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Scafa-Udriște A, Popa-Fotea NM, Calmac L, Onciul S, Bataila V, Mihai C, Ploscaru V, Uscatescu V, Gherghe G, Grigore I, Dorobanțu M, Micheu MM. Anti-platelet treatment challenges in Glanzmann thrombasthenia-clinical practice when data lacks. Haemophilia 2022; 28:e98-e100. [PMID: 35218677 DOI: 10.1111/hae.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/22/2021] [Accepted: 02/20/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Alexandru Scafa-Udriște
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Nicoleta-Monica Popa-Fotea
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Lucian Calmac
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Sebastian Onciul
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Vlad Bataila
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Cosmin Mihai
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Vlad Ploscaru
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Valentina Uscatescu
- Department of Haemostasis and Fibrinolysis, The Clinic Institute Fundeni, Bucharest, Romania
| | - Georgiana Gherghe
- Department of Haemostasis and Fibrinolysis, The Clinic Institute Fundeni, Bucharest, Romania
| | - Iulia Grigore
- Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
| | - Maria Dorobanțu
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.,Department of Cardiology, Emergency Clinical Hospital, Bucharest, Romania
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Endothelial Cell Participation in Inflammatory Reaction. Int J Mol Sci 2021; 22:ijms22126341. [PMID: 34199319 PMCID: PMC8231964 DOI: 10.3390/ijms22126341] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Inflammation is an old concept that has started to be considered as an important factor in infection and chronic diseases. The role of leukocytes, the plasmatic components, then of the mediators such as prostaglandins, cytokines, and, in recent decades, of the endothelium has completed the concept of the inflammation process. The function of the endothelium appeared to be crucial as a regulator or the initiator of the inflammatory process. Culture of human endothelial cells and experimental systems made it possible to define the molecular basis of inflammation in vascular diseases, in diabetes mellitus, atherosclerosis, vasculitis and thromboembolic complications. Advanced glycation end product receptor (RAGE), present on endothelial cells (ECs) and monocytes, participates in the activation of these cells in inflammatory conditions. Inflammasome is a cytosolic multiprotein that controls the response to diverse microorganisms. It is positively regulated by stimulator of interferon response CGAMP interactor-1 (STING1). Angiogenesis and thrombotic events are dysregulated during inflammation. ECs appear to be a protector, but also a possible initiator of thrombosis.
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Ali T, Gul S, Amar A, Shakoor M, Farhan S, Mohsin S, Khaliq S. Two homozygous missense mutations in ITGB3 gene as a cause of Glanzmann Thrombasthenia in four consanguineous Pakistani pedigrees. Int J Lab Hematol 2020; 42:628-635. [PMID: 32558238 DOI: 10.1111/ijlh.13266] [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: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Glanzmann thrombasthenia (GT) is most common of inherited platelet disorders, resulting from quantitative/qualitative defects in platelet surface integrin αIIbβ3, encoded by ITGA2B and ITGB3 genes. Little is known about clinical and molecular characteristics of GT patients from highly consanguineous Pakistani population. METHODS This study analyzed the clinical and molecular spectrum of six GT patients from four unrelated but consanguineous families. Platelet surface expression of αIIbβ3 integrin was determined using flow cytometry analysis. ITGA2B and ITGB3 genes were screened for causative mutations by DNA sequencing. Detected mutations were characterized for their pathogenicity using a variety of in silico tools. RESULTS Glanzmann thrombasthenia patients in this study generally presented early in life, had a severe course of clinical disease with transfusion dependency for management of bleeding episodes. Molecular analysis revealed 2 homozygous missense mutations in ITGB3 gene, c.422 A˃G (p.Y141C) in three GT patients from a single pedigree with familial segregation and c.1641 C>G (p.C547W) in three unrelated GT patients from three families manifesting type I GT with severe reduction in platelet αIIbβ3 levels. In silico pathogenicity predictions, multiple sequence alignment and 3D protein modeling unanimously suggested deleterious nature of the detected mutations, possibly due to aberrant disulfide bonding. Of note, clinical diversity was observed even among GT patients with same mutation in GT1 family. CONCLUSION This study provides an initial yet important account of clinical and genetic characterization of GT in local patients which may spark further studies to help molecular diagnosis, optimal disease management, and genetic counseling based prevention efforts.
