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Nguyen MT, Nguyen TT, Nguyen DB, Nguyen TM, Nguyen KN, Ngo VNM, Nguyen VD, Tran NA, Lian M, Tan ASC, Chong SS, Dang TT. Robust preimplantation genetic testing of the common F8 Inv22 pathogenic variant of severe hemophilia A using a highly polymorphic multi-marker panel encompassing the paracentric inversion. Thromb J 2023; 21:108. [PMID: 37864173 PMCID: PMC10588207 DOI: 10.1186/s12959-023-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Hemophilia A (HEMA) is an X-linked bleeding disorder caused by reduced/absent coagulation factor VIII expression, as a result of pathogenic variants in the F8 gene. Preimplantation prevention of HEMA should ideally include direct pathogenic F8 variant detection, complemented by linkage analysis of flanking markers to identify the high-risk F8 allele. Linkage analysis is particularly indispensable when the pathogenic variant cannot be detected directly or identified. This study evaluated the suitability of a panel of F8 intragenic and extragenic short tandem repeat markers for standalone linkage-based preimplantation genetic testing for monogenic disorder (PGT-M) of the Inv22 pathogenic variant, an almost 600 kb paracentric inversion responsible for almost half of all severe HEMA globally, for which direct detection is challenging. METHODS Thirteen markers spanning 1 Mb and encompassing both F8 and the Inv22 inversion interval were genotyped in 153 unrelated females of Viet Kinh ethnicity. RESULTS All individuals were heterozygous for ≥ 1 marker, ~ 90% were heterozygous for ≥ 1 of the five F8 intragenic markers, and almost 98% were heterozygous for ≥ 1 upstream (telomeric) and ≥ 1 downstream (centromeric) markers. A prospective PGT-M couple at risk of transmitting F8 Inv22 were fully informative at four marker loci (2 intra-inversion, 1 centromeric, 1 telomeric) and partially informative at another five (2 intra-inversion, 3 centromeric), allowing robust phasing of low- and high-risk haplotypes. In vitro fertilization produced three embryos, all of which clearly inherited the low-risk maternal allele, enabling reliable unaffected diagnoses. A single embryo transfer produced a clinical pregnancy, which was confirmed as unaffected by amniocentesis and long-range PCR, and a healthy baby girl was delivered at term. CONCLUSION Robust and reliable PGT-M of HEMA, including the common F8 Inv22 pathogenic variant, can be achieved with sufficient informative intragenic and flanking markers.
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Affiliation(s)
- Minh Tam Nguyen
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thanh Tung Nguyen
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Duy Bac Nguyen
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thi Mai Nguyen
- National Institute of Hematology and Blood Transfusion, Hanoi, Vietnam
| | - Kim Ngan Nguyen
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Van Nhat Minh Ngo
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Van Dieu Nguyen
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Ngoc Anh Tran
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam
| | - Mulias Lian
- Preimplantation Genetic Diagnosis Centre, National University Centre for Women and Children, National University Hospital, Singapore, Singapore
| | - Arnold S C Tan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Samuel S Chong
- Preimplantation Genetic Diagnosis Centre, National University Centre for Women and Children, National University Hospital, Singapore, Singapore.
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore.
| | - Tien Truong Dang
- Department of Anatomy, Vietnam Military Medical University, Hanoi, Vietnam.
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Abstract
Rare bleeding disorders (RBDs) comprise inherited deficiencies of factors I (fibrinogen), II (prothrombin), V, VII, X, XI, and XIII as well as combined factor V + VIII and vitamin K-dependent factors. They represent 3-5% of all congenital bleeding disorders and are usually transmitted as autosomal recessive traits. These disorders often manifest during childhood and have varied clinical presentations from mucocutaneous bleeding to life-threatening symptoms such as central nervous system and gastrointestinal bleeding. Bleeding manifestations generally vary within the same RBD and may also vary from 1 RBD to the other. Laboratory diagnosis is based on coagulation screening tests and specific factor assays, with molecular techniques providing diagnostic accuracy and enabling prenatal counseling. The approach to treatment of bleeding episodes and invasive procedures needs to be individualized and depends on the severity, frequency and procedure-related risk of bleeding. The first line of treatment of RBDs is replacement of the deficient factor, using specific plasma-derived or recombinant products and using fresh frozen plasma or cryoprecipitate when specific products are not available or in resource-limited countries. Prophylaxis may be considered in individuals with recurrent serious bleeding and especially after life-threatening bleeding episodes. Novel no-replacement strategies promoting hemostasis by through different mechanisms need to be studied in RBDs as alternative therapeutic options.
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Affiliation(s)
- Shilpa Jain
- Division of Pediatric Hematology-Oncology, Women and Children's Hospital of Buffalo and Hemophilia Center of Western New York, Buffalo, NY, 14209, United States.
| | - Suchitra S Acharya
- Bleeding Disorders and Thrombosis Program, Cohen Children's Medical Center of New York and Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Lin XY, Wang J, Xiao X, Xu YW, Yan QJ, Jiang WY. Establishing a comprehensive genetic diagnosis strategy for hemophilia B and its application in Chinese population. Int J Lab Hematol 2017; 40:215-228. [PMID: 29274203 DOI: 10.1111/ijlh.12771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To reduce the incidence of hemophilia B (HB) which with no complete cure currently, prenatal diagnosis and preimplantation genetic diagnosis (PGD) are effective and feasible means. However, previous studies about genetic diagnosis in HB mostly just focused on the detection of patients and carriers. Here, we established a comprehensive genetic diagnosis strategy for HB and worked it out in Chinese population. The strategy includes the detection of patients and carriers, prenatal diagnosis, and PGD. METHODS Seven unrelated HB families from Chinese population involved in this study. Firstly, probands and available members were carried out coagulation laboratory assays, and the clinical information has been recorded. Secondly, we used DNA direct sequencing to screen the whole FIX gene of them. The pathogenicity of novel mutations was verified according to 2015 ACMG-AM guidelines. For prenatal diagnosis, a mix of DNA direct sequencing and STR linkage analysis was employed. To explore a better PGD protocol, Karyomapping was first applied in PGD of HB, comparing with conventional PCR-based methods. RESULTS Six different pathogenic mutations including 1 novel duplication (c.660_661dup ATCA) were identified. The results of prenatal diagnosis were consistent with birth outcomes. In the PGD case, 4 of 11 embryos were confirmed to be normal and one of them was transferred and led to a healthy birth. CONCLUSIONS The established genetic diagnosis strategy for HB in our study was comprehensive and well applied in clinic practice. Besides, we recommended that DNA direct sequencing combined with Karyomapping was a better PGD protocol.
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Affiliation(s)
- X Y Lin
- Department of Medical Genetics, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - J Wang
- Reproductive center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - X Xiao
- Department of Medical Genetics, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.,The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Y W Xu
- Reproductive center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Q J Yan
- Guangzhou Kingmed Diagnostics Technology Co., LTD, Guangzhou, China
| | - W Y Jiang
- Department of Medical Genetics, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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