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Niwa K, Toyoda H, Kohso A, Okumura Y, Kunishima S, Hirayama M. Case Report: MYH9-related disease caused by Ala44Pro mutation in a child with a previous diagnosis of chronic immune thrombocytopenia. Front Pediatr 2024; 12:1391742. [PMID: 38827217 PMCID: PMC11140069 DOI: 10.3389/fped.2024.1391742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
MYH9-related disease, a rare autosomal dominant platelet disorder characterized by thrombocytopenia, giant platelets, and leukocyte inclusion bodies, may mimic immune thrombocytopenia in children unless suspected and carefully excluded. Here, we present a case involving a three-year-old girl with mild bleeding symptoms since infancy, previously diagnosed with chronic immune thrombocytopenia. The patient exhibited isolated thrombocytopenia and lacked any family history of thrombocytopenia, hearing impairment, or renal failure. Examination of peripheral blood smears via light microscopy revealed significant platelet macrocytosis with giant platelets and basophilic Döhle-like bodies in the neutrophils. Subsequent sequencing analysis of MYH9 gene identified a p.Ala44Pro mutation. Throughout a six-year follow-up period, the patient's condition remained stable. Our report underscores the significance of identifying leukocyte inclusion bodies in peripheral blood smears and considering MYH9-related diseases, even in instances of chronic macrothrombocytopenia devoid of familial history or non-hematological manifestations.
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Affiliation(s)
- Kaori Niwa
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidemi Toyoda
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Atsushi Kohso
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yosuke Okumura
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shinji Kunishima
- Department of Medical Technology, Gifu University of Medical Science, Gifu, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
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Lian X, Wang Y, Gao J, Liu H, Hao J, Kunishima S. Novel variant of MYH9 associated with mild evaluation of MYH9 related disorder in a Chinese family. Clin Chem Lab Med 2021; 59:e398-e400. [PMID: 34013674 DOI: 10.1515/cclm-2021-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Xiaoqiang Lian
- Department of Clinical Laboratory, The Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Yuxin Wang
- Department of Laboratory Medicine, College of Medical Technology, Hebei Medical University, Shijiazhuang, P.R. China
| | - Jie Gao
- Department of Laboratory Medicine, College of Medical Technology, Hebei Medical University, Shijiazhuang, P.R. China
| | - Heqiong Liu
- Department of Laboratory Medicine, College of Medical Technology, Hebei Medical University, Shijiazhuang, P.R. China
| | - Jihong Hao
- Department of Medical Technology, Gifu University of Medical Science, Gifu, Japan
| | - Shinji Kunishima
- Department of Clinical Laboratory, The Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China
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Zaninetti C, Greinacher A. Diagnosis of Inherited Platelet Disorders on a Blood Smear. J Clin Med 2020; 9:jcm9020539. [PMID: 32079152 PMCID: PMC7074415 DOI: 10.3390/jcm9020539] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
Inherited platelet disorders (IPDs) are rare diseases featured by low platelet count and defective platelet function. Patients have variable bleeding diathesis and sometimes additional features that can be congenital or acquired. Identification of an IPD is desirable to avoid misdiagnosis of immune thrombocytopenia and the use of improper treatments. Diagnostic tools include platelet function studies and genetic testing. The latter can be challenging as the correlation of its outcomes with phenotype is not easy. The immune-morphological evaluation of blood smears (by light- and immunofluorescence microscopy) represents a reliable method to phenotype subjects with suspected IPD. It is relatively cheap, not excessively time-consuming and applicable to shipped samples. In some forms, it can provide a diagnosis by itself, as for MYH9-RD, or in addition to other first-line tests as aggregometry or flow cytometry. In regard to genetic testing, it can guide specific sequencing. Since only minimal amounts of blood are needed for the preparation of blood smears, it can be used to characterize thrombocytopenia in pediatric patients and even newborns further. In principle, it is based on visualizing alterations in the distribution of proteins, which result from specific genetic mutations by using monoclonal antibodies. It can be applied to identify deficiencies in membrane proteins, disturbed distribution of cytoskeletal proteins, and alpha as well as delta granules. On the other hand, mutations associated with impaired signal transduction are difficult to identify by immunofluorescence of blood smears. This review summarizes technical aspects and the main diagnostic patterns achievable by this method.
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Affiliation(s)
- Carlo Zaninetti
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, 17489 Greifswald, Germany;
- University of Pavia, and IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- PhD Program of Experimental Medicine, University of Pavia, 27100 Pavia, Italy
| | - Andreas Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, 17489 Greifswald, Germany;
- Correspondence: ; Tel.: +49-3834-865482; Fax: +49-3834-865489
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Pecci A, Ma X, Savoia A, Adelstein RS. MYH9: Structure, functions and role of non-muscle myosin IIA in human disease. Gene 2018; 664:152-167. [PMID: 29679756 PMCID: PMC5970098 DOI: 10.1016/j.gene.2018.04.048] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
The MYH9 gene encodes the heavy chain of non-muscle myosin IIA, a widely expressed cytoplasmic myosin that participates in a variety of processes requiring the generation of intracellular chemomechanical force and translocation of the actin cytoskeleton. Non-muscle myosin IIA functions are regulated by phosphorylation of its 20 kDa light chain, of the heavy chain, and by interactions with other proteins. Variants of MYH9 cause an autosomal-dominant disorder, termed MYH9-related disease, and may be involved in other conditions, such as chronic kidney disease, non-syndromic deafness, and cancer. This review discusses the structure of the MYH9 gene and its protein, as well as the regulation and physiologic functions of non-muscle myosin IIA with particular reference to embryonic development. Moreover, the review focuses on current knowledge about the role of MYH9 variants in human disease.
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Affiliation(s)
- Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Piazzale Golgi, 27100 Pavia, Italy.
| | - Xuefei Ma
- Laboratory of Molecular Cardiology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg. 10 Room 6C-103B, 10 Center Drive, Bethesda, MD 20892-1583, USA.
| | - Anna Savoia
- Department of Medical Sciences, University of Trieste, via Dell'Istria, 65/1, I-34137 Trieste, Italy; IRCCS Burlo Garofolo, via Dell'Istria, 65/1, I-34137 Trieste, Italy.
| | - Robert S Adelstein
- Laboratory of Molecular Cardiology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg. 10 Room 6C-103B, 10 Center Drive, Bethesda, MD 20892-1583, USA.
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Rabbolini DJ, Chun Y, Latimer M, Kunishima S, Fixter K, Valecha B, Tan P, Chew LP, Kile BT, Burt R, Radhakrishnan K, Bird R, Ockelford P, Gabrielli S, Chen Q, Stevenson WS, Ward CM, Morel-Kopp MC. Diagnosis and treatment of MYH9-RD in an Australasian cohort with thrombocytopenia. Platelets 2017; 29:793-800. [DOI: 10.1080/09537104.2017.1356920] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- David J. Rabbolini
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Yenna Chun
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | | | - Shinji Kunishima
- Department of Advanced Diagnosis, Clinical Research Center, Nagoya Medical Center, Nagoya, Japan
| | - Kathleen Fixter
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Bhavia Valecha
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Peter Tan
- Department of Haematology, Royal Perth Hospital, Perth, Australia
| | - Lee Ping Chew
- Clinical Research Malaysia, Sarawak General Hospital, Sarawak, Malaysia
| | - Benjamin T. Kile
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Rachel Burt
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Kottayam Radhakrishnan
- Children’s Cancer Centre Monash Children’s Hospital, Melbourne, Australia
- Department of Haematology, Monash Medical Centre, Melbourne, Australia
| | - Robert Bird
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul Ockelford
- Department of Haematology, Auckland Hospital, Auckland, New Zealand
| | - Sara Gabrielli
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Qiang Chen
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - William S. Stevenson
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Christopher M. Ward
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Marie-Christine Morel-Kopp
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
- Northern Blood Research Centre, Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia
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Canzi P, Pecci A, Manfrin M, Rebecchi E, Zaninetti C, Bozzi V, Benazzo M. Severe to profound deafness may be associated with MYH9-related disease: report of 4 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 36:415-420. [PMID: 27958602 PMCID: PMC5225798 DOI: 10.14639/0392-100x-702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/30/2016] [Indexed: 11/24/2022]
Abstract
MYH9-related disease (MYH9-RD) is a rare genetic syndromic disorder characterised by congenital thrombocytopenia and is associated with the risk of developing progressive sensorineural hearing loss, nephropathy and presenile cataracts during childhood or adult life. All consecutive patients enrolled in the Italian Registry for MYH9-RD with severe to profound deafness were included in a retrospective study. The study population involved 147 Italian patients with MYH9-RD: hearing loss was identified in 52% of cases and only 4 patients (6%) presented severe to profound deafness at a mean age of 33 years. Deafness was associated with mild spontaneous bleeding in all patients and with kidney involvement in 3 cases. Cochlear implantation was carried out in 3 cases with benefit, and no major complications were observed. Diagnosis was performed about 28 years after the first clinical manifestation of MYH9-RD, which was never suspected by an otolaryngologist. The clinical and diagnostic aspects of 4 patients with severe to profound deafness are discussed with a focus on therapeutic implications.
