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Freitas SDS, Rezende SM, de Oliveira LC, Prezotti ANL, Renni MS, Corsini CA, Amorim MVDA, Matosinho CGR, Carvalho MRS, Chaves DG. Genetic variants of VWF gene in type 2 von Willebrand disease. Haemophilia 2019; 25:e78-e85. [PMID: 30817071 DOI: 10.1111/hae.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/31/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION von Willebrand disease (VWD) is the most common inherited bleeding disorder. Few studies have explored the molecular basis of type 2 VWD. AIM This study aimed to identify variants associated with type 2 VWD. METHODS We collected clinical and laboratory data, as well as response to desmopressin and bleeding assessment tool (BAT) score in patients diagnosed with type 2 VWD. We sequenced exons 17, 18, 20 and 28 of the VWF gene. RESULTS We identified 19 different variants in 40 unrelated patients (47.5%). Most of the variants (84.2%) were found in exon 28. A total of 10/19 variants (52.6%) were identified as "likely causative" in 17/40 patients (42.5%), according to the ISTH-SSC and EAHAD VWF gene mutations databases. Nine variants were initially identified as potentially benign. However, through analyses in silico, four of these variants were reclassified as "likely pathogenic" (Ile1380Val, Asn1435Ser, Ser1486Leu and Tyr1584Cys). Response to desmopressin was associated with three variants: Met740Ile, Arg1597Gln and Tyr1584Cys. Major bleeding was associated with variants related to VWD subtypes 2B and 2M. CONCLUSION In conclusion, we identified 19 variants, of which 14 are "likely pathogenic" and therefore associated with VWD. We suggest a possible association of pathogenic variants with major bleeding, response to desmopressin and BAT score ≥10, although this requires further confirmation.
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Affiliation(s)
- Samuel da Silva Freitas
- Fundação HEMOMINAS, Minas Gerais, Brazil.,Faculty of Medicine, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - Luciana Correa de Oliveira
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | | | - Marília Sande Renni
- Instituto de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
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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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Penel-Page M, Meunier S, Fretigny M, Le Quellec S, Boisseau P, Vinciguerra C, Ternisien C, Rugeri L. Differential diagnosis of neonatal alloimmune thrombocytopenia: Type 2B von Willebrand disease. Platelets 2017; 28:825-828. [DOI: 10.1080/09537104.2017.1293811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mathilde Penel-Page
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Meunier
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Mathilde Fretigny
- Laboratoire de biologie moléculaire, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sandra Le Quellec
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Pierre Boisseau
- Laboratoire de Génétique Médicale, CHU Hôtel Dieu, Nantes, France
| | - Christine Vinciguerra
- Laboratoire de biologie moléculaire, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Lucia Rugeri
- Hemophilia Comprehensive Care Center, Hôpital Cardiologique, Hospices Civils de Lyon, Lyon, France
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Kumar R, Creary S, Varga EA, Kahwash SB. Thrombocytopenia Pitfalls: Misdiagnosing Type 2B von Willebrand Disease as Ethylenediaminetetraacetic Acid-Dependent Pseudothrombocytopenia. J Pediatr 2016; 175:238-238.e1. [PMID: 27215777 DOI: 10.1016/j.jpeds.2016.04.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/21/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Riten Kumar
- Division of Hematology/Oncology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Susan Creary
- Division of Hematology/Oncology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Elizabeth A Varga
- Division of Molecular and Human Genetics, Nationwide Children's Hospital, Columbus, Ohio
| | - Samir B Kahwash
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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Geddis AE. The molecular basis of congenital thrombocytopenias: insights into megakaryopoiesis. ACTA ACUST UNITED AC 2005; 10 Suppl 1:299-305. [PMID: 16188691 DOI: 10.1080/10245330512331390401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amy E Geddis
- Department of Pediatrics, University of California, San Diego, USA
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Ribba AN, Hilbert L, Lavergne JM, Fressinaud E, Boyer-Neumann C, Ternisien C, Juhan-Vague I, Goudemand J, Girma J, Mazurier C, Meyer D. The arginine-552-cysteine (R1315C) mutation within the A1 loop of von Willebrand factor induces an abnormal folding with a loss of function resulting in type 2A-like phenotype of von Willebrand disease: study of 10 patients and mutated recombinant von Willebrand factor. Blood 2001; 97:952-9. [PMID: 11159522 DOI: 10.1182/blood.v97.4.952] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The study identified 10 patients from 6 families with prolonged bleeding time, decreased von Willebrand factor (vWF) ristocetin cofactor activity (RCoF) to vWF:Ag (antigen) ratio, and reduced ristocetin-induced platelet agglutination as well as ristocetin- or botrocetin-induced binding of plasma vWF to platelet glycoprotein Ib (GpIb). In addition, all patients showed a decrease of intermediate-molecular-weight (intermediate-MW) and high-molecular-weight (HMW) multimers of vWF. In the heterozygous state, a cysteine-to-threonine (C --> T) transversion was detected at nucleotide 4193 of the VWF gene of all patients and lead to the arginine (R)522C substitution in the A1 loop of vWF mature subunit (R1315C in the preprovWF). By in vitro mutagenesis of full-length complementary DNA (cDNA) of vWF and transient expression in COS-7 cells, the mutated C552 recombinant vWF (C552rvWF) was found to exhibit decreased expression, abnormal folding, and lack of intermediate-MW and HMW multimers. In addition, direct binding of botrocetin to C552rvWF, as well as ristocetin- and botrocetin-induced binding of C552rvWF to GpIb, was markedly decreased. Although being localized in an area of the A1 loop of vWF where most of the type 2B mutations that induce a gain-of-function have been identified, the R552C mutation induces a 2A-like phenotype with a decrease of intermediate-MW and HMW multimers as well as a loss-of-function of vWF in the presence of either ristocetin or botrocetin. (Blood. 2001;97:952-959)
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Affiliation(s)
- A N Ribba
- Institut National de la Santé et de la Recherche Médicale (INSERM) U.143, Hôpital de Bicêtre, Paris, France.
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Facey DA, Favaloro EJ, Koutts J, Berndt MC, Hertzberg MS. Identification and characterization of a novel mutation in von Willebrand factor causing type 2B von Willebrand's disease. Br J Haematol 1999. [DOI: 10.1111/j.1365-2141.1999.01358.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Considerable progress has been made in characterizing the specific molecular defects responsible for the heterogeneous disorder known as von Willebrand disease (VWD). A large number of molecular defects have been identified and precise characterization may now be possible in the majority of type 2A, type 2B, type 2N, and potentially also type 3 VWD cases. However, the most common variant, type 1 VWD, still remains a major challenge. Continued progress in this area will improve our understanding of the pathogenesis of VWD and lead to more rapid and precise diagnosis and classification for this common disorder. The problems of incomplete VWD penetrance and poor diagnostic sensitivity and accuracy for the currently available clinical laboratory tests provide strong incentives for the development of DNA-based diagnostics. In addition, prenatal diagnosis is now possible either at the level of single point mutations (for some subtypes) or by RFLP analysis (assuming linkage to the von Willebrand factor [VWF] gene) and will probably be applied with increasing frequency for VWD type 3 (17, 133, 175). Understanding the molecular basis of VWD also has important implications for VWF structure and function and is helping to define critical binding domains within the VWF molecule. Insights gained from these studies may eventually lead to improved therapeutic approaches not only for VWD, but also for a variety of other genetic and acquired hemorrhagic and thrombotic disorders.
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Affiliation(s)
- W C Nichols
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA
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McKeown LP, Connaghan G, Wilson O, Hansmann K, Merryman P, Gralnick HR. 1-Desamino-8-arginine-vasopressin corrects the hemostatic defects in type 2B von Willebrand's disease. Am J Hematol 1996; 51:158-63. [PMID: 8579058 DOI: 10.1002/(sici)1096-8652(199602)51:2<158::aid-ajh11>3.0.co;2-e] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
DDAVP is effective treatment in most types of von Willebrand's disease; however, in type 2B von Willebrand's disease the use of DDAVP has been contraindicated due to DDAVP-induced thrombocytopenia. Several reports have confirmed the thrombocytopenic effects of DDAVP and the presence of circulating platelet aggregates in type 2B von Willebrand's disease. We have infused three type 2B patients with DDAVP. The three patients had different mutations of their vWf. All three patients had a missense mutation which resulted in a single amino acid substitution in the disulfide loop of the A1 domain. Administration of 20 micrograms of DDAVP resulted in significant elevations of factor VIII, vWf antigen, and ristocetin cofactor levels. In contrast to other studies, DDAVP did not induce or enhance thrombocytopenia in these three patients. When blood was obtained by fingerstick and diluted into sodium oxalate (Unopette) or EDTA (Microvette), the platelet counts did not change over 4 hr. In contrast, blood collected directly into evacuated tubes containing sodium citrate, lithium heparin, or EDTA consistently demonstrated varying degrees of thrombocytopenia and platelet clumping. We also observed a shortening of the pre-infusion bleeding time over the 4 hr period. All three patients have been studied twice and each has shown consistent results. DDAVP appears to be a useful form of treatment in type 2B vWd.
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Affiliation(s)
- L P McKeown
- Hematology Service, National Institutes of Health, Bethesda, Maryland 20892, USA
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Eikenboom JCJ, Reitsma PH, Briët E. The inheritance and molecular genetics of von Willebrand's disease. Haemophilia 1995; 1:77-90. [DOI: 10.1111/j.1365-2516.1995.tb00045.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eikenboom JC, Vink T, Briët E, Sixma JJ, Reitsma PH. Multiple substitutions in the von Willebrand factor gene that mimic the pseudogene sequence. Proc Natl Acad Sci U S A 1994; 91:2221-4. [PMID: 8134377 PMCID: PMC43342 DOI: 10.1073/pnas.91.6.2221] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We have analyzed a type IIB and a type I von Willebrand disease family for the presence of mutations in the region coding for the glycoprotein Ib binding domain of the von Willebrand factor. Since this sequence is also present in the highly homologous von Willebrand factor pseudogene, we have studied genomic DNA as well as cDNA, which was produced from RNA isolated from endothelial cells or platelets. In both families, we have detected multiple consecutive nucleotide substitutions in the 5' end of exon 28 that result in a sequence identical to the von Willebrand factor pseudogene. These substitutions were also found in cDNA, which proves that they are present in the active gene. The occurrence of multiple adjacent substitutions that exactly reflect a part of the sequence of the von Willebrand factor pseudogene is difficult to reconcile with sequential single mutational events. We therefore hypothesize that each of these multiple substitutions arose from one recombinational event between gene and pseudogene.
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Affiliation(s)
- J C Eikenboom
- Department of Hematology, University Hospital, Leiden, The Netherlands
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Rabinowitz I, Randi A, Shindler K, Tuley E, Rustagi P, Sadler J. Type IIB mutation His-505–>Asp implicates a new segment in the control of von Willebrand factor binding to platelet glycoprotein Ib. J Biol Chem 1993. [DOI: 10.1016/s0021-9258(20)80753-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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