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Xu F, Zhang K, Xu Q, Ye L, Zeng M, Jin Y, Wang M, Yang L. Analysis of PROC mutations and clinical features in 22 unrelated families with inherited protein C deficiency. Ann Hematol 2024; 103:645-652. [PMID: 37950050 DOI: 10.1007/s00277-023-05487-w] [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: 05/22/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
Currently, limited information is available in the literature regarding the relationships between PROC mutations and clinical features in Chinese individuals. We aimed to characterize severe congenital Protein C deficiency in 22 unrelated Chinese families in a tertiary hospital by analyzing its clinical manifestation, associated risk factors, and gene mutations. We measured protein C activity and antigen levels for all participants, screened them for mutations in the PROC gene, and analyzed the clinical features of each family to identify commonalities and differences. The analysis revealed a total of 75 individuals with PCD and 16 different PROC mutations, including 12 missense mutations and 4 deletion mutations. Among them, 11 who were compound heterozygotes or homozygotes for mutations tended to develop symptoms at a younger age without any clear triggers. In contrast, the remaining 64 individuals who were heterozygotes for mutations often had clear triggers for their symptoms and experienced a milder course of the disease. It is worth noting that the mutation c.565C > T occurred most frequently, being identified in 8 out of 22 families (36%). Our team also reported five novel mutations, including c.742-744delAAG, c.383G > A, c.997G > A, c.1318C > T, and c.833T > C mutations. The identification of five novel mutations adds to the richness of the Human Genome Database. Asymptomatic heterozygotes are not uncommon, and they are prone to develop symptoms with obvious triggers. The evidence presented strongly suggest that asymptomatic individuals with family history of protein C deficiency can benefit from mutational analysis of PROC gene.
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Affiliation(s)
- Fei Xu
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Ke Zhang
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Qiyu Xu
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Longying Ye
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Manlin Zeng
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Yanhui Jin
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Mingshan Wang
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China
| | - Lihong Yang
- Department of Laboratory Medicine, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, China.
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Zhang Z, Yang Z, Chen M, Li Y. Compound heterozygous protein C deficiency with pulmonary embolism caused by a novel PROC gene mutation: Case report and literature review. Medicine (Baltimore) 2022; 101:e31221. [PMID: 36281079 PMCID: PMC9592271 DOI: 10.1097/md.0000000000031221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RATIONALE Protein C is an anticoagulation agent, and protein C deficiency results in vascular thrombosis disease. Hereditary protein C deficiency is a risk factor for pulmonary embolism in adults. Pathogenic variants of the Protein C, Inactivator Of Coagulation Factors Va And VIIIa (PROC) gene which encodes protein C have been identified as a cause of protein C deficiency. PATIENT CONCERNS We describe a patient with a novel mutation in the PROC gene who was diagnosed with pulmonary embolism in a Chinese family. DIAGNOSIS According to the results of the pulmonary computed tomography angiography (CTA) and the level of blood protein C, the patient was diagnosed with pulmonary embolism caused by protein C deficiency. INTERVENTIONS Whole-exome sequencing (WES) was performed for the molecular analysis. OUTCOME The results of patient's deoxyribonucleic acid revealed a heterozygous mutation (c.237 + 5G > A) in intron 3 of the PROC gene. His father also harbored the same mutation in the PROC gene. We also reviewed the protein C deficiencies caused by PROC gene mutations in cases. LESSONS A novel mutation in intron 3 of PROC gene has not been previously reported in patients with pulmonary embolism caused by protein C deficiency. After anticoagulation therapy, the patient recovered, and CT showed resolution of the thrombosis. Pulmonary embolism may be caused by protein C deficiency and the rare compound heterozygous mutation in intron 3 of the PROC gene could cause protein C deficiency via impairment of the secretory activity of protein C.
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Affiliation(s)
- Zhaorui Zhang
- Department of Respiration, Eighth Medical Center of Chinese PLA General Hospital, Beijing City, People’s Republic of China
| | - Zhen Yang
- Department of Respiration, Eighth Medical Center of Chinese PLA General Hospital, Beijing City, People’s Republic of China
| | - Mei Chen
- Kingmed Diagnostic Group Co.Ltd, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Yuzhu Li
- Department of Respiratory Disease, Hainan Hospital of Chinese PLA General Hospital, Hainan Province, People’s Republic of China
- * Correspondence: Yuzhu Li, Department of Respiration, The Hainan Hospital of PLA General Hospital, Haitang Harbour, Sanya City, Hainan Province 572013, People’s Republic of China (e-mail: )
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Togashi T, Meguro-Horike M, Nagaya S, Sugihara S, Ichinohe T, Araiso Y, Yamaguchi K, Mori K, Imai Y, Kuzasa K, Horike SI, Asakura H, Watanabe A, Morishita E. Molecular genetic analysis of inherited protein C deficiency caused by the novel large deletion across two exons of PROC. Thromb Res 2020; 188:115-118. [PMID: 32199175 DOI: 10.1016/j.thromres.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/01/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Tomoki Togashi
- Department of Laboratory Sciences, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
| | | | - Satomi Nagaya
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Sayaka Sugihara
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yuhei Araiso
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Koichi Yamaguchi
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kotaro Mori
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yuta Imai
- Department of Laboratory Sciences, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kana Kuzasa
- Department of Laboratory Sciences, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shin-Ichi Horike
- Advanced Science Research Center, Kanazawa University, Kanazawa, Japan
| | - Hidesaku Asakura
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
| | - Atsushi Watanabe
- Division of Clinical Genetics, Kanazawa University Hospital, Kanazawa, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan; Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan.
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Yue Y, Liu S, Han X, Xiao L, Huang Q, Li S, Zhuang K, Yang M, Zou C, Fu Y. Pathogenic variants of PROC gene caused type I activity deficiency in a familial Chinese venous thrombosis. J Cell Mol Med 2019; 23:7099-7104. [PMID: 31338992 PMCID: PMC6787509 DOI: 10.1111/jcmm.14563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 01/01/2023] Open
Abstract
Pathogenic mutation of protein C (PROC) gene results into the deficiency of PROC activity. This study aimed to identify the pathogenic genetic variants and to explore the functional consequence in Chinese familial venous thrombosis (VTE). Whole exome sequencing was performed to identify the pathogenic variants of anticoagulant factors. Serum coagulation and anti-coagulation factors activity were assayed to evaluate the genetic association. Functional study of PROC antigen secretion deficiency was conducted in VTE subjects and in vitro cell lines. One rare pathogenic variant (p.Ala178Pro) was identified in the four VTE subjects but not in the normal subjects from the family. An inframeshift variant (rs199469469) was also identified in a paediatric subject of the pedigree. Further evaluation of serum PROC activity levels in p.Ala178Pro variants VTE carriers showed significantly lower PROC activity compared to non-carriers. Furthermore, in vitro study showed that the p.Ala178Pro mutant cells had a consistent reduction in concentration of PROC antigen. In conclusions, our study demonstrated the pathogenic variant (p.Ala178Pro) contributed to PROC type I activity deficiency, which may be due to decreased secretion of PROC.
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Affiliation(s)
- Yongjian Yue
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Shengguo Liu
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Xuemei Han
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Lu Xiao
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
- The Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenGuangdongChina
| | - Qijun Huang
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Shulin Li
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Kaixue Zhuang
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Mo Yang
- The Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenGuangdongChina
| | - Chang Zou
- Clinical Medical Research Center, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
| | - Yingyun Fu
- Key Laboratory of Shenzhen Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Institute of Shenzhen Respiratory Diseases, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan UniversityShenzhen People's HospitalShenzhenGuangdongChina
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