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Plasminogen activator inhibitor-1 (PAI-1) plays an inhibitory role in the fibrinolytic enzyme system and is associated with thrombotic diseases. The gene for PAI-1 has an insertion/deletion polymorphism at the promoter region, the 4G/5G polymorphism, which is related to differences in transcription activity in vitro. Association of the 4G/5G polymorphism with plasma PAI-1 levels, however, has not been uniformly reported. We evaluated the relationship between the 4G/5G polymorphism and plasma PAI-1 antigen levels in 104 Japanese males not taking lipid-lowering drugs and without non-insulin-dependent (type 2) diabetes mellitus or coronary artery disease. The genotype frequency was 37.5%, 50.0%, and 12.5% for 4G/4G, 4G/5G, and 5G/5G genotypes, respectively, which differs from that reported for healthy Caucasian males (P0.01), with the 4G allele more frequently found in the Japanese population. No association was found between the 4G/5G polymorphism and plasma PAI-1 antigen levels. Multiple regression analysis revealed a significant (P0.01) contribution of triglyceride (TG) levels to variations in plasma PAI-1 antigen levels. The correlation between TG levels and plasma PAI-1 antigen levels was not 4G/5G genotype-specific. These findings suggest that PAI-1 4G/5G polymorphism is not associated with plasma PAI-1 antigen levels among healthy Japanese males and that TG levels correlate to plasma PAI-1 antigen levels in all PAI-1 4G/5G genotypes.

We report a new family with hereditary factor X deficiency. The propositus had a markedly prolonged prothrombin time, a mild prolongation of activated partial thromboplastin time and a clotting time activated by Russell's viper venom. Factor X activity in plasma was 3 u/dl (normal range 56-138 u/dl). Factor X antigen level was 61 u/dl. Molecular analysis revealed a homozygous mutation, Glu (GAG) to Gln (CAG) at residue 32 which normally undergoes gamma-carboxylation within the gamma-carboxyglutamic acid rich domain. The genotypes of family members completely correlated with their factor X activities. It is suggested that the Glu32 to Gln mutation is the molecular basis for the abnormal factor X in this family.

Resistance to activated protein C (APC), recently reported to be the most prevalent inherited cause of thrombosis among Caucasians, is associated with a single point mutation in the coagulation factor V gene. We investigated the prevalence of APC resistance and the factor V gene mutation (R506Q) in 34 consecutive Japanese patients with venous thrombosis or pulmonary thromboembolism and 63 control subjects. Three of the 33 patients examined (9%) had an APC ratio below the 5th percentile of control values (2.27), but all were above 2.0. The factor V mutation (R506Q) was not detected in the 29 patients studied, including the 3 patients whose APC ratios were below 2.27, or in 53 controls. In a tissue factor-based factor V assay to detect APC resistance recently described by Le et al. (Blood 1995;85:1704-1711), all patients studied were found to be normal including the three with a low APC ratio. We conclude that APC resistance and factor V gene mutation are less prevalent in Japan than in several European countries.