51
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Tillman BF, Gruber A, McCarty OJT, Gailani D. Plasma contact factors as therapeutic targets. Blood Rev 2018; 32:433-448. [PMID: 30075986 PMCID: PMC6185818 DOI: 10.1016/j.blre.2018.04.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/27/2018] [Accepted: 04/06/2018] [Indexed: 12/20/2022]
Abstract
Direct oral anticoagulants (DOACs) are small molecule inhibitors of the coagulation proteases thrombin and factor Xa that demonstrate comparable efficacy to warfarin for several common indications, while causing less serious bleeding. However, because their targets are required for the normal host-response to bleeding (hemostasis), DOACs are associated with therapy-induced bleeding that limits their use in certain patient populations and clinical situations. The plasma contact factors (factor XII, factor XI, and prekallikrein) initiate blood coagulation in the activated partial thromboplastin time assay. While serving limited roles in hemostasis, pre-clinical and epidemiologic data indicate that these proteins contribute to pathologic coagulation. It is anticipated that drugs targeting the contact factors will reduce risk of thrombosis with minimal impact on hemostasis. Here, we discuss the biochemistry of contact activation, the contributions of contact factors in thrombosis, and novel antithrombotic agents targeting contact factors that are undergoing pre-clinical and early clinical testing.
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Affiliation(s)
- Benjamin F Tillman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andras Gruber
- Department of Biomedical Engineering, Oregon Health & Sciences University, Portland, OR, USA; Division of Hematology and Medical Oncology School of Medicine, Oregon Health & Sciences University, Portland, OR, USA; Aronora, Inc., Portland, OR, USA
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Sciences University, Portland, OR, USA; Division of Hematology and Medical Oncology School of Medicine, Oregon Health & Sciences University, Portland, OR, USA
| | - David Gailani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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52
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Abstract
Rare bleeding disorders (RBDs) comprise inherited deficiencies of factors I (fibrinogen), II (prothrombin), V, VII, X, XI, and XIII as well as combined factor V + VIII and vitamin K-dependent factors. They represent 3-5% of all congenital bleeding disorders and are usually transmitted as autosomal recessive traits. These disorders often manifest during childhood and have varied clinical presentations from mucocutaneous bleeding to life-threatening symptoms such as central nervous system and gastrointestinal bleeding. Bleeding manifestations generally vary within the same RBD and may also vary from 1 RBD to the other. Laboratory diagnosis is based on coagulation screening tests and specific factor assays, with molecular techniques providing diagnostic accuracy and enabling prenatal counseling. The approach to treatment of bleeding episodes and invasive procedures needs to be individualized and depends on the severity, frequency and procedure-related risk of bleeding. The first line of treatment of RBDs is replacement of the deficient factor, using specific plasma-derived or recombinant products and using fresh frozen plasma or cryoprecipitate when specific products are not available or in resource-limited countries. Prophylaxis may be considered in individuals with recurrent serious bleeding and especially after life-threatening bleeding episodes. Novel no-replacement strategies promoting hemostasis by through different mechanisms need to be studied in RBDs as alternative therapeutic options.
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Affiliation(s)
- Shilpa Jain
- Division of Pediatric Hematology-Oncology, Women and Children's Hospital of Buffalo and Hemophilia Center of Western New York, Buffalo, NY, 14209, United States.
| | - Suchitra S Acharya
- Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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53
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Franchini M, Marano G, Pupella S, Vaglio S, Masiello F, Veropalumbo E, Piccinini V, Pati I, Catalano L, Liumbruno GM. Rare congenital bleeding disorders. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:331. [PMID: 30306070 DOI: 10.21037/atm.2018.08.34] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The rare congenital bleeding disorders are a heterogeneous group of diseases which include deficiencies of fibrinogen, prothrombin and factors V, V + VIII, VII, X, XI and XIII. They are usually transmitted as autosomal recessive disorders, and the prevalence of the severe forms ranges from one case in 500,000 for factor VII up to one in 2,000,000 for factor XIII in the general population. Patients with rare congenital bleeding disorders may have a broad spectrum of clinical symptoms, ranging from mucocutaneous bleeding to life-threatening haemorrhages, such as those occurring in the central nervous system. The treatment of these disorders is based principally on the replacement of the deficient factor using, when available, specific plasma-derived or recombinant products. The aim of this narrative review is to summarise current knowledge about these rare bleeding conditions.
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Affiliation(s)
- Massimo Franchini
- Italian National Blood Centre, National Institute of Health, Rome, Italy.,Department of Haematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Simonetta Pupella
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Francesca Masiello
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Eva Veropalumbo
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Vanessa Piccinini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Ilaria Pati
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Liviana Catalano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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54
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Gidley GN, Holle LA, Burthem J, Bolton-Maggs PHB, Lin FC, Wolberg AS. Abnormal plasma clot formation and fibrinolysis reveal bleeding tendency in patients with partial factor XI deficiency. Blood Adv 2018; 2:1076-1088. [PMID: 29760205 PMCID: PMC5965046 DOI: 10.1182/bloodadvances.2017015123] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/06/2018] [Indexed: 11/20/2022] Open
Abstract
Individuals with factor XI (FXI) deficiency have a variable bleeding risk that cannot be predicted from plasma FXI antigen or activity. This limitation can result in under- or overtreatment of patients and risk of bleeding or thrombosis. Previously, plasma clot fibrinolysis assays showed sensitivity to bleeding tendency in a small cohort of patients with severe FXI deficiency. Here, we determined the ability of plasma clot formation, structure, and fibrinolysis assays to predict bleeding tendency in a larger, independent cohort of patients with severe and partial FXI deficiency. Patients were characterized as nonbleeders or bleeders based on bleeding after tonsillectomy and/or dental extraction before diagnosis of FXI deficiency. Blood was collected in the absence or presence of the contact pathway inhibitor corn trypsin inhibitor (CTI). Clotting was triggered in platelet-poor plasma with tissue factor, CaCl2, and phospholipids in the absence and presence of thrombomodulin or tissue plasminogen activator. Clot formation and fibrinolysis were assessed by turbidity and confocal microscopy. CTI-treated plasmas from bleeders showed significantly reduced clot formation and decreased resistance to fibrinolysis compared with plasmas from controls or nonbleeders. Differences were enhanced in the presence of CTI. A model that combines activated partial thromboplastin time with the rate of clot formation and area under the curve in fibrinolysis assays identifies most FXI-deficient bleeders. These results show assays with CTI-treated platelet-poor plasma reveal clotting and clot stability deficiencies that are highly associated with bleeding tendency. Turbidity-based fibrinolysis assays may have clinical utility for predicting bleeding risk in patients with severe or partial FXI deficiency.
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Affiliation(s)
- Gillian N Gidley
- Department of Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Lori A Holle
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John Burthem
- Department of Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Paula H B Bolton-Maggs
- Institute of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
- Serious Hazards of Transfusion Office, Manchester Blood Centre, Plymouth Grove, Manchester, United Kingdom; and
| | - Feng-Chang Lin
- Department of Biostatistics and
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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55
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Ogawa Y, Yanagisawa K, Uchiyama Y, Akashi N, Mieda T, Iizuka H, Inoue M, Shizuka R, Murakami M, Matsumoto N, Handa H. Successful hemostatic management of major surgery for cervical spondylotic myelopathy in a patient with severe factor XI deficiency. Int J Hematol 2018; 108:443-446. [PMID: 29713955 DOI: 10.1007/s12185-018-2462-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 11/30/2022]
Abstract
Factor XI deficiency (FXID) is a rare bleeding disorder caused by mutations in the F11 gene. Spontaneous bleeding in patients with factor XI deficiency is rare, but major bleeding may occur after surgery or trauma. The basic method for hemostatic treatment is replacement of the missing factor using FXI concentrate or fresh frozen plasma (FFP). We report the case of a 72-year-old male with severe FXID who underwent a laminoplasty under sufficient, but minimal, FFP transfusion. Through detailed monitoring of activated partial thromboplastin time (APTT) and FXI activity at the perioperative period, we succeeded in hemostatic management of major surgery without significant blood loss and fluid overload. From the course of this case, we found that measuring FXI activity is superior to measuring APTT. Furthermore, we identified a novel homozygous mutation in F11 [NM_000128.3:c.1041C > A:p.(Tyr347*)] by whole exome sequencing.
