Hemostasis is a constant balancing act between pro- and anticoagulant factors, platelets, and the vasculature
that is required to prevent excessive bleeding or pathological clotting. The anticoagulant, Tissue Factor Pathway
Inhibitor (TFPI), is a vital factor in this balance and modulates a broad range of bleeding and clotting disorders
through inhibition of TF-FVIIa, FXa, and prothrombinase (FXa-FVa). The TFPI gene is evolutionarily conserved
and due to alternative splicing, different TFPI isoforms are predominant within distinct pools. While the specific
inhibitory function of each TFPI isoform has been characterized, little is known regarding differences in isoform-
specific contributions under prothrombotic disease conditions such as Factor V Leiden (FVL) and during
embryonic development. Further, the pre-mRNA splicing and processing mechanisms dictating expression of
each isoform are unknown. As a causal relationship exists between aberrant splicing of FV and TFPI isoform-
specific function in human bleeding disorders, these mechanisms, coordinated by precise cues directed at
maintaining the hemostatic balance, are highly relevant. Thus, the long-term objective of this proposal is to
differentiate the physiological, site-specific production of each TFPI isoform at a molecular level and define their
anticoagulant function in embryonic development and disease. TFPIα is the only isoform present in platelets and
the only isoform that inhibits prothrombinase during the initiation of blood coagulation. Additionally, global TFPI
deficiency results in prothrombotic perinatal lethality in FVL mice, and TFPIα prothrombinase inhibitory activity
is reduced in the presence of FVL. To this end, K99 phase studies probe the physiological role of TFPIα as a
regulator of FV/FVL, particularly in prothrombinase assembly on platelet surfaces during development (AIM 1)
and characterizes biological activity of new platelet-specific TFPIα splice variants identified in mice and humans
(AIM 2). The candidate will acquire technical expertise to define TFPIα anticoagulant function both in vivo using
two unique isoform- and site-specific TFPIα mutant mouse models and ex vivo using human and mouse platelets.
In AIM 3 (R00 phase), the candidate will take advantage of the evolutionary conservation of alternative TFPI
splice forms and splicing signals embedded in highly conserved sequences to determine cis-RNA element and
trans-acting splicing factor interactions regulating TFPI isoform diversity in mice and humans. Deciphering the
pre-mRNA processing mechanisms that regulate site-specific TFPI isoform expression will delineate how
alternative splicing contributes to the physiological and pathophysiological hemostatic balance during embryonic
development and in adulthood. As there are many patients with bleeding and clotting disorders of unknown
cause, the relation of aberrant splicing to these diseases represents a relatively new and unexplored area with
great potential for launching a successful independent career. This proposal also outlines an intensive training
plan of courses, seminars, and hands-on training for transitioning the candidate into a well-equipped independent
investigator with a unique combination of research skills and a highly promising basic research pipeline.