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Nagoshi R, Sakamoto A, Imai T, Uchiyama T, Kaname T, Kunishima S, Ishiguro A. Bernard-Soulier syndrome caused by a novel GP1BB variant and 22q11.2 deletion. Int J Hematol 2024; 120:142-145. [PMID: 38625506 DOI: 10.1007/s12185-024-03768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
Bernard-Soulier syndrome (BSS) is caused by defects in GP1BA, GP1BB, or GP9 genes. Patients with 22q11.2 deletion syndrome (22q11.2DS) are obligate carriers of BSS because GP1BB resides on chromosome 22q11.2. A 15-month-old girl without bleeding symptoms had giant platelets and thrombocytopenia. Physical findings and macrothrombocytopenia suggested 22q11.2DS, which was confirmed by fluorescence in situ hybridization. Flow cytometry showed decreased GPIbα on the platelets. Gene panel testing revealed a novel variant in GP1BB, p.(Val169_Leu172del). These findings confirmed that the patient had BSS. This case suggests that any patient with 22q11.2DS and macrothrombocytopenia should be further tested for BSS.
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Affiliation(s)
- Rintaro Nagoshi
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Atsushi Sakamoto
- Division of Hematology, Center for Postgraduate Education and Training, NCCHD, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
| | - Tsuyoshi Imai
- Department of Pediatric Hematology and Oncology, National Hospital Organization Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | | | | | - Shinji Kunishima
- Department of Medical Technology, School of Health Sciences, Gifu University of Medical Science, Gifu, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan
- Division of Hematology, Center for Postgraduate Education and Training, NCCHD, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
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2
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Kornya M, Abrams-Ogg A, St-Jean C, Phillips E, Dickinson M, Collier A, Barry M, Durzi T, Khan O, Blois S. Point-of-care platelet function testing results in a dog with Bernard-Soulier syndrome. Vet Clin Pathol 2023; 52:569-575. [PMID: 37438861 DOI: 10.1111/vcp.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 07/14/2023]
Abstract
Bernard-Soulier syndrome (BSS), also known as hemorrhagiparous thrombocytic dystrophy (OMIA 002207-9615), is a rare defect in platelet function recognized in both dogs and humans. It is caused by a deficiency in glycoprotein 1b-IX-V, the platelet surface protein which acts as a receptor for the von Willebrand factor. The characteristic features of BSS in humans and dogs include macrothrombocytes and mild-to-moderate thrombocytopenia with a bleeding tendency. This condition has previously been reported in European Cocker Spaniel dogs; however, the results of platelet function tests in these animals have not been reported. This case report describes a European Cocker Spaniel dog with spontaneously occurring Bernard-Soulier syndrome and the results of point-of-care platelet function tests, including a prolonged buccal mucosal bleeding time (>8 min), prolongation (>300 s) of PFA-200 COL/ADP, COL/EPI, and P2Y closure times, and reduced aggregation (15%-48%) with Plateletworks ADP, but with normal aggregation (92%) with Plateletworks AA. This is the first description of the results of platelet function tests in canine Bernard-Soulier syndrome.
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Affiliation(s)
- Matthew Kornya
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Camille St-Jean
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Erin Phillips
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Melanie Dickinson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Allison Collier
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Maureen Barry
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Tiffany Durzi
- Smith Lane Animal Hospital, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Omar Khan
- Smith Lane Animal Hospital, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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3
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Rujitharanawong C, Kulthanan K, Tuchinda P, Chularojanamontri L, Metz M, Maurer M. A Systematic Review of Aquagenic Urticaria-Subgroups and Treatment Options. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2154-2162. [PMID: 35533998 DOI: 10.1016/j.jaip.2022.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aquagenic urticaria (AquaU) is a rare variant of chronic inducible urticaria where wheals occur after skin contact with water. Information on clinical manifestations and treatment outcomes is limited, which makes the management of AquaU challenging. OBJECTIVE To systematically review disease features and relevant triggers of AquaU and patients' response to treatment. METHODS Related articles were searched by use of the terms "aquagenic urticaria" and "aquagenic angioedema" until June 2021 and reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. RESULTS A total of 77 patients with AquaU were investigated in 59 studies including 47 case reports and 12 case series. AquaU predominantly presented in women (47 patients, 61%), and the mean age of onset of the disease was 19.6 ± 10.8 years (range: 0-54 years). Wheals commonly occurred in localized areas and regardless of the water temperature. Based on the reviewed evidence, AquaU can be classified as familial AquaU (FAquaU, 18.2%) and acquired AquaU (AAquaU, 81.8%). Although many treatments were used in both subtypes of AquaU, the use of second-generation H1 antihistamines (2ndAH1) was reported most often to achieve marked improvement in both subtypes. The use of topical therapies in AquaU, which most commonly use hydrophobic vehicles, is poorly documented and of controversial efficiency. CONCLUSIONS AquaU is proposed to be classified into 2 subtypes, FAquaU and the more common AAquaU. Treatment with a 2ndAH1 is recommended as the first-line treatment for both types of AquaU. Further studies are required to fill knowledge gaps.
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Affiliation(s)
- Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martin Metz
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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4
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Characterization of zebrafish gp1ba mutant and modelling Bernard Soulier syndrome. Blood Coagul Fibrinolysis 2022; 33:272-279. [PMID: 35802508 DOI: 10.1097/mbc.0000000000001135] [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
The aim of this study is to model classical Bernard Soulier Syndrome in the zebrafish by targeting Gp1ba. We obtained gp1ba mutant embryos from Zebrafish International Resource Center and grew them to adulthood. The tail clips from these fish were used to prepare DNA and sequenced to identify heterozygotes. They were then bred to obtain homozygotes. The mutation was confirmed by DNA sequencing as a termination codon UAA in place of AAA codon at position 886 in the gp1ba transcript. Thus, at the Pro-295, the Gp1ba protein could be terminated. The blood from gp1ba homozygous and heterozygous mutants showed decreased ristocetin-mediated agglutination in the whole blood agglutination assay. The gp1ba heterozygous and homozygous larvae were subjected to a laser-assisted arterial thrombosis assay, and the results showed the prolonged occlusion in the caudal artery. These results suggested that the gp1ba mutant had a bleeding phenotype. The blood smears from the adult gp1ba, heterozygous and homozygous mutants, showed macrothrombocytes, similar to the human GP1BA deficiency that showed giant platelets. The bleeding assay on these heterozygous and homozygous mutants showed greater bleeding than wildtype, confirming the above findings. Taken together, the characterization of gp1ba zebrafish mutant suggested an autosomal dominant mode of inheritance. The zebrafish gp1ba mutant models classical Bernard Soulier Syndrome and could be used for reversing this phenotype to identify novel factors by the genome-wide piggyback knockdown method.
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Chen Y, Hu J, Chen Y. Platelet desialylation and TFH cells-the novel pathway of immune thrombocytopenia. Exp Hematol Oncol 2021; 10:21. [PMID: 33722280 PMCID: PMC7958461 DOI: 10.1186/s40164-021-00214-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/07/2021] [Indexed: 12/15/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by immune-mediated destruction of one's own platelets. The progression of thrombocytopenia involves an imbalance of platelet production and clearance. B cells can induce autoantibodies, and T cells contribute to the pathological progression as well. Some patients with ITP have a poor response to common first-line therapies. Recent studies have shown that a novel Fc-independent platelet clearance pathway is associated with poor prognosis in these patients. By this pathway, desialylated platelets can be cleared by Ashwell-Morell receptor (AMR) on hepatocytes. Research has demonstrated that patients with refractory ITP usually have a high level of desialylation, indicating the important role of sialylation on platelet membrane glycoprotein (GP) in patients with primary immune thrombocytopenia, and neuraminidase 1(NEU1) translocation might be involved in this process. Patients with ITP who are positive for anti-GPIbα antibodies have a poor prognosis, which indicates that anti-GPIbα antibodies are associated with this Fc-independent platelet clearance pathway. Experiments have proven that these antibodies could lead to the desialylation of GPs on platelets. The T follicular helper (TFH) cell level is related to the expression of the anti-GPIbα antibody, which indicates its role in the progression of desialylation. This review will discuss platelet clearance and production, especially the role of the anti-GPIbα antibody and desialylation in the pathophysiology of ITP and therapy for this disease.
