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Congenital (hypo-)dysfibrinogenemia and bleeding: A systematic literature review. Thromb Res 2022; 217:36-47. [PMID: 35853369 DOI: 10.1016/j.thromres.2022.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/17/2022]
Abstract
Ranging from bleeding to thrombosis, the clinical features of congenital fibrinogen qualitative disorders, including dysfibrinogenemia and hypodysfibrinogenemia, are highly heterogeneous. Although the associations between some specific fibrinogen mutations and the thrombotic phenotypes have been well elucidated, the underlying mechanism between fibrinogen variants and bleeding events remains underestimated. After systematically reviewing the literature of (hypo-)dysfibrinogenemia patients with bleeding phenotypes, we identified several well-characterized bleeding-related fibrinogen variants in those patients. Several possible pathomechanisms are proposed to explain the genotype-phenotype associations: 1, mutations in the NH2-terminal portion of the Aα chain hamper fibrinogen fitting into the active site cleft of thrombin and drastically slow the conversion of fibrinogen into monomeric fibrin; 2, mutations adding new N-linked glycosylation sites introduce bulky and negatively charged carbohydrate side chains and undermine the alignment of fibrin monomers during polymerization; 3, mutations generating unpaired cysteine form extra disulfide bonds between the abnormal fibrinogen chains and produce highly branched and fragile fibrin networks; 4, truncation mutations in the fibrinogen αC regions impair the lateral fibril aggregation, as well as factor XIII crosslinking, endothelial cell and platelet binding. These established relationships between specific variants and the bleeding tendency will help manage (hypo-)dysfibrinogenemia patients to avoid adverse bleeding outcomes.
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Extension of the Human Fibrinogen Database with Detailed Clinical Information—The αC-Connector Segment. Int J Mol Sci 2021; 23:ijms23010132. [PMID: 35008554 PMCID: PMC8745514 DOI: 10.3390/ijms23010132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Fibrinogen, an abundant plasma glycoprotein, is involved in the final stage of blood coagulation. Decreased fibrinogen levels, which may be caused by mutations, are manifested mainly in bleeding and thrombotic disorders. Clinically relevant mutations of fibrinogen are listed in the Human Fibrinogen Database. For the αC-connector (amino acids Aα240–410, nascent chain numbering), we have extended this database, with detailed descriptions of the clinical manifestations among members of reported families. This includes the specification of bleeding and thrombotic events and results of coagulation assays. Where available, the impact of a mutation on clotting and fibrinolysis is reported. The collected data show that the Human Fibrinogen Database reports considerably fewer missense and synonymous mutations than the general COSMIC and dbSNP databases. Homozygous nonsense or frameshift mutations in the αC-connector are responsible for most clinically relevant symptoms, while heterozygous mutations are often asymptomatic. Symptomatic subjects suffer from bleeding and, less frequently, from thrombotic events. Miscarriages within the first trimester and prolonged wound healing were reported in a few subjects. All mutations inducing thrombotic phenotypes are located at the identical positions within the consensus sequence of the tandem repeats.
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McPherson HR, Duval C, Baker SR, Hindle MS, Cheah LT, Asquith NL, Domingues MM, Ridger VC, Connell SDA, Naseem KM, Philippou H, Ajjan RA, Ariëns RAS. Fibrinogen αC-subregions critically contribute blood clot fibre growth, mechanical stability, and resistance to fibrinolysis. eLife 2021; 10:e68761. [PMID: 34633287 PMCID: PMC8553339 DOI: 10.7554/elife.68761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022] Open
Abstract
Fibrinogen is essential for blood coagulation. The C-terminus of the fibrinogen α-chain (αC-region) is composed of an αC-domain and αC-connector. Two recombinant fibrinogen variants (α390 and α220) were produced to investigate the role of subregions in modulating clot stability and resistance to lysis. The α390 variant, truncated before the αC-domain, produced clots with a denser structure and thinner fibres. In contrast, the α220 variant, truncated at the start of the αC-connector, produced clots that were porous with short, stunted fibres and visible fibre ends. These clots were mechanically weak and susceptible to lysis. Our data demonstrate differential effects for the αC-subregions in fibrin polymerisation, clot mechanical strength, and fibrinolytic susceptibility. Furthermore, we demonstrate that the αC-subregions are key for promoting longitudinal fibre growth. Together, these findings highlight critical functions of the αC-subregions in relation to clot structure and stability, with future implications for development of novel therapeutics for thrombosis.
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Affiliation(s)
- Helen R McPherson
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Cedric Duval
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Stephen R Baker
- Department of Physics, Wake Forest UniversityWinston SalemUnited States
| | - Matthew S Hindle
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Lih T Cheah
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Nathan L Asquith
- Division of Hematology, Brigham and Women’s Hospital, Harvard Medical SchoolBostonUnited States
| | - Marco M Domingues
- Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina, Universidade de LisboaLisbonPortugal
| | - Victoria C Ridger
- Department of Infection, Immunity and Cardiovascular Disease, University of SheffieldSheffieldUnited Kingdom
| | - Simon DA Connell
- Molecular and Nanoscale Physics Group, University of LeedsLeedsUnited Kingdom
| | - Khalid M Naseem
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Helen Philippou
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Ramzi A Ajjan
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
| | - Robert AS Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsLeedsUnited Kingdom
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Marchi R, Vilar R, Durual S, Goodyer M, Gay V, Neerman-Arbez M, Casini A. Fibrin clot properties to assess the bleeding phenotype in unrelated patients with hypodysfibrinogenemia due to novel fibrinogen mutations. Thromb Res 2020; 197:56-64. [PMID: 33186848 DOI: 10.1016/j.thromres.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/18/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022]
Abstract
Congenital hypodysfibrinogenemia is a rare fibrinogen disorder, defined by decreased levels of a dysfunctional fibrinogen. We present the functional and structural characterization of two new fibrinogen variants. A duplication of 32 bases in FGA exon 5, p.Ser382GlyfsTer50 was identified in a patient (P1) with history of hemoptysis and traumatic cerebral bleeding. A missense mutation in FGG exon 8, p.Ala353Ser was identified in two siblings (P2 and P3) with tendency to bruising and menorrhagia. Fibrin polymerization was studied in plasma and in purified fibrinogen by turbidimetry. Fibrin structure was studied by a permeability assay, laser scanning confocal microscopy (LSCM) and scanning electron microscopy (SEM). In both plasma and purified fibrinogen samples, all patients had an abnormal polymerization characterized by a decreased maximal absorption compared to controls. The permeation constant (Ks) was markedly increased in all patients: 31 ± 9 × 10-9 cm2 in P1, and 20 ± 0.1 × 10-9 cm2 in P2 and P3, compared to 6 ± 2 × 10-9 cm2 in the control (p < 0.05). The presence of very large pores that accounts for the increased Ks was confirmed by LSCM and SEM patients' clots images. By SEM, the patients' fibrin fibers diameters were thicker: 90 ± 25 nm in P1, 162 ± 64 nm in P2 and 132 ± 46 nm in P3 compared to 74 ± 25 nm in control (p < 0.0001). In conclusion, both new causative fibrinogen mutations altered clot structure by forming thick fibers, diminishing fiber branching, and increasing pore filling space. These structural changes to clots explain the patients' bleeding phenotypes.
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Affiliation(s)
- Rita Marchi
- Experimental Medicine, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rui Vilar
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Durual
- Biomaterials Laboratory, University Clinics of Dental Medicine, University of Geneva
| | - Matthew Goodyer
- Service d'Hématologie, Hôpital du Valais - Institut Central des Hôpitaux, Sion, Switzerland
| | - Valérie Gay
- Hemophilia Treatment Centre, Centre hospitalier Métropole Savoie, Chambery, France
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alessandro Casini
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Angiology and Hemostasis, University Hospitals of Geneva, Geneva, Switzerland.
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Vilar R, Casini A, Fournel A, Mourey G, Neerman-Arbez M. Identification and expression of a novel heterozygous frameshift mutation in FGA accounting for congenital hypofibrinogenemia in carriers of severe hemophilia A. Thromb Res 2020; 193:5-8. [PMID: 32497950 DOI: 10.1016/j.thromres.2020.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Rui Vilar
- Department of Genetic Medicine and Development, University of Geneva Faculty of Medicine, Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospitals, University of Geneva Faculty of Medicine, Switzerland
| | - Alexandra Fournel
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | - Guillaume Mourey
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France; Hemostasis Laboratory, Etablissement Français du Sang, Besançon, France
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, University of Geneva Faculty of Medicine, Switzerland; iGE3, Institute of Genetics and Genomics in Geneva, Geneva, Switzerland.
