Thomas Lee Ortel, MD, PhD

Professor of Medicine
Chief, Division of Hematology in the Department of Medicine
Professor of Pathology
Member of the Duke Cancer Institute
Campus mail 0563 Stead Bldg, Durham, NC 27710
Phone (919) 684-5350
Email address ortel001@mc.duke.edu

My research program investigates the molecular mechanisms whereby various congenital and acquired abnormalities result in ‘dysfunctional’ hemostasis (i.e., hemorrhage or thrombosis) to better understand the molecular mechanisms and interactions that are necessary for normal hemostasis. We are particularly interested in the mechanisms whereby antibodies and other inhibitors can interfere with normal hemostatic mechanisms. Several projects extensively overlap and focus on the assembly and function of procoagulant (e.g., factor X-ase and prothrombinase) and anticoagulant (e.g., activated protein C complex) phospholipid membrane-dependent complexes.

We utilize a variety of approaches in these studies. Monoclonal antibodies, single-chain variable domain fragments, polyclonal antibodies prepared from patients with factor VIII inhibitors, and site-specific mutagenesis have all been used to characterize structure-function relationships in coagulation factor VIII. Our laboratory has also extensively characterized anti-factor V antibodies, investigating autoantibodies as well as xenogenic antibodies developing after exposure to topical bovine thrombin preparations which contain trace amounts of contaminating bovine factor V. We have also characterized how antiphospholipid antibodies interfere with the activated protein C complex, a lipid-dependent natural anticoagulant complex that proteolytically inactivates factor Va and factor VIIIa.

Our current studies are focusing on two antibody-mediated thrombotic syndromes, heparin-induced thrombocytopenia and antiphospholipid antibody syndrome. First, we are initiating a large clinical trial investigating the incidence of clinically-significant heparin-induced thrombocytopenia in patients who develop anti-heparin/platelet factor 4 antibodies following cardiac bypass procedures. While these antibodies are commonly seen following cardiac bypass, the true incidence of thromboembolic complications related to these prothrombotic antibodies remains unknown. We are also collaborating with investigators in the Center for Human Genetics on a large, multi-center study exploring the genetics of familial antiphospholipid antibody syndrome. In addition, we have used a genomic strategy to investigate patients with antiphospholipid antibody syndrome and have identified a gene expression profile that appears to be unique to patients with this syndrome in contrast to patients with venous thromboembolism who do not have these autoantibodies.

We also participate in a variety of collaborative research efforts, both with individual investigators as well as participating in multi-center clinical research studies. For example, we are one of seventeen centers participating in the NIH-supported Transfusion Medicine/Hemostasis Network, and we are currently conducting a trial through this network to define the optimal dose of platelets for patients needing platelet transfusions for hypoproliferative thrombocytopenia. We are also part of a multi-center registry of patients with thrombotic thrombocytopenic purpura, and we are one of eight centers in the Hemostasis and Thrombosis Center pilot program sponsored by the Centers for Disease Control and Prevention. Participation in these registries and networks provides us with access to the patient populations that we study in the research laboratory.

In Their Words

Education and Training

  • Fellow in Hematology-Oncology, Medicineq, Duke University, 1988 - 1991
  • Medical Resident, Medicine, Duke University, 1985 - 1988
  • M.D., Indiana University at Indianapolis, 1985
  • Ph.D., Indiana University at Bloomington, 1983

Publications

McNeeley, PA, Dlott, JS, Furie, RA, Jack, RM, Ortel, TL, Triplett, DA, Victoria, EJ, and Linnik, MD. "β2-Glycoprotein I-dependent anticardiolipin antibodies preferentially bind the amino terminal domain of β2-glycoprotein I." Thrombosis and Haemostasis 86, no. 2 (2001): 590-595.

Scholars@Duke

Kelley, MJ, Jawien, W, Ortel, TL, and Korczak, JF. "Mutation of MYH9, encoding non-muscle myosin heavy chain A, in May-Hegglin anomaly." Nature Genetics 26, no. 1 (September 2000): 106-108.

PMID
10973260
Full Text

Ortel, TL, James, AH, Thames, EH, Moore, KD, and Greenberg, CS. "Assessment of primary hemostasis by PFA-100 analysis in a tertiary care center." Thromb Haemost 84, no. 1 (July 2000): 93-97.

PMID
10928477
Scholars@Duke

Sands, JJ, Nudo, SA, Ashford, RG, Moore, KD, and Ortel, TL. "Antibodies to topical bovine thrombin correlate with access thrombosis." Am J Kidney Dis 35, no. 5 (May 2000): 796-801.

PMID
10793011
Scholars@Duke

Sands, JJ, Nudo, S, and Ortel, TL. "Antibodies to prothrombin and factor V correlate-with PTFE graft thrombosis." Asaio Journal 46, no. 2 (January 1, 2000): 209-null.

Full Text

Macedo-Ribeiro, S, Bode, W, Huber, R, Quinn-Allen, MA, Kim, SW, Ortel, TL, Bourenkov, GP, Bartunik, HD, Stubbs, MT, Kane, WH, and Fuentes-Prior, P. "Crystal structures of the membrane-binding C2 domain of human coagulation factor V." Nature 402, no. 6760 (November 1999): 434-439.

PMID
10586886
Full Text

Hansen, KE, Moore, KD, Ortel, TL, and Allen, NB. "Antiphospholipid antibodies in patients with Wegener's granulomatosis and polyarteritis nodosa." Arthritis and Rheumatism 42, no. 10 (October 1999): 2250-2252.

PMID
10524702
Full Text

Kim, SW, Ortel, TL, Quinn-Allen, MA, Yoo, L, Worfolk, L, Zhai, X, Lentz, BR, and Kane, WH. "Partial glycosylation at asparagine-2181 of the second C-type domain of human factor V modulates assembly of the prothrombinase complex." Biochemistry 38, no. 35 (August 31, 1999): 11448-11454.

PMID
10471296
Full Text

Ortel, TL. "Clinical and laboratory manifestations of anti-factor V antibodies." J Lab Clin Med 133, no. 4 (April 1999): 326-334. (Review)

PMID
10218762
Scholars@Duke

Taylor, CT, Petros, WP, and Ortel, TL. "Two instruments to determine activated partial thromboplastin time: implications for heparin monitoring." Pharmacotherapy 19, no. 4 (April 1999): 383-387.

PMID
10212007
Scholars@Duke

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