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Affiliation(s)
- P Canzi
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - A Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - M Manfrin
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - E Rebecchi
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - C Zaninetti
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - V Bozzi
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
| | - M Benazzo
- Department of Otorhinolaryngology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Italy
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Greinacher A, Pecci A, Kunishima S, Althaus K, Nurden P, Balduini CL, Bakchoul T. Diagnosis of inherited platelet disorders on a blood smear: a tool to facilitate worldwide diagnosis of platelet disorders. J Thromb Haemost 2017; 15:1511-1521. [PMID: 28457011 DOI: 10.1111/jth.13729] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Indexed: 01/08/2023]
Abstract
Essentials There are many hereditary platelet disorders (HPD) but diagnosing these is challenging. We provide a method to diagnose several HPDs using standard blood smears requiring < 100 µL blood. By this approach, the underlying cause of HPD was characterized in ~25-30% of referred individuals. The method facilitates diagnosis of HPD for patients of all ages around the world. SUMMARY Background Many hereditary thrombocytopenias and/or platelet function disorders have been identified, but diagnosis of these conditions remains challenging. Diagnostic laboratory techniques are available only in a few specialized centers and, using fresh blood, often require the patient to travel long distances. For the same reasons, patients living in developing countries usually have limited access to diagnosis. Further, the required amount of blood is often prohibitive for pediatric patients. Objectives By a collaborative international approach of four centers, we aimed to overcome these limitations by developing a method using blood smears prepared from less than 100 μL blood, for a systematic diagnostic approach to characterize the platelet phenotype. Methods We applied immunofluorescence labelling (performed centrally) to standard air-dried peripheral blood smears (prepared locally, shipped by regular mail), using antibodies specific for proteins known to be affected in specific hereditary platelet disorders. Results By immunofluorescence labelling of blood smears we characterized the underlying cause in 877/3217 (27%) patients with suspected hereditary platelet disorders (HPD). Currently about 50 genetic causes for HPD are identified. Among those, the blood smear method was especially helpful to identify MYH9 disorders/MYH9-related disease, biallelic Bernard-Soulier syndrome, Glanzmann thrombasthenia and gray platelet syndrome. Diagnosis could be established for GATA1 macrothrombocytopenia, GFI1B macrothrombocytopenia, ß1-tubulin macrothrombocytopenia, filamin A-related thrombocytopenia and Wiskott-Aldrich syndrome. Conclusion Combining basic and widely available preanalytical methods with the immunomorphological techniques presented here, allows detailed characterization of the platelet phenotype. This supports genetic testing and facilitates diagnosis of hereditary platelet disorders for patients of all ages around the world.
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Affiliation(s)
- A Greinacher
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - A Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - S Kunishima
- Department of Advanced Diagnosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - K Althaus
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - P Nurden
- Institut Hospitalo-Universitaire LIRYC, PTIB, Hôpital Xavier Arnozan, Pessac, France
| | - C L Balduini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - T Bakchoul
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Affiliation(s)
- Anna Savoia
- a Institute for Maternal and Child Health - IRCCS Burlo Garofolo , Trieste , Italy.,b Department of Medical Sciences , University of Trieste , Trieste , Italy
| | - Daniela De Rocco
- a Institute for Maternal and Child Health - IRCCS Burlo Garofolo , Trieste , Italy
| | - Alessandro Pecci
- c Department of Internal Medicine , IRCCS Policlinico San Matteo Foundation and University of Pavia , Pavia , Italy
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Kunishima S, Yusuke O, Muramatsu H, Kojima D, Nagai N, Takahashi Y, Kojima S. Efficacy of neutrophil non-muscle myosin heavy chain-IIA immunofluorescence analysis in determining the pathogenicity of MYH9 variants. Ann Hematol 2017; 96:1065-1066. [DOI: 10.1007/s00277-017-2972-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/04/2017] [Indexed: 12/01/2022]
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Pecci A. Diagnosis and treatment of inherited thrombocytopenias. Clin Genet 2015; 89:141-53. [PMID: 25920516 DOI: 10.1111/cge.12603] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 12/26/2022]
Abstract
Knowledge in the field of inherited thrombocytopenias (ITs) has greatly improved over the last 15 years. Several new genes responsible for thrombocytopenia have been identified leading to the definition of novel nosographic entities and to a much better characterization of the phenotypes of these diseases. To date, ITs encompass 22 disorders caused by mutations in 24 genes and characterized by different degrees of complexity and great variability in prognosis. Making a definite diagnosis is important for setting an appropriate follow-up, choosing the best treatments and providing proper counseling. Despite the abovementioned progress, diagnosis of ITs remains difficult and these disorders are still underdiagnosed. The purpose of this review is to provide an updated guide to the diagnosis of ITs based on simple procedures. Moreover, the currently available therapeutic options for these conditions are recapitulated and discussed.
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Affiliation(s)
- A Pecci
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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Sirachainan N, Komwilaisak P, Kitamura K, Hongeng S, Sekine T, Kunishima S. The first two cases of MYH9 disorders in Thailand: an international collaborative study. Ann Hematol 2014; 94:707-9. [DOI: 10.1007/s00277-014-2234-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
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