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Seidizadeh O, Baronciani L, Lillicrap D, Peyvandi F. Application of genetic testing for the diagnosis of von Willebrand disease. J Thromb Haemost 2024; 22:2115-2128. [PMID: 38762018 DOI: 10.1016/j.jtha.2024.05.006] [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: 01/12/2024] [Revised: 04/13/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
von Willebrand disease (VWD) is the most frequent inherited bleeding disorder, with an estimated symptomatic prevalence of 1 per 1000 in the general population. VWD is characterized by defects in the quantity, quality, or multimeric structure of von Willebrand factor (VWF), a glycoprotein being hemostatically essential in circulation. VWD is classified into 3 principal types: low VWF/type 1 with partial quantitative deficiency of VWF, type 3 with virtual absence of VWF, and type 2 with functional abnormalities of VWF, being classified as 2A, 2B, 2M, and 2N. A new VWD type has been officially recognized by the ISTH SSC on von Willebrand factor which has also been discussed by the joint ASH/ISTH/NHF/WFH 2021 guidelines (ie, type 1C), indicating patients with quantitative deficiency due to an enhanced VWF clearance. With the advent of next-generation sequencing technologies, the process of genetic diagnosis has substantially changed and improved accuracy. Therefore, nowadays, patients with type 3 and severe type 1 VWD can benefit from genetic testing as much as type 2 VWD. Specifically, genetic testing can be used to confirm or differentiate a VWD diagnosis, as well as to provide genetic counseling. The focus of this manuscript is to discuss the current knowledge on VWD molecular pathophysiology and the application of genetic testing for VWD diagnosis.
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Affiliation(s)
- Omid Seidizadeh
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. https://twitter.com/OmidSeidi
| | - Luciano Baronciani
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - David Lillicrap
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada. https://twitter.com/DavidLillicrap
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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Djordjevic A, Jovicic V, Lazovic D, Terzic D, Gacic J, Petrovic M, Matejic A, Salovic B, Radovic I, Jesic-Petrovic T, Ristic A, Soldatovic I. Acquired von Willebrand syndrome and post-operative drainage: a comparison of patients with aortic stenosis versus coronary artery disease. Gen Thorac Cardiovasc Surg 2024; 72:512-518. [PMID: 38280130 DOI: 10.1007/s11748-023-02007-5] [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: 10/28/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Degenerative aortic stenosis and coronary artery disease are considered to be the most prevalent cardiovascular diseases in industrialized countries. This study aims to determine the change over time in von Willebrand factor antigen, von Willebrand factor activity, and factor VIII and where there is a correlation with total post-operative drainage. METHODS The single-center retrospective study included 203 consecutive patients (64.5% male), undergoing coronary artery bypass surgery between March 1, 2019 and June 30, 2020 at the University Clinical Center of Serbia in the Clinic for Cardiac Surgery in Belgrade, Serbia. All patients 18 years or older who presented with isolated, hemodynamically significant aortic stenosis were included. The control group consisted of patients who presented with only coronary artery disease. RESULTS Between patients with only coronary artery disease and patients with coronary artery diseases and aortic stenosis, there was a statistically significant difference between pre-op and 1-month post-op fibrinogen, factor VIII, von Willebrand factor antigen, and von Willebrand factor (p < 0.001), post-op drainage, with overall lower drainage in coronary artery disease patients, and consistent increase in von Willebrand factor antigen, von Willebrand factor activity, and Factor VIII post-operatively in patients with coronary artery diseases and aortic stenosis. CONCLUSION This study has shown that there is a correlation between von Willebrand factor antigen, von Willebrand factor activity and total drainage to the level of statistical significance in aortic stenosis patients and in the overall study population.
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Affiliation(s)
- Aleksandar Djordjevic
- Department of Cardiac Surgery, University of Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Jovicic
- Department of Cardiac Surgery, University of Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Lazovic
- Department of Cardiac Surgery, University of Clinical Center of Serbia, Belgrade, Serbia
| | - Dusko Terzic
- Department of Cardiac Surgery, University of Clinical Center of Serbia, Belgrade, Serbia
| | - Jasna Gacic
- University Hospital Medical Center Bežanijska Kosa, Belgrade, Serbia
| | - Masa Petrovic
- Faculty of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000, Belgrade, Serbia.
- Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia.
| | - Aleksandar Matejic
- Faculty of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000, Belgrade, Serbia
- Institute for Orthopedic Surgery "Banjica", Belgrade, Serbia
| | - Bojana Salovic
- Faculty of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000, Belgrade, Serbia
| | - Ivana Radovic
- Faculty of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000, Belgrade, Serbia
- Blood and Transfusion Institute of Serbia, Belgrade, Serbia
| | - Tanja Jesic-Petrovic
- Public Primary Health Care Center Doboj, Doboj, Republic of Srpska, Bosnia and Herzegovina
| | - Arsen Ristic
- Department of Cardiac Surgery, University of Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, dr Subotića Starijeg 8, 11000, Belgrade, Serbia
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Tran AD, Waller E, Mack JM, Crary SE, Citla-Sridhar D. Mental health in persons with von Willebrand disease in the United States - a large national database study. J Thromb Haemost 2024; 22:1583-1590. [PMID: 38453024 DOI: 10.1016/j.jtha.2024.02.015] [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: 11/10/2023] [Revised: 01/31/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND There are very few large population-based studies studying mental health in persons with von Willebrand disease (PwVWD). OBJECTIVES We aim to assess prevalence of depression and anxiety in PwVWD over a period of 20 years and identify bleeding symptoms that may be more likely associated with depression and anxiety in PwVWD. METHODS This is a retrospective cohort study using a deidentified national dataset from 1118 hospitals with 176 million patients. Cases were defined as patients aged 0-110 years, both male and female, with von Willebrand disease (VWD), without hemophilia. Controls were defined as patients aged 0-110 years, both male and female, without VWD or hemophilia. We compared rates of depression and anxiety in cases and controls and by type of bleeding symptoms. RESULTS We identified 66 367 PwVWD and 183 890 766 controls. The prevalence of depression (23.12% vs 8.62%; p ≤ .00093; relative risk = 2.68) and anxiety (32.90% vs 12.29%; p ≤ .00093; relative risk = 2.68) was higher in PwVWD. Most of the bleeding symptoms were associated with higher rates of depression and anxiety in PwVWD with the highest rates with abnormal uterine bleeding, hematemesis, hemoptysis, hematuria, and melena. CONCLUSION Our study shows that mental health disorders in PwVWD are a significant health burden, and that burden is increased with documented bleeding symptoms. It is important that primary care physicians and hematologists caring for this population recognize this increased risk and appropriately screen and refer to mental health professionals.
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Affiliation(s)
- Andrew D Tran
- Division of Hematology/Oncology, Department of Pediatrics, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA; Arkansas Children's Hospital, Little Rock, Arkansas, USA.
| | - Emily Waller
- Division of Hematology/Oncology, Department of Pediatrics, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Joana M Mack
- Division of Hematology/Oncology, Department of Pediatrics, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA; Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Shelley E Crary
- Division of Hematology/Oncology, Department of Pediatrics, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA; Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Divyaswathi Citla-Sridhar
- Division of Hematology/Oncology, Department of Pediatrics, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA; Arkansas Children's Hospital, Little Rock, Arkansas, USA
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Sidonio RF, Lu A, Hale S, Caicedo J, Bullano M, Xing S. Early diagnosis of persons with von Willebrand disease using a machine learning algorithm and real-world data. Expert Rev Hematol 2024; 17:261-268. [PMID: 38779711 DOI: 10.1080/17474086.2024.2354925] [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: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Von Willebrand disease (VWD) is underdiagnosed, often delaying treatment. VWD claims coding is limited and includes no severity qualifiers; improved identification methods for VWD are needed. The aim of this study is to identify and characterize undiagnosed symptomatic persons with VWD in the US from medical insurance claims using predictive machine learning (ML) models. RESEARCH DESIGN AND METHODS Diagnosed and potentially undiagnosed VWD cohorts were defined using Komodo longitudinal US claims data (January 2015-March 2020). ML models were built using key characteristics predictive of VWD diagnosis from the diagnosed cohort. Two ML models predicted VWD diagnosis with the highest accuracy in females (random forest; 84%) and males (gradient boosting machine; 85%). Undiagnosed persons suspected to have VWD were identified using an 80% cutoff probability; profiles of key characteristics were constructed. RESULTS The trained ML models were applied to the undiagnosed cohort (28,463 females; 20,439 males) with suspected VWD. Fifty-two percent of undiagnosed females had heavy menstrual bleeding, a key pre-diagnosis symptom. Undiagnosed males tended to have more frequent medical procedures, hospitalizations, and emergency room visits compared with undiagnosed females. CONCLUSIONS ML algorithms successfully identified potentially undiagnosed symptomatic people with VWD, although many may remain undiagnosed and undertreated. External validation of the algorithms is recommended.
