS13(a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13),又称温韦伯氏因子裂合酶(von Willebrand factor-cleaving protease,VWFCP)是一种含锌的金属蛋白酶。ADAMTS13可以裂解一种称为温韦伯氏因子(vWf)的大型凝血因子。为一种主要由肝脏星状细胞(stellate cell)制造的蛋白酶,少量由血管内皮细胞、血小板、肾脏足细胞及肾小管上皮细胞分泌[6],在人体与动物实验中皆发现受试者接受部分肝切除手术后,ADAMTS13的活性会下降至正常值的30~40%,可见肝脏对ADAMTS13的制造具有重要的贡献。本酵素存在于血液之中,降解vWf多聚体,以降低它们的活性[7]。
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ADAMTS13基因存在于第九对染色体(9q34)上[7]。
自1982年时,人们就知道遗传性血栓性血小板减少性紫癜(TTP,一种微血管病性溶血性贫血)患者的血浆中,存在异常巨大的温韦伯氏因子多聚体(ULVWF)[7]。
1994年,发现在高剪力下时,有一种血浆金属酶会从vWF第1605位的酪氨酸及1606位的甲硫氨酸间切割。1996年,两个独立研究团队分别发现该酵素。自接下来的两年,同样的两个团队证明了vWF裂合酶与小血管的血小板血栓生成相关。此外他们还报导了在大部分非遗传性TTP患者身上,能发现对抗ADAMTS13的IgG抗体[7]。
ADAMTS家族目前共已知有19种蛋白质,ADAMTS13属于其中一员,与其他金属蛋白酶族同样有一个14个相异的结构域组成的结构,包括金属蛋白酶(metalloprotease)、解整合素(disintegrin)、TSP1(first thrombospondin type 1 repeat)和间隔域(spacer domain) ,但ADAMTS13并不具备穿膜蛋白结构 ,因此其不存在细胞膜上,而是随着血液循环在大小血管内作用。该家族的蛋白质拥有蛋白酶结构域,可以水解蛋白质,邻近则有解聚素结构域,且含有多个血小板反应蛋白结构域。ADAMTS13含有8个血小板反应蛋白结构域,且无输水穿膜段,所以该蛋白并非膜蛋白[7]。
ADAMTS13缺乏症最早发现于Upshaw Schulman Syndrome,为一种复发性遗传性血栓性血小板减少性紫癜。当时学界认为该病属于一种自身免疫疾病,因为该疾病使用血浆置换及IgG抑制剂。在ADAMTS13发现后,研究人员发现这些自身抗体会对抗该蛋白上的抗原表位[7][8][9]。ADAMTS13具有裂解温韦伯氏因子多聚体(UL-VWFM)并降低温韦伯氏因子活性的功能 ,能抑止血小板堆积于微血管形成血栓。[10]由血管内皮细胞分泌的ADAMTS13,可能负责大部分新生温韦伯氏因子多聚体的裂解,以达到即刻性抑止血栓形成的作用。当ADAMTS13受到自身抗体的攻击而导致活性下降(小于正常活性10%),即可能造成呈现巨分子状态的温韦伯氏因子(也就是温韦伯氏因子多聚体)沉积后黏附于血管内皮细胞表层,促使微小血管中血小板凝集,使血液中游离的血小板数量不足,同时血管中的纤维蛋白增加亦破坏红细胞结构,形成不正常型态的血细胞 (例如:裂细胞Schistocyte)与发生溶血现象,导致产生获得性血栓性血小板减少性紫斑症的临床症状。
研究中發現ADAMTS13低下除了與獲得性血栓性血小板減少性紫斑症的形成密切相關外,在其他栓塞性微血管病變(thrombotic microangiopathy,TMA)中ADAMTS13有不同程度的下降[11] ,在敗血症、惡性高血壓病患及自體免疫患者中也有發生相似的變化[12][13] ,因此合理的推論ADAMTS13活性下降雖然不一定成為直接造成上述疾病的成因,但極有可能在這些病症中擔任促成因子的角色。
[Turner N, Nolasco L, Tao Z, et al. Human endothelial cells synthesize and release ADAMTS-13. J Thromb Haemost. 2006;4:1396–1404.]
Furlan M, Lämmle B. Aetiology and pathogenesis of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome: the role of von Willebrand factor-cleaving protease. Best Pract Res Clin Haematol. 2001, 14 (2): 437–54. PMID 11686108. doi:10.1053/beha.2001.0142.
[Levy GG, Motto DG, Ginsburg D. ADAMTS13 turns 3. Blood. 2005, 106 (1): 11–7]
[Martin K, Borgel D, Lerolle N, et al. Decreased ADAMTS-13 (A disintegrin-like and metalloprotease with thrombospondin type 1 repeats) is associated with a poor prognosis in sepsis-induced organ failure. Crit Care Med. 2007;35(10):2375-2382.]
[Farkas P, Csuka D, Mikes B, et al. Complement activation, inflammation and relative ADAMTS13 deficiency in secondary thrombotic microangiopathies. Immunobiology. 2017;222(2):119-127.]
[Khanal N, Dahal S, Upadhyay S, Bhatt VR, Bierman PJ. Differentiating malignant hypertension-induced thrombotic microangiopathy from thrombotic thrombocytopenic purpura. Ther Adv Hematol. 2015;6(3):97-102..]
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