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Affiliation(s)
- Yuwen Chen
- Department of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, No.29 Xinquan Road, 350001, Fuzhou, Fujian, China
| | - Jianda Hu
- Department of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, No.29 Xinquan Road, 350001, Fuzhou, Fujian, China
| | - Yingyu Chen
- Department of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, No.29 Xinquan Road, 350001, Fuzhou, Fujian, China.
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6
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Matsushima N, Takatsuka S, Miyashita H, Kretsinger RH. Leucine Rich Repeat Proteins: Sequences, Mutations, Structures and Diseases. Protein Pept Lett 2019; 26:108-131. [PMID: 30526451 DOI: 10.2174/0929866526666181208170027] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
Abstract
Mutations in the genes encoding Leucine Rich Repeat (LRR) containing proteins are associated with over sixty human diseases; these include high myopia, mitochondrial encephalomyopathy, and Crohn's disease. These mutations occur frequently within the LRR domains and within the regions that shield the hydrophobic core of the LRR domain. The amino acid sequences of fifty-five LRR proteins have been published. They include Nod-Like Receptors (NLRs) such as NLRP1, NLRP3, NLRP14, and Nod-2, Small Leucine Rich Repeat Proteoglycans (SLRPs) such as keratocan, lumican, fibromodulin, PRELP, biglycan, and nyctalopin, and F-box/LRR-repeat proteins such as FBXL2, FBXL4, and FBXL12. For example, 363 missense mutations have been identified. Replacement of arginine, proline, or cysteine by another amino acid, or the reverse, is frequently observed. The diverse effects of the mutations are discussed based on the known structures of LRR proteins. These mutations influence protein folding, aggregation, oligomerization, stability, protein-ligand interactions, disulfide bond formation, and glycosylation. Most of the mutations cause loss of function and a few, gain of function.
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Affiliation(s)
- Norio Matsushima
- Center for Medical Education, Sapporo Medical University, Sapporo 060-8556, Japan.,Institute of Tandem Repeats, Noboribetsu 059-0464, Japan
| | - Shintaro Takatsuka
- Center for Medical Education, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Hiroki Miyashita
- Institute of Tandem Repeats, Noboribetsu 059-0464, Japan.,Hokubu Rinsho Co., Ltd, Sapporo 060-0061, Japan
| | - Robert H Kretsinger
- Department of Biology, University of Virginia, Charlottesville, VA 22904, United States
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7
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Murase M, Nakayama Y, Sessler DI, Mukai N, Ogawa S, Nakajima Y. Changes in platelet Bax levels contribute to impaired platelet response to thrombin after cardiopulmonary bypass: prospective observational clinical and laboratory investigations. Br J Anaesth 2019; 119:1118-1126. [PMID: 29040496 DOI: 10.1093/bja/aex349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 11/13/2022] Open
Abstract
Background Anucleate platelets can undergo apoptosis in response to various stimuli, as do nucleated cells. Cardiopulmonary bypass (CPB) causes platelet dysfunction and can also activate platelet apoptotic pathways. We therefore evaluated time-dependent changes in blood platelet Bax (a pro-apoptotic molecule) levels and platelet dysfunction after cardiac surgery. Methods We assessed blood samples obtained from subjects having on-pump or off-pump coronary artery bypass graft surgery ( n =20 each). We also evaluated the in vitro effects of platelet Bax increase in eight healthy volunteers. Results Thrombin-induced platelet calcium mobilisation and platelet-surface glycoprotein Ib (GPIb) expression were lowest at weaning from CPB and did not recover on postoperative day one. On-pump surgery increased platelet expression of Bax, especially the oligomerised form, along with translocation of Bax from the cytosol to mitochondria and platelet-surface tumour necrosis factor-alpha (TNF-α)-converting enzyme (TACE) expression. In contrast, mitochondrial cytochrome c expression was reduced. While similar in direction, the magnitude of the observed changes was smaller in patients having off-pump surgery. In vitro , a cell-permeable Bax peptide increased platelet Bax expression to the same extent seen during bypass and produced similar platelet changes. These apoptotic-like changes were largely reversed by Bcl-xL pre-administration, and were completely reversed by combined application of inhibitors that stabilise outer mitochondrial membrane permeability and TACE. Conclusions CPB increases platelet Bax expression, which contributes to reduced platelet-surface GPIb expression and thrombin-induced platelet calcium changes. These changes in platelet apoptotic signalling might contribute to platelet dysfunction after CPB. Clinical trial registration UMIN Clinical Trials Registry (number UMIN000006033).
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Affiliation(s)
- M Murase
- Department of Anaesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Y Nakayama
- Department of Anaesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - D I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH 44195, USA
| | - N Mukai
- Department of Anaesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - S Ogawa
- Department of Anaesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Y Nakajima
- Department of Anesthesiology and Critical Care, Kansai Medical University, Osaka 573-1191, Japan
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8
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Zwifelhofer NMJ, Bercovitz RS, Weik LA, Moroi A, LaRose S, Newman PJ, Newman DK. Hemizygosity for the gene encoding glycoprotein Ibβ is not responsible for macrothrombocytopenia and bleeding in patients with 22q11 deletion syndrome. J Thromb Haemost 2019; 17:295-305. [PMID: 30549403 PMCID: PMC6410711 DOI: 10.1111/jth.14357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/17/2022]
Abstract
Essentials How thrombocytopenia relates to bleeding in 22q11 deletion syndrome (22q11DS) is not clear. Bleeding severity, platelet count and volume, and GPIBB were examined in patients with 22q11DS. Macrothrombocytopenia and bleeding typified imperfectly overlapping subsets of 22q11DS patients. GPIBB hemizygosity does not cause macrothrombocytopenia or bleeding in patients with 22q11DS. SUMMARY: Background and objectives Macrothrombocytopenia and bleeding are frequently associated with 22q11 deletion syndrome (22q11DS). GPIBB, which encodes the glycoprotein (GP) Ibβ subunit of GPIb-IX-V, is commonly deleted in patients with 22q11DS. Absence of functional GPIb-IX-V causes Bernard-Soulier syndrome, which is a severe bleeding disorder characterized by macrothrombocytopenia. Patients with 22q11DS are often obligate hemizygotes for GPIBB, and those with only a pathogenically disrupted copy of GPIBB present with Bernard-Soulier syndrome. The objective of this study was to determine how GPIBB hemizygosity and sequence variation relate to macrothrombocytopenia and bleeding in patients with 22q11DS who do not have Bernard-Soulier syndrome. Patients/methods We thoroughly characterized bleeding severity, mean platelet volume, platelet count and GPIBB copy number and sequence in patients with 22q11DS. Results and conclusions Macrothrombocytopenia and mild bleeding were observed in incompletely overlapping subsets of patients, and GPIBB copy number and sequence variation did not correlate with either macrothrombocytopenia or bleeding in patients with 22q11DS. These findings indicate that GPIBB hemizygosity does not result in either macrothrombocytopenia or bleeding in these patients. Alternative genetic causes of macrothrombocytopenia, potential causes of acquired thrombocytopenia and bleeding and ways in which platelet size, platelet count and GPIBB sequence information can be used to aid in the diagnosis and management of patients with 22q11DS are discussed.