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Affiliation(s)
- Robert F Sidonio
- Aflac Cancer and Blood Disorders Center, Egleston Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Anan Lu
- Life Sciences Practice, Charles River Associates, Boston, MA, USA
| | - Sarah Hale
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - Jorge Caicedo
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - Mike Bullano
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
| | - Shan Xing
- US Medical, Takeda Pharmaceuticals USA Inc, Lexington, MA, USA
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Platton S, Baker P, Bowyer A, Keenan C, Lawrence C, Lester W, Riddell A, Sutherland M. Guideline for laboratory diagnosis and monitoring of von Willebrand disease: A joint guideline from the United Kingdom Haemophilia Centre Doctors' Organisation and the British Society for Haematology. Br J Haematol 2024; 204:1714-1731. [PMID: 38532595 DOI: 10.1111/bjh.19385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Sean Platton
- Royal London Hospital Haemophilia Centre, London, UK
| | - Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Hospital, Oxford, UK
| | - Annette Bowyer
- Department of Coagulation, Royal Hallamshire Hospital, Sheffield, UK
| | - Catriona Keenan
- Department of Haematology & the National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | | | - Will Lester
- Haemophilia Unit, University Hospitals, Birmingham, UK
| | - Anne Riddell
- Katharine Dormandy Haemophilia Centre, Royal Free Hospital, London, UK
| | - Megan Sutherland
- North West Genomic Laboratory Hub, Manchester University NHS Foundation Trust, Manchester, UK
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Salazar-Martín AG, Kalluri AS, Villanueva MA, Hughes TK, Wadsworth MH, Dao TT, Balcells M, Nezami FR, Shalek AK, Edelman ER. Single-Cell RNA Sequencing Reveals That Adaptation of Human Aortic Endothelial Cells to Antiproliferative Therapies Is Modulated by Flow-Induced Shear Stress. Arterioscler Thromb Vasc Biol 2023; 43:2265-2281. [PMID: 37732484 PMCID: PMC10659257 DOI: 10.1161/atvbaha.123.319283] [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: 03/10/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Endothelial cells (ECs) are capable of quickly responding in a coordinated manner to a wide array of stresses to maintain vascular homeostasis. Loss of EC cellular adaptation may be a potential marker for cardiovascular disease and a predictor of poor response to endovascular pharmacological interventions such as drug-eluting stents. Here, we report single-cell transcriptional profiling of ECs exposed to multiple stimulus classes to evaluate EC adaptation. METHODS Human aortic ECs were costimulated with both pathophysiological flows mimicking shear stress levels found in the human aorta (laminar and turbulent, ranging from 2.5 to 30 dynes/cm2) and clinically relevant antiproliferative drugs, namely paclitaxel and rapamycin. EC state in response to these stimuli was defined using single-cell RNA sequencing. RESULTS We identified differentially expressed genes and inferred the TF (transcription factor) landscape modulated by flow shear stress using single-cell RNA sequencing. These flow-sensitive markers differentiated previously identified spatially distinct subpopulations of ECs in the murine aorta. Moreover, distinct transcriptional modules defined flow- and drug-responsive EC adaptation singly and in combination. Flow shear stress was the dominant driver of EC state, altering their response to pharmacological therapies. CONCLUSIONS We showed that flow shear stress modulates the cellular capacity of ECs to respond to paclitaxel and rapamycin administration, suggesting that while responding to different flow patterns, ECs experience an impairment in their transcriptional adaptation to other stimuli.
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Affiliation(s)
- Antonio G. Salazar-Martín
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
| | - Aditya S. Kalluri
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
| | - Martin A. Villanueva
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Departments of Biology (M.A.V.), Massachusetts Institute of Technology, Cambridge
| | - Travis K. Hughes
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Department of Immunology, Harvard Medical School, Boston, MA (T.K.H., M.H.W., A.K.S.)
| | - Marc H. Wadsworth
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Department of Immunology, Harvard Medical School, Boston, MA (T.K.H., M.H.W., A.K.S.)
| | - Tyler T. Dao
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Biological Engineering (T.T.D.), Massachusetts Institute of Technology, Cambridge
| | - Mercedes Balcells
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
| | - Farhad R. Nezami
- Division of Cardiac Surgery (F.R.N.), Brigham and Women’s Hospital, Boston, MA
| | - Alex K. Shalek
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA (A.G.S.-M., M.A.V., T.T.D., A.K.S.)
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA (M.A.V., T.K.H., M.H.W., T.T.D., A.K.S.)
- Chemistry (A.K.S.), Massachusetts Institute of Technology, Cambridge
- Department of Immunology, Harvard Medical School, Boston, MA (T.K.H., M.H.W., A.K.S.)
| | - Elazer R. Edelman
- Institute for Medical Engineering and Science (A.G.S.-M., A.S.K., M.A.V., T.K.H., M.H.W., T.T.D., M.B., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Koch Institute for Integrative Cancer Research (T.K.H., M.H.W., A.K.S., E.R.E.), Massachusetts Institute of Technology (MIT), Cambridge, MA
- Division of Cardiovascular Medicine, Department of Medicine (E.R.E.), Brigham and Women’s Hospital, Boston, MA
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Alavi P, Yousef Abdualla R, Brown D, Mojiri A, Nagendran J, Lewis J, Bourque SL, Jahroudi N. Aging Is Associated With Organ-Specific Alterations in the Level and Expression Pattern of von Willebrand Factor. Arterioscler Thromb Vasc Biol 2023; 43:2183-2196. [PMID: 37732483 DOI: 10.1161/atvbaha.123.319255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND VWF (von Willebrand factor) is an endothelial-specific procoagulant protein with a major role in thrombosis. Aging is associated with increased circulating levels of VWF, which presents a risk factor for thrombus formation. METHODS Circulating plasma, cellular protein, and mRNA levels of VWF were determined and compared in young and aged mice. Major organs were subjected to immunofluorescence analyses to determine the vascular pattern of VWF expression and the presence of platelet aggregates. An in vitro model of aging, using extended culture time of endothelial cells, was used to explore the mechanism of age-associated increased VWF levels. RESULTS Increased circulating plasma levels of VWF with elevated levels of larger multimers, indicative of VWF functional activity, were observed in aged mice. VWF mRNA and cellular protein levels were significantly increased in the brains, lungs, and livers but not in the kidneys and hearts of aged mice. Higher proportion of small vessels in brains, lungs, and livers of aged mice exhibited VWF expression compared with young, and this was concomitant with increased platelet aggregate formation. Prolonged culture of endothelial cells resulted in increased cell senescence that correlated with increased VWF expression; VWF expression was specifically detected in senescent cultured endothelial cells and abolished in response to p53 knockdown. A significantly higher proportion of VWF expressing endothelial cells in vivo exhibited senescence markers SA-β-Gal (senescence-associated β-galactosidase) and p53 in aged mouse brains compared with that of the young. CONCLUSIONS Aging elicits a heterogenic response in endothelial cells with regard to VWF expression, leading to organ-specific increase in VWF levels and alterations in vascular tree pattern of expression. This is concomitant with increased platelet aggregate formation. The age-associated increase in VWF expression may be modulated through the process of cell senescence, and p53 transcription factor contributes to its regulation.
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Affiliation(s)
- Parnian Alavi
- Departments of Medicine (P.A., R.Y.A., A.M., N.J.), University of Alberta, Edmonton, Canada
| | - Radya Yousef Abdualla
- Departments of Medicine (P.A., R.Y.A., A.M., N.J.), University of Alberta, Edmonton, Canada
| | - Douglas Brown
- Oncology (D.B., J.L.), University of Alberta, Edmonton, Canada
| | - Anahita Mojiri
- Departments of Medicine (P.A., R.Y.A., A.M., N.J.), University of Alberta, Edmonton, Canada
- Now with Department of Cardiovascular Sciences, Houston Methodist Research Institute, TX (A.M.)
| | | | - John Lewis
- Oncology (D.B., J.L.), University of Alberta, Edmonton, Canada
| | - Stephane L Bourque
- Anesthesiology and Pain Medicine (S.L.B.), University of Alberta, Edmonton, Canada
| | - Nadia Jahroudi
- Departments of Medicine (P.A., R.Y.A., A.M., N.J.), University of Alberta, Edmonton, Canada
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Kontogiannis A, Matsas A, Valsami S, Livanou ME, Panoskaltsis T, Christopoulos P. Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age. J Clin Med 2023; 12:5702. [PMID: 37685769 PMCID: PMC10488471 DOI: 10.3390/jcm12175702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Heavy menstrual bleeding (HMB) is a common clinical condition affecting adolescent and adult women and compromising their quality of life. Primary hemostasis disorders, affecting platelet plug formation, can be the underlying cause of HMB. They comprise a heterogeneous group of diseases with Von Willebrand disease (VWD) being the most commonly diagnosed; other disorders in this group that have been linked to HMB include (a) Glanzmann thrombasthenia, (b) Bernard-Soulier syndrome, (c) Hermansky-Pudlak syndrome, (d) immune thrombocytopenia (ITP), and (e) Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD). Diagnosing these diseases can be challenging, as the basic laboratory investigations can be within the normal range. Thus, identification of specific clinical features and a thorough hematologic workup can be very important, providing the correct diagnosis. Proper diagnosis of the underlying disorder is important, as management may vary accordingly. Although disease-specific management guidelines exist for some of these disorders such as VWD and ITP, due to the rarity of most primary hemostasis disorders, the best approach for the management of HMB in these women remains elusive. The goal of this study was to create an informative, comprehensive review of the primary hemostasis disorders that have been linked to HMB. This study provides a summary of the basic published information regarding epidemiology, pathophysiology, clinical phenotype, diagnosis, and treatment of HMB in those diseases and serves as a reference guide for further reading.
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Affiliation(s)
- Athanasios Kontogiannis
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Alkis Matsas
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Effrosyni Livanou
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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Ocran E, Chornenki NLJ, Bowman M, Sholzberg M, James P. Gastrointestinal bleeding in von Willebrand patients: special diagnostic and management considerations. Expert Rev Hematol 2023; 16:575-584. [PMID: 37278227 DOI: 10.1080/17474086.2023.2221846] [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: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Severe and recurrent gastrointestinal (GI) bleeding caused by angiodysplasia is a significant problem in patients with von Willebrand disease (VWD) and in those with acquired von Willebrand syndrome (AVWS). At present, angiodysplasia-related GI bleeding is often refractory to standard treatment including replacement therapy with von Willebrand factor (VWF) concentrates and continues to remain a major challenge and cause of significant morbidity in patients despite advances in diagnostics and therapeutics. AREAS COVERED This paper reviews the available literature on GI bleeding in VWD patients, examines the molecular mechanisms implicated in angiodysplasia-related GI bleeding, and summarizes existing strategies in the management of bleeding GI angiodysplasia in patients with VWF abnormalities. Suggestions are made for further research directions. EXPERT OPINION Bleeding from angiodysplasia poses a significant challenge for individuals with abnormal VWF. Diagnosis remains a challenge and may require multiple radiologic and endoscopic investigations. Additionally, there is a need for enhanced understanding at a molecular level to identify effective therapies. Future studies of VWF replacement therapies using newer formulations as well as other adjunctive treatments to prevent and treat bleeding will hopefully improve care.
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Affiliation(s)
- Edwin Ocran
- Department of Medicine, Queen's University, Kingston, Canada
| | | | | | - Michelle Sholzberg
- Division of Hematology-Oncology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
| | - Paula James
- Department of Medicine, Queen's University, Kingston, Canada
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Tang GH, Thachil J, Bowman M, Bekdache C, James PD, Sholzberg M. Patient-centered care in von Willebrand disease: are we there yet? Expert Rev Hematol 2023; 16:641-649. [PMID: 37581602 DOI: 10.1080/17474086.2023.2243386] [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: 04/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Von Willebrand Disease is the most common inherited bleeding disorder. Paradoxically, affected individuals are often misdiagnosed and experience substantial diagnostic delay. There are sex-specific health disparities in VWD rooted in the stigmatization of vaginal bleeding, which leads to symptom dismissal, lack of timely access to care and lower health-related quality of life. AREAS COVERED Following the core elements of patient-centered care - respect for patient preferences, values, and needs, we describe the current state of VWD care. Challenges of diagnostic delay, serial misrecognition of abnormal bleeding, and symptom dismissal are barriers that disproportionately affect women with VWD. These negative effects are further amplified in individuals living in low- and middle-income countries. We describe the importance of coordinated multidisciplinary care, as well as the need for patient education and empowered self-advocacy. EXPERT OPINION While tremendous work has been done to improve the diagnosis and management of VWD, timely and high-quality research is urgently needed to address care gaps. Systemic changes such as resource investment, dedicated research funding for novel treatment modalities, and effective knowledge translation strategies to address structural barriers are needed to facilitate effective patient-centered care for VWD.
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Affiliation(s)
- Grace H Tang
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jecko Thachil
- Department of Hematology, Manchester University Hospitals, Manchester, UK
| | - Mackenzie Bowman
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Carine Bekdache
- Hematology-Oncology Clinical Research Group, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology, St. Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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11
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Dhanisha SS, Guruvayoorappan C. Pathological Implications of Mucin Signaling in Metastasis. Curr Cancer Drug Targets 2023; 23:585-602. [PMID: 36941808 DOI: 10.2174/1568009623666230320121332] [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: 06/10/2022] [Revised: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 03/23/2023]
Abstract
The dynamic mucosal layer provides a selective protective barrier for the epithelial cells lining the body cavities. Diverse human malignancies exploit their intrinsic role to protect and repair epithelia for promoting growth and survival. Aberrant expression of mucin has been known to be associated with poor prognosis of many cancers. However, the emergence of new paradigms in the study of metastasis recognizes the involvement of MUC1, MUC4, MUC5AC, MUC5B, and MUC16 during metastasis initiation and progression. Hence mucins can be used as an attractive target in future diagnostic and therapeutic strategies. In this review, we discuss in detail about mucin family and its domains and the role of different mucins in regulating cancer progression and metastasis. In addition, we briefly discuss insights into mucins as a therapeutic agent.
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Affiliation(s)
| | - Chandrasekharan Guruvayoorappan
- Laboratory of Immunopharmacology and Experimental Therapeutics, Division of Cancer Research, Regional Cancer Centre, Medical College Campus, University of Kerala, Thiruvananthapuram, Kerala, 695011, India
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12
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Javitt G, Yeshaya N, Khmelnitsky L, Fass D. Assembly of von Willebrand factor tubules with in vivo helical parameters requires A1 domain insertion. Blood 2022; 140:2835-2843. [PMID: 36179246 PMCID: PMC10653096 DOI: 10.1182/blood.2022017153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 09/23/2022] [Indexed: 01/05/2023] Open
Abstract
The von Willebrand factor (VWF) glycoprotein is stored in tubular form in Weibel-Palade bodies (WPBs) before secretion from endothelial cells into the bloodstream. The organization of VWF in the tubules promotes formation of covalently linked VWF polymers and enables orderly secretion without polymer tangling. Recent studies have described the high-resolution structure of helical tubular cores formed in vitro by the D1D2 and D'D3 amino-terminal protein segments of VWF. Here we show that formation of tubules with the helical geometry observed for VWF in intracellular WPBs requires also the VWA1 (A1) domain. We reconstituted VWF tubules from segments containing the A1 domain and discovered it to be inserted between helical turns of the tubule, altering helical parameters and explaining the increased robustness of tubule formation when A1 is present. The conclusion from this observation is that the A1 domain has a direct role in VWF assembly, along with its known activity in hemostasis after secretion.
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Affiliation(s)
- Gabriel Javitt
- Department of Chemical and Structural Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Noa Yeshaya
- Department of Chemical and Structural Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Lev Khmelnitsky
- Department of Chemical and Structural Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Deborah Fass
- Department of Chemical and Structural Biology, Weizmann Institute of Science, Rehovot, Israel
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13
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What have we learned about the patient's experience of von Willebrand disease? A focus on women. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:631-636. [PMID: 36485077 PMCID: PMC9820129 DOI: 10.1182/hematology.2022000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Von Willebrand disease (VWD), the most common inherited bleeding disorder (IBD), disproportionately affects females, given the hemostatic challenges they may encounter throughout their lifetimes. Despite this, research about VWD remains grossly underrepresented, particularly compared to hemophilia, which is historically diagnosed in males. Structural sexism, stigmatization of menstrual bleeding, delayed diagnosis, and a lack of timely access to care result in an increased frequency of bleeding events, iron deficiency, iron deficiency anemia, and a decreased quality of life. However, we are only beginning to recognize and acknowledge the magnitude of the burden of this disease. With an increasing number of studies documenting the experiences of women with IBDs and recent international guidelines suggesting changes to optimal management, a paradigm shift in recognition and treatment is taking place. Here, we present a fictional patient case to illustrate one woman's history of bleeding. We review the evidence describing the impact of VWD on quality of life, normalization of vaginal bleeding, diagnostic delays, and the importance of access to multidisciplinary care. Furthermore, we discuss considerations around reproductive decision-making and the intergenerational nature of bleeding, which often renders patients as caregivers. Through incorporating the patient perspective, we argue for an equitable and compassionate path to overcome decades of silence, misrecognition, and dismissal. This path moves toward destigmatization, open dialogue, and timely access to specialized care.
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14
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Chen M, Shen MC, Chang SP, Ma GC, Huang YC, Lin CY. Origin and timing of de novo variants implicated in type 2 von Willebrand disease. J Cell Mol Med 2022; 26:5403-5413. [PMID: 36226571 PMCID: PMC9639050 DOI: 10.1111/jcmm.17563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/30/2022] [Accepted: 09/11/2022] [Indexed: 12/03/2022] Open
Abstract
Very few studies have shown the real origin and timing of de novo variants (DNV) implicated in von Willebrand disease (VWD). We investigated four families with type 2 VWD. First, we conducted linkage analysis using single nucleotide variant genotyping to recognize the possible provenance of DNV. Second, we performed amplification refractory mutation system‐quantitative polymerase chain reaction to confirm the real origin of variant (~0% mutant cells) or presence of a genetic mosaic variant (0%–50% mutant cells) in three embryonic germ layer‐derived tissues and sperm cells. Then, three possible timings of DNV were categorized based on the relative likelihood of occurrence according to the number of cell divisions during embryogenesis. Two each with type 2B VWD (proband 1 p.Arg1308Cys, proband 4 p.Arg1306Trp) and type 2A VWD (proband 2 p.Leu1276Arg, proband 3 p.Ser1506Leu) were identified. Variant origins were identified for families 1, 2 and 3 and confirmed to originate from the mother, father and father, respectively. However, the father of family 4 was confirmed to have isolated germline mosaicism with 2.2% mutant sperm cells. Further investigation confirmed the paternal grandfather to be the origin of variant. Thus, we proposed that DNV originating from the two fathers most likely occurred at the single sperm cell, the one originating from the mother occurred at the zygote during the first few cellular divisions; alternatively, in family 4, the DNV most likely occurred at the early postzygotic development in the father. Our findings are essential for understanding genetic pathogenesis and providing accurate genetic counselling.
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Affiliation(s)
- Ming Chen
- Department of Genomic Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Ching Shen
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Department of Laboratory Medicine and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shun-Ping Chang
- Department of Genomic Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Gwo-Chin Ma
- Department of Genomic Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Chih Huang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Yeh Lin
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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15
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Azis FA, Hardjianti T, Benyamin AF, Saleh S, Minhajat R, Bayu D. Acquired Hemophilia A in a Female: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION: Coagulation factor deficit is a very uncommon hemostatic condition in which a single component or numerous factors are lacking. Hereditary coagulation factor defects are autosomal recessive, meaning that they can affect both men and women. However, hemophilia A, caused by lack of clotting factor VIII (FVIII), is an X-linked condition. Acquired hemophilia A (AHA) is a bleeding disorder caused by autoantibodies to FVIII. It should be distinguished from congenital hemophilia, an inherited disorder caused by a mutation in the FVIII gene. Here, we report the first known case in Indonesia, a 24-year-old female diagnosed with AHA.
CASE PRESENTATION: A 24-year-old woman was referred to our facility for prolonged epistaxis. She had no previous history of extended menstrual flow or frequent epistaxis episodes, and there was no history of epistaxis or prolonged bleeding in her family. Bleeding time and prothrombin time were both normal, but time to activate partial thromboplastin was longer. The patient was diagnosed with AHA after von Willebrand disease (VWD) was ruled out.
DISCUSSION: In some rare situations, females can be affected by X-linked illnesses such as hemophilia A and B. This may be due to a carrier mother or affected father, skewed X chromosome inactivation, Turner syndrome, inhibitory antibodies (acquired hemophilia), or a random mutation on the active X chromosome. In such instances, treatment is challenging. The usual treatment of choice is recombinant coagulation factors.
CONCLUSION: Although VWD is the most frequent hereditary bleeding problem in females, other rare disorders such as AHA may be implicated. Clinicians should be aware of this when faced with patients that lack a history of bleeding disorders. Furthermore, AHA should be considered as a differential diagnosis in every female patient suffering from hemorrhage. Therefore, a comprehensive diagnostic approach is needed.