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Affiliation(s)
- Yoshiyuki Ogawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Kunio Yanagisawa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuri Uchiyama
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naoki Akashi
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Hospital, Maebashi, Japan
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Gunma University Hospital, Maebashi, Japan
| | - Madoka Inoue
- Clinical Laboratory Center, Gunma University Hospital, Maebashi, Japan
| | - Reiko Shizuka
- Clinical Laboratory Center, Gunma University Hospital, Maebashi, Japan
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
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56
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Kim JH, Kang MH, Seong M, Cho H, Shin YU. Anomalous coagulation factors in non-arteritic anterior ischemic optic neuropathy with central retinal vein occlusion: A case report. Medicine (Baltimore) 2018; 97:e0437. [PMID: 29642215 PMCID: PMC5908582 DOI: 10.1097/md.0000000000010437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Non-arteritic anterior ischemic optic neuropathy (NAION) is characterized by sudden, painless visual loss and optic disc edema. NAION occurs mainly in the presence of cardiovascular disease and hypercoagulability, mainly in patients over 50 years of age. We experienced a case of NAION associated with central retinal vein occlusion (CRVO) in a young man with no underlying disease. PATIENT CONCERNS A 46-year-old man was referred to our clinic following a sudden loss of vision in his right eye. The patient exhibited no underlying disease and reported no ongoing medication. Significant visual loss and visual disturbance of the right eye were observed. The pupil of the right eye was enlarged and an afferent pupillary defect was observed. On fundus examination, retinal hemorrhage was observed in the peripheral retina; macular edema was observed in optical coherence tomography analysis. However, optic disc edema was not evident. No abnormal findings were found in routine blood tests for hypercoagulability. After 3 days of steroid intravenous injection, macular edema disappeared and visual acuity was improved, but optic disc edema began to appear. One week later, optic disc edema was evident and visual acuity was significantly reduced; thus, the patient was diagnosed with NAION. In fluorescein angiography, peripheral retinal ischemia was observed, suggesting that CRVO was complicated. Blood tests, including analysis of coagulation factors, were performed again, showing that coagulation factors IX and XI were increased. DIAGNOSES Anomalous coagulation factors in non-arteritic anterior ischemic optic neuropathy with central retinal vein occlusion. INTERVENTIONS Systemic steroids were administered. OUTCOMES One month later, optic disc edema and retinal hemorrhage gradually diminished and eventually disappeared; however, visual acuity did not recover. CONCLUSION In young patients without underlying disease, cases of NAION require careful screening for coagulation disorders. Even if there is no abnormality in the test for routine coagulation status, it may be necessary to confirm a coagulation defect through an additional coagulation factor assay.
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57
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McCarthy ML, Ordway SM, Jones RM, Perkins JG. Successful perioperative management in a patient with factor XI deficiency. BMJ Case Rep 2018; 2018:bcr-2017-222434. [PMID: 29467123 DOI: 10.1136/bcr-2017-222434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Factor XI (FXI) deficiency is an autosomal disorder which manifests as bleeding of varying severity. While homozygotes typically experience more dramatic bleeding symptoms, heterozygotes may experience clinically significant bleeding following surgical procedures or trauma, and therefore the condition is not purely recessive. The clinical significance of FXI deficiency is complicated in that FXI levels do not correlate well with bleeding severity, and in fact the bleeding risk is variable even for an individual in response to different haemostatic challenges. We present the case of a 74-year-old man of Ashkenazi Jewish heritage with a family and personal history of bleeding during surgical procedures, who presented with excessive bleeding following total thyroidectomy. He was found to have a FXI level of 52% (low normal). Genetic testing revealed that he was heterozygous for the c.403G>T mutation. This case demonstrates successful work-up and perioperative management of a patient with FXI deficiency.
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Affiliation(s)
| | - Sarah M Ordway
- Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ryan M Jones
- Hematology-Oncology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jeremy G Perkins
- Hematology-Oncology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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58
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Ely LK, Lolicato M, David T, Lowe K, Kim YC, Samuel D, Bessette P, Garcia JL, Mikita T, Minor DL, Coughlin SR. Structural Basis for Activity and Specificity of an Anticoagulant Anti-FXIa Monoclonal Antibody and a Reversal Agent. Structure 2018; 26:187-198.e4. [PMID: 29336885 DOI: 10.1016/j.str.2017.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 11/18/2022]
Abstract
Coagulation factor XIa is a candidate target for anticoagulants that better separate antithrombotic efficacy from bleeding risk. We report a co-crystal structure of the FXIa protease domain with DEF, a human monoclonal antibody that blocks FXIa function and prevents thrombosis in animal models without detectable increased bleeding. The light chain of DEF occludes the FXIa S1 subsite and active site, while the heavy chain provides electrostatic interactions with the surface of FXIa. The structure accounts for the specificity of DEF for FXIa over its zymogen and related proteases, its active-site-dependent binding, and its ability to inhibit substrate cleavage. The inactive FXIa protease domain used to obtain the DEF-FXIa crystal structure reversed anticoagulant activity of DEF in plasma and in vivo and the activity of a small-molecule FXIa active-site inhibitor in vitro. DEF and this reversal agent for FXIa active-site inhibitors may help support clinical development of FXIa-targeting anticoagulants.
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Affiliation(s)
- Lauren K Ely
- Centers for Therapeutic Innovation, San Francisco, Pfizer Inc., 1700 Owens Street, San Francisco, CA 94158, USA
| | - Marco Lolicato
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Tovo David
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kate Lowe
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Yun Cheol Kim
- Centers for Therapeutic Innovation, San Francisco, Pfizer Inc., 1700 Owens Street, San Francisco, CA 94158, USA
| | - Dharmaraj Samuel
- Centers for Therapeutic Innovation, San Francisco, Pfizer Inc., 1700 Owens Street, San Francisco, CA 94158, USA
| | - Paul Bessette
- Centers for Therapeutic Innovation, San Francisco, Pfizer Inc., 1700 Owens Street, San Francisco, CA 94158, USA
| | - Jorge L Garcia
- PMI PreClinical, 1031 Bing Street, San Carlos, CA 94070, USA
| | - Thomas Mikita
- Centers for Therapeutic Innovation, San Francisco, Pfizer Inc., 1700 Owens Street, San Francisco, CA 94158, USA.
| | - Daniel L Minor
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA; Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA 94143, USA; Department of Cellular and Molecular Pharmacology, University of California, San Francisco, San Francisco, CA 94143, USA; Molecular Biophysics and Integrated Bio-imaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA.
| | - Shaun R Coughlin
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA 94143, USA.
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59
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van Montfoort M, Meijers J. Anticoagulation beyond direct thrombin and factor Xa inhibitors: indications for targeting the intrinsic pathway? Thromb Haemost 2017; 110:223-32. [DOI: 10.1160/th12-11-0803] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 05/07/2013] [Indexed: 11/05/2022]
Abstract
SummaryAntithrombotic drugs like vitamin K antagonists and heparin have been the gold standard for the treatment and prevention of thromboembolic disease for many years. Unfortunately, there are several disadvantages of these antithrombotic drugs: they are accompanied by serious bleeding problems, it is necessary to monitor the therapeutic window, and there are various interactions with food and other drugs. This has led to the development of new oral anticoagulants, specifically inhibiting either thrombin or factor Xa. In terms of effectiveness, these drugs are comparable to the currently available anticoagulants; however, they are still associated with issues such as bleeding, reversal of the drug and complicated laboratory monitoring. Vitamin K antagonists, heparin, direct thrombin and factor Xa inhibitors have in common that they target key proteins of the haemostatic system. In an attempt to overcome these difficulties we investigated whether the intrinsic coagulation factors (VIII, IX, XI, XII, prekallikrein and high-molecular-weight kininogen) are superior targets for anticoagulation. We analysed epidemiological data concerning thrombosis and bleeding in patients deficient in one of the intrinsic pathway proteins. Furthermore, we discuss several thrombotic models in intrinsic coagulation factor-deficient animals. The combined results suggest that intrinsic coagulation factors could be suitable targets for anticoagulant drugs.