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Affiliation(s)
- N M J Zwifelhofer
- Blood Research Institute, BloodCenter of Wisconsin - part of Versiti, Milwaukee, WI, USA
| | - R S Bercovitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - L A Weik
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - A Moroi
- Blood Research Institute, BloodCenter of Wisconsin - part of Versiti, Milwaukee, WI, USA
| | - S LaRose
- Blood Research Institute, BloodCenter of Wisconsin - part of Versiti, Milwaukee, WI, USA
| | - P J Newman
- Blood Research Institute, BloodCenter of Wisconsin - part of Versiti, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D K Newman
- Blood Research Institute, BloodCenter of Wisconsin - part of Versiti, Milwaukee, WI, USA
- Department of Pharmacology & Toxicology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI, USA
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Ghosh K, Bhattacharya M, Chowdhury R, Mishra K, Ghosh M. Inherited Macrothrombocytopenia: Correlating Morphology, Epidemiology, Molecular Pathology and Clinical Features. Indian J Hematol Blood Transfus 2018; 34:387-397. [PMID: 30127546 PMCID: PMC6081320 DOI: 10.1007/s12288-018-0950-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/14/2018] [Indexed: 01/19/2023] Open
Abstract
Inherited macrothrombocytopenia is increasingly being recognized as a relatively common condition. This descriptive review aims at focusing on the different areas of advancement that have taken place with this condition with particular reference to India. A pubmed search of articles between January 1990 and October 2017 with the key words-macrothrombocytopenia, asymptomatic macrothrombocytopenia, macrothrombocytopenia India, syndromic macrothrombocytopenia, molecular pathology, megakaryopoiesis and platelet formation were searched. The shortlisted articles were then read. Review articles provided additional references and the articles thus obtained were also read. Special interest and research conducted by the authors provided further sources of information. A total of 487 articles were found of which 68 articles were related to our subject of review. Review articles were read and additional articles from the reference quoted. Forty-four percent of nonsyndromic Inherited macrothrombocytopenia showed mutations of MYH9, GP1BB, GP1Ba, GPIX, ABCG5 and 8, ACTN, FLI, TUBB and RUNX1 frequently in heterozygous state. All types of inheritance pattern namely autosomal dominant, recessive and sex linked patterns have been described. Syndromic causes of this phenomenon are well known and have been described. Many asymptomatic patients do have mild or moderate bleeding history. Clinical algorithms to differentiate chronic ITP associated macrothrombocytopenia from inherited variety have been explored. Inherited macrothrombocytopenia is an emerging area of interest in platelet biology with its implication in diagnosis, prognosis, genetic counseling, management and in transfusion medicine.
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Affiliation(s)
- Kanjaksha Ghosh
- Surat Raktadan Kendra and Research Centre, Udhna Magdalla Road, Near Chosath Joganio Mataji Temple, Surat, 395002 India
| | - Maitreyee Bhattacharya
- Institute of Haematology and Transfusion Medicine, Medical College, Kolkata, 12 College Street, Kolkata, 700078 India
| | - Ranjini Chowdhury
- Institute of Haematology and Transfusion Medicine, Medical College, Kolkata, 12 College Street, Kolkata, 700078 India
| | - Kanchan Mishra
- Surat Raktadan Kendra and Research Centre, Udhna Magdalla Road, Near Chosath Joganio Mataji Temple, Surat, 395002 India
| | - Malay Ghosh
- P-78 Green View, Garia-P.O., Kolkata, 700084 India
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10
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Ferrari S, Lombardi AM, Cortella I, Businaro MA, Bertomoro A, Di Pasquale I, Fabris F. New heterozygous variant in GP1BB gene is responsible for an inherited form of macrothrombocytopenia. Br J Haematol 2018. [PMID: 29527674 DOI: 10.1111/bjh.15176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Silvia Ferrari
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Anna M Lombardi
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Irene Cortella
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Maria A Businaro
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | | | - Irene Di Pasquale
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Fabrizio Fabris
- Department of Medicine, University of Padua Medical School, Padua, Italy
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11
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Wentzell R, Santoso S, Zieger B, Sandrock-Lang K. Angeborene Thrombozytenfunktionsstörungen. Hamostaseologie 2017; 36:178-86. [DOI: 10.5482/hamo-14-11-0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/30/2015] [Indexed: 11/05/2022] Open
Abstract
ZusammenfassungAngeborene Thrombozytopathien können zu Blutungssymptomen unterschiedlichen Schweregrades führen, da die Thrombozyten nicht mehr ihre Funktion nach einer Gefäß-verletzung erfüllen können. In manchen Fällen sind Thrombozytopathien schwierig zu diagnostizieren und können Probleme in der Therapie und im Management verursachen. Dieser Review beschreibt den klinischen und molekulargenetischen Phänotyp der verschiedenen angeborenen Thrombozytopathien. Die angeborenen Thrombozytopathien werden entsprechend des Thrombozytendefekts eingeteilt: Rezeptordefekte (Adhäsion oder Aggregation), Sekretionsdefekte und Zytoskelettdefekte.Die am besten charakterisierten thrombozytären Rezeptordefekte sind die Glanzmann Thrombasthenie (Defekt des Integrins [uni03B1]IIb[uni03B2]3) und das Bernard-Soulier Syndrom (Defekt des GPIb/IX/V Rezeptors). Umfassende Fall-berichte über die Blutungsdiathese sowie die Untersuchung der Thrombozytenaggregation bzw. -agglutination und Rezeptorexpression von Patienten, die an der Glanzmann Thrombasthenie (GT) oder am Bernard-Soulier Syndrom (BSS) leiden, sollen diesen Review ergänzen. Darüber hinaus wird das HermanskyPudlak Syndrom (HPS) als eine bedeutende Störung der [uni03B4]-Granula Sekretion zusammen mit einer Fallbeschreibung eines Patienten, der an HPS Typ 1 leidet, beschrieben.
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12
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Lambert MP, Arulselvan A, Schott A, Markham SJ, Crowley TB, Zackai EH, McDonald-McGinn DM. The 22q11.2 deletion syndrome: Cancer predisposition, platelet abnormalities and cytopenias. Am J Med Genet A 2017; 176:2121-2127. [PMID: 28940864 DOI: 10.1002/ajmg.a.38474] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/08/2017] [Accepted: 08/21/2017] [Indexed: 01/10/2023]
Abstract
The 22q11.2 deletion syndrome (DS) is associated with variable phenotypic expression as findings range from severely affected individuals with the classical triad of DiGeorge and velocardiofacial syndromes, including congenital heart disease, immunodeficiency, hypocalcemia, and palatal abnormalities, to subtly affected adults who only come to attention following the diagnosis of a more severely affected child. The multiple manifestations can affect all organ systems, including the hematologic system resulting in baseline lower platelet counts for individuals with 22q11.2DS and increased platelet size. In addition, there may be an associated increased risk of bleeding. Individuals with 22q11.2DS are also at increased risk of autoimmune cytopenias that can complicate the evaluation or management of other manifestations. Finally, there may be an increased risk of malignancy, although the mechanism for this risk is not fully understood. This review summarizes the currently available data on hematologic/oncologic manifestations of 22q11.2DS and reports on our findings within a large cohort of individuals with the deletion.