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16
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Sandoval‐Pérez A, Mejía‐Restrepo V, Aponte‐Santamaría C. Thermodynamic stabilization of von Willebrand factor
A1
domain induces protein loss of function. Proteins 2022; 90:2058-2066. [DOI: 10.1002/prot.26397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Angélica Sandoval‐Pérez
- Max Planck Tandem Group in Computational Biophysics Universidad de Los Andes Bogotá Colombia
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17
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Berntorp E, Trakymienė SS, Federici AB, Holstein K, Corrales-Medina FF, Pierce GF, Srivastava A, Prondzinski MVD, Johnsen JM, Zupan IP, Halimeh S, Nummi V, Roberts JC. Sixth Åland Island Conference on von Willebrand disease. Haemophilia 2022; 28 Suppl 5:3-15. [PMID: 35861919 PMCID: PMC9543245 DOI: 10.1111/hae.14495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 01/19/2023]
Abstract
Introduction The sixth Åland Islands Conference on von Willebrand disease (VWD) on the Åland Islands, Finland, was held from 20 to 22 September 2018. Aim The meeting brought together experts in the field of VWD from around the world to share the latest advances and knowledge in VWD. Results and discussion The topics covered both clinical aspects of disease management, and biochemical and laboratory insights into the disease. The clinical topics discussed included epidemiology, diagnosis and treatment of VWD in different countries, management of children with VWD, bleeding control during surgery, specific considerations for the management of type 3 VWD and bleeding control in women with VWD. Current approaches to the management of acquired von Willebrand syndrome were also discussed. Despite significant advances in the understanding and therapeutic options for VWD, there remain many challenges to be overcome in order to optimise patient care. In comparison with haemophilia A, there are very few registries of VWD patients, which would be a valuable source of data on the condition and its management. VWD is still underdiagnosed, and many patients suffer recurrent or severe bleeding that could be prevented. Awareness of VWD among healthcare practitioners, including non‐haematologists, should be improved to allow timely diagnosis and intervention. Diagnosis remains challenging, and the development of fast, simple assays may help to facilitate accurate and rapid diagnosis of VWD.
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Affiliation(s)
- Erik Berntorp
- Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Sonata S Trakymienė
- Clinic of Children's Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Augusto B Federici
- Department of Oncology and Oncologic Haematology, Haematology and Transfusion Medicine, L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Katharina Holstein
- Department of Hematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Fernando F Corrales-Medina
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Miami - Miller School of Medicine and University of Miami - Hemophilia Treatment Center, Miami, Florida, USA
| | | | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | | | - Jill M Johnsen
- Research Institute, Bloodworks, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Irena P Zupan
- Department of Haematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Vuokko Nummi
- Coagulation Disorders Unit, Helsinki University Hospital, Helsinki, Finland
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18
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Yeung K, McGrath C, Howse K, James P. Management of patients with elevated Self-BAT scores or other bleeding symptoms: Updated overview for primary care practitioners. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:494-499. [PMID: 35831073 PMCID: PMC9842138 DOI: 10.46747/cfp.6807494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for management of patients presenting with elevated self-administered bleeding assessment tool (Self-BAT) scores or other bleeding symptoms in a primary care setting. SOURCES OF INFORMATION Primary research sources, clinical review articles, and interviews with research staff, hematologists, and family physicians were used to create the poster tools and reference guide resources. MAIN MESSAGE Recommendations to manage a patient with an elevated Self-BAT score or other bleeding symptoms include reviewing the results of the Self-BAT to clarify relevant symptoms, performing initial diagnostic laboratory tests, and doing basic symptom management. Clinical judgment should be used when determining whether referral to a hematologist is necessary, but referral should be considered if the bleeding score is abnormal or if initial management options are ineffective. Some bleeding symptoms warrant evaluation by a gastroenterologist, obstetrician-gynecologist, or otolaryngologist. CONCLUSION Primary care providers should conduct a thorough review of the Self-BAT results and associated management recommendations when working with a patient presenting with an elevated score or other bleeding manifestations. A review consists of the clarification of relevant symptoms, appropriate initial laboratory workups, and patient education. Treatment options for symptom management should be explored while recognizing the threshold for referral to a hematologist.
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Affiliation(s)
- Katie Yeung
- Medical student at Queen’s University in Kingston, Ont
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19
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Yeung K, McGrath C, Howse K, James P. Prise en charge des patients ayant des scores élevés au Self-BAT ou d’autres symptômes hémorragiques. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:501-506. [PMID: 35831077 PMCID: PMC9842154 DOI: 10.46747/cfp.6807501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Katie Yeung
- Étudiante en médecine à l'Université Queen's à Kingston (Ontario)
| | - Clare McGrath
- Étudiante en médecine à l'Université Queen's à Kingston (Ontario)
| | - Kelly Howse
- Étudiante en médecine à l'Université Queen's à Kingston (Ontario)
| | - Paula James
- Professeure au Département de médecine à l'Université Queen's à Kingston (Ontario).
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20
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Naveed MA, Abid A, Ali N, Hassan Y, Amar A, Javed A, Qamar K, Mustafa G, Raza A, Saleem U, Hussain S, Shakoor M, Khaliq S, Mohsin S. Genetic Alterations, DNA Methylation, Alloantibodies and Phenotypic Heterogeneity in Type III von Willebrand Disease. Genes (Basel) 2022; 13:971. [PMID: 35741733 PMCID: PMC9222927 DOI: 10.3390/genes13060971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Type III von Willebrand disease is present in the Punjab province of Pakistan along with other inherited bleeding disorders like hemophilia. Cousin marriages are very common in Pakistan so genetic studies help to establish protocols for screening, especially at the antenatal level. Factors behind the phenotypic variation of the severity of bleeding in type III vWD are largely unknown. The study was conducted to determine Mutations/genetic alterations in type III von Willebrand disease and also to determine the association of different mutations, methylation status, ITGA2B/B3 mutations and alloimmunization with the severity of type III vWD. After informed consent and detailed history of the patients, routine tests and DNA extraction from blood, mutational analysis was performed by Next Generation Sequencing on Ion Torrent PGM. DNA methylation status was also checked with the help of PCR. In our cohort, 55 cases were detected with pathogenic mutations. A total of 27 different mutations were identified in 55 solved cases; 16 (59.2%) were novel. The mean bleeding score in truncating mutations and essential splice site mutations was relatively higher than weak and strong missense mutations. The mean bleeding score showed insignificant variation for different DNA methylation statuses of the VWF gene at the cg23551979 CpG site. Mutations in exons 7,10, 25, 28, 31, 43, and intron 41 splice site account for 75% of the mutations.
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Affiliation(s)
- Muhammad Asif Naveed
- Department of Haematology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (K.Q.); (G.M.); (S.M.)
| | - Aiysha Abid
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology Transplantation, Karachi 42000, Pakistan; (A.A.); (A.R.)
| | - Nadir Ali
- Kulsoom International Hospital, 2020 Jinnah Ave, G 6/2 Blue Area, Islamabad 53000, Pakistan;
| | - Yaqoob Hassan
- Chughtai’s Lahore Lab, 42300 Jail Road, Lahore 52600, Pakistan;
| | - Ali Amar
- Human Genetics and Molecular Biology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (A.A.); (M.S.); (S.K.)
| | - Aymen Javed
- Department of Obstetrics and Gynaecology Services Hospital Jail Road, Lahore 42500, Pakistan;
| | - Khansa Qamar
- Department of Haematology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (K.Q.); (G.M.); (S.M.)
| | - Ghulam Mustafa
- Department of Haematology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (K.Q.); (G.M.); (S.M.)
| | - Ali Raza
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology Transplantation, Karachi 42000, Pakistan; (A.A.); (A.R.)
| | - Umera Saleem
- Department of Pathology, Nishter Medical University, Nishter Road, Multan 32003, Pakistan;
| | - Shabbir Hussain
- Department of Biochemistry, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan;
| | - Madiha Shakoor
- Human Genetics and Molecular Biology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (A.A.); (M.S.); (S.K.)
| | - Shagufta Khaliq
- Human Genetics and Molecular Biology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (A.A.); (M.S.); (S.K.)
| | - Shahida Mohsin
- Department of Haematology, University of Health Sciences, Khayaban Jamia Punjab, Lahore 52600, Pakistan; (K.Q.); (G.M.); (S.M.)
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21
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Lapić I, Radić Antolic M, Dejanović Bekić S, Coen-Herak D, Bilić E, Rogić D, Zadro R. Reevaluation of von Willebrand disease diagnosis in a Croatian paediatric cohort combining bleeding scores, phenotypic laboratory assays and next generation sequencing: a pilot study. Biochem Med (Zagreb) 2022; 32:010707. [PMID: 35210927 PMCID: PMC8833252 DOI: 10.11613/bm.2022.010707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction This study reevaluated von Willebrand disease (vWD) diagnosis in a Croatian paediatric cohort by combining bleeding scores (BS), phenotypic laboratory testing, and next-generation sequencing (NGS). Materials and methods A total of 25 children (11 males and 14 females, median age 10 years, from 2 to 17) previously diagnosed with vWD were included. BS were calculated using an online bleeding assessment tool. Phenotypic laboratory analyses included platelet count, platelet function analyser closure times, prothrombin time, activated partial thromboplastin time, von Willebrand factor antigen (vWF:Ag), vWF gain-of-function mutant glycoprotein Ib binding activity (vWF:GPIbM), vWF collagen binding activity (vWF:CBA), factor VIII activity (FVIII:C) and multimeric analysis. Next-generation sequencing covered regions of both vWF and FVIII genes and was performed on MiSeq (Illumina, San Diego, USA). Results Disease-associated variants identified in 15 patients comprised 11 distinct heterozygous vWF gene variants in 13 patients and one novel FVIII gene variant (p.Glu2085Lys) in two male siblings. Four vWF variants were novel (p.Gln499Pro, p.Asp1277Tyr, p.Asp1277His, p.Lys1491Glu). Three patients without distinctive variants had vWF:GPIbM between 30 and 50%. Patients with identified vWF gene variants had statistically significant lower values of vWF:GPIbM (P = 0.002), vWF:Ag (P = 0.007), vWF:CBA (P < 0.001) and FVIII:C (P = 0.002), compared to those without. Correlations between BS and phenotypic laboratory test results were not statistically significant for either of the tests. Conclusion The applied diagnostic approach confirmed the diagnosis of vWD in 13 patients and mild haemophilia A in two. Limited utility of BS in the paediatric population was evidenced.
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Affiliation(s)
- Ivana Lapić
- Department of Laboratory Diagnostics,University Hospital Center Zagreb, Zagreb, Croatia
- Corresponding author:
| | | | - Sara Dejanović Bekić
- Referral Center for Pediatrics Hematology and Oncology, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Désirée Coen-Herak
- Department of Laboratory Diagnostics,University Hospital Center Zagreb, Zagreb, Croatia
| | - Ernest Bilić
- Referral Center for Pediatrics Hematology and Oncology, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dunja Rogić
- Department of Laboratory Diagnostics,University Hospital Center Zagreb, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Renata Zadro
- Medical Biochemistry Laboratory, St Catherine Specialty Hospital, Zagreb, Croatia
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22
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Platelets' Role in Dentistry: From Oral Pathology to Regenerative Potential. Biomedicines 2022; 10:biomedicines10020218. [PMID: 35203428 PMCID: PMC8869410 DOI: 10.3390/biomedicines10020218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Platelets are a cellular subgroup of elements circulating in the bloodstream, responsible for the innate immunity and repairing processes. The diseases affecting this cellular population, depending on the degree, can vary from mild to severe conditions, which have to be taken into consideration in cases of minor dental procedures. Their secretion of growth factors made them useful in the regenerative intervention. The aim of this review is to examine the platelets from biological, examining the biogenesis of the platelets and the biological role in the inflammatory and reparative processes and clinical point of view, through the platelets' pathology and their use as platelets concentrates in dental regenerative surgery.