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60
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Factor XI gene variants in factor XI-deficient patients of Southern Italy: identification of a novel mutation and genotype-phenotype relationship. Hum Genome Var 2017; 4:17043. [PMID: 29138690 PMCID: PMC5678205 DOI: 10.1038/hgv.2017.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/12/2022] Open
Abstract
Congenital Factor XI (FXI) deficiency shows a high variability in clinical phenotype. To date, many allele variants have been shown to cause this bleeding disorder. However, the genotype–phenotype relationship is difficult to establish. This report provides insights into this bleeding disorder. Sixteen unrelated Italian index cases with congenital FXI deficiency and their relatives were investigated. After the identification of the deficiency, we obtained DNA from each subject and analyzed the FXI gene using direct sequencing. We identified 5 and 11 individuals with severe and moderate deficiency of FXI activity, respectively. Most patients (8/16) carried mutations in the Apple 2 domain and 4 patients showed c.403G>T (p.Glu135*; type II mutation). Four novel compound heterozygosities were identified. Bleeding symptoms were present in two severely deficient subjects carrying the combinations c.901T>C (p.Phe301Leu)/c.1556G>A (p.Trp519*) and c.943G>A (p.Glu315)/c.1556G>A (p.Trp519*), respectively. Bleeding episodes were also observed in the presence of a moderate deficiency in two individuals heterozygous for c.449C>T (p.Thr150Met) and c.1253G>T (p.Gly418Val), respectively. One novel mutation, c.1682C>A (p.Ala561Asp), was identified as potentially deleterious in an asymptomatic individual. We confirm an unclear prediction of phenotype from mutational data. The FXI levels should be coupled with FXI analysis for a more comprehensive prediction of the bleeding phenotype in FXI deficiency.
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61
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Esteban J, de la Morena-Barrio ME, Salloum-Asfar S, Padilla J, Miñano A, Roldán V, Soria JM, Vidal F, Corral J, Vicente V. High incidence of FXI deficiency in a Spanish town caused by 11 different mutations and the first duplication of F11: Results from the Yecla study. Haemophilia 2017; 23:e488-e496. [PMID: 28960694 DOI: 10.1111/hae.13356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Factor XI (FXI) deficiency is a rare disorder with molecular heterogeneity in Caucasians but relatively frequent and molecularly homogeneous in certain populations. AIM To characterize FXI deficiency in a Spanish town of 60 000 inhabitants. METHODS A total of 324 764 APTT tests were screened during 20 years. FXI was evaluated by FXI:C and by Western blot. Genetic analysis of F11 was performed by sequencing, multiplex ligation-dependent probe amplification and genotyping. RESULTS Our study identified 46 unrelated cases and 170 relatives with FXI deficiency carrying 12 different genetic defects. p.Cys56Arg, described as founder mutation in the French-Basque population, was identified in 109 subjects from 24 unrelated families. This mutation was also identified in 2% of the general population. p.Cys416Tyr, c.1693G>A and p.Pro538Leu were identified in 7, 6 and 2 unrelated families, respectively. NGS analysis of the whole F11 gene revealed a common haplotype for each of the four recurrent mutations, suggesting a founder effect. The analysis of plasma FXI of four p.Pro538Leu homozygous carriers revealed that this variant was not activated by FXIIa. We identified four mutations previously described in other Caucasian subjects with FXI deficiency (p.Lys536Asn; p.Thr322Ile, p.Arg268Cys and c.325G>A) and four new gene defects: p.(Cys599Tyr) potentially causing a functional deficiency, p.(Ile426Thr), p.(Ile592Thr) and the first worldwide duplication of 1653 bp involving exons 8 and 9. Bleeding was rare and mild. CONCLUSIONS Our population-cohort study supplies new evidences that FXI deficiency in Caucasians is more common than previously thought and confirmed the wide underlying genetic heterogeneity, caused by both recurrent and sporadic mutations.
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Affiliation(s)
- J Esteban
- Servicio de Hematología, Hospital Virgen del Castillo de Yecla, Murcia, Spain
| | - M E de la Morena-Barrio
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
| | - S Salloum-Asfar
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
| | - J Padilla
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
| | - A Miñano
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
| | - V Roldán
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
| | - J M Soria
- IIB-Sant Pau, Unitat de Genòmica de Malalties Complexes, Barcelona, Spain
| | - F Vidal
- Coagulopaties congènites, Banc de Sang i Teixits, Barcelona, Spain.,Unitat de Diagnòstic i Teràpia Molecular, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares, Spain
| | - J Corral
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
| | - V Vicente
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, CIBERER, Murcia, Spain
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62
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Verghese L, Tingi E, Thachil J, Hay C, Byrd L. Management of parturients with Factor XI deficiency—10 year case series and review of literature. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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63
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Alsammak MS, Ashrani AA, Winters JL, Pruthi RK. Therapeutic plasma exchange for perioperative management of patients with congenital factor XI deficiency. J Clin Apher 2017; 32:429-436. [DOI: 10.1002/jca.21532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/17/2017] [Accepted: 02/13/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Mohamed S. Alsammak
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Aneel A. Ashrani
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Rajiv K. Pruthi
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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64
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Pike GN, Cumming AM, Thachil J, Hay CRM, Bolton-Maggs PHB, Burthem J. Evaluation of the use of rotational thromboelastometry in the assessment of FXI deficency. Haemophilia 2017; 23:449-457. [DOI: 10.1111/hae.13136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
- G. N. Pike
- Department of Haematology; Manchester Royal Infirmary; Central Manchester University Hospital NHS Trust; Manchester UK
- Institute of Cancer Sciences; The University of Manchester; Manchester UK
| | - A. M. Cumming
- Haematology Molecular Diagnostics Centre; Manchester Royal Infirmary; Central Manchester University Hospital NHS Trust; Manchester UK
| | - J. Thachil
- Department of Haematology; Manchester Royal Infirmary; Central Manchester University Hospital NHS Trust; Manchester UK
| | - C. R. M. Hay
- Department of Haematology; Manchester Royal Infirmary; Central Manchester University Hospital NHS Trust; Manchester UK
- Haematology Molecular Diagnostics Centre; Manchester Royal Infirmary; Central Manchester University Hospital NHS Trust; Manchester UK
| | - P. H. B. Bolton-Maggs
- The University of Manchester; Manchester UK
- SHOT Office; Manchester Blood Centre; Manchester UK
| | - J. Burthem
- Department of Haematology; Manchester Royal Infirmary; Central Manchester University Hospital NHS Trust; Manchester UK
- Institute of Cancer Sciences; The University of Manchester; Manchester UK
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65
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Yoshikawa S, Kumano I, Satoh Y, Yufune S. Anesthetic management using peripheral nerve block in patients with factor XI deficiency: a case report. JA Clin Rep 2016; 2:17. [PMID: 29497672 PMCID: PMC5818777 DOI: 10.1186/s40981-016-0047-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022] Open
Abstract
Factor XI deficiency is rare but may cause life-threatening bleeding during the perioperative period. The clinical manifestation of factor XI deficiency is characterized by bleeding tendency. This unpredictable bleeding tendency makes anesthetic management difficult. We report a case of a partial duodenectomy in a patient with factor XI deficiency. The patient was scheduled for duodenectomy because of a duodenal tumor. When checked for coagulation before surgery, the patient was found to have a remarkably prolonged activated partial thrombin time, and further investigation revealed factor XI deficiency. Fresh frozen plasma was transfused before surgery, and general anesthesia and peripheral nerve block were performed. In the present case of factor XI deficiency, supplementation with clotting factor and proper anesthetic management were important to prevent severe complications.
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Affiliation(s)
- Sachio Yoshikawa
- Department of Anesthesiology, Japan Self Defense Forces Hospital Yokosuka, 1766-1 Tauraminatocho, Yokosuka, Kanagawa 237-0071 Japan
| | - Isao Kumano
- Department of Surgery, Japan Self Defense Forces Hospital Yokosuka, 1766-1 Tauraminatocho, Yokosuka, Kanagawa 237-0071 Japan
| | - Yasushi Satoh
- Department of Pharmacology and Department of Anesthesiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513 Japan
| | - Shinya Yufune
- Department of Anesthesiology, Japan Self Defense Forces Hospital Yokosuka, 1766-1 Tauraminatocho, Yokosuka, Kanagawa 237-0071 Japan
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66
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Brenner B, Stemberg T, Laor A, Tavori S, Tatarsky I, Lanir N. Von Willebrand Factor Antigen and Factor XI Activity Levels As Predictors of Bleeding Tendency in Israeli Patients with Von Willebrand's Disease. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969500100402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous preliminary data and case reports have suggested an association of von Willebrand's disease (vWD) with factor XI deficiency and platelet abnormalities. We have analyzed the prevalence of factor XI deficiency and thrombocytopathy in a cohort of Israeli patients with vWD. Decreased factor XI levels (<67 U/dl) were documented in 35 of 63 (36%) vWD subjects; factor XI levels were <30 U/dl in five of 60 (8%). A significant decline in ADP-induced platelet aggregation (<30% of control) was found in 48% of vWD patients. Likewise, epinephrine-induced aggregation was reduced in 41%, and collagen-induced aggregation was decreased in 7% of vWD patients. Logistic regression analysis showed that while Ivy bleeding time, ristocetin cofactor, and ristocetin-induced platelet aggregation did not predict bleeding, both von Willebrand factor antigen and factor XI activity levels predict bleeding in patients with vWD. These findings suggest that mild factor XI deficiency and thrombocytopathy are common in Israeli subjects with vWD and that associated factor XI deficiency can result in clinical bleeding in these patients. Key Words: Von Willebrand' s disease—Factor XI deficiency—Thrombocytopathy.