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Affiliation(s)
- Michele P Lambert
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Abinaya Arulselvan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda Schott
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Arcadia University, Glenside, Pennsylvania
| | - Stephen J Markham
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Terrance B Crowley
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine H Zackai
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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13
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Nygaard G, Herfindal L, Asrud KS, Bjørnstad R, Kopperud RK, Oveland E, Berven FS, Myhren L, Hoivik EA, Lunde THF, Bakke M, Døskeland SO, Selheim F. Epac1-deficient mice have bleeding phenotype and thrombocytes with decreased GPIbβ expression. Sci Rep 2017; 7:8725. [PMID: 28821815 PMCID: PMC5562764 DOI: 10.1038/s41598-017-08975-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022] Open
Abstract
Epac1 (Exchange protein directly activated by cAMP 1) limits fluid loss from the circulation by tightening the endothelial barrier. We show here that Epac1-/- mice, but not Epac2-/- mice, have prolonged bleeding time, suggesting that Epac1 may limit fluid loss also by restraining bleeding. The Epac1-/- mice had deficient in vitro secondary hemostasis. Quantitative comprehensive proteomics analysis revealed that Epac1-/- mouse platelets (thrombocytes) had unbalanced expression of key components of the glycoprotein Ib-IX-V (GPIb-IX-V) complex, with decrease of GP1bβ and no change of GP1bα. This complex is critical for platelet adhesion under arterial shear conditions. Furthermore, Epac1-/- mice have reduced levels of plasma coagulation factors and fibrinogen, increased size of circulating platelets, increased megakaryocytes (the GP1bβ level was decreased also in Epac1-/- bone marrow) and higher abundance of reticulated platelets. Viscoelastic measurement of clotting function revealed Epac1-/- mice with a dysfunction in the clotting process, which corresponds to reduced plasma levels of coagulation factors like factor XIII and fibrinogen. We propose that the observed platelet phenotype is due to deficient Epac1 activity during megakaryopoiesis and thrombopoiesis, and that the defects in blood clotting for Epac1-/- is connected to secondary hemostasis.
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Affiliation(s)
- Gyrid Nygaard
- Department of Biomedicine, University of Bergen, Bergen, Norway
- The Proteomics Unit at the University of Bergen, Bergen, Norway
| | - Lars Herfindal
- Centre for Pharmacy, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Ronja Bjørnstad
- Centre for Pharmacy, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hospital Pharmacies Enterprise, Western Norway, Bergen, Norway
| | | | - Eystein Oveland
- The Proteomics Unit at the University of Bergen, Bergen, Norway
| | - Frode S Berven
- Department of Biomedicine, University of Bergen, Bergen, Norway
- The Proteomics Unit at the University of Bergen, Bergen, Norway
| | - Lene Myhren
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Erling A Hoivik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Turid Helen Felli Lunde
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marit Bakke
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | | | - Frode Selheim
- Department of Biomedicine, University of Bergen, Bergen, Norway.
- The Proteomics Unit at the University of Bergen, Bergen, Norway.
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14
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Wang F, Zhao YK, Luo ZY, Gao Q, Wu W, Sarkar R, Luo DQ. Aquagene Hauterkrankungen. J Dtsch Dermatol Ges 2017; 15:602-609. [PMID: 28591437 DOI: 10.1111/ddg.13234_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Fang Wang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Kun Zhao
- Department of Dermatology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Yu Luo
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Gao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Wu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical college and LNJP Hospital, New Delhi, India
| | - Di-Qing Luo
- Department of Dermatology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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15
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Wang F, Zhao YK, Luo ZY, Gao Q, Wu W, Sarkar R, Luo DQ. Aquagenic cutaneous disorders. J Dtsch Dermatol Ges 2017; 15:602-608. [PMID: 28513988 DOI: 10.1111/ddg.13234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Fang Wang
- Department of Dermatology; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Yu-Kun Zhao
- Department of Dermatology; The Eastern Hospital of The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Ze-Yu Luo
- Department of Dermatology; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Qian Gao
- Department of Dermatology; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Wei Wu
- Department of Dermatology; Affiliated Hospital of Guangdong Medical University; Zhanjiang China
| | - Rashmi Sarkar
- Department of Dermatology; Maulana Azad Medical college and LNJP Hospital; New Delhi India
| | - Di-Qing Luo
- Department of Dermatology; The Eastern Hospital of The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
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16
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17
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Bruno EK, Bennett JD. Platelet Abnormalities in the Oral Maxillofacial Surgery Patient. Oral Maxillofac Surg Clin North Am 2016; 28:473-480. [PMID: 27600533 DOI: 10.1016/j.coms.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Platelet abnormalities result from a wide range of congenital and acquired conditions, which may be known or unknown to patients presenting for oral maxillofacial surgery. It is critical to obtain a thorough history, including discussion of any episodes of bleeding or easy bruising, to potentially discern patients with an underlying platelet disorder. If patients indicate a positive history, preoperative laboratory studies are indicated, with potential referral or consultation with a hematologist. Appropriate preoperative planning may reduce the risk of bleeding associated with platelet dysfunction, potentially avoiding serious perioperative and postoperative complications.
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Affiliation(s)
| | - Jeffrey D Bennett
- Division of Oral and Maxillofacial Surgery, Roudebush VA Medical Center, Indianapolis, IN, USA.
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18
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Okoli S, Madan B, Mwirigi A, Moore G, Drew A, Mitchell MJ, Cutler JA. A diagnostic dilemma: variant Bernard-Soulier syndrome, a difficult clinical and genetic diagnosis. Haemophilia 2015; 21:e510-3. [PMID: 26226975 DOI: 10.1111/hae.12777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S Okoli
- Haematology, Guys & St Thomas NHS foundation Trust, London, UK
| | - B Madan
- Haemophilia, Guys & St Thomas NHS foundation Trust, London, UK
| | - A Mwirigi
- Haematology, Guys & St Thomas NHS foundation Trust, London, UK
| | - G Moore
- Haematology, Guys & St Thomas NHS foundation Trust, London, UK
| | - A Drew
- Haematology, Guys & St Thomas NHS foundation Trust, London, UK
| | - M J Mitchell
- Molecular Haemostasis, Viapath LLP St Thomas' Hospital, London, UK
| | - J A Cutler
- Haematology, Guys & St Thomas NHS foundation Trust, London, UK.,Haemophilia, Guys & St Thomas NHS foundation Trust, London, UK
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19
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Shlebak A, Poles A, Manning R, Almuhareb S, De La Funte J, Mitchell M, Lucas G. A Novel Homozygous c.800C>G Substitution in GP1BA Exon 2 in a Kuwaiti Family with Bernard-Soulier Syndrome. Acta Haematol 2015; 134:193-8. [PMID: 26044173 DOI: 10.1159/000381328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/02/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bernard-Soulier syndrome (BSS) is a congenital bleeding disorder characterised by thrombocytopenia, giant platelets and decreased platelet adhesion resulting from genetic alterations of the glycoprotein (GP) Ib/IX/V complex. OBJECTIVES Three sisters with a lifelong bleeding history and a provisional diagnosis of BSS were referred for further characterisation of their bleeding diathesis. The siblings' symptoms varied in severity from skin and gum bleeding to menorrhagia associated with iron-deficiency anaemia requiring regular transfusion of red cells and platelets. The parents were consanguineous but did not demonstrate any bleeding disorder. METHODS The family were investigated using standard haematological techniques, platelet aggregometry, platelet membrane GP analysis and DNA sequencing of the genes encoding the GPIb/IX complex. RESULTS All 3 sisters had thrombocytopenia and giant platelets. Platelet aggregation and flow cytometry studies confirmed the lack of aggregation with ristocetin and a markedly reduced GPIb/IX surface expression. Molecular analysis demonstrated a novel homozygous c.800C>G substitution in GP1BA exon 2 leading to a serine 267 Ter stop codon in all 3 siblings. CONCLUSIONS A novel, nonsense mutation was identified as the cause of the bleeding disorder in this family. This is the first reported BSS mutation identified in a family from Kuwait.
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Affiliation(s)
- Abdul Shlebak
- Haemostasis and Thrombosis Unit, Imperial College Healthcare, St. Thomas' Hospital, London, UK
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20
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Sato T, Kunishima S, Shirayama R, Ichikawa S, Sakai M, Kusuhara K. Bernard-Soulier syndrome due to compound heterozygosity for a novel glycoprotein Ibβ mutation. Acta Haematol 2014; 131:46-9. [PMID: 24051937 DOI: 10.1159/000351057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Tetsuji Sato
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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21
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Kunishima S, Imai T, Kobayashi R, Kato M, Ogawa S, Saito H. Bernard-Soulier syndrome caused by a hemizygous GPIbβ mutation and 22q11.2 deletion. Pediatr Int 2013; 55:434-7. [PMID: 23566026 DOI: 10.1111/ped.12105] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/17/2012] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bernard-Soulier syndrome (BSS) is a rare autosomal recessive bleeding disorder characterized by giant platelets, thrombocytopenia, and a prolonged bleeding time, which is caused by homozygous mutations in the GPIbα, GPIbβ, or GPIX genes. The 22q11.2 deletion syndrome (22q11.2DS) is caused by a microdeletion on chromosome 22, which includes the GPIbβ gene, and is characterized by abnormal development of the pharyngeal apparatus and heart. Thus, patients with 22q11.2DS are obligate carriers for BSS. METHODS We evaluated two infants with BSS and performed the genetic analysis of the GPIbα, GPIbβ, or GPIX genes, and investigated the segregation of the mutation within the families. The status of the 22q11.2 deletion was examined by fluorescence in situ hybridization and single-nucleotide polymorphism array copy number analysis. RESULTS DNA sequencing analysis revealed that the infants were compound heterozygous for a hemizygous mutation in the GPIbβ gene (p.Trp148X and p.Leu97Phe, respectively) and 22q11.2 deletion in the other chromosome. Both infants had the common 3Mb 22q11.2 deletion but did not show major phenotypic features of 22q11.2DS, such as developmental delay, cardiac defects, dysmorphic facial features, palatal anomalies, hypocalcemia, and immune deficiency. The 22q11.2DS would not have become clear if detailed molecular genetic analyses of BSS had not been performed. CONCLUSIONS Our cases illustrate that a suspicion of 22q11.2 deletion is warranted in pediatric BSS patients with a mutation in the GPIbβ gene, even without remarkable symptoms.
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Affiliation(s)
- Shinji Kunishima
- Department of Advanced Diagnosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
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22
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Novel Bernard-Soulier syndrome variants caused by compound heterozygous mutations (case I) or a cytoplasmic tail truncation (case II) of GPIbα. Thromb Res 2013; 131:e160-7. [DOI: 10.1016/j.thromres.2013.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/28/2012] [Accepted: 01/09/2013] [Indexed: 11/21/2022]
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23
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Kunishima S, Okuno Y, Yoshida K, Shiraishi Y, Sanada M, Muramatsu H, Chiba K, Tanaka H, Miyazaki K, Sakai M, Ohtake M, Kobayashi R, Iguchi A, Niimi G, Otsu M, Takahashi Y, Miyano S, Saito H, Kojima S, Ogawa S. ACTN1 mutations cause congenital macrothrombocytopenia. Am J Hum Genet 2013; 92:431-8. [PMID: 23434115 DOI: 10.1016/j.ajhg.2013.01.015] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/20/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022] Open
Abstract
Congenital macrothrombocytopenia (CMTP) is a heterogeneous group of rare platelet disorders characterized by a congenital reduction of platelet counts and abnormally large platelets, for which CMTP-causing mutations are only found in approximately half the cases. We herein performed whole-exome sequencing and targeted Sanger sequencing to identify mutations that cause CMTP, in which a dominant mode of transmission had been suspected but for which no known responsible mutations have been documented. In 13 Japanese CMTP-affected pedigrees, we identified six (46%) affected by ACTN1 variants cosegregating with CMTP. In the entire cohort, ACNT1 variants accounted for 5.5% of the dominant forms of CMTP cases and represented the fourth most common cause in Japanese individuals. Individuals with ACTN1 variants presented with moderate macrothrombocytopenia with anisocytosis but were either asymptomatic or had only a modest bleeding tendency. ACTN1 encodes α-actinin-1, a member of the actin-crosslinking protein superfamily that participates in the organization of the cytoskeleton. In vitro transfection experiments in Chinese hamster ovary cells demonstrated that altered α-actinin-1 disrupted the normal actin-based cytoskeletal structure. Moreover, transduction of mouse fetal liver-derived megakaryocytes with disease-associated ACTN1 variants caused a disorganized actin-based cytoskeleton in megakaryocytes, resulting in the production of abnormally large proplatelet tips, which were reduced in number. Our findings provide an insight into the pathogenesis of CMTP.
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Affiliation(s)
- Shinji Kunishima
- Department of Advanced Diagnosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
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24
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Kai AC, Flohr C. Aquagenic urticaria in twins. World Allergy Organ J 2013; 6:2. [PMID: 23663417 PMCID: PMC3646536 DOI: 10.1186/1939-4551-6-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 01/16/2013] [Indexed: 11/21/2022] Open
Abstract
We describe the case of 18 year old twin brothers who presented to our unit with a 3 year history of aquagenic urticaria. This rare form of urticaria usually presents within an hour of contact with water. The aetiology is unknown. Most cases are sporadic but there are a small number of familial cases in the medical literature. A specific genetic mutation has not yet been found. To our knowledge, this is the first report of aquagenic urticaria in monozygotic twins, further supporting a genetic component to this disease.
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Affiliation(s)
- Anneke C Kai
- Cutaneous Allergy Department, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK.
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25
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Novel mutation in the glycoprotein Ibβ in a patient with Bernard–Soulier syndrome. Blood Coagul Fibrinolysis 2012; 23:335-7. [DOI: 10.1097/mbc.0b013e32835187e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Edelstein LC, Luna EJ, Gibson IB, Bray M, Jin Y, Kondkar A, Nagalla S, Hadjout-Rabi N, Smith TC, Covarrubias D, Jones SN, Ahmad F, Stolla M, Kong X, Fang Z, Bergmeier W, Shaw C, Leal SM, Bray PF. Human genome-wide association and mouse knockout approaches identify platelet supervillin as an inhibitor of thrombus formation under shear stress. Circulation 2012; 125:2762-71. [PMID: 22550155 DOI: 10.1161/circulationaha.112.091462] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High shear force critically regulates platelet adhesion and thrombus formation during ischemic vascular events. To identify genetic factors that influence platelet thrombus formation under high shear stress, we performed a genome-wide association study and confirmatory experiments in human and animal platelets. METHODS AND RESULTS Closure times in the shear-dependent platelet function analyzer (PFA)-100 were measured on healthy, nondiabetic European Americans (n=125) and blacks (n=116). A genome-wide association (P<5×10(-8)) was identified with 2 single-nucleotide polymorphisms within the SVIL gene (chromosome 10p11.23) in African Americans but not European Americans. Microarray analyses of human platelet RNA demonstrated the presence of SVIL isoform 1 (supervillin) but not muscle-specific isoforms 2 and 3 (archvillin, SmAV). SVIL mRNA levels were associated with SVIL genotypes (P≤0.02) and were inversely correlated with PFA-100 closure times (P<0.04) and platelet volume (P<0.02). Leukocyte-depleted platelets contained abundant levels of the ≈205-kDa supervillin polypeptide. To assess functionality, mice lacking platelet supervillin were generated and back-crossed onto a C57BL/6 background. Compared with controls, murine platelets lacking supervillin were larger by flow cytometry and confocal microscopy and exhibited enhanced platelet thrombus formation under high-shear but not low-shear conditions. CONCLUSIONS We show for the first time that (1) platelets contain supervillin; (2) platelet thrombus formation in the PFA-100 is associated with human SVIL variants and low SVIL expression; and (3) murine platelets lacking supervillin exhibit enhanced platelet thrombus formation at high shear stress. These data are consistent with an inhibitory role for supervillin in platelet adhesion and arterial thrombosis.
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Affiliation(s)
- Leonard C Edelstein
- Cardeza Foundation for Hematologic Research, Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Curtis Building, Room 324, 1015 Walnut St, Philadelphia, PA 19107, USA
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27
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Human deficiencies of fucosylation and sialylation affecting selectin ligands. Semin Immunopathol 2012; 34:383-99. [PMID: 22461019 DOI: 10.1007/s00281-012-0304-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Selectins are carbohydrate-binding adhesion molecules that are required for leukocyte trafficking to secondary lymphoid organs and to sites of infection. They interact with fucosylated and sialylated ligands bearing sialyl-Lewis X as a minimal carbohydrate structure. With this in mind, it should be expected that individuals with deficient fucosylation or sialylation show immunodeficiency. However, as this review shows, the picture appears to be more complex and more interesting. Although there are only few patients with such glycosylation defects, they have turned out to be very instructive for our understanding of the functions of fucosylation and sialylation in immunity, development and hemostasis.
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28
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Jones C, Denecke J, Sträter R, Stölting T, Schunicht Y, Zeuschner D, Klumperman J, Lefeber DJ, Spelten O, Zarbock A, Kelm S, Strenge K, Haslam SM, Lühn K, Stahl D, Gentile L, Schreiter T, Hilgard P, Beck-Sickinger AG, Marquardt T, Wild MK. A novel type of macrothrombocytopenia associated with a defect in α2,3-sialylation. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:1969-77. [PMID: 21864493 DOI: 10.1016/j.ajpath.2011.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 05/25/2011] [Accepted: 06/03/2011] [Indexed: 01/15/2023]
Abstract
We describe a novel type of human thrombocytopenia characterized by the appearance of giant platelets and variable neutropenia. Searching for the molecular defect, we found that neutrophils had strongly reduced sialyl-Lewis X and increased Lewis X surface expression, pointing to a deficiency in sialylation. We show that the glycosylation defect is restricted to α2,3-sialylation and can be detected in platelets, neutrophils, and monocytes. Platelets exhibited a distorted structure of the open canalicular system, indicating defective platelet generation. Importantly, patient platelets, but not normal platelets, bound to the asialoglycoprotein receptor (ASGP-R), a liver cell-surface protein that removes desialylated thrombocytes from the circulation in mice. Taken together, this is the first type of human thrombocytopenia in which a specific defect of α2,3-sialylation and an induction of platelet binding to the liver ASGP-R could be detected.
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Affiliation(s)
- Claire Jones
- Max Planck Institute for Molecular Biomedicine, Münster, Germany
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29
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Abstract
Platelets are a remarkable mammalian adaptation that are required for human survival by virtue of their ability to prevent and arrest bleeding. Ironically, however, in the past century, the platelets' hemostatic activity became maladaptive for the increasingly large percentage of individuals who develop age-dependent progressive atherosclerosis. As a result, platelets also make a major contribution to ischemic thrombotic vascular disease, the leading cause of death worldwide. In this brief review, I provide historical descriptions of a highly selected group of topics to provide a framework for understanding our current knowledge and the trends that are likely to continue into the future of platelet research. For convenience, I separate the eras of platelet research into the "Descriptive Period" extending from ~1880-1960 and the "Mechanistic Period" encompassing the past ~50 years since 1960. We currently are reaching yet another inflection point, as there is a major shift from a focus on traditional biochemistry and cell and molecular biology to an era of single molecule biophysics, single cell biology, single cell molecular biology, structural biology, computational simulations, and the high-throughput, data-dense techniques collectively named with the "omics postfix". Given the progress made in understanding, diagnosing, and treating many rare and common platelet disorders during the past 50 years, I think it appropriate to consider it a Golden Age of Platelet Research and to recognize all of the investigators who have made important contributions to this remarkable achievement..
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Affiliation(s)
- Barry S. Coller
- Laboratory of Blood and Vascular Biology, Rockefeller University, 1230 York Avenue, New York, NY 10065, Tel: 212-327-7490, Fax: 212-327-7493
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30
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Okita R, Hihara J, Konishi K, Osaki A, Fujimura K. Successful perioperative management for a breast cancer patient with Bernard–Soulier syndrome. Breast Cancer 2010; 19:88-92. [DOI: 10.1007/s12282-010-0241-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
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31
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FLNA p.V528M substitution is neither associated with bilateral periventricular nodular heterotopia nor with macrothrombocytopenia. J Hum Genet 2010; 55:844-6. [PMID: 20844545 DOI: 10.1038/jhg.2010.114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Filamin A is encoded by the FLNA gene on chromosome Xq28 and functions in cross-linking actin filaments into orthogonal networks in the cortical cytoplasm. FLNA p.V528M was initially detected in a female autopsy case of X-linked bilateral periventricular nodular heterotopia (BPNH), a neuronal migration disorder characterized by subependymal nodules of gray matter. During our mutation analysis of FLNA in a boy with apparent X-linked thrombocytopenia, we detected the p.V528M variant. The patient, mother and sister, who were heterozygous for the substitution, did not have BPNH. We observed an allele frequency of 4.8% in healthy control Japanese, but did not observe the variant in Caucasian subjects. Hemizygous controls had a normal platelet count and size. We suggest that p.V528M is neither associated with BPNH nor with thrombocytopenia and giant platelets, and represents a functional polymorphism.
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32
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Sandrock K, Knöfler R, Greinacher A, Fürll B, Gerisch S, Schuler U, Gehrisch S, Busse A, Zieger B. Novel Mutation in Bernard-Soulier Syndrome. ACTA ACUST UNITED AC 2010; 37:278-284. [PMID: 21113250 DOI: 10.1159/000320255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 08/17/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND: Bernard-Soulier syndrome (BSS) is a severe congenital bleeding disorder characterized by thrombocytopenia, thrombocytopathy and decreased platelet adhesion. BSS results from genetic alterations of the glycoprotein (GP) Ib/IX/V complex. METHODS: We report on a patient demonstrating typical BSS phenotype (thrombocytopenia with giant platelets, bleeding symptoms). However, BSS was not diagnosed until he reached the age of 39 years. RESULTS: Flow cytometry of the patient's platelets revealed absence of GPIb/IX/V receptor surface expression. In addition, immunofluorescence analysis of patient's platelets demonstrated very faint staining of GPIX. A novel homozygous deletion comprising 11 nucleotides starting at position 1644 of the GPIX gene was identified using molecular genetic analysis. CONCLUSIONS: The novel 11-nucleotide deletion (g.1644_1654del11) was identified as causing the bleeding disorder in the BSS patient. This homozygous deletion includes the last 4 nucleotides of the Kozak sequence as well as the start codon and the following 4 nucleotides of the coding sequence. The Kozak sequence is a region indispensable for the initiation of the protein translation process, thus preventing synthesis of functional GPIX protein in the case of deletion.