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23
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Samii A, Norouzi M, Ahmadi A, Dorgalaleh A. Gastrointestinal Bleeding in Congenital Bleeding Disorders. Semin Thromb Hemost 2022; 48:529-541. [PMID: 35021252 DOI: 10.1055/s-0041-1741571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Gastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.
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Affiliation(s)
- Amir Samii
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshaad Norouzi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Abbas Ahmadi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
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Du P, Morgan G, Brighton S, Sun SX. Disease Burden in Patients with von Willebrand Disease Potentially Eligible for Prophylaxis: Post Hoc Analysis of a European Cross-Sectional Study. Clin Appl Thromb Hemost 2022; 28:10760296221130334. [DOI: 10.1177/10760296221130334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Recent international guidelines conditionally recommend von Willebrand factor (VWF) prophylaxis for von Willebrand disease (VWD) patients with a history of severe/frequent bleeds. This post hoc analysis of the Cost of VWD Across Europe, a Socioeconomic Study (CVESS; conducted in 2018), assessed patient characteristics and disease burden in patients aged >1 year with congenital VWD not receiving but potentially eligible for prophylaxis based on severe/frequent bleeds, and those receiving prophylaxis in the previous 12 months. Data were collected using medical records and a patient questionnaire. Patients considered potentially prophylaxis-eligible (n = 102) experienced more bleeds than patients receiving prophylaxis (n = 229) and were more likely to be admitted to the hospital due to bleeding events in the prior 12 months. Quality of life and work productivity were similar between the two groups. Logistic regression analysis showed that the prophylaxis-eligible group was more likely to have poor joint function and moderate chronic pain than the prophylaxis group. This retrospective study suggests that 1/7 patients not receiving VWF prophylaxis had a higher disease burden than patients receiving prophylaxis and would potentially benefit from prophylaxis.
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Affiliation(s)
- Ping Du
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | | | - Shawn X. Sun
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
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25
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Apgar TL, Sanders CR. Compendium of causative genes and their encoded proteins for common monogenic disorders. Protein Sci 2022; 31:75-91. [PMID: 34515378 PMCID: PMC8740837 DOI: 10.1002/pro.4183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023]
Abstract
A compendium is presented of inherited monogenic disorders that have a prevalence of >1:20,000 in the human population, along with their causative genes and encoded proteins. "Simple" monogenic diseases are those for which the clinical features are caused by mutations impacting a single gene, usually in a manner that alters the sequence of the encoded protein. Of course, for a given "monogenic disorder", there is sometimes more than one potential disease gene, mutations in any one of which is sufficient to cause phenotypes of that disorder. Disease-causing mutations for monogenic disorders are usually passed on from generation to generation in a Mendelian fashion, and originate from spontaneous (de novo) germline founder mutations. In the past monogenic disorders have often been written off as targets for drug discovery because they sometimes are assumed to be rare disorders, for which the meager projected financial payoff of drug discovery and development has discouraged investment. However, not all monogenic diseases are rare. Here, we report that that currently available data identifies 72 disorders with a prevalence of at least 1 in 20,000 humans. For each, we tabulate the gene(s) for which mutations cause the spectrum of phenotypes associated with that disorder. We also identify the gene and protein that most commonly causes each disease. 34 of these disorders are caused exclusively by mutations in only a single gene and encoded protein.
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Affiliation(s)
- Tucker L. Apgar
- Department of Biochemistry and Center for Structural BiologyVanderbilt University School of Medicine Basic SciencesNashvilleTennesseeUSA
| | - Charles R. Sanders
- Department of Biochemistry and Center for Structural BiologyVanderbilt University School of Medicine Basic SciencesNashvilleTennesseeUSA
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26
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Turan O, Kadir RA. Pregnancy in special populations: challenges and solutions practical aspects of managing von Willebrand disease in pregnancy. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:552-558. [PMID: 34889419 PMCID: PMC8791099 DOI: 10.1182/hematology.2021000321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pregnancy and childbirth pose an important hemostatic challenge for women with von Willebrand disease (VWD) and can be associated with an increased risk of maternal and neonatal bleeding complications. VWD is a genetically and clinically heterogeneous bleeding disorder caused by a deficiency or an abnormality in the function of von Willebrand factor. Understanding inheritance pattern, hemostatic response to pregnancy, and response to treatment is essential for provision of individualized obstetric care and optimal outcome. A multidisciplinary approach to management with a close liaison between the obstetric team and the hemophilia treatment center is required for continuity of care from preconception counseling through to antenatal, peripartum, and postpartum care. Delivery plan must be coordinated by the multidisciplinary team and include decisions on place and mode of delivery, implementation of safe analgesia/anesthesia, and peripartum hemostasis. In this clinical case-based review, we aim to deliver evidence-based practical guidance for challenges encountered during pregnancy and management of childbirth and puerperium.
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Affiliation(s)
- Ozlem Turan
- Katharine Dormandy Haemophilia and Thrombosis Unit and Department of Obstetrics and Gynecology, Royal Free Hospital NHS Trust, London, UK
- EGA Institute for Women's Health, University College London, London, UK
| | - Rezan Abdul Kadir
- Katharine Dormandy Haemophilia and Thrombosis Unit and Department of Obstetrics and Gynecology, Royal Free Hospital NHS Trust, London, UK
- EGA Institute for Women's Health, University College London, London, UK
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27
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Alavi P, Rathod AM, Jahroudi N. Age-Associated Increase in Thrombogenicity and Its Correlation with von Willebrand Factor. J Clin Med 2021; 10:4190. [PMID: 34575297 PMCID: PMC8472522 DOI: 10.3390/jcm10184190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023] Open
Abstract
Endothelial cells that cover the lumen of all blood vessels have the inherent capacity to express both pro and anticoagulant molecules. However, under normal physiological condition, they generally function to maintain a non-thrombogenic surface for unobstructed blood flow. In response to injury, certain stimuli, or as a result of dysfunction, endothelial cells release a highly adhesive procoagulant protein, von Willebrand factor (VWF), which plays a central role in formation of platelet aggregates and thrombus generation. Since VWF expression is highly restricted to endothelial cells, regulation of its levels is among the most important functions of endothelial cells for maintaining hemostasis. However, with aging, there is a significant increase in VWF levels, which is concomitant with a significant rise in thrombotic events. It is not yet clear why and how aging results in increased VWF levels. In this review, we have aimed to discuss the age-related increase in VWF, its potential mechanisms, and associated coagulopathies as probable consequences.
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Affiliation(s)
| | | | - Nadia Jahroudi
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2S2, Canada; (P.A.); (A.M.R.)
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28
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Chornenki NLJ, Shanjer M, James PD. Vascular abnormalities in patients with von Willebrand disease: A scoping review. J Thromb Haemost 2021; 19:2151-2160. [PMID: 34060212 DOI: 10.1111/jth.15410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Qualitative or quantitative defects of von Willebrand factor (VWF) such as in von Willebrand disease (VWD) are associated with vascular abnormalities, especially in the gastrointestinal (GI) tract. However, the locations, extent, and natural history of vascular abnormalities in patients with VWD is not well understood. To summarize the existing literature on the topic, we conducted a scoping review of vascular abnormalities in patients with VWD. METHODS We searched MEDLINE and EMBASE from inception to September 1, 2020, for studies clinically describing vascular abnormalities in VWD patients. Screening and data extraction was completed independently and in duplicate and each abnormality was documented individually. RESULTS After screening, 54 studies that reported patient level data comprising 146 patients were included. Type 2A (39%) and type 3 (14.4%) were the most common VWD subtypes. The most common site of vascular malformation was the GI tract, occurring in 124 patients (84.9%), whereas 18 (12.3%) had non-GI vascular abnormalities and 4 (2.7%) had both GI and non-GI vascular abnormalities. With respect to outcomes, the clinical course was not specified in the majority (55.5%) of patients. Survey and population level data were reported in nine studies, demonstrating vascular abnormalities occurred at higher rates in VWD and that VWD patients are overrepresented among those with those abnormalities. CONCLUSION Vascular malformations in patients with VWD occur primarily in the gastrointestinal tract. Type 2A and type 3 VWD are the most common subtypes affected. The clinical treatment and natural history of these abnormalities remains understudied and further research is needed.
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Affiliation(s)
| | - Maaz Shanjer
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Paula D James
- Department of Medicine, Queen's University, Kingston, ON, Canada
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Case Report: Peripheral Retinal Ischemia and Retinal Neovascularization in von Willebrand Disease. Optom Vis Sci 2021; 98:418-424. [PMID: 33828041 DOI: 10.1097/opx.0000000000001670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Although von Willebrand disease is the most common inherited bleeding disorder, there are only a few published reports of ocular complications. To our knowledge, this is the first case of peripheral retinal ischemia and retinal neovascularization in a patient with von Willebrand disease. PURPOSE This study aimed to demonstrate the value of multispecialty care when exploring a diagnosis for bilateral retinopathy. CASE REPORT A 55-year-old African American woman presented with peripheral retinal hemorrhages on routine examination. She was asymptomatic and did not have any personal or family history of bleeding disorders. Blood work was ordered, and she was referred to a retinal specialist who found peripheral telangiectasia, retinal ischemia, and leakage on fluorescein angiography, consistent with retinal neovascularization. Laser photocoagulation was performed while numerous specialists were consulted to determine the cause for her retinopathy. Laboratory testing confirmed low-grade type 1 von Willebrand disease. She was monitored without systemic treatment. She remained stable and asymptomatic, but her retinal neovascularization did not regress fully, so laser treatment was repeated. CONCLUSIONS This case described a new finding of peripheral retinal ischemia and retinal neovascularization in von Willebrand disease. It was discovered in an asymptomatic patient who did not have a history of bleeding but presented with bilateral retinal hemorrhages. Diagnosis was challenging because of the high degree of variation in this bleeding disorder, requiring extensive testing and careful consideration of the individual's clinical profile. Most people with von Willebrand disease do not know they have the disease because symptoms are mild or absent, so most cases are unreported. The von Willebrand factor is poorly recognized in ocular disease, but given its role in angiogenesis, it may be a valuable target to consider in future research.
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ASH ISTH NHF WFH 2021 guidelines on the diagnosis of von Willebrand disease. Blood Adv 2021; 5:280-300. [PMID: 33570651 DOI: 10.1182/bloodadvances.2020003265] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/23/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND von Willebrand disease (VWD) is the most common inherited bleeding disorder known in humans. Accurate and timely diagnosis presents numerous challenges. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF), and the World Federation of Hemophilia (WFH) are intended to support patients, clinicians, and other health care professionals in their decisions about VWD diagnosis. METHODS ASH, ISTH, NHF, and WFH established a multidisciplinary guideline panel that included 4 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Outcomes and Implementation Research Unit at the University of Kansas Medical Center (KUMC) supported the guideline-development process, including performing or updating systematic evidence reviews up to 8 January 2020. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subsequently subject to public comment. RESULTS The panel agreed on 11 recommendations. CONCLUSIONS Key recommendations of these guidelines include the role of bleeding-assessment tools in the assessment of patients suspected of VWD, diagnostic assays and laboratory cutoffs for type 1 and type 2 VWD, how to approach a type 1 VWD patient with normalized levels over time, and the role of genetic testing vs phenotypic assays for types 2B and 2N. Future critical research priorities are also identified.
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31
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Yadegari H, Biswas A, Ahmed S, Naz A, Oldenburg J. von Willebrand factor propeptide missense variants affect anterograde transport to Golgi resulting in ER retention. Hum Mutat 2021; 42:731-744. [PMID: 33942438 DOI: 10.1002/humu.24204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/22/2021] [Accepted: 04/01/2021] [Indexed: 11/07/2022]
Abstract
von Willebrand disease (VWD), the most prevalent congenital bleeding disorder, arises from a deficiency in von Willebrand factor (VWF), which has crucial roles in hemostasis. The present study investigated functional consequences and underlying pathomolecular mechanisms of several VWF propeptide (VWFpp) missense variants detected in our cohort of VWD patients for the first time. Transient expression experiments in HEK293T cells demonstrated that four out of the six investigated missense variants (p.Gly55Glu, p.Val86Glu, p.Trp191Arg, and p.Cys608Trp) severely impaired secretion. Their cotransfections with the wild-type partly corrected VWF secretion, displaying loss of large/intermediate multimers. Immunostaining of the transfected HEK293 cells illustrated the endoplasmic reticulum (ER) retention of the VWF variants. Docking of the COP I and COP II cargo recruitment proteins, ADP-ribosylation factor 1 and Sec24, onto the N-terminal VWF model (D1D2D'D3) revealed that these variants occur at VWFpp putative interfaces, which can hinder VWF loading at the ER exit quality control. Furthermore, quantitative and automated morphometric exploration of the three-dimensional immunofluorescence images showed changes in the number/size of the VWF storage organelles, Weibel-Palade body (WPB)-like vesicles. The result of this study highlighted the significance of the VWFpp variants on anterograde ER-Golgi trafficking of VWF as well as the biogenesis of WPB-like vesicles.
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Affiliation(s)
- Hamideh Yadegari
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
| | - Arijit Biswas
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
| | - Shariq Ahmed
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Arshi Naz
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
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32
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Hossenbaccus L, Thibeault L, Grabell J, Braund H, Hopman W, James P. Evaluating the effectiveness of let's talk period's high school educational outreach program: A pilot study. Haemophilia 2021; 27:470-478. [PMID: 33626190 DOI: 10.1111/hae.14277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Menorrhagia impacts ~40% of adolescent females, with about half having an underlying bleeding disorder, most commonly von Willebrand Disease (VWD). VWD affects ~1 in 1000 individuals, though many are unaware of their condition. Let's Talk Period (LTP) is an online knowledge translation platform aimed at increasing awareness of bleeding disorders symptoms, with a validated self-administered bleeding assessment tool (Self-BAT). AIM To evaluate the effectiveness of the LTP high school outreach program in Grade 9 girls' health classes quantitatively, using baseline, post-presentation, and follow-up quiz scores, and qualitatively, with student and teacher feedback forms. METHODS The 75-minute in-class presentations, developed in alignment with the 2015 Ontario Curriculum for Grade 9 Health and Physical Activity, were led by a haemophilia nurse, clinical research assistant, and undergraduate student from the LTP team. Students completed baseline, post-presentation, and 4-6-week follow-up Kahoot quizzes featuring the same nine questions to evaluate change in knowledge levels and retention. Both student and teacher feedback were collected. RESULTS There was a significant increase (p < 0.001) from baseline to post-presentation scores, with a significant gain in knowledge, for all questions (p < 0.01). Students found content related to the basics and management of menstruation to be most interesting. Many had constructive feedback on how the presentation method could be improved. On average, the presentations were rated an 8.6 of 10 by students and 8.75 of 10 by teachers. CONCLUSION The LTP high school outreach program effectively increases student knowledge of menorrhagia and bleeding disorders. It was well-received by students and staff alike.
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Affiliation(s)
- Lubnaa Hossenbaccus
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Lisa Thibeault
- Clinical Research Centre, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Julie Grabell
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Faculty of Education and the Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Wilma Hopman
- Clinical Research Centre, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Paula James
- Department of Medicine, Queen's University, Kingston, ON, Canada
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Nakajima Y, Yada K, Ogiwara K, Furukawa S, Shimonishi N, Shima M, Nogami K. A microchip flow-chamber assay screens congenital primary hemostasis disorders. Pediatr Int 2021; 63:160-167. [PMID: 32640065 DOI: 10.1111/ped.14378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/04/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Von Willebrand disease (VWD) and platelet function disorders (PFDs) are congenital bleeding disorders caused by primary hemostasis defects. Platelet function tests are time-consuming and require considerable amounts of blood sample, and there have been no easy-to-use assays for assessing platelet function quickly and sensitively. We report the usefulness of a microchip flow-chamber system (T-TAS® ) for detecting and/or predicting clinical severity in patients with VWD type 1 and type 2N and platelet storage pool disease. Here, we developed an application of a screening assay for primary hemostasis disorders. METHODS Microchips coated with collagen (PL-chip) and collagen/thromboplastin (AR-chip) were utilized to evaluate platelet thrombus formation (PTF) at high shear and fibrin-rich PTF at low shear, respectively, in whole blood samples from 22 patients with VWD (16 type 2A, four type 2B, two type 3) and four patients with PFDs (two BSS, two Glanzmann thrombasthenia). The time-to-increase by 10 kPa (T10 ) was calculated from flow pressure curves. Also, whole blood-induced platelet aggregation was assessed using Multiplate® analysis. RESULTS PL-chip T10 values ≥10 min successfully distinguished patients with all types of VWD and PFDs from healthy controls, irrespective of age, bleeding scores, and von Willebrand factor levels. However, AR-chip assay incompletely distinguished between type 2A patients and healthy ones. Multiplate analysis permitted screening of PFDs and type 3 VWD, but values in type 2A partially overlapped with those in controls. PL-chip assay did not reflect the clinical severity in these patients. CONCLUSIONS T-TAS with PL-chip could be a quick screening tool for congenital primary hemostasis disorder, VWD, and PFDs.
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Affiliation(s)
- Yuto Nakajima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Koji Yada
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,The Course of Hemophilia Education, Nara Medical University, Kashihara, Nara, Japan
| | - Kenichi Ogiwara
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Shoko Furukawa
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,The Course of Thrombosis and Hemostasis Molecular Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Naruto Shimonishi
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
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Zavelia Padilla-Romo MG, Ornelas-Ricardo D, Luna-Záizar H, Rebeca Jaloma-Cruz A. Diagnosis of von Willebrand disease in Western Mexico. Haemophilia 2020; 27:e78-e87. [PMID: 33215800 DOI: 10.1111/hae.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Von Willebrand disease (VWD) is the most common inherited bleeding disorder with a prevalence of 0.1%, characterised by quantitative or functional deficiency of von Willebrand factor (VWF). VWD diagnosis is based on symptomology, biochemical and genetic tests, but limited laboratory resources and VWD heterogeneity still generate an important subdiagnosis gap worldwide and in our country. AIM To identify the type and subtype of VWD in a cohort of patients with a history of excessive bleeding in Western Mexico. METHODS This prospective cohort study from 2012 to 2019 included patients with mucocutaneous bleeding or abnormal laboratory tests. A standardised questionnaire and confirmatory tests were applied: FVIII:C, VWF activity, VWF antigen, and VWF multimeric analysis. RESULTS Of the 297 patients recruited, 207 (69.7%) were excluded because their values exceeded 50% in VWF activity and VWF antigen. Of those 90 remaining, 54 (18.2%) had low VWF, and only 36 patients (12.1%) were diagnosed with VWD. Among them, 17 (47.2%) had quantitative deficiencies, of whom 14 were assigned as type 1 and 3 as type 3.The remaining 19 cases were diagnosed as type 2 (52.8%): type 2A and 2B were the most frequent with 6 and 7 cases respectively; 4 cases were possible type 2M and two suggestive of 2N, however, this was not confirmed. CONCLUSION This study highlights the challenges of VWD diagnosis using a comprehensive panel of diagnostic tests which should extend to supplemental tests of VWF:CB, VWF:FVIIIB, and sequencing the VWD gene to confirm the results from the panel assays.
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Affiliation(s)
- María Guadalupe Zavelia Padilla-Romo
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.,Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Diana Ornelas-Ricardo
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.,Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Hilda Luna-Záizar
- Departamento de Química, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Ana Rebeca Jaloma-Cruz
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
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Mannhalter C. Ex Vivo Improvement of a von Willebrand Disease Type 2A Phenotype Using an Allele-Specific Small Interfering RNA. Thromb Haemost 2020; 120:1483. [DOI: 10.1055/s-0040-1718412] [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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Abstract
This article explores how to prevent and manage complications of dentoalveolar surgery. Many complications are avoidable. Surgical skills and knowledge of anatomy play an important role in prevention of complications. Prevention starts with detailed history and physical examination of the patient. Key to perioperative management of patients is risk assessment. Without a proper history and physical examination, the clinician is unable to assess the risk of performing surgery and anesthesia for each patient. Some illnesses and medications increase the risk of complications. The following complications are discussed: alveolar osteitis, displacement, fracture, hemorrhage, infection, nonhealing wound, oroantral communication, swelling, and trismus.
