Coagulation protein function VII: diametric effects of acetaldehyde on factor VII and factor IX function

Aldehyde-Induced DNA and Protein Adducts as Biomarker Tools for Alcohol Use Disorder

Alcohol use disorder (AUD) screening frequently involves questionnaires complemented by laboratory work to monitor alcohol use and/or evaluate AUD-associated complications. Here we suggest that measuring aldehyde-induced DNA and protein adducts produced during alcohol metabolism may lead to earlier detection of AUD and AUD-associated complications compared with existing biomarkers. Use of aldehyde-induced adducts to monitor AUD may also be important when considering that approximately 540 million people bear a genetic variant of aldehyde dehydrogenase 2 (ALDH2) predisposing this population to aldehyde-induced toxicity with alcohol use. We posit that measuring aldehyde-induced adducts may provide a means to improve precision medicine approaches, taking into account lifestyle choices and genetics to evaluate AUD and AUD-associated complications.

Acetaldehyde adducts in alcoholic liver disease

Chronic alcohol abuse causes liver disease that progresses from simple steatosis through stages of steatohepatitis, fibrosis, cirrhosis, and eventually hepatic failure. In addition, chronic alcoholic liver disease (ALD), with or without cirrhosis, increases risk for hepatocellular carcinoma (HCC). Acetaldehyde, a major toxic metabolite, is one of the principal culprits mediating fibrogenic and mutagenic effects of alcohol in the liver. Mechanistically, acetaldehyde promotes adduct formation, leading to functional impairments of key proteins, including enzymes, as well as DNA damage, which promotes mutagenesis. Why certain individuals who heavily abuse alcohol, develop HCC (7.2-15%) versus cirrhosis (15-20%) is not known, but genetics and co-existing viral infection are considered pathogenic factors. Moreover, adverse effects of acetaldehyde on the cardiovascular system and hematologic systems leading to ischemia, heart failure, and coagulation disorders, can exacerbate hepatic injury and increase risk for liver failure. Herein, we review the role of acetaldehyde adducts in the pathogenesis of chronic ALD and HCC.

The effect of acetaldehyde on human plasma factor XIII function

The effect of acetaldehyde on the transglutaminase activity in pooled normal human plasma has been investigated. In this study, 0.05, 0.2, and 0.7 ml of pooled human plasma were preincubated for 30 min. at room temperature with buffer or acetaldehyde at final concentrations of 40.6, 22.4, and 11.2 mM before being utilized for Factor XIIIa assay with fibrinogen and thrombin which had been preheated at 40 degrees C to destroy endogenous Factor XIII/XIIIa activity. At all concentrations of acetaldehyde and all concentrations of plasma-containing Factor XIII which were employed, prolongation of both clotting time and stabilization time was observed. The 11.2 mM acetaldehyde is within the range of daily acetaldehyde production to be predicted in severe alcoholics as a consequence of imbibing alcohol. The stabilization times measured for Factor XIIIa activity appear to be the most sensitive to acetaldehyde compared to acetaldehyde effects on thrombin, Factor Xa, and fibrinogen studied earlier in this laboratory, as well as Factors II, VII, and X.

Clotted blood as sign of alcohol intoxication: a retrospective study

A total of 138 autopsies performed at the Institute of Legal Medicine of the University of Münster between 1994 and 2006 were subdivided into two groups: (1) 69 asphyxial deaths with a blood alcohol level (BAL) > 1 per thousand and (2) 69 asphyxial deaths with a BAL of 0.00 per thousand. The coagulation state in the central vessels was registered in all cases as fluid, compactly clotted or loosely clotted, and the post-mortem interval was recorded. Histology investigations were performed on the liver to analyze the incidence of hepatic fibrosis/cirrhosis. Fisher's exact test was performed to check for statistical significance. The blood was found to be clotted in 49.3% of the cases of group (1) and in 5.8% of group (2) (p < 0.01). The post-mortem interval did not have any influence on the coagulation state as observed in both groups. Liver fibrosis/cirrhosis was a rare finding detected in three cases in group 1 and in two cases in the control group 2 and, therefore, not relative to our observations. A distinctly positive BAL is often associated with heavy stages of blood coagulation as observed during autopsy. Distinctly positive alcohol concentrations have an influence on the fibrinolytic process and, hence, on the coagulation status.