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Affiliation(s)
- Benjamin Brenner
- Institute of Hematology, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Arieh Laor
- Department of Internal Medicine B, Carmel Hospital
| | - Shulamit Tavori
- Institute of Hematology, Rambam Medical Center, Institute of Hematology, Rambam Medical Center
| | - Ilana Tatarsky
- Institute of Hematology, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Naomi Lanir
- Institute of Hematology, Rambam Medical Center
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67
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Abstract
INTRODUCTION Inherited fXI deficiency has been an enigma since its discovery in 1953. The variable and relatively mild symptoms in patients with even the most severe form of the disorder seem out of step with the marked abnormalities in standard clotting assays. Indeed, the contribution of factor XI to hemostasis in an individual is not adequately assessed by techniques available in modern clinical laboratories. AREAS COVERED We discuss clinical studies, genetic/genomic analyses, and advances in laboratory medicine that are reshaping our views on the role of factor XI in pathologic coagulation. We review how the disorder associated with factor XI deficiency has contributed to changes in blood coagulation models, and discuss the complex genetics of the deficiency state and its relationship to bleeding. Finally, we cover new laboratory approaches that may distinguish deficient patients who are prone to bleeding from those without such predisposition. Expert commentary: Advances in understanding the biology of factor XI have led to modifications in treatment of factor XI-deficient patients. Factor replacement is used more judiciously, and alternative approaches are gaining favor. In the future, better laboratory tests may allow us to target therapy to those patients who would benefit most.
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Affiliation(s)
- Allison P Wheeler
- a Department of Pathology, Microbiology and Immunology , Vanderbilt University , Nashville , TN , USA.,b The Department of Pediatrics , Vanderbilt University , Nashville , TN , USA
| | - David Gailani
- a Department of Pathology, Microbiology and Immunology , Vanderbilt University , Nashville , TN , USA.,c The Department of Medicine , Vanderbilt University , Nashville , TN , USA
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68
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Clinical manifestations and mutation spectrum of 57 subjects with congenital factor XI deficiency in China. Blood Cells Mol Dis 2016; 58:29-34. [PMID: 27067486 DOI: 10.1016/j.bcmd.2016.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/23/2022]
Abstract
Congenital factor XI (FXI) deficiency is a rare bleeding disorder with unpredictable bleeding tendency. Few studies in a large cohort have been reported regarding associations between FXI activity (FXI:C) or genotypes and bleeding symptoms currently. This study characterized clinical manifestations and mutation spectrum of 57 subjects with FXI deficiency in China. Clinical data were collected and mutations were identified by direct sequencing and determined by mRNA analysis. The result revealed bleeding symptoms were only found in 12 patients (12/57, 21.1%) with severely reduced FXI:C, and prolonged bleeding post injury/surgery as well as easy bruising were the commonest bleeding manifestations presented in respective 5 cases (5/12, 41.7%). A total number of 37 mutations were identified including 19 missense mutations, 9 nonsense mutations, 6 splice site mutations and 3 small deletions. Among them, 4 missense mutations, 5 splice mutations, 3 small deletions and a nonsense mutation were newly detected. W228*, G400V, Q263* and c.1136-4delGTTG with a total frequency of 48.3% were the most four common mutations in Chinese patients. RT-PCR analysis was carried out and confirmed that both c.596-8T>A and c.1136-4delGTTG were pathogenic due to frameshift resulting in respective truncated proteins. Our findings suggested clinical manifestations had little to do with FXI:C or genotypes, which required further study. This study, the largest investigation of FXI deficiency in China revealed that the F11 mutation spectrum of Chinese population was distinct from those of other populations earlier established.
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69
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Preoperative management of factor XI deficiency with therapeutic plasma exchange: A case report and literature review. J Clin Apher 2015; 31:579-583. [DOI: 10.1002/jca.21442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/24/2015] [Indexed: 11/07/2022]
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70
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Wiewel-Verschueren S, Arendz IJ, M. Knol H, Meijer K. Gynaecological and obstetrical bleeding in women with factor XI deficiency - a systematic review. Haemophilia 2015; 22:188-195. [DOI: 10.1111/hae.12856] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 12/15/2022]
Affiliation(s)
- S. Wiewel-Verschueren
- Division of Haemostasis and Thrombosis; Department of Haematology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
- Department of Obstetrics and Gynaecology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
| | - I. J. Arendz
- Department of Obstetrics and Gynaecology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
| | - H. M. Knol
- Department of Obstetrics and Gynaecology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
- Isala Clinics Department of Obstetrics and Gynaecology; Zwolle The Netherlands
| | - K. Meijer
- Division of Haemostasis and Thrombosis; Department of Haematology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
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71
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Kenne E, Nickel KF, Long AT, Fuchs TA, Stavrou EX, Stahl FR, Renné T. Factor XII: a novel target for safe prevention of thrombosis and inflammation. J Intern Med 2015; 278:571-85. [PMID: 26373901 DOI: 10.1111/joim.12430] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Plasma protein factor XII (FXII) activates the procoagulant and proinflammatory contact system that drives both the kallikrein-kinin system and the intrinsic pathway of coagulation. When zymogen FXII comes into contact with negatively charged surfaces, it auto-activates to the serine proteaseactivated FXII (FXIIa). Recently, various in vivo activators of FXII have been identified including heparin, misfolded protein aggregates, polyphosphate and nucleic acids. Murine models have established a central role of FXII in arterial and venous thrombosis. Despite its central function in thrombosis, deficiency in FXII does not impair haemostasis in animals and humans. In a preclinical cardiopulmonary bypass system in large animals, the FXIIa-blocking antibody 3F7 prevented thrombosis; however, in contrast to traditional anticoagulants, bleeding was not increased. In addition to its function in thrombosis, FXIIa initiates formation of the inflammatory mediator bradykinin. This mediator increases vascular leak, causes vasodilation, and induces chemotaxis with implications for septic, anaphylactic and allergic disease states. Therefore, targeting FXIIa appears to be a promising strategy for thromboprotection without associated bleeding risks but with anti-inflammatory properties.
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Affiliation(s)
- E Kenne
- Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Center of Molecular Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - K F Nickel
- Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Center of Molecular Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A T Long
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University and Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - T A Fuchs
- Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Center of Molecular Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E X Stavrou
- Department of Medicine, Hematology and Oncology Division, Case Western Reserve University and Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - F R Stahl
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Renné
- Division of Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Center of Molecular Medicine, Karolinska Institutet and University Hospital, Stockholm, Sweden.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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72
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Pike GN, Cumming AM, Hay CRM, Sempasa B, Sutherland M, Thachil J, Burthem J, Bolton‐Maggs PHB. In vitro
comparison of the effect of two factor XI (FXI) concentrates on thrombin generation in major
FXI
deficiency. Haemophilia 2015; 22:403-10. [DOI: 10.1111/hae.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G. N. Pike
- Department of Haematology Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
- Institute of Cancer Sciences The University of ManchesterManchester UK
| | - A. M. Cumming
- Haematology Molecular Diagnostics Centre Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
| | - C. R. M. Hay
- Department of Haematology Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
- The University of Manchester Manchester UK
| | - B. Sempasa
- Haematology Molecular Diagnostics Centre Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
| | - M. Sutherland
- Haematology Molecular Diagnostics Centre Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
| | - J. Thachil
- Department of Haematology Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
| | - J. Burthem
- Department of Haematology Manchester Royal Infirmary Central Manchester University Hospital NHS TrustManchester UK
- Institute of Cancer Sciences The University of ManchesterManchester UK
| | - P. H. B. Bolton‐Maggs
- The University of Manchester Manchester UK
- SHOT office Manchester Blood Centre Plymouth Grove Manchester UK
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73
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Swanepoel AC, Nielsen VG, Pretorius E. Viscoelasticity and Ultrastructure in Coagulation and Inflammation: Two Diverse Techniques, One Conclusion. Inflammation 2015; 38:1707-26. [PMID: 25772112 DOI: 10.1007/s10753-015-0148-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The process of blood clotting has been studied for centuries. A synopsis of current knowledge pertaining to haemostasis and the blood components, including platelets and fibrin networks which are closely involved in coagulation, are discussed. Special emphasis is placed on tissue factor (TF), calcium and thrombin since these components have been implicated in both the coagulation process and inflammation. Analysis of platelets and fibrin morphology indicate that calcium, tissue factor and thrombin at concentrations used during viscoelastic analysis (with thromboelastography or TEG) bring about alterations in platelet and fibrin network ultrastructure, which is similar to that seen in inflammation. Scanning electron microscopy indicated that, when investigating platelet structure in disease, addition of TF, calcium or thrombin will mask disease-induced alterations associated with platelet activation. Therefore, washed platelets without any additives is preferred for morphological analysis. Furthermore, morphological and viscoelastic analysis confirmed that thrombin activation is the preferred method of fibrin activation when investigating fibrin network ultrastructure.