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Amri Y, Dabboubi R, Mghaieth F, Zili M, Messaoud T, Casini A, De Moerloose P, Toumi NEH. Molecular characterization of two hypofibrinogenemic patients associated with a novel FGG IVS6+23T>A substitution and a previously reported FGB IVS6-10_16delTTTG deletion. Haemophilia 2020; 26:e194-e197. [PMID: 32202028 DOI: 10.1111/hae.13974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yessine Amri
- Biochemistry Laboratory (LR 00SP03), Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Rym Dabboubi
- Biochemistry Laboratory (LR 00SP03), Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Fathia Mghaieth
- Service of Cardiology, Rabta University Hospital, Tunis, Tunisia
| | - Mohamed Zili
- Medical Biology Laboratory, Habib Thameur's Hospital, Tunis, Tunisia
| | - Taieb Messaoud
- Biochemistry Laboratory (LR 00SP03), Bechir Hamza Children's Hospital, Tunis, Tunisia
| | - Alessandro Casini
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Philippe De Moerloose
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Nour El Houda Toumi
- Hematology Laboratory, Bechir Hamza Children's Hospital, Tunis, Tunisia.,Department of Clinical Biology A, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
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Tiscia GL, Margaglione M. Human Fibrinogen: Molecular and Genetic Aspects of Congenital Disorders. Int J Mol Sci 2018; 19:ijms19061597. [PMID: 29844251 PMCID: PMC6032319 DOI: 10.3390/ijms19061597] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 12/19/2022] Open
Abstract
Congenital fibrinogen disorders can be quantitative (afibrinogenemia, hypofibrinogenemia) or functional (dysfibrinognemia). To date, several genetic variants have been identified in individuals with fibrinogen disorders. The complexity of the fibrinogen molecules, formed by three non-identical chains and with a trinodal organization, renders the identification of molecular causes and of clinical and biochemical phenotypes very challenging. However, the acknowledgement of the type of molecular defect is crucial for a safer therapy, which is going to improve the clinical management of these patients. In this review, some aspects concerning molecular and clinical findings available on congenital fibrinogen disorders will be discussed.
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Affiliation(s)
- Giovanni Luca Tiscia
- Atherosclerosis and Thrombosis Unit, I.R.C.C.S. "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy.
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
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Congenital hypodysfibrinogenemia associated with a novel deletion of three residues (γAla289_Asp291del) in fibrinogen. J Thromb Thrombolysis 2018; 46:211-218. [PMID: 29748775 DOI: 10.1007/s11239-018-1678-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hypodysfibrinogenemia is the least frequently reported congenital fibrinogen disorder, characterized by both quantity and quality defects of fibrinogen. In this study, we investigated the molecular basis of hypodysfibrinogenemia in a Chinese family. Functional fibrinogen was measured by Clauss method, and the antigenic fibrinogen was measured by immunoturbidimetry assay. All the exons and exon-intron boundaries of fibrinogen genes (FGA, FGB and FGG) were analysed by direct DNA sequencing. To further evaluate its molecular and functional characterizations, fibrinogen was purified from the plasma of propositus, then SDS-PAGE, fibrin polymerization, clot lysis, and electron microscopy scanning were all performed. The propositus showed a slight decrease of immunologic fibrinogen (1.52 g/L) but dramatically reduced functional fibrinogen (0.3 g/L). DNA sequencing revealed a novel heterozygous CCTTTGATG deletion in the exon 8 of FGG, leading to the deletion of Ala289, Phe290, and Asp291 in fibrinogen γ-chain. The polymerization of the fibrinogen from the propositus was markedly impaired, with prolonged lag period and decreased final turbidity. The fibrinogen clottability showed a reduced fraction of participating clot formation. While the clot lysis showed normal. Scanning electron microscopy revealed that the fibers of the propositus were thicker than normal, with larger pores and curlier meshworks. We conclude that γAla289_Asp291del is responsible for the hypodysfibrinogenemia in this case.
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