Development and application of a new ADAMTS13 assay for TTP diagnosis

A plasma glycoprotein, von Willebrand factor (VWF), is essential for normal platelet aggregation. In healthy individuals, the homo-multimeric forms (VWF multimers) are partially cleaved by a plasma metalloprotease, ADAMTS13. Congenital or acquired deficiency of ADAMTS13 activity leads to the accumulation of hyperactive large VWF multimers, inducing a life-threatening disease, thrombotic thrombocytopenic purpura (TTP). As measuring ADAMTS13 activity is important in TTP diagnosis, a number of assay methods have been developed in the past few years. However, the time and skill required for these methods prohibited the progress of clinical usage. Recently, we have developed a fluorescence resonance energy transfer (FRET) assay for ADAMTS13 activity. A synthetic 73-amino-acid peptide, FRETS-VWF73, which is now commercially available, is used as a substrate. Cleavage of this peptide between two modified residues relieves the fluorescence quenching in the intact form. Incubation of FRETS-VWF73 with normal plasma quantitatively increased fluorescence over time, while TTP-patient plasma had little or no effect. The measurement can be achieved within a one-hour period using a 96-well format in commercial plate readers with common filters. The FRET assay will be useful not only for TTP diagnosis but also characterization of thrombotic microangiopathies.