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Affiliation(s)
- Albe C Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, 0007, South Africa,
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74
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Zantek ND, Hsu P, Meijer P, Smock KJ, Plumhoff EA, Refaai MA, Van Cott EM. Quality of factor XI activity testing in North American Specialized Coagulation Laboratories. Int J Lab Hematol 2015; 37 Suppl 1:99-107. [DOI: 10.1111/ijlh.12359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- N. D. Zantek
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN USA
| | - P. Hsu
- Department of Pathology/Laboratory Medicine; Hofstra North Shore-Long Island Jewish School of Medicine; Lake Success NY USA
| | - P. Meijer
- ECAT Foundation; Voorschoten The Netherlands
| | - K. J. Smock
- Department of Pathology; ARUP Laboratories; University of Utah; Salt Lake City UT USA
| | - E. A. Plumhoff
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | - M. A. Refaai
- Department of Pathology and Laboratory Medicine; University of Rochester School of Medicine and Dentistry; Rochester NY USA
| | - E. M. Van Cott
- Department of Pathology; Massachusetts General Hospital; Boston MA USA
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75
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Abstract
The contact system, also named as plasma kallikrein-kinin system, consists of three serine proteinases: coagulation factors XII (FXII) and XI (FXI), and plasma prekallikrein (PK), and the nonenzymatic cofactor high molecular weight kininogen (HK). This system has been investigated actively for more than 50 years. The components of this system and their interactions have been elucidated from in vitro experiments, which indicates that this system is prothrombotic by activating intrinsic pathway, and proinflammatory by producing bioactive peptide bradykinin. Although the activation of the contact system have been implicated in various types of human disease, in only a few instances is its role clearly defined. In the last 10 years, our understanding of the contact system, particularly its biology and (patho)physiology has greatly increased through investigations using gene-modified animal models. In this review we will describe a revitalized view of the contact system as a critical (patho)physiologic mediator of coagulation and inflammation.
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Affiliation(s)
- Yi Wu
- The Sol Sherry Thrombosis Research Center, Temple University School of Medicine, 3420 N. Broad Street, Philadelphia, PA 19140 USA
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76
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Sample conditions determine the ability of thrombin generation parameters to identify bleeding phenotype in FXI deficiency. Blood 2015; 126:397-405. [PMID: 25911238 DOI: 10.1182/blood-2014-12-616565] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/22/2015] [Indexed: 11/20/2022] Open
Abstract
Individuals with Factor XI (FXI) deficiency have a variable bleeding tendency that does not correlate with FXI:C levels or genotype. Comparing a range of sample conditions, we tested whether the thrombin generation assay (TGA) could discriminate between control subjects (n = 50) and FXI-deficient individuals (n = 97), and between those with bleeding tendency (n = 50) and without (n = 24). The comparison used platelet-rich plasma (PRP) and platelet-poor plasma (PPP), either with or without corn trypsin inhibitor (CTI) to prevent contact activation, over a range of tissue factor (TF) concentrations. When contact activation was inhibited and platelets were absent, FXI:C levels did not correlate with thrombin generation parameters, and control and FXI-deficient individuals were not distinguished. In all other sample types, the best discrimination was obtained using TF 0.5 pM and assay measures: endogenous thrombin potential (ETP) and peak height. We showed that although a number of conditions could distinguish differences between the groups tested, TGA measured in PRP with CTI best differentiated between bleeders and nonbleeders. These measures provided high sensitivity and specificity (peak height receiver operating characteristic [ROC] area under the curve [AUC] = 0.9362; P < .0001) (ETP ROC AUC = 0.9362; P < .0001). We conclude that by using sample conditions directed to test specific pathways of FXI activation, the TGA can identify bleeding phenotype in FXI deficiency.
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77
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Batty P, Honke A, Bowles L, Hart DP, Pasi KJ, Uprichard J, Austin SK. Ongoing risk of thrombosis with factor XI concentrate: 5 years experience in two centres. Haemophilia 2015; 21:490-5. [DOI: 10.1111/hae.12682] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Batty
- St George's University Hospitals NHS Foundation Trust; London UK
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - A. Honke
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - L. Bowles
- The Royal London Hospital; Barts Health NHS Trust; London UK
| | - D. P. Hart
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - K. J. Pasi
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - J. Uprichard
- St George's University Hospitals NHS Foundation Trust; London UK
| | - S. K. Austin
- St George's University Hospitals NHS Foundation Trust; London UK
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78
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Bauduer F, de Raucourt E, Boyer-Neumann C, Trossaert M, Beurrier P, Faradji A, Peynet J, Borg JY, Chamouni P, Chatelanaz C, Henriet C, Bridey F, Goudemand J. Factor XI replacement for inherited factor XI deficiency in routine clinical practice: results of the HEMOLEVEN prospective 3-year postmarketing study. Haemophilia 2015; 21:481-9. [PMID: 25817556 PMCID: PMC4657494 DOI: 10.1111/hae.12655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/28/2022]
Abstract
Factor XI (FXI)-deficient patients may develop excessive bleeding after trauma or surgery. Replacement therapy should be considered in high-risk situations, especially when FXI levels are below 20 IU dL(-1) . HEMOLEVEN is a human plasma-derived factor XI concentrate available in France since 1992, but there are few data regarding its use by physicians. This prospective study assessed the use, efficacy and safety of HEMOLEVEN in common clinical practice. HEMOLEVEN was evaluated in FXI-deficient patients in 13 French centres in a 3-year postmarketing study. Forty-four patients (30 females, 14 males) received 67 treatments. The median age was 37 years (8 months-91 years). Basal FXI levels were <1 to 51 IU dL(-1) (median: 5.5); 29 patients were severely FXI-deficient (<20 IU dL(-1) ). FXI was administered prophylactically before 43 surgical procedures, 10 invasive procedures, 8 vaginal deliveries, or as curative treatment for six bleeds. The efficacy was assessed as excellent/good in 63, moderate in two and undetermined in two treatments. Seven patients experienced seven adverse effects, including two rated as serious: one sudden massive pulmonary embolism with fatal outcome and one case of inhibitor to FXI. HEMOLEVEN is effective for bleeding prevention in FXI deficiency. However, considering the benefit/risk ratio observed in relation to dosage in this study; firstly, it should be used sparingly due to its potential prothrombotic effect; secondly, new prescription procedures should be defined to adapt the dosage, especially in patients with intrinsic and/or acquired risk factors for thrombosis.