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Affiliation(s)
- Kirstin Sandrock
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg i.Br., Germany
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Bilal RH, Moideen I, Pyke L, Makahleh Z, Fernandez-Jimenez P, Hasan R. Off-Pump Coronary Artery Bypass Grafting in a Patient With Bernard-Soulier Syndrome. Ann Thorac Surg 2010; 90:284-5. [DOI: 10.1016/j.athoracsur.2009.11.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 11/15/2009] [Accepted: 11/19/2009] [Indexed: 11/17/2022]
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Xu LM, Sun GB, Wang P, Sun N, Hu QP, Cao FF, Peng B, Zhang DH. Single novel mutation in transmembrane region of glycoprotein (GP) IX affects GP Ib- IX complex expression and causes Bernard-Soulier syndrome. Br J Haematol 2010; 150:627-9. [PMID: 20497174 DOI: 10.1111/j.1365-2141.2010.08241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peitsidis P, Datta T, Pafilis I, Otomewo O, Tuddenham EGD, Kadir RA. Bernard Soulier syndrome in pregnancy: a systematic review. Haemophilia 2010; 16:584-91. [PMID: 20070385 DOI: 10.1111/j.1365-2516.2009.02137.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib-IX-V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder.
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Affiliation(s)
- P Peitsidis
- Royal Free Hospital, Obstetrics and Gynaecology, London, UK
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A novel homozygous 8-base pair deletion mutation in the glycoprotein Ibα gene in a patient with Bernard–Soulier syndrome. Blood Coagul Fibrinolysis 2009; 20:470-4. [DOI: 10.1097/mbc.0b013e32832b27fa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Thrombocytopenia is one of the commonest haematological problems in neonates, affecting at least 25% of all admissions to neonatal intensive care units (NICUs) [Murray NA, Howarth LJ, McCloy MP et al. Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients. Transfus Med 2002;12:35-41; Garcia MG, Duenas E, Sola MC et al. Epidemiologic and outcome studies of patients who received platelet transfusions in the neonatal intensive care unit. J Perinatol 2001;21:415-20; Del Vecchio A, Sola MC, Theriaque DW et al. Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple transfusions. Transfusion 2001;41:803-8]. Although a long list of disorders associated with neonatal thrombocytopenia can be found in many textbooks, newer classifications based on the timing of onset of thrombocytopenia (early vs. late) are more useful for planning diagnostic investigations and day-to-day management. The mainstay of treatment of neonatal thrombocytopenia remains platelet transfusion although it is important to note that no studies have yet shown clinical benefit of platelet transfusion in this setting. Indeed some reports even suggest that there may be significant adverse effects of platelet transfusion in neonates, including increased mortality, and that the effects of transfusion may differ in different groups of neonates with similar degrees of thrombocytopenia [Bonifacio L, Petrova A, Nanjundaswamy S, Mehta R. Thrombocytopenia related neonatal outcome in preterms. Indian J Pediatr 2007;74:269-74; Kenton AB, Hegemier S, Smith EO et al. Platelet transfusions in infants with necrotizing enterocolitis do not lower mortality but may increase morbidity. J Perinatol 2005;25:173-7]. There is also considerable variation in transfusion practice between different countries and between different neonatal units. Here we review recent progress in understanding the prevalence, causes and pathogenesis of thrombocytopenia in the newborn, the clinical consequences of thrombocytopenia and developments in neonatal platelet transfusion.
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Affiliation(s)
- Irene Roberts
- Paediatric Haematology, Imperial College, London, UK.
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Wiwanitkit V. Mutation-prone points in thrombin receptor. J Thromb Thrombolysis 2007; 25:190-2. [PMID: 18064407 DOI: 10.1007/s11239-007-0167-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 10/30/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Thrombin receptor (TR) is a G-protein-coupled receptor that transmits cellular responses to coagulant proteases in a variety of cell types in the vasculature and other tissues. Mutation within TR can be seen. Presently, the prediction of protein nanostructure and function is a great challenge in the proteomics and structural genomics era. METHODS To identify the points vulnerable to mutation is a new trend directed at expanding the knowledge on disorders in genomic and proteomic levels of diseases. In this paper, the author performed a bioinformatics analysis to find the mutation-prone positions in the amino acid sequence of TR. To identify those points in TR, a new bioinformatics tool, namely, GlobPlot was used. RESULTS According to this work, no position was identified to be resistant to mutation. CONCLUSION This means that TR is a very highly genetically unstable molecule. Thousands of types of mutation can be expected. Of interest, only a few sense mutations are mentioned in clinical settings. Therefore, many occulted sense mutations might still be detected.
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Affiliation(s)
- Viroj Wiwanitkit
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
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Freson K, Labarque V, Thys C, Wittevrongel C, Geet CV. What's new in using platelet research? To unravel thrombopathies and other human disorders. Eur J Pediatr 2007; 166:1203-10. [PMID: 17619901 PMCID: PMC2042511 DOI: 10.1007/s00431-007-0543-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 06/06/2007] [Indexed: 11/26/2022]
Abstract
This review on platelet research focuses on defects of adhesion, cytoskeletal organisation, signal transduction and secretion. Platelet defects can be studied by different laboratory platelet functional assays and morphological studies. Easy bruising or a suspected platelet-based bleeding disorder is of course the most obvious reason to test the platelet function in a patient. However, nowadays platelet research also contributes to our understanding of human pathology in other disciplines such as neurology, nephrology, endocrinology and metabolic diseases. Apart from a discussion on classical thrombopathies, this review will also deal with the less commonly known relation between platelet research and disorders with a broader clinical phenotype. Classical thrombopathies involve disorders of platelet adhesion such as Glanzmann thrombastenia and Bernard-Soulier syndrome, defective G protein signalling diseases with impaired phospholipase C activation, and abnormal platelet granule secretion disorders such as gray platelet disorder and delta-storage pool disease. Other clinical symptoms besides a bleeding tendency have been described in MYH9-related disorders and Duchenne muscular dystrophy due to adhesion defects, and also in disorders of impaired Gs signalling, in Hermansky Pudlack disease and Chediak Higashi disease with abnormal secretion. Finally, platelet research can also be used to unravel novel mechanisms involved in many neurological disorders such as depression and autism with only a subclinical platelet defect.
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Affiliation(s)
- Kathleen Freson
- Center for Molecular and Vascular Biology, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Dağistan N, Kunishima S. First Turkish case of Bernard-Soulier syndrome associated with GPIX N45S. Acta Haematol 2007; 118:146-8. [PMID: 17804902 DOI: 10.1159/000107926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 04/28/2007] [Indexed: 11/19/2022]
Abstract
Bernard-Soulier syndrome (BSS) is a rare bleeding disorder characterized by giant platelets, thrombocytopenia, and a prolonged bleeding time. It is caused by homozygous defects in the glycoprotein (GP) Ib/IX/V complex, which is the receptor for the von Willebrand factor. We examined a Turkish patient with suspected BSS to identify a molecular basis. Flow cytometric analysis revealed that platelet GPIb alpha and GPIX expression was markedly reduced and DNA sequence analysis showed a homozygous N45S missense mutation in the GPIX gene. Haplotype analysis revealed that the family had the same disease haplotype associated with the GPIX N45S commonly found in Northern European BSS. This is the first non-Caucasian Turkish BSS case due to GPIX N45S and is likely the result of a recurrent mutational event.
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Affiliation(s)
- Necati Dağistan
- Department of Hematology, Gölcük Military Hospital, Gölcük, Turkey.