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Affiliation(s)
- Tooba Ali
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
| | - Saira Gul
- Department of Haematology, University of Health Sciences, Lahore, Pakistan
| | - Ali Amar
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
| | - Madiha Shakoor
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
| | - Saima Farhan
- Haematology and Transfusion Medicine Division, The Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Shahida Mohsin
- Department of Haematology, University of Health Sciences, Lahore, Pakistan
| | - Shagufta Khaliq
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore, Pakistan
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Different biochemical expression pattern of platelet surface glycoproteins suggests molecular diversity of Glanzmann's thrombasthenia in Iran. Blood Coagul Fibrinolysis 2014; 24:613-8. [PMID: 23912132 DOI: 10.1097/mbc.0b013e328360a558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Glanzmann's thrombasthenia is a rare congenital bleeding disorder characterized by lack of platelet aggregation induced by most agonists. The disease is caused by different mutations in either GPIIb or GPIIIa genes that lead to a lack or dysfunction of the αIIbβ3. Western blot analysis was performed on the platelet lysates of 95 patients with Glanzmann's thrombasthenia who were referred to the Iranian Blood Transfusion and Hemophilia Clinic. Glanzmann's thrombasthenia was diagnosed based on clinical findings and were classified according to Glanzmann's Thrombasthenia Italian Team (GLATIT) protocol. The platelet glycoprotein expression pattern in Iranian patients with Glanzmann's thrombasthenia was studied and the relationship between the platelet glycoprotein expression levels and clinical symptoms were investigated. Loss or severe reduction of platelet GpIIb and GpIIIa were observed in majority of patients (78%). The remaining patients (22%) showed a relatively sharp decline to the normal amounts of the glycoproteins. None of the patients showed expression of CD41 without CD61. Statistical analysis showed no significant relationship between clinical symptoms and expression of platelet glycoproteins. Different patterns of platelet glycoproteins expression suggest that there is variety of mutations in the patients. Unlike the universal Glanzmann's thrombasthenia database, the majority of Iranian patients may suffer from a GpIIIa gene mutation. This study also confirmed a lack of correlation between clinical manifestation and GPIIb/IIIa expression in the patients.
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Park KJ, Chung HS, Lee KO, Park IA, Kim SH, Kim HJ. Novel and recurrent mutations of ITGA2B and ITGB3 genes in Korean patients with Glanzmann thrombasthenia. Pediatr Blood Cancer 2012; 59:335-8. [PMID: 22190468 DOI: 10.1002/pbc.24041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 11/14/2011] [Indexed: 11/09/2022]
Abstract
Glanzmann thrombasthenia (GT) is an autosomal recessive bleeding disorder caused by defective glycoprotein, αIIb and β3, encoded by ITGA2B and ITGB3 genes, respectively. We herein describe four unrelated Korean patients with genetically confirmed GT. Two patients were homozygous for c.1913+5G>T (IVS11+5G>T) mutation of ITGB3 with a signature of founder effect. The other two patients were compound heterozygous for two mutations of ITGA2B: c.[2333A>C];[2975delA] (p.[Q778P];[E992Gfs*30]) and c.[1750C>T];[2333A>C] (p.[R584X];[Q778P]). The c.2975delA mutation was a novel frameshift mutation of ITGA2B. Although from a limited number of patients, these results suggests c.1913+5G>T of ITGB3 is a recurrent mutation in Korean patients with GT.