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Affiliation(s)
- F Bauduer
- Clinical Haematology, Centre Hospitalier de la Côte Basque, Bayonne and Laboratory MRGM, University of Bordeaux, Bordeaux, France
| | - E de Raucourt
- Haemophilia Treatment Center, CH Le Chesnay, Le Chesnay, France
| | - C Boyer-Neumann
- Haematology Department, CHU Antoine Beclère, Clamart, France
| | - M Trossaert
- Haematology Department, CHU Nantes, Nantes, France
| | - P Beurrier
- Haemophilia Treatment Center, CHU Angers, Angers, France
| | - A Faradji
- Haemophilia Treatment Center, Haematology Department, Hautepierre Hospital, Strasbourg, France
| | - J Peynet
- Haemophilia Treatment Center, CH Le Chesnay, Le Chesnay, France
| | - J-Y Borg
- Haemostasis Unit-CRTH, CHRU Hôpital Charles Nicolle, Rouen, France
| | - P Chamouni
- Haemostasis Unit-CRTH, CHRU Hôpital Charles Nicolle, Rouen, France
| | - C Chatelanaz
- Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - C Henriet
- Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - F Bridey
- Laboratoire français du Fractionnement et des Biotechnologies (LFB), Les Ulis, France
| | - J Goudemand
- Hematology and Transfusion, Faculté de Médecine, Lille University Hospital, Lille 2 University, Lille, France
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79
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Lee SE, Choi YJ, Chi SI, Kim HJ, Seo KS. Factor XI deficiency and orthognathic surgery: a case report on anesthesia management. J Dent Anesth Pain Med 2015; 15:25-29. [PMID: 28879255 PMCID: PMC5564066 DOI: 10.17245/jdapm.2015.15.1.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/15/2022] Open
Abstract
Factor XI deficiency (Hemophilia C) is a very rare autosomal recessive bleeding disorder. Patients with factor XI deficiency do not typically show any spontaneous bleeding or specific symptoms. Sometimes those who have this disorder are identified during special situations such as trauma or surgery. Orthognathic surgery is particularly associated with a high bleeding risk. Therefore, great care must be taken when treating patients with bleeding disorders such as factor XI deficiency. There are a few reports that address the management of patients with bleeding disorders during orthognathic surgery. The current report describes a patient with factor XI deficiency who underwent Le Fort I osteotomy together with bilateral sagittal split osteotomy. The patient's condition was assessed using both rotation thromboelastometry (ROTEM™) and noninvasive measurements of total hemoglobin (SpHb) using Masimo Radical 7 (Masimo Co. CA, USA).
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Affiliation(s)
- Soo Eon Lee
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Yoon Ji Choi
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Seong-In Chi
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Hyun-Jeong Kim
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Korea
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80
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Fjellström O, Akkaya S, Beisel HG, Eriksson PO, Erixon K, Gustafsson D, Jurva U, Kang D, Karis D, Knecht W, Nerme V, Nilsson I, Olsson T, Redzic A, Roth R, Sandmark J, Tigerström A, Öster L. Creating novel activated factor XI inhibitors through fragment based lead generation and structure aided drug design. PLoS One 2015; 10:e0113705. [PMID: 25629509 PMCID: PMC4309560 DOI: 10.1371/journal.pone.0113705] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/27/2014] [Indexed: 11/19/2022] Open
Abstract
Activated factor XI (FXIa) inhibitors are anticipated to combine anticoagulant and profibrinolytic effects with a low bleeding risk. This motivated a structure aided fragment based lead generation campaign to create novel FXIa inhibitor leads. A virtual screen, based on docking experiments, was performed to generate a FXIa targeted fragment library for an NMR screen that resulted in the identification of fragments binding in the FXIa S1 binding pocket. The neutral 6-chloro-3,4-dihydro-1H-quinolin-2-one and the weakly basic quinolin-2-amine structures are novel FXIa P1 fragments. The expansion of these fragments towards the FXIa prime side binding sites was aided by solving the X-ray structures of reported FXIa inhibitors that we found to bind in the S1-S1'-S2' FXIa binding pockets. Combining the X-ray structure information from the identified S1 binding 6-chloro-3,4-dihydro-1H-quinolin-2-one fragment and the S1-S1'-S2' binding reference compounds enabled structure guided linking and expansion work to achieve one of the most potent and selective FXIa inhibitors reported to date, compound 13, with a FXIa IC50 of 1.0 nM. The hydrophilicity and large polar surface area of the potent S1-S1'-S2' binding FXIa inhibitors compromised permeability. Initial work to expand the 6-chloro-3,4-dihydro-1H-quinolin-2-one fragment towards the prime side to yield molecules with less hydrophilicity shows promise to afford potent, selective and orally bioavailable compounds.
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Affiliation(s)
- Ola Fjellström
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
- * E-mail:
| | - Sibel Akkaya
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Hans-Georg Beisel
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | | | - Karl Erixon
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - David Gustafsson
- Bioscience, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Ulrik Jurva
- Drug Metabolism and Pharmacokinetics, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Daiwu Kang
- Bioscience, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - David Karis
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Wolfgang Knecht
- Bioscience, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Viveca Nerme
- Bioscience, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Ingemar Nilsson
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Thomas Olsson
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Alma Redzic
- Medicinal Chemistry, Cardiovascular & Metabolic Diseases Innovative Medicines, AstraZeneca R&D, Mölndal, Sweden
| | - Robert Roth
- Discovery Sciences, AstraZeneca R&D, Mölndal, Sweden
| | | | | | - Linda Öster
- Discovery Sciences, AstraZeneca R&D, Mölndal, Sweden
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81
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Santoro C, Di Mauro R, Baldacci E, De Angelis F, Abbruzzese R, Barone F, Bochicchio RA, Ferrara G, Guarini A, Foà R, Mazzucconi MG. Bleeding phenotype and correlation with factor XI (FXI) activity in congenital FXI deficiency: results of a retrospective study from a single centre. Haemophilia 2015; 21:496-501. [DOI: 10.1111/hae.12628] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 01/08/2023]
Affiliation(s)
- C. Santoro
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. Di Mauro
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - E. Baldacci
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - F. De Angelis
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. Abbruzzese
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - F. Barone
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. A. Bochicchio
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - G. Ferrara
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - A. Guarini
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - R. Foà
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
| | - M. G. Mazzucconi
- Division of Hematology; Department of Cellular Biotechnologies and Hematology; “Sapienza” University of Rome; Rome Italy
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82
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Molecular basis and bleeding manifestations of factor XI deficiency in 11 Turkish families. Blood Coagul Fibrinolysis 2015; 26:63-8. [DOI: 10.1097/mbc.0000000000000185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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83
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Hangeland JJ, Friends TJ, Rossi KA, Smallheer JM, Wang C, Sun Z, Corte JR, Fang T, Wong PC, Rendina AR, Barbera FA, Bozarth JM, Luettgen JM, Watson CA, Zhang G, Wei A, Ramamurthy V, Morin PE, Bisacchi GS, Subramaniam S, Arunachalam P, Mathur A, Seiffert DA, Wexler RR, Quan ML. Phenylimidazoles as Potent and Selective Inhibitors of Coagulation Factor XIa with in Vivo Antithrombotic Activity. J Med Chem 2014; 57:9915-32. [DOI: 10.1021/jm5010607] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jon J. Hangeland
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Todd J. Friends
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Karen A. Rossi
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Joanne M. Smallheer
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Cailan Wang
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Zhong Sun
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - James R. Corte
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Tianan Fang
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Pancras C. Wong
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Alan R. Rendina
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Frank A. Barbera
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Jeffrey M. Bozarth
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Joseph M. Luettgen
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Carol A. Watson
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Ge Zhang
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Anzhi Wei
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Vidhyashankar Ramamurthy
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Paul E. Morin
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Gregory S. Bisacchi
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Srinath Subramaniam
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Piramanayagam Arunachalam
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Arvind Mathur
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Dietmar A. Seiffert
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Ruth R. Wexler
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
| | - Mimi L. Quan
- Research and Development, Bristol-Myers Squibb,
P.O. Box 5400, Princeton, New Jersey 08543, United States
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84
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Mumford AD, Ackroyd S, Alikhan R, Bowles L, Chowdary P, Grainger J, Mainwaring J, Mathias M, O'Connell N. Guideline for the diagnosis and management of the rare coagulation disorders: a United Kingdom Haemophilia Centre Doctors' Organization guideline on behalf of the British Committee for Standards in Haematology. Br J Haematol 2014; 167:304-26. [PMID: 25100430 DOI: 10.1111/bjh.13058] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
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85
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Choi SJ, Kim J, Lee KA, Choi JR, Yoo J. Cys482Trp missense mutation in the coagulation factor XI gene (F11) in a Korean patient with factor XI deficiency. Ann Lab Med 2014; 34:332-5. [PMID: 24982842 PMCID: PMC4071194 DOI: 10.3343/alm.2014.34.4.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/16/2013] [Accepted: 01/29/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Seung Jun Choi
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Juwon Kim
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyung-A Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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86
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Zucker M, Seligsohn U, Salomon O, Wolberg AS. Abnormal plasma clot structure and stability distinguish bleeding risk in patients with severe factor XI deficiency. J Thromb Haemost 2014; 12:1121-30. [PMID: 24815347 PMCID: PMC4107079 DOI: 10.1111/jth.12600] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Factor XI (FXI) deficiency is a rare autosomal recessive disorder. Many patients with even very low FXI levels (< 20 IU dL(-1) ) are asymptomatic or exhibit only mild bleeding, whereas others experience severe bleeding, usually following trauma. Neither FXI antigen nor activity predicts the risk of bleeding in FXI-deficient patients. OBJECTIVES (i) Characterize the formation, structure and stability of plasma clots from patients with severe FXI deficiency and (ii) determine whether these assays can distinguish asymptomatic patients ('non-bleeders') from those with a history of bleeding ('bleeders'). METHODS Platelet-poor plasmas were prepared from 16 severe FXI-deficient patients who were divided into bleeders or non-bleeders, based on bleeding associated with at least two tooth extractions without prophylaxis. Clot formation was triggered by recalcification and addition of tissue factor and phospholipids in the absence or presence of tissue plasminogen activator and/or thrombomodulin. Clot formation and fibrinolysis were measured by turbidity and fibrin network structure by laser scanning confocal microscopy. RESULTS Non-bleeders and bleeders had similarly low FXI levels, normal prothrombin times, normal levels of fibrinogen, factor VIII, von Willebrand factor and factor XIII, and normal platelet number and function. Compared with non-bleeders, bleeders exhibited lower fibrin network density and lower clot stability in the presence of tissue plasminogen activator. In the presence of thrombomodulin, seven of eight bleeders failed to form a clot, whereas only three of eight non-bleeders did not clot. CONCLUSIONS Plasma clot structure and stability assays distinguished non-bleeders from bleeders. These assays may reveal hemostatic mechanisms in FXI-deficient patients and have clinical utility for assessing the risk of bleeding.
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Affiliation(s)
- M Zucker
- Thrombosis and Hemostasis Unit, Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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87
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Argade MD, Mehta AY, Sarkar A, Desai UR. Allosteric inhibition of human factor XIa: discovery of monosulfated benzofurans as a class of promising inhibitors. J Med Chem 2014; 57:3559-69. [PMID: 24666186 PMCID: PMC4317055 DOI: 10.1021/jm5002698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
![]()
Factor
XIa (fXIa) is being recognized as a prime target for developing
safer anticoagulants. To discover synthetic, small, allosteric inhibitors
of fXIa, we screened an in-house, unique library of 65 molecules displaying
many distinct scaffolds and varying levels of sulfation. Of these,
monosulfated benzofurans were the only group of molecules found to
inhibit fXIa (∼100% efficacy) and led to the identification
of monosulfated trimer 24 (IC50 0.82 μM)
as the most potent inhibitor. Michaelis–Menten kinetics studies
revealed a classic noncompetitive mechanism of action for 24. Although monosulfated, the inhibitors did not compete with unfractionated
heparin alluding to a novel site of interaction. Fluorescence quenching
studies indicated that trimer 24 induces major conformational
changes in the active site of fXIa. Docking studies identified a site
near Lys255 on the A3 domain of fXIa as the most probable site of
binding for 24. Factor XIa devoid of the A3 domain displayed
a major defect in the inhibition potency of 24 supporting
the docking prediction. Our work presents the sulfated benzofuran
scaffold as a promising framework to develop allosteric fXIa inhibitors
that likely function through the A3 domain.
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Affiliation(s)
- Malaika D Argade
- Department of Medicinal Chemistry and Institute for Structural Biology and Drug Discovery, Virginia Commonwealth University , Richmond, Virginia 23219, United States
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88
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Abstract
Bleeding symptoms are common in healthy children but occasionally may indicate an underlying congenital or acquired bleeding diathesis. The rare bleeding disorders (RBDs) comprise inherited deficiencies of coagulation factors I (congenital fibrinogen deficiencies), II, V, VII, X, XI, and XIII and combined factor deficiencies, most notably of factors V and VIII and of vitamin K-dependent factors. These disorders often manifest during childhood and may present with recurrent or even serious or life-threatening bleeding episodes, particularly during the neonatal period. Accordingly, primary care and other nonhematologist pediatric providers should be familiar with the clinical presentation and initial evaluation of these rare disorders. Bleeding manifestations generally vary within the same RBD and may be indistinguishable from 1 RBD to another or from other more common bleeding disorders. Serious bleeding events such as intracranial hemorrhage may be heralded by less serious bleeding symptoms. The results of initial coagulation studies, especially prothrombin time and activated partial thromboplastin time, are often helpful in narrowing down the potential factor deficiency, with factor XIII deficiency being an exception. Consultation with a hematologist is advised to facilitate accurate diagnosis and to ensure proper management and follow-up. The approach to bleeding episodes and invasive procedures is individualized and depends on the severity, frequency, and, in the case of procedures, likelihood of bleeding. Prophylaxis may be appropriate in children with recurrent serious bleeding and specifically after life-threatening bleeding episodes. When available, specific purified plasma-derived or recombinant factor concentrates, rather than fresh frozen plasma or cryoprecipitate, are the treatment of choice.
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Affiliation(s)
- Suchitra S Acharya
- Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York, 269-01 76th Ave, Suite 255, New Hyde Park, NY 11040.
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89
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Ammollo CT, Semeraro F, Colucci M, Simioni P. Factor IX-Padua enhances the fibrinolytic resistance of plasma clots. Thromb Haemost 2013; 111:226-32. [PMID: 24136406 DOI: 10.1160/th13-06-0489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 09/14/2013] [Indexed: 11/05/2022]
Abstract
Hypercoagulable conditions may determine a hypofibrinolytic state by increasing the activation of thrombin-activatable fibrinolysis inhibitor (TAFI). Factor (F)IX-Padua is a mutated FIX with an eight-fold increased clotting activity and associates with a higher venous thrombotic risk. We evaluated the influence of FIX-Padua on TAFI-mediated regulation of fibrinolysis. A subject hemizygous for FIX-Padua, two family members (heterozygous and normal) and six healthy controls were studied. Clot lysis, TAFI activation and thrombin generation were evaluated in contact-inhibited plasma challenged with low concentrations of tissue factor. Fibrinolysis times were significantly longer in FIX-Padua carriers than controls. The difference disappeared when activated TAFI (TAFIa) was inhibited, when TAFI activation was avoided or when clotting was made independent of FIX. TAFIa generation was markedly enhanced in FIX-Padua carriers as compared to controls, and this could be explained by a greater thrombin generation in the former. Hyperactive FIX, but not wild-type FIX, enhanced fibrinolytic resistance also when the FXI-dependent positive feedback was blocked by a neutralising anti-FXI antibody. This thrombin-mediated, TAFI-dependent down-regulation of fibrinolysis provides new clues for explaining the heightened thrombotic risk in subjects carrying the FIX-Padua mutation.
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Affiliation(s)
| | | | | | - Paolo Simioni
- Paolo Simioni, MD, PhD, Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Via Giustiniani 2 - 35100 Padua, Italy, Tel./Fax: +39 049 8212667, E-mail:
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90
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A family with factor-XI deficiency due to a compound heterozygosis between Gln 47 Pro (new mutation) in exon 3 and Leu 619 Pro in exon 15. Blood Coagul Fibrinolysis 2013; 25:191-5. [PMID: 24121361 DOI: 10.1097/mbc.0b013e3283641935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A new factor XI mutation (Gln 47 Pro) has been found in combination with another known mutation (Leu 619 Pro) in a female patient with FXI deficiency and a moderate bleeding tendency. FXI activity and antigen in the proposita were 2% activity and less than 5% of normal, respectively. The parents are not consanguineous and are asymptomatic. The father is heterozygote for the new mutation whereas the mother is heterozygote for the known mutation. Other family members are heterozygotes for either one of the two mutations. The new mutation is not a polymorphism as it was not found in the population of the area. The geographical area, north-east of Italy, of the present family is the same area where a cluster of another new mutation (Ile 436 Lys) was recently reported. No relation was found between the present family and those with the previous mutation.
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91
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Abstract
Inherited factor XI (FXI) deficiency, also called Hemophilia C, is an uncommon autosomal recessive disorder, which is associated with a variable bleeding tendency that usually manifests after trauma or surgery. This concise report reviews current knowledge regarding the pathogenesis, genetics, diagnosis, clinical manifestations and management of this inherited bleeding disorder.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione - Centro Emofilia, Azienda Ospedaliera di Verona, Italy
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92
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Yamagishi T, Ochi N, Yamane H, Fukazawa T, Wada H, Takigawa N. Successful treatment of a lung cancer patient with factor XI deficiency. Haemophilia 2013; 19:e367-9. [PMID: 23992470 DOI: 10.1111/hae.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- T Yamagishi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
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93
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Lee RG, Crosby J, Baker BF, Graham MJ, Crooke RM. Antisense technology: an emerging platform for cardiovascular disease therapeutics. J Cardiovasc Transl Res 2013; 6:969-80. [PMID: 23856914 PMCID: PMC3838598 DOI: 10.1007/s12265-013-9495-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/21/2013] [Indexed: 12/25/2022]
Abstract
Antisense oligonucleotides and small interfering RNAs, which suppress the translation of specific mRNA target proteins, are emerging as important therapeutic modalities for the treatment of cardiovascular disease. Over the last 25 years, the advances in all aspects of antisense technology, as well as a detailed understanding of the mechanism of action of antisense drugs, have enabled their use as therapeutic agents. These advancements culminated in the FDA approval of the first chronically administered cardiovascular antisense therapeutic, mipomersen, which targets hepatic apolipoprotein B mRNA. This review provides a brief history of antisense technology, highlights the progression of mipomersen from preclinical studies to multiple Phase III registration trials, and gives an update on the status of other cardiovascular antisense therapeutics currently in the clinic.
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Affiliation(s)
- Richard G Lee
- Isis Pharmaceuticals, Inc., 2855 Gazelle Court, Carlsbad, CA, 92010, USA,
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94
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Crosby JR, Marzec U, Revenko AS, Zhao C, Gao D, Matafonov A, Gailani D, MacLeod AR, Tucker EI, Gruber A, Hanson SR, Monia BP. Antithrombotic effect of antisense factor XI oligonucleotide treatment in primates. Arterioscler Thromb Vasc Biol 2013; 33:1670-8. [PMID: 23559626 DOI: 10.1161/atvbaha.113.301282] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE During coagulation, factor IX (FIX) is activated by 2 distinct mechanisms mediated by the active proteases of either FVIIa or FXIa. Both coagulation factors may contribute to thrombosis; FXI, however, plays only a limited role in the arrest of bleeding. Therefore, therapeutic targeting of FXI may produce an antithrombotic effect with relatively low hemostatic risk. APPROACH AND RESULTS We have reported that reducing FXI levels with FXI antisense oligonucleotides produces antithrombotic activity in mice, and that administration of FXI antisense oligonucleotides to primates decreases circulating FXI levels and activity in a dose-dependent and time-dependent manner. Here, we evaluated the relationship between FXI plasma levels and thrombogenicity in an established baboon model of thrombosis and hemostasis. In previous studies with this model, antibody-induced inhibition of FXI produced potent antithrombotic effects. In the present article, antisense oligonucleotides-mediated reduction of FXI plasma levels by ≥ 50% resulted in a demonstrable and sustained antithrombotic effect without an increased risk of bleeding. CONCLUSIONS These results indicate that reducing FXI levels using antisense oligonucleotides is a promising alternative to direct FXI inhibition, and that targeting FXI may be potentially safer than conventional antithrombotic therapies that can markedly impair primary hemostasis.
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Affiliation(s)
- Jeffrey R Crosby
- Department of Antisense Drug Discovery, ISIS Pharmaceuticals, Inc, Carlsbad, CA, USA.
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95
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Peretz H, Salomon O, Mor-Cohen R, Usher S, Zucker M, Zivelin A, Seligsohn U. Type I mutation in the F11 gene is a third ancestral mutation which causes factor XI deficiency in Ashkenazi Jews. J Thromb Haemost 2013; 11:724-30. [PMID: 23332144 DOI: 10.1111/jth.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/09/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Factor XI (FXI) deficiency is one of the most frequent inherited disorders in Ashkenazi Jews (AJ). Two predominant founder mutations termed type II (p.Glu117Stop) and type III (p.Phe283Leu) account for most cases. OBJECTIVES To present clinical aspects of a third FXI mutation, type I (c.1716 + 1G>A), which is also prevalent in AJ and to discern a possible founder effect. METHODS Bleeding manifestations, FXI levels and origin of members of 13 unrelated families harboring the type I mutation were determined. In addition, eight intragenic and five extragenic polymorphisms were analyzed in patients with a type I mutation, in 16 unrelated type II homozygotes, in 23 unrelated type III homozygotes and in Ashkenazi Jewish controls. Analysis of these polymorphisms enabled haplotype analysis and estimation of the age of the type I mutation. RESULTS Four of 16 type I heterozygotes (25%) and 6 of 12 (50%) compound heterozygotes for type I mutation (I/II and I/III), or a type I homozygote had bleeding manifestations. Haplotype analysis disclosed that like type II and type III mutations, the type I is also an ancestral mutation. An age estimate revealed that the type I mutation occurred approximately 600 years ago. The geographic distribution of affected families suggested that there was a distinct origin of the type I mutation in Eastern Europe. CONCLUSIONS The rather rare type I mutation in the FXI gene is a third founder mutation in AJ.
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Affiliation(s)
- H Peretz
- Clinical Biochemistry Laboratory, Sourasky Medical Center, Tel Aviv, Israel.
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Abstract
The evaluation of a patient presenting with bleeding symptoms is challenging. Bleeding symptoms are frequently reported by a normal population, and overlap significantly with bleeding disorders, such as type 1 Von Willebrand disease. The history is subjective; bleeding assessment tools significantly facilitate an accurate quantification of bleeding severity. The differential diagnosis is broad, ranging from defects in primary hemostasis, coagulation deficiencies, to connective tissue disorders. Finally, despite significant clinical evidence of abnormal bleeding, many patients will have not an identifiable disorder. Clinical management of bleeding disorders is highly individualized and focuses on the particular symptoms experienced by the patient.
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Affiliation(s)
- Natalia Rydz
- Department of Pathology and Molecular Medicine, Queen's University, Room 2025, Etherington Hall, Kingston, ON, Canada K7L 3N6
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Inhibition of factor XI activation attenuates inflammation and coagulopathy while improving the survival of mouse polymicrobial sepsis. Blood 2012; 119:4762-8. [PMID: 22442348 DOI: 10.1182/blood-2011-10-386185] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Severe bacterial sepsis often leads to a systemic procoagulant and proinflammatory condition that can manifest as disseminated intravascular coagulation, septic shock, and multiple organ failure. Because activation of the contact proteases factor XII (FXII), prekallikrein, and factor XI (FXI) can trigger coagulation and inflammatory responses, the contact factors have been considered potential targets for the treatment of sepsis. However, the pathogenic role of contact activation in severe infections has not been well defined. We therefore investigated whether an anticoagulant antibody (14E11) that selectively inhibits prothrombotic FXI activation by activated FXII (FXIIa) modifies the course of bowel perforation-induced peritoneal sepsis in mice. Early anticoagulation with 14E11 suppressed systemic thrombin- antithrombin complex formation, IL-6, and TNF-α levels, and reduced platelet consumption in the circulation and deposition in the blood vessels. Treatment with 14E11 within 12 hours after bowel perforation significantly improved survival compared with vehicle treatment, and the saturating dose did not increase tail bleeding. These data suggest that severe polymicrobial abdominal infection induces prothrombotic FXI activation, to the detriment of the host. Systemic anticoagulation by inhibiting FXI activation or FXIIa procoagulant activity during sepsis may therefore limit the development of disseminated intravascular coagulation without increasing bleeding risks.
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Yamaguchi S, Tsutsumi S, Fujii T, Yajima R, Ide M, Kigure W, Morita H, Suto T, Kato T, Mochiki E, Suzuki H, Asao T, Kuwano H. Successful Treatment of a Patient with Colon Cancer with Congenital Coagulation Factor XI Deficiency. Am Surg 2012. [DOI: 10.1177/000313481207800213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Satoru Yamaguchi
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Soichi Tsutsumi
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Takaaki Fujii
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Reina Yajima
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Munenori Ide
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Wakako Kigure
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Hiroki Morita
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Toshinaga Suto
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Toshihide Kato
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Erito Mochiki
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Hideki Suzuki
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Takayuki Asao
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science Gunma University Graduate School Graduate School of Medicine Gunma, Japan
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