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Gohda F, Uchiumi H, Handa H, Matsushima T, Tsukamoto N, Morita K, Amagai H, Murakami M, Murakami H, Nojima Y, Karasawa M. Identification of inherited macrothrombocytopenias based on mean platelet volume among patients diagnosed with idiopathic thrombocytopenia. Thromb Res 2007; 119:741-6. [PMID: 16916536 DOI: 10.1016/j.thromres.2006.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 06/23/2006] [Accepted: 06/23/2006] [Indexed: 10/24/2022]
Abstract
Inherited macrothrombocytopenia is a rare illness that is often misdiagnosed as idiopathic thrombocytopenia (ITP), a more widespread acquired disease. Automated blood cell counters in routine clinical use usually miss giant platelets and underestimate mean platelet volume (MPV). Incorrect diagnoses might expose patients to a risk of unnecessary treatment. The ADVIA 120 hematology counter efficiently detects large platelets based on two-dimensional laser light scatter. The present study measures and re-evaluates MPV using the ADVIA 120 in 112 patients who had initially been diagnosed with ITP. We identified 11 unrelated patients as having probable macrothrombocytopenia (average MPV of 19.2+/-3.8 fL; normal range 7.8-10.2). Functional, phenotypical and DNA analyses confirmed that three of these patients had Bernard-Soulier syndrome and one had MYH9-related disease, both of which are the most common forms of inherited macrothrombocytopenia. We stress that a conventional automated hematology analyzer had overlooked giant platelets in these patients, and that all of them had received high-dose steroid therapy and/or splenectomy before this study according to a diagnosis of ITP. Thus, checking MPV using the ADVIA 120 in thrombocytopenic patients is a useful method of correctly diagnosing inherited macrothrombocytopenia, and thus avoiding patient exposure to unnecessary and sometimes toxic treatment.
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Affiliation(s)
- Fumito Gohda
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Roberts IA, Murray NA. Thrombocytopenia in the Newborn. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kunishima S, Sako M, Yamazaki T, Hamaguchi M, Saito H. Molecular genetic analysis of a variant Bernard?Soulier syndrome due to compound heterozygosity for two novel glycoprotein Ib? mutations. Eur J Haematol 2006; 77:501-12. [PMID: 16978236 DOI: 10.1111/j.0902-4441.2006.t01-1-ejh2817.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bernard-Soulier syndrome (BSS) is a rare bleeding disorder characterized by giant platelets, thrombocytopenia, and prolonged bleeding time. It is caused by abnormalities in the glycoprotein (GP) Ib/IX/V complex, the receptor for von Willebrand factor (vWF). Most cases of BSS described so far involve quantitative rather than qualitative defects in the complex. In this study, we investigated the effects of two naturally occurring mutations in the GPIbbeta gene, C122S and 443delG, on the expression of the GPIb/IX complex identified in a variant type of BSS in which the platelets had severely reduced GPIbalpha ( approximately 10%) and less markedly reduced GPIbbeta and GPIX ( approximately 20%) expression. Immunoblot analysis showed the absence of non-reduced GPIb (GPIbalpha/GPIbbeta) in the patient's platelets. Transient transfection experiments in 293T cells revealed the expression of GPIbbeta Ser122 polypeptide and absence of GPIbbeta 443delG polypeptide. Although no disulfide-linked association was observed between GPIbbeta Ser122 and GPIbalpha, GPIbbeta Ser122 was non-covalently associated with both GPIbalpha and GPIX subunits on the cell surface when cotransfected with wild-type GPIbalpha and GPIX. Chinese hamster ovary cells stably expressing GPIbalpha/Ibbeta Ser122/IX had the ability to bind soluble vWF and to aggregate in the presence of ristocetin. These results suggest that despite disruption of the disulfide linkage between GPIbalpha and GPIbbeta, GPIb/IX is formed, but its stability may be impaired, resulting in low levels of the complex on the platelet membranes.
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Affiliation(s)
- Shinji Kunishima
- Department of Hemostasis and Thrombosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
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Bowers MJ, Orr NJ, Dempsey S, Alexander HD. Molecular genetics and transfusion management in a child with Bernard Soulier syndrome. Blood Coagul Fibrinolysis 2006; 17:409-11. [PMID: 16788318 DOI: 10.1097/01.mbc.0000233372.33852.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We present a case of Bernard Soulier syndrome in a 9-year-old boy caused by a novel genetic mutation. This child was shown to be homozygous for a single nucleotide deletion (c.1077delG) in the GP1BA gene not previously reported. Clinically, the boy has become refractory to platelet transfusions with both allo-antibodies and iso-antibodies and a massive transfusion requirement for ongoing haemorrhage. We describe the critical role that the blood product transfusion continues to play in the management of Bernard Soulier syndrome and discuss therapeutic options in these patients.
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Saito H, Matsushita T, Yamamoto K, Kojima T, Kunishima S. Giant platelet syndrome. ACTA ACUST UNITED AC 2006; 10 Suppl 1:41-6. [PMID: 16188632 DOI: 10.1080/10245330512331389881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Saito
- Nagoya Medical Center and Nagoya University School of Medicine, Nagoya, Japan
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Kunishima S, Yamada T, Hamaguchi M, Saito H. Bernard-Soulier Syndrome due to GPIX W127X Mutation in Japan Is Frequently Misdiagnosed as Idiopathic Thrombocytopenic Purpura. Int J Hematol 2006; 83:366-7. [PMID: 16757441 DOI: 10.1532/ijh97.06017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kunishima S, Imai T, Hamaguchi M, Saito H. Novel heterozygous missense mutation in the second leucine rich repeat of GPIbalpha affects GPIb/IX/V expression and results in macrothrombocytopenia in a patient initially misdiagnosed with idiopathic thrombocytopenic purpura. Eur J Haematol 2006; 76:348-55. [PMID: 16519708 DOI: 10.1111/j.1600-0609.2005.00612.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recent studies have shown that heterozygous carriers of the bleeding disorder Bernard-Soulier syndrome are occasionally identified as isolated case of giant platelet disorder/macrothrombocytopenia or misdiagnosed with idiopathic thrombocytopenic purpura (ITP). We describe here a patient with congenital macrothrombocytopenia who had been diagnosed with ITP. On peripheral blood smears, platelet diameter was approximately 30% larger than normal controls. In the patient's platelets, the expression level of the GPIbIX complex was slightly decreased (70-80% of normal control). Densitometric analysis of immunoblots showed GPIbalpha to be approximately 52% of normal. DNA sequencing analysis revealed a novel heterozygous missense mutation in the GPIbalpha gene that converts Tyr to Asp at residue 54 (Y54D) in the second leucine-rich repeat. Mutant GPIbalpha protein was not detected in the patient's platelets. Transient transfection studies demonstrated that mutant GPIbalpha affects complex expression. These findings suggest that null expression of the mutant GPIbalpha causes decreased density of the complex and results in macrothrombocytopenia.
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Affiliation(s)
- Shinji Kunishima
- Department of Hemostasis and Thrombosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
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Abstract
Congenital macrothrombocytopenias comprise a heterogeneous group of rare disorders, characterized by abnormal giant platelets, thrombocytopenia and bleeding tendency with variable severity. Many of these disorders share common clinical and laboratory features, making accurate diagnosis difficult and patients are often misdiagnosed with and treated for idiopathic thrombocytopenic purpura. Recent progress in the elucidation of underlying defects and further developments of specific diagnostic techniques for several congenital macrothrombocytopenias have renewed our approach to the classification and the diagnosis of the disease. This review summarizes the current knowledge on the clinical and laboratory features of common congenital macrothrombocytopenias and discusses how that knowledge aids in making a proper diagnosis.
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Affiliation(s)
- Shinji Kunishima
- Department of Hemostasis and Thrombosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
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