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Affiliation(s)
- Kyoung-Jin Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Seoul, Korea
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Fiore M, Nurden AT, Nurden P, Seligsohn U. Clinical utility gene card for: Glanzmann thrombasthenia. Eur J Hum Genet 2012; 20:ejhg2012151. [PMID: 22781097 DOI: 10.1038/ejhg.2012.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mathieu Fiore
- Centre de Référence des Pathologies Plaquettaires, Plateforme Technologique d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
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Fiore M, Firah N, Pillois X, Nurden P, Heilig R, Nurden AT. Natural history of platelet antibody formation against αIIbβ3 in a French cohort of Glanzmann thrombasthenia patients. Haemophilia 2012; 18:e201-9. [PMID: 22250950 DOI: 10.1111/j.1365-2516.2011.02744.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of the bleeding syndrome in Glanzmann thrombasthenia (GT) is often complicated by naturally occurring isoantibodies directed against the αIIbβ3 integrin that cause the removal of or render ineffective transfused donor platelets. Such antibodies are produced after transfusion or pregnancy when the patient's immune system comes into contact with normal platelets. Despite many reports of anti-αIIbβ3 antibodies in GT patients, there is no consensus pertaining to their frequency, their long-term evolution in the circulation, or their formation in relation to either (i) the extent of the αIIbβ3 deficiency in the patient's platelets or (ii) the nature of the genetic defect (ITGA2B or ITGB3 genes). Antibody screening was performed on a large series of 24 GT patients in South-West France dividing the patients into two cohorts: (i) 16 patients with the French gypsy mutation (c.1544 + 1G>A) within ITGA2B that gives platelets totally lacking αIIbβ3 and (ii) 8 patients carrying other defects of ITGA2B or ITGB3 with different expression levels of αIIbβ3. Our results confirm that patients with premature termination mutations resulting in platelets lacking αIIbβ3 are the most susceptible to form isoantibodies, a finding that may be useful in deciding the choice of therapy between platelet transfusion and the use of recombinant factor VIIa (FVIIa).
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Affiliation(s)
- M Fiore
- Centre de Référence des Pathologies Plaquettaires (CRPP), Plateforme Technologique d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
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Farsinejad A, Abolghasemi H, Kazemi A, Aghaiipour M, Hadjati E, Faranoush M, Jazebi M, Ala F. Classification of Iranian patients with Glanzmann's Thrombasthenia using a flow cytometric method. Platelets 2011; 22:321-7. [PMID: 21526886 DOI: 10.3109/09537104.2011.556275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Glanzmann's Thrombasthenia (GT) is a rare inherited autosomal recessive platelet disorder caused by a deficiency or dysfunction of the GPIIb-IIIa receptor on platelets, which is characterized by a lack of platelet aggregation in response to multiple physiologic agonists and a life-long bleeding disorder. Flow cytometry is a rapid and highly sensitive method that can detect reduced levels of receptors, as well as absolute deficiency. The aim of this study was to classify Iranian GT patients by a flow cytometric method, and to correlate these findings with the severity of clinical bleeding. The expression of GPIIb-IIIa on the platelet surface was assessed in 123 GT patients using quantitative flow cytometry to determine the most common subtype among these patients. We used a panel of antibodies to detect the expression of glycoproteins GPIb, GPIIb, GPIIIa, as well as Integrin αv. Patients were also interviewed with regard to the severity and frequency of bleeding, according to history and gender, in order to evaluate the nature of their bleeding phenotype, and classify them as mild, moderate or severe bleeders, in accordance with the Glanzmann's Thrombasthenia Italian Team (GLATIT) protocol. In the detailed analysis of the results of our investigation, 95 out of 123 (77.5%) were classified as type I; 20 (16%) as type II with residual GPIIb-IIIa, and eight (6.5%) as GT variants. The variant type was diagnosed by the inability of GPIIb-IIIa to bind fibrinogen, as evidenced by the absence of platelet aggregation in response to physiologic agonists. There was no significant correlation between bleeding severity and different subtypes of GT. This study demonstrates that GT type I is the most common subtype among Iranian patients. There was no correlation between severity of symptoms and cytometric phenotype of the disease. The identification of families at risk may significantly decrease the incidence of the severe form of the disorder if genetic counseling is provided.
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Affiliation(s)
- A Farsinejad
- Department of Laboratory Sciences, School of Allied Health Sciences, Kerman University of Medical Sciences, Kerman, Iran
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