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Zguro K, Baldassarri M, Fava F, Beligni G, Daga S, Leoncini R, Galasso L, Cirianni M, Rusconi S, Siano M, Francisci D, Schiaroli E, Luchi S, Morelli G, Martinelli E, Girardis M, Busani S, Parisi SG, Panese S, Piscopo C, Capasso M, Tacconi D, Spertilli Raffaelli C, Giliberti A, Gori G, Katsikis PD, Lorubbio M, Calzoni P, Ognibene A, Bocchia M, Tozzi M, Bucalossi A, Marotta G, Furini S, Renieri A, Fallerini C. Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19. Viruses 2022; 14:1185. [PMID: 35746657 PMCID: PMC9227269 DOI: 10.3390/v14061185] [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: 03/21/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/08/2023] Open
Abstract
Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage.
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Affiliation(s)
- Kristina Zguro
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
| | - Margherita Baldassarri
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| | - Francesca Fava
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Giada Beligni
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| | - Sergio Daga
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
| | - Roberto Leoncini
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Lucrezia Galasso
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Michele Cirianni
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, 20025 Legnano, Italy;
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy;
| | - Matteo Siano
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20157 Milan, Italy;
| | - Daniela Francisci
- Infectious Diseases Clinic, “Santa Maria della Misericordia” Hospital, University of Perugia, 06124 Perugia, Italy; (D.F.); (E.S.)
| | - Elisabetta Schiaroli
- Infectious Diseases Clinic, “Santa Maria della Misericordia” Hospital, University of Perugia, 06124 Perugia, Italy; (D.F.); (E.S.)
| | - Sauro Luchi
- Infectious Disease Unit, Hospital of Lucca, 55100 Lucca, Italy; (S.L.); (G.M.)
| | - Giovanna Morelli
- Infectious Disease Unit, Hospital of Lucca, 55100 Lucca, Italy; (S.L.); (G.M.)
| | - Enrico Martinelli
- Department of Respiratory Diseases, Azienda Ospedaliera di Cremona, 26100 Cremona, Italy;
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.G.); (S.B.)
| | - Stefano Busani
- Department of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, 41124 Modena, Italy; (M.G.); (S.B.)
| | | | - Sandro Panese
- Clinical Infectious Diseases, Mestre Hospital, 30171 Venezia, Italy;
| | - Carmelo Piscopo
- Medical Genetics and Laboratory Genetics Unit, “Antonio Cardarelli” hospital, 80131 Naples, Italy;
| | - Mario Capasso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80138 Naples, Italy;
- CEINGE Biotecnologie Avanzate, 80145 Naples, Italy
| | - Danilo Tacconi
- Department of Specialized and Internal Medicine, Infectious Diseases Unit, San Donato Hospital Arezzo, 52100 Arezzo, Italy; (D.T.); (C.S.R.)
| | - Chiara Spertilli Raffaelli
- Department of Specialized and Internal Medicine, Infectious Diseases Unit, San Donato Hospital Arezzo, 52100 Arezzo, Italy; (D.T.); (C.S.R.)
| | - Annarita Giliberti
- Medical Genetics Unit, Meyer Children’s University Hospital, 50134 Florence, Italy; (A.G.); (G.G.)
| | - Giulia Gori
- Medical Genetics Unit, Meyer Children’s University Hospital, 50134 Florence, Italy; (A.G.); (G.G.)
| | - Peter D. Katsikis
- Department of Immunology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Maria Lorubbio
- UOC Laboratorio Analisi Chimico Cliniche, 52100 Arezzo, Italy; (M.L.); (A.O.)
| | - Paola Calzoni
- Laboratorio Patologia Clinica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy; (R.L.); (L.G.); (M.C.); (P.C.)
| | - Agostino Ognibene
- UOC Laboratorio Analisi Chimico Cliniche, 52100 Arezzo, Italy; (M.L.); (A.O.)
| | - Monica Bocchia
- Hematology Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy;
| | - Monica Tozzi
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (A.B.); (G.M.)
| | - Alessandro Bucalossi
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (A.B.); (G.M.)
| | - Giuseppe Marotta
- Stem Cell Transplant and Cellular Therapy Unit, University Hospital of Siena, 53100 Siena, Italy; (M.T.); (A.B.); (G.M.)
| | - Simone Furini
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
| | | | - Alessandra Renieri
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Chiara Fallerini
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (K.Z.); (M.B.); (F.F.); (G.B.); (S.D.); (S.F.); (C.F.)
- Medical Genetics, University of Siena, 53100 Siena, Italy
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Annual incidence and severity of acute episodes in hereditary thrombotic thrombocytopenic purpura. Blood 2021; 137:3563-3575. [PMID: 33649760 DOI: 10.1182/blood.2020009801] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Hereditary thrombotic thrombocytopenic purpura (hTTP) is a rare thrombotic microangiopathy characterized by severe congenital ADAMTS13 deficiency and recurring acute episodes causing morbidity and premature death. Information on the annual incidence and severity of acute episodes in patients with hTTP is largely lacking. This study reports prospective data on 87 patients from the Hereditary TTP Registry (clinicaltrials.gov #NCT01257269) for survival, frequency, and severity of acute episodes from enrollment until December 2019. The 87 patients, followed up for a median of 4.2 years (range, 0.01-15 years), had a median age at overt disease onset and at clinical diagnosis of 4.6 years and 18 years (range, 0.0-70 years for both), respectively. Forty-three patients received regular plasma prophylaxis, whereas 22 did not, and treatment changed over time or was unknown in the remaining 22. Forty-three patients experienced 131 acute episodes, of which 91 (69%) occurred in patients receiving regular prophylaxis. This resulted in an annual incidence of acute episodes of 0.36 (95% confidence interval [CI], 0.29-0.44) with regular plasma treatment and of 0.41 (95% CI, 0.30-0.56) without regular plasma treatment. More than one-third of acute episodes (n = 51) were documented in children <10 years of age at enrollment and were often triggered by infections. Their annual incidence of acute episodes was significantly higher than in patients aged >40 years (1.18 [95% CI, 0.88-1.55] vs 0.14 [95% CI, 0.08-0.23]). The prophylactic plasma infusion regimens used were insufficient to prevent acute episodes in many patients. Such regimens are burdensome, and caregivers, patients, and their guardians are reluctant to start regular plasma infusions, from which children particularly would benefit.
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Abstract
Von Willebrand disease (VWD) is an inherited bleeding disorder that affects up to 1% of the population. In most cases, VWD results from a mutation in the von Willebrand Factor (VWF) gene, which alters the amount and function of VWF, a key glycoprotein in both primary and secondary hemostasis. A comprehensive analysis of patients with VWD should include VWF activity, antigen levels, platelet function, and a careful bleeding history. Treatment options include antifibrinolytics, desmopressin, and VWF replacement therapy. VWF levels fluctuate due to age, stress, environmental exposures, and pharmacologic treatment. Treatment guidelines exist to treat and prevent bleeding for patients undergoing surgery and medical procedures, but often these must be reevaluated in the setting of age-related comorbidities including cardiovascular events, venous thrombosis, and malignancy. In addition, many age-related complications are associated with a secondary acquired von Willebrand syndrome (AVWS), including malignancies, hypothyroidism, cardiovascular diseases, and cardiac replacement devices. The current literature is limited by a lack of older patients in clinical trials. Larger studies are needed to determine if age-related comorbidities affect VWD patients at different frequencies than the general elderly population. There is also a significant need for registry-based studies to evaluate many age-related comorbidities in VWD patients.
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Affiliation(s)
- John Chapin
- Department of Hematology, Shire, Lexington, MA, USA,
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