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Pinto P, Ghosh K, Shetty S. F8 gene mutation profile in Indian hemophilia A patients: Identification of 23 novel mutations and factor VIII inhibitor risk association. Mutat Res 2016; 786:27-33. [PMID: 26897466 DOI: 10.1016/j.mrfmmm.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/20/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
'FVIII inhibitors', especially in severe hemophilia A (HA) patients, is a serious adverse effect that complicates their clinical management. Many genetic and non-genetic risk factors have been proposed for FVIII inhibitor development, diverse in different population groups. This is the first study in Indian hemophiliacs that analyzes inhibitor risk in relation to the complete F8 mutation profile, in a case-control study that included 145 Indian severe HA patients, i.e. 69 inhibitor positive (with 18 inhibitor concordant/discordant family members), and 58 inhibitor negative patients, after informed consent. While 53.54% (68/127) index cases were positive for intron 22 or intron 1 inversions, 55 causative F8 mutations were detected in the 59 inversion negative patients, of which 23 were novel mutations (in 24 patients) and 32 were reported earlier (in 35 patients). A higher incidence of mutations, in the C1 and C2 domains in inhibitor positive patients, and in the A1 domain in inhibitor negative patients was observed, though not significantly different. The study suggests that large F8 rearrangements (significantly higher in the inhibitor positive patients) pose the highest risk, while missense mutations (significantly higher in the inhibitor negative patients) pose the lowest risk of inhibitor development in Indian hemophilia A patients.
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Affiliation(s)
- Patricia Pinto
- National Institute of Immunohaematology (ICMR), 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai 400 012, India
| | - Kanjaksha Ghosh
- National Institute of Immunohaematology (ICMR), 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai 400 012, India
| | - Shrimati Shetty
- National Institute of Immunohaematology (ICMR), 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai 400 012, India.
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Pinto P, Shelar T, Nawadkar V, Mirgal D, Mukaddam A, Nair P, Kasatkar P, Gaikwad T, Ali S, Jadli A, Patil R, Parihar A, Shanbhag S, Kulkarni B, Ghosh K, Shetty S. The Epidemiology of FVIII Inhibitors in Indian Haemophilia A Patients. Indian J Hematol Blood Transfus 2014; 30:356-63. [PMID: 25435742 DOI: 10.1007/s12288-014-0342-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
A serious complication of replacement therapy in patients with bleeding disorders is the development of 'inhibitors', particularly FVIII inhibitors in haemophilia A patients. This leads to an increase in the management cost, morbidity and mortality, especially post-operatively. The mechanism of FVIII inhibitor development is quite complex and it is difficult to predict inhibitor development, but a prompt and accurate diagnosis is critical as early therapy can save lives. The aim of this study was to screen patients with bleeding disorders in India for inhibitors, and to analyse and compare the prevalence of inhibitors in different regions in India. Patient details were recorded and blood samples were collected in sodium citrate vacutainers from 1,505 patients with bleeding disorders, in different cities in India. Coagulation and inhibitor screening assays were performed, followed by the Bethesda assay in inhibitor positive samples to quantify the FVIII inhibitor titre. Out of the 1,505 samples analysed, 1,285 were Haemophilia A patients, out of which 78 (6.07 %) were positive for 'FVIII Inhibitors'. The highest incidence of FVIII Inhibitors was seen in South India (13.04 %). The highest incidence of 20.99 % was observed in Chennai, followed by Hyderabad (13.33 %), Jammu (9.90 %) and Guwahati (8.51 %), respectively, with respect to the samples analysed. The other regions showed an inhibitor incidence <8 %. The incidence of inhibitors in haemophilia A patients is different in different regions of India; this may be due to the intensity of treatment, type of product or the genetic characteristics of these patients.
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Affiliation(s)
- Patricia Pinto
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Tejashree Shelar
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Vidhya Nawadkar
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Darshana Mirgal
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Alfiya Mukaddam
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Preethi Nair
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Priyanka Kasatkar
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Tejasvita Gaikwad
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Shahnaz Ali
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Anshul Jadli
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Rucha Patil
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Anita Parihar
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Sharda Shanbhag
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Bipin Kulkarni
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Kanjaksha Ghosh
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
| | - Shrimati Shetty
- Department of Haemostasis & Thrombosis, National Institute of Immunohaematology, Indian Council of Medical Research, 13th Floor, New Multistoreyed Building, KEM Hospital Campus, Parel, Mumbai, 400 012 India
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