The effect of glycosaminoglycans with acetaldehyde on the activation of prothrombin

Heparin17–19k, (25, 50, and 100 ng), heparin6k(50 and 100 ng), heparin3k(50, 100, and 200 µg), chondroitin sulfates B (dermatan sulfate) (0.25, 0.5, and 1.0 µg), C (1 and 10 µg), and A (1 and 10 µg) each prolong the activated partial thromboplastin time (APTT) when preincubated with prothrombin to a greater extent than when preincubated with Factor II-deficient plasma prior to their mixing and subsequent additions of APTT reagent and Ca2+. In all cases statistical significance (p ≤ 0.05) was observed except with the 2 lower levels of heparin3k. These results suggest that the glycosaminoglycans (GAGs) may exert a direct effect upon prothrombin (FII) in their anticoagulant activity. Pre mix tures of [(FII/25 ng H17–19k) + 447 mmol acetaldehyde (AcH)/L] as well as [(AcH/H) + FII] and [(FII/AcH) + H] each exert a synergistic anticoagulant effect upon APTT. At low AcH concentrations (44.7 mmol/L), neither a synergistic nor an additive effect is seen. H6kand H3k, on premixing with 447 mmol AcH/L, exhibit an additive effect on APTT prolongation but no synergism. Similarly, premixtures of CSB/447 mmol AcH/L/FII show a greater anticoagulant effect than do [(CSB/AcH) + FII] or [(FII/AcH) + CSB] premixtures. CSC–AcH and CSA–AcH patterns are analogous to those of CSB (DS). These data suggest the possibility that AcH, the primary product of ethanol metabolism, may serve as a crosslinking adduct with proteins, in this case, prothrombin, as well as GAGs. Thus ternary complexes between the zymogen form of coagulation factors, GAGs, and AcH are possible, further influencing coagulopathy.Key words: prothrombin, alcoholism, acetaldehyde, glycosaminoglycans, heparins, chondroitin sulfates.

The influence of acetaldehyde and glycosaminoglycans upon factor Xa- and factor X-deficient plasma

The comparative effects of glycosaminoglycans and acetaldehyde (AcH)--glycosaminoglycan (GAG) mixtures upon Factor Xa- (FXa) and Factor X-deficient plasma (FXDP) have been studied by activated partial thromboplastin time (APTT) studies. Heparin at 0.025, 0.030, 0.04, and 0.05 U statistically prolonged the APTT when pre-incubated with FXa at 37 degrees C for 3 min prior to addition to FXDP and subsequent addition of Ca2+. Upon addition of 0.25, 0.375, and 0.5 microg heparin-6000 (H6k) to FXa, significant increases in APTT were observed. Similarly, profound increases in APTT were observed when 0.5, 0.75, and 1.0 microg heparin-3000 (H3k) was added to FXa. The chondroitin sulfates (CSA, CSB, CSC) had far less impact upon APTT with the FXa-FXDP system. In examining the effects of AcH-GAG mixtures upon the clotting factor, it was observed that 44.3 and 443 mM AcH synergistically prolonged the APTT in a statistically significant manner regardless of the order of premixing the three components. Hence, AcH may play a role in prolonging APTT in alcoholics. It synergistically prolonged APTT in concert with GAGs and FXa at the AcH levels used in this study. The effect of the GAGs upon FXDP is far less than its effect upon FXa.

Short- and long-term effects of acetaldehyde on plasma

The effect of low concentrations of acetaldehyde on activated partial thromboplastin time (APTT) and prothrombin time (PT) of Accuclot coagulation plasmas was monitored over a prolonged time to mimic effects observed in alcoholism. A prolongation of the APTT from 31.9 +/- 0.7 s to 32.6 +/- 0.9 s (n = 8; P =.007) was observed after a 30-min preincubation time with 140 microM acetaldehyde. However, a minimum of 3.6 mM acetaldehyde was required to extend the APTT from 36.6 +/- 1.0 s to 41.2 +/- 0.8 s (P =.001) over an 18-h exposure time. Plasma acetaldehyde levels as low as 2.24 mM caused elevation of PTs from 12.5 +/- 0.5 s to 14.4 +/- 0.2 s (P =.005) after a 24-h preincubation time. These findings seem to indicate that short-term contact of acetaldehyde with plasma, probably yielding reversible interactions, may interfere with APTTs to a greater extent than long-term contact, which would presumably yield stable, irreversible interactions. In comparing the effects of 8.94, 17.9, 89.4, and 447 mM acetaldehyde on the PTs of Level I, II, and III plasma, the PTs were most increasingly prolonged in Level III plasma and least prolonged in Level I plasma at each acetaldehyde concentration, although the plasmas have comparable protein concentrations. These findings seem to indicate that coagulation factors are sensitive to inactivation by acetaldehyde.