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Affiliation(s)
- Patrick J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, 1919 7th Avenue South, SDB 419, Birmingham, AL 35294, USA.
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37
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De Padua V, Romeo U, Santoro C, Bosco R, Baldacci E, Ferretti A, Malaspina F, Mazzucconi MG, Gaglioti D. Dental invasive procedures in von Willebrand disease outpatients treated with high purity FVIII/VWF complex concentrate (Fanhdi®): experience of a single center. Heliyon 2020; 6:e03426. [PMID: 32140581 PMCID: PMC7044789 DOI: 10.1016/j.heliyon.2020.e03426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/18/2019] [Accepted: 02/12/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To retrospectively assess the effectiveness and safety of customized hemostatic protocols using a plasma-derived, von Willebrand Factor (VWF)-containing Factor VIII concentrate (pdVWF/FVIII) in von Willebrand disease (VWD) patients undergoing dental invasive procedures. METHODS Protocol for each patient was drawn up by the Blood Unit based on the VWD type, disease severity, and type of treatment. pdFVIII/VWF infusions and doses were registered at 30-60 min before intervention (t0) and at 12-24-36-48-72 h after intervention (t12-t72) and up to day 7. Any peri- or postoperative bleeding, complication or adverse event was registered. RESULTS Forty-five dental procedures were performed on 20 VWD patients (six type-1, two type-2a, six type-2b, six type-3). Most pdFVIII/VWF infusions at t0 were 60 IU/kg (n = 7) and 50 IU/kg (n = 9). Subsequent infusions were mostly 30-50 IU/kg. No bleeding complications or adverse events were reported. CONCLUSION This study supports the safety and efficacy of pdFVIII/VWF to prevent peri- and postoperative bleeding after invasive oral procedures.
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Affiliation(s)
| | - Umberto Romeo
- Department Head-Neck, Sapienza University, Rome, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | | | - Erminia Baldacci
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | - Antonietta Ferretti
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
| | - Francesco Malaspina
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy
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Vonicog alfa for the management of von Willebrand disease: a comprehensive review and single-center experience. J Thromb Thrombolysis 2020; 49:431-440. [DOI: 10.1007/s11239-019-02018-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Kalot MA, Al-Khatib M, Connell NT, Flood V, Brignardello-Petersen R, James P, Mustafa RA. An international survey to inform priorities for new guidelines on von Willebrand disease. Haemophilia 2019; 26:106-116. [PMID: 31769905 DOI: 10.1111/hae.13881] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION von Willebrand disease (VWD) is an inherited bleeding disorder caused by a quantitative or qualitative dysfunction of von Willebrand factor. Clinicians, patients and other stakeholders have many questions about the diagnosis and management of the disease. AIM To identify topics of highest importance to stakeholders that could be addressed by guidelines to be developed by the American Society of Hematology (ASH), the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF) and the World Federation of Hemophilia (WFH). METHODS A survey to determine and prioritize topics to be addressed in the collaborative development of guidelines for VWD was distributed to international stakeholders including patients, caregivers and healthcare providers (HCPs). Representatives of the four organizations coordinated the distribution strategy. The survey focused on both diagnosis and management of VWD, soliciting 7-point Likert-scale responses and open-ended comments, in English, French and Spanish. We conducted descriptive analysis with comparison of results by stakeholder type, gender and countries' income classification for the rating questions and qualitative conventional content data analysis for the open-ended responses. RESULTS A total of 601 participants responded to the survey (49% patients/caregivers and 51% healthcare providers). The highest priority topics identified were diagnostic criteria/classification, bleeding assessment tools and treatment options for women and surgical patients. In contrast, screening for anaemia and differentiating plasma-derived therapy versus recombinant therapies received lower ratings. CONCLUSION This survey highlighted areas of importance to a diverse representation of stakeholders in the diagnosis and management of VWD, providing a framework for future guideline development and implementation.
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Affiliation(s)
- Mohamad A Kalot
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mohammed Al-Khatib
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nathan T Connell
- Hematology Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Veronica Flood
- Division of Hematology/Oncology, Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, WI, USA
| | | | | | - Reem A Mustafa
- Outcomes and Implementation Research Unit, Department of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Ahmed S, Yadegari H, Naz A, Biswas A, Budde U, Saqlain N, Amanat S, Tariq S, Raziq F, Masood S, Pavlova A, Shamsi TS, Oldenburg J. Characterization of the mutation spectrum in a Pakistani cohort of type 3 von Willebrand disease. Haemophilia 2019; 25:1035-1044. [PMID: 31532876 DOI: 10.1111/hae.13841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Type 3 von Willebrand disease (VWD), a severe autosomal recessive hereditary bleeding disorder, is described by the virtual absence of von Willebrand factor (VWF). In consanguineous populations, for example Pakistan, the disease is reported with a higher incidence rate than the worldwide prevalence. AIMS This study aims to characterize molecular pathology and clinical profile of type 3 VWD cohort of Pakistani origin. METHODS In total, 48 patients were enrolled in the current study. Initially, the index patients (IPs) were evaluated by a standardized questionnaire for recording bleeding manifestations and by performing conventional coagulation tests. The diagnosis of VWD type 3 was confirmed by VWF antigens less than 5 IU/dL. Direct sequencing of VWF gene (VWF) was carried out to identify causative gene variations. We evaluated the potential consequence of novel splice site and missense variations by predictive computational programs and in silico structural analysis. RESULTS VWF mutations were detected in 46 out of 48 IPs (95.8%), predominantly as homozygous variants. In total, twenty-nine different gene defects were characterized in this cohort from which 10 (34.5%) are novel. The majority of the mutations were null alleles (66%; including gene conversions, nonsense, splice site variations, small deletions and insertions), and 34% of them were missense substitutions. CONCLUSION Herein, we reported for the first time, the pattern of gene defects in Pakistani type 3 VWD cohort. We identified a wide heterogeneous mutation spectrum along with variability in the type of bleeding episodes.
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Affiliation(s)
- Shariq Ahmed
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Hamideh Yadegari
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
| | - Arshi Naz
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Arijit Biswas
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
| | - Ulrich Budde
- Hämostaseology, Medilys Laborgesellschaft mbH, Hamburg, Germany
| | | | - Samina Amanat
- Atomic Energy Commission Islamabad, Islamabad, Pakistan
| | | | - Fazle Raziq
- Hayatabad Medical Complex Peshawar, Peshawar, Pakistan
| | | | - Anna Pavlova
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
| | - Tahir Sultan Shamsi
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinics Bonn, Bonn, Germany
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41
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The Importance and Complications of Sequencing of Von Willebrand Gene in Von Willebrand Disease. ACTA MEDICA MARTINIANA 2019. [DOI: 10.2478/acm-2019-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Genetic testing in patients with von Willebrand disease completes phenotypic testing with an aim to confirm the von Willebrand factor defect at a molecular level. Structure of the VWF gene was described 30 years ago; since then a large number of mutations leading to VWD have been described in this gene. Thanks to describing these mechanisms it is possible to understand the pathogenesis of the most common congenital bleeding disorder.
In the Slovak Republic genetic testing is still not a routine part of VWD diagnostics. The National Center of Hemostasis and Thrombosis in Martin is the first department in Slovakia which has begun genetic testing of patients with VWD. Sequencing of the VWF gene has many limitations which are referred in more details within this article. Therefore, we decided to use the methods of new generation sequencing in combination with Sanger sequencing. We believe that soon we will have the first results which will help us to identify the possible cause of VWD in these patients.
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Manderstedt E, Nilsson R, Lind-Halldén C, Ljung R, Astermark J, Halldén C. Targeted re-sequencing of F8, F9 and VWF: Characterization of Ion Torrent data and clinical implications for mutation screening. PLoS One 2019; 14:e0216179. [PMID: 31026269 PMCID: PMC6485758 DOI: 10.1371/journal.pone.0216179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
Mutations are not identified in ~5% of hemophilia A and 10–35% of type 1 VWD patients. The bleeding tendency also varies among patients carrying the same causative mutation, potentially indicating variants in additional genes modifying the phenotype that cannot be identified by routine single-gene analysis. The F8, F9 and VWF genes were analyzed in parallel using an AmpliSeq strategy and Ion Torrent sequencing. Targeting all exonic positions showed an average read depth of >2000X and coverage close to 100% in 24 male patients with known disease-causing mutations. Discrimination between reference alleles and alternative/indel alleles was adequate at a 25% frequency threshold. In F8, F9 and VWF there was an absolute majority of all reference alleles at allele frequencies >95% and the average alternative allele and indel frequencies never reached above 10% and 15%, respectively. In VWF, 4–5 regions showed lower reference allele frequencies; in two regions covered by the pseudogene close to the 25% cut-off for reference alleles. All known mutations, including indels, gross deletions and substitutions, were identified. Additional VWF variants were identified in three hemophilia patients. The presence of additional mutations in 2 out of 16 (12%) randomly selected hemophilia patients indicates a potential mutational contribution that may affect the disease phenotype and counseling in these patients. Parallel identification of disease-causing mutations in all three genes not only confirms the deficiency, but differentiates phenotypic overlaps and allows for correct genetic counseling.
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Affiliation(s)
- Eric Manderstedt
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Rosanna Nilsson
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
- * E-mail:
| | - Christina Lind-Halldén
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Rolf Ljung
- Department of Clinical Sciences–Pediatrics and Malmö Center for Thrombosis and Hemostasis, Skåne University Hospital, Malmö, Sweden
| | - Jan Astermark
- Department for Hematology Oncology and Radiation Physics, Center for Thrombosis and Hemostasis, Skåne University Hospital, Malmö, Sweden
| | - Christer Halldén
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
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Graham RA, Davis JA, Corrales-Medina FF. The Adolescent with Menorrhagia: Diagnostic Approach to a Suspected Bleeding Disorder. Pediatr Rev 2018; 39:588-600. [PMID: 30504251 DOI: 10.1542/pir.2017-0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Rudi-Ann Graham
- Department of Pediatrics, Holtz Children's Hospital-Jackson Memorial Medical Center, Miami, FL.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL
| | - Joanna A Davis
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL.,University of Miami-Hemophilia Treatment Center, Miami, FL
| | - Fernando F Corrales-Medina
- Department of Pediatrics, Holtz Children's Hospital-Jackson Memorial Medical Center, Miami, FL.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Miami-Miller School of Medicine, Miami, FL.,University of Miami-Hemophilia Treatment Center, Miami, FL
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44
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Rao ES, Ng CJ. Current approaches to diagnostic testing in von Willebrand Disease. Transfus Apher Sci 2018; 57:463-465. [DOI: 10.1016/j.transci.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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45
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Pagliari MT, Baronciani L, Stufano F, Colpani P, Siboni SM, Peyvandi F. Differential diagnosis between type 2A and 2B von Willebrand disease in a child with a previously undescribed de novo mutation. Haemophilia 2018; 24:e263-e266. [PMID: 30044032 DOI: 10.1111/hae.13532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- M T Pagliari
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - L Baronciani
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - F Stufano
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - P Colpani
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - S M Siboni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - F Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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46
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Oliveira LMM, Amorim MVA, Corsini CA, Neto CCA, Chaves DG. Standardization and comparison of nonautomated assays to measure the collagen binding activity of von Willebrand factor. Int J Lab Hematol 2018; 40:597-603. [DOI: 10.1111/ijlh.12874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - C. A. Corsini
- Fundação Hemominas; Belo Horizonte Minas Gerais Brazil
| | - C. C. A. Neto
- Fundação Hemominas; Belo Horizonte Minas Gerais Brazil
| | - D. G. Chaves
- Fundação Hemominas; Belo Horizonte Minas Gerais Brazil
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47
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Berntorp E, Ågren A, Aledort L, Blombäck M, Cnossen MH, Croteau SE, von Depka M, Federici AB, Goodeve A, Goudemand J, Mannucci PM, Mourik M, Önundarson PT, Rodeghiero F, Szántó T, Windyga J. Fifth Åland Island conference on von Willebrand disease. Haemophilia 2018; 24 Suppl 4:5-19. [DOI: 10.1111/hae.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Affiliation(s)
- E. Berntorp
- Centre for Thrombosis and Haemostasis; Skåne University Hospital; Lund University; Malmö Sweden
| | - A. Ågren
- Coagulation Unit; Department of Medicine; Division of Haematology; Karolinska University Hospital; Stockholm Sweden
| | - L. Aledort
- Department of Hematology and Medical Oncology; Mount Sinai Hospital; New York NY USA
| | - M. Blombäck
- Department of Molecular Medicine and Surgery; Karolinska University Hospital; Stockholm Sweden
| | - M. H. Cnossen
- Erasmus University Medical Center - Sophia Children's Hospital Rotterdam; Rotterdam The Netherlands
| | - S. E. Croteau
- Boston Children's Hospital; Boston Hemophilia Center; Harvard Medical School; Boston MA USA
| | | | - A. B. Federici
- Department of Oncology and Oncologic Hematology, Haematology and Transfusion Medicine; L. Sacco University Hospital; University of Milan; Milan Italy
| | - A. Goodeve
- Haemostasis Research Group; University of Sheffield; Sheffield UK
- Sheffield Diagnostic Genetics Service; Sheffield Children's NHS Foundation Trust; Sheffield UK
| | - J. Goudemand
- Department of Haematology; Lille University Hospital; Lille France
| | - P. M. Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; IRCCS Cà Grande Maggiore Policlinico Hospital Foundation; Milan Italy
| | - M. Mourik
- Department of Molecular Cell Biology; Leiden University Medical Center; Leiden The Netherlands
| | - P. T. Önundarson
- Landspitali University Hospital; University of Iceland School of Medicine; Reykjavik Iceland
| | - F. Rodeghiero
- Department of Cell Therapy and Hematology; San Bortolo Hospital; Vicenza Italy
| | - T. Szántó
- Coagulation Disorders Unit; Departments of Hematology and Clinical Chemistry (HUSLAB Laboratory Services); Helsinki University Central Hospital; Helsinki Finland
| | - J. Windyga
- Department of Disorders of Hemostasis and Internal Medicine; Institute of Hematology and Transfusion Medicine; Warsaw Poland
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Linhares P, Viana-Pereira M, Ferreira M, Amorim J, Nabiço R, Pinto F, Costa S, Vaz R, Reis RM. Genetic variants of vascular endothelial growth factor predict risk and survival of gliomas. Tumour Biol 2018; 40:1010428318766273. [PMID: 29584591 DOI: 10.1177/1010428318766273] [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] [Indexed: 12/12/2022] Open
Abstract
The vascular endothelial growth factor regulates angiogenesis that is increased in glioma. VEGF polymorphisms are thought to modulate vascular endothelial growth factor plasma levels and therefore may be implicated in glioma risk. We aimed to clarify the role of VEGF and von Willebrand factor polymorphisms in glioma susceptibility and prognosis. A case-control study of 126 glioma patients and 180 cancer-free controls was performed. Using Sequenom MassARRAY platform, 11 VEGF and 1 VWF polymorphisms were genotyped. Unconditional multivariate logistic regression models were used to calculate odds ratios and 95% confidence intervals. The associations between polymorphisms and survival were evaluated using a Cox regression model. Bonferroni's adjustment was used to correct for multiple testing. The VEGF polymorphism rs833061 was strongly associated with increased risk for glioma (odds ratio = 164.85) and glioblastoma (odds ratio = 155.66), confirmed after Bonferroni correction. Also, the VEGF polymorphisms rs3024994, rs2010963, and particularly the homozygous carriers of rs1005230 were associated with a worse prognosis for glioma and glioblastoma. Our data support a role of VEGF and VWF polymorphisms as glioma biomarkers, with additional potential relevance for molecular stratification of patients for anti-angiogenic therapies.
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Affiliation(s)
- Paulo Linhares
- 1 Department of Neurosurgery, Hospital S. João, Porto, Portugal.,2 Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Viana-Pereira
- 3 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,4 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Mónica Ferreira
- 3 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,4 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Júlia Amorim
- 5 Department of Oncology, Hospital de Braga, Braga, Portugal
| | - Rui Nabiço
- 5 Department of Oncology, Hospital de Braga, Braga, Portugal
| | - Filipe Pinto
- 3 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,4 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Sandra Costa
- 3 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,4 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui Vaz
- 1 Department of Neurosurgery, Hospital S. João, Porto, Portugal.,2 Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Manuel Reis
- 3 Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,4 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,6 Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
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49
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Kalbhenn J, Schlagenhauf A, Rosenfelder S, Schmutz A, Zieger B. Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: Rapid onset and fast recovery. J Heart Lung Transplant 2018; 37:985-991. [PMID: 29650295 DOI: 10.1016/j.healun.2018.03.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/18/2018] [Accepted: 03/14/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Bleeding contributes to the high mortality of venovenous extracorporeal membrane oxygenation (vvECMO). The development of acquired von Willebrand syndrome (AVWS) has been identified as relevant pathology during ECMO. This study was performed to determine the onset of AVWS after implantation and the recovery of von Willebrand factor (VWF) parameters after explantation of ECMO in a large cohort of patients. METHODS VWF parameters of 59 patients treated with vvECMO at a university ECMO center were obtained before ECMO implantation, during therapy, and after explantation. In a subgroup of patients, light transmission aggregometry of platelets and flow-cytometric quantification of platelet granule secretion were performed. RESULTS All patients developed severe AVWS hours after implantation of vvECMO. After explantation, AVWS recovered within 3 hours in 60%, within 6 hours in 86%, and in all patients within 1 day. Aggregometry showed hypoaggregability of platelets after stimulation with ADP, ristocetin, collagen, and epinephrine. Flow-cytometric platelet analyses revealed severely reduced expression of CD62 and CD63. CONCLUSIONS All patients during vvECMO support rapidly develop AVWS and platelet dysfunction, resulting in severe impairment of coagulation. After explantation, AVWS overwhelmingly recovers within hours, resulting in a hypercoagulative state. These findings augment the need for novel extracorporeal technologies with reduced shear stress, and shift the emphasis for intense anti-coagulation during ECMO instead to a time-point after explantation.
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Affiliation(s)
- Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Axel Schlagenhauf
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Simone Rosenfelder
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Axel Schmutz
- Department of Anesthesiology and Critical Care, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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50
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Kumar S, Cruz E, Joshi S, Patel A, Jahan R, Batra SK, Jain M. Genetic variants of mucins: unexplored conundrum. Carcinogenesis 2017; 38:671-679. [PMID: 27838635 DOI: 10.1093/carcin/bgw120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/10/2016] [Indexed: 12/12/2022] Open
Abstract
Alternative gene splicing, occurring ubiquitously in multicellular organisms can produce several protein isoforms with putatively different functions. The enormously extended genomic structure of mucin genes characterized by the presence of multiple exons encoding various domains may result in functionally diverse repertoire of mucin proteins due to alternative splicing. Splice variants (Svs) and mutations in mucin genes have been observed in various cancers and shown to participate in cancer progression and metastasis. Although several mucin Svs have been identified, their potential functions remain largely unexplored with the exception of the Svs of MUC1 and MUC4. A few studies have examined the expression of MUC1 and MUC4 Svs in cancer and indicated their potential involvement in promoting cancer cell proliferation, invasion, migration, angiogenesis and inflammation. Herein we review the current understanding of mucin Svs in cancer and inflammation and discuss the potential impact of splicing in generating a functionally diverse repertoire of mucin gene products. We also performed mutational analysis of mucin genes across five major cancer types in International Cancer Genome Consortium database and found unequal mutational rates across the panel of cancer-associated mucins. Although the functional role of mucins in the pathobiology of various malignancies and their utility as diagnostic and therapeutic targets remain undisputed, these attributes need to be reevaluated in light of the potentially unique functions of disease-specific genetic variants of mucins. Thus, the expressional and functional characterization of the genetic variants of mucins may provide avenues to fully exploit their potential as novel biomarkers and therapeutic targets.
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Affiliation(s)
- Sushil Kumar
- Department of Biochemistry and Molecular Biology
| | - Eric Cruz
- Department of Biochemistry and Molecular Biology
| | | | - Asish Patel
- Department of Biochemistry and Molecular Biology
| | - Rahat Jahan
- Department of Biochemistry and Molecular Biology
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology.,Eppley Institute for Research in Cancer and Allied Diseases.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Maneesh Jain
- Department of Biochemistry and Molecular Biology.,Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
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