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Wang W, Xu L, Wu J, Liu W, Jin J, Huang J, Xu Z, Huang Y, Li B, Liu Y, Zhang Q, Zhou M, Peng J, Hu Q. Clinical analysis and quality of life survey of hemophilia B patients in the central and western regions of China. Front Pediatr 2024; 12:1366990. [PMID: 38783919 PMCID: PMC11111977 DOI: 10.3389/fped.2024.1366990] [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: 01/08/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To study the current status of hemophilia B (HB) patients in the central and western regions of China. Methods This cross-sectional, multicenter study was conducted in seven provinces in the central and western regions of China from April 2019 to June 2023. Samples were collected for the factor IX activity, inhibitor screen, and gene mutation. Furthermore, the status of six index joints and quality of life (QoL) were assessed. Results A total of 185 HB patients (mild 15, moderate 75, and severe 95) with a median age of 12.17 years were enrolled. 30.3% (56/185) of patients had a family history of HB. 34.6% (64/185) of HB patients had diagnostic delay and 38.5% (69/179) experienced treatment delay. The incidence of inhibitors was 6.1% (11/179). We identified 123 genetic variants in this study, with missense mutations being the most common. 84.0% (89/106) of HB mothers were genetically identified as carriers, with 27.7% (13/47) of carriers having clotting factor levels less than 0.40 IU/ml. 71.4% (132/185) of HB patients had a history of joint hemorrhage, with a rate of target joint in these patients was 64.4% (85/132). Lower extremity joints were most often affected in patients. The Hemophilia Joint Health Score (HJHS) score was significantly positively correlated with the Hemophilia Early Arthropathy Detection with Ultrasound in China (HEAD-US-C) (r = 0.542, P < 0.001). Patients who received prevention treatment, inhibitor negative, without treatment delay, and without high-intensity replacement therapy showed a higher total score of the short form-36 health survey (SF-36). Conclusions One-third of HB patients had delay in diagnosis and treatment, and the incidence of inhibitors was 6.1%. Target joints were present in nearly half of HB patients. Missense was the main mutation type. 84.0% of mothers of HB patients in this study were found to be carriers. HEAD-US-C and HJHS can complement each other in the evaluation of joint status and give a valid basis for early clinical management. Early detection and preventive treatment, as well as reducing high-intensity replacement therapy and inhibitor generation, can effectively improve the QoL of patients.
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Affiliation(s)
- Wen Wang
- Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
| | - Li Xu
- Department of Hematology, The Second People's Hospital of Anhui Province, Hefei, China
| | - Jingsheng Wu
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Weiyong Liu
- Department of Ultrasound, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Jiao Jin
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Huang
- Department of Pediatrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhongjin Xu
- Department of Hematology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yali Huang
- Department of Hematology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Bai Li
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yufeng Liu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Zhang
- Haemophilia Diagnosis and Treatment Center, Department of Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Min Zhou
- Haemophilia Diagnosis and Treatment Center, Department of Hematology and Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Peng
- Department of Hematology, Xiangya Hospital Central South University, Changsha, China
| | - Qun Hu
- Department of Pediatrics, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, China
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Mårtensson A, Letelier A, Manderstedt E, Glosli H, Ljung R. Origin of pathogenic variant and mosaicism in families with a sporadic case of haemophilia B. Haemophilia 2024; 30:774-779. [PMID: 38632836 DOI: 10.1111/hae.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Of newly diagnosed cases of haemophilia B, the proportion of sporadic cases is usually 50% of severe cases and 25% of moderate/mild cases. However, cases presumed to be sporadic due to family history may not always be sporadic. Few case reports have been published on mosaicism in haemophilia B. AIM The present study aimed to trace the origin of the pathogenic variant in a well-defined cohort of sporadic cases of haemophilia B by haplotyping markers. It also aimed to determine the frequency of mosaicism in presumed non-carrier mothers. METHODS The study group was 40 families, each with a sporadic case of haemophilia B analysed in two-to-three generations by Sanger sequencing, haplotyping and using the sensitive droplet digital polymerase chain reaction (ddPCR) technique. RESULTS In 31/40 (78%) of the families, the mother carried the same pathogenic variant as her son, while Sanger sequencing showed that 9/40 (22%) of the mothers did not carry this variant. Of these variants, 2/9 (22%) were shown to be mosaics by using the ddPCR technique. 16/21 carrier mothers, with samples from three generations available, had a de novo pathogenic variant of which 14 derived from the healthy maternal grandfather. CONCLUSION The origin of the pathogenic variant in sporadic cases of haemophilia B is most often found in the X-chromosome derived from the maternal grandfather or, less often, from the maternal grandmother. Mosaic females seem to be found at the same frequency as in haemophilia A but at a lower percentage of the pathogenic variant.
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Affiliation(s)
- Annika Mårtensson
- Department of Clinical Sciences Lund - Paediatrics, Lund University, Lund, Sweden
- Department of Paediatrics, Skåne University Hospital, Lund, Sweden
| | - Anna Letelier
- Department of Clinical Sciences Lund - Paediatrics, Lund University, Lund, Sweden
| | - Eric Manderstedt
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Heidi Glosli
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Rolf Ljung
- Department of Clinical Sciences Lund - Paediatrics, Lund University, Lund, Sweden
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3
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Labarque V, Mancuso ME, Kartal-Kaess M, Ljung R, Mikkelsen TS, Andersson NG. F8/F9 variants in the population-based PedNet Registry cohort compared with locus-specific genetic databases of the European Association for Haemophilia and Allied Disorders and the Centers for Disease Control and Prevention Hemophilia A or Hemophilia B Mutation Project. Res Pract Thromb Haemost 2023; 7:100036. [PMID: 36798899 PMCID: PMC9926204 DOI: 10.1016/j.rpth.2023.100036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/11/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023] Open
Abstract
Background Hemophilia A and B are caused by variants in the factor (F) VIII or FIX gene. Selective reporting may influence the distribution of variants reported in genetic databases. Objectives To compare the spectrum of F8 and F9 variants in an international population-based pediatric cohort (PedNet Registry) with the spectrum found in the European Association for Haemophilia and Allied Disorders (EAHAD) and the Centers for Disease Control and Prevention Hemophilia A or Hemophilia B Mutation Project (CHAMP/CHBMP) databases. Methods All patients registered in the PedNet Registry on January 1, 2021 were included in this study. As comparators, data from patients with severe hemophilia included in the CHAMP/CHBMP registry (US center data) and EAHAD were used. Results Genetic information was available for 1941 patients. Intron 22 inversion was present in 52% of patients with severe hemophilia A; frameshift (36%), missense (28%), and nonsense (20%) were the most frequent variants in patients with severe hemophilia A who were inversion-negative. The most frequent variants in severe hemophilia B were missense (48%). In nonsevere disease, most variants were missense variants (moderate hemophilia A: 91%; mild hemophilia A: 95%, moderate and mild hemophilia B: 86% each). Comparison with the databases demonstrated a higher proportion of missense variants associated with severe hemophilia B in EAHAD (68%) than in PedNet (48%) and CHBMP (46%). Conclusion The PedNet population-based cohort provides an alternative to the established databases, which collect data by selective reporting, as it is a well-maintained database covering the full spectrum of pathogenic F8 and F9 variants, and indicates the number of patients affected by each particular variant.
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Affiliation(s)
- Veerle Labarque
- Department of Paediatrics, Paediatric Haematology and Oncology, University Hospitals Leuven, Leuven, Belgium,Correspondence Veerle Labarque, Department of Paediatrics, Paediatric Haematology and Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy,Humanitas University, Rozzano, Milan, Italy
| | - Mutlu Kartal-Kaess
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Rolf Ljung
- Department of Clinical Sciences and Paediatrics, Lund University, Lund, Sweden
| | - Torben S. Mikkelsen
- Department of Paediatric Oncology and Haematology, University Hospital, Aarhus, Denmark
| | - Nadine G. Andersson
- Department of Clinical Sciences and Paediatrics, Lund University, Lund, Sweden,Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund, Sweden
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4
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Branchini A, Morfini M, Lunghi B, Belvini D, Radossi P, Bury L, Serino ML, Giordano P, Cultrera D, Molinari AC, Napolitano M, Bigagli E, Castaman G, Pinotti M, Bernardi F. F9 missense mutations impairing factor IX activation are associated with pleiotropic plasma phenotypes. J Thromb Haemost 2022; 20:69-81. [PMID: 34626083 PMCID: PMC9298354 DOI: 10.1111/jth.15552] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Circulating dysfunctional factor IX (FIX) might modulate distribution of infused FIX in hemophilia B (HB) patients. Recurrent substitutions at FIX activation sites (R191-R226, >300 patients) are associated with variable FIX activity and antigen (FIXag) levels. OBJECTIVES To investigate the (1) expression of a complete panel of missense mutations at FIX activation sites and (2) contribution of F9 genotypes on the FIX pharmacokinetics (PK). METHODS We checked FIX activity and antigen and activity assays in plasma and after recombinant expression of FIX variants and performed an analysis of infused FIX PK parameters in patients (n = 30), mostly enrolled in the F9 Genotype and PK HB Italian Study (GePKHIS; EudraCT ID2017-003902-42). RESULTS The variable FIXag amounts and good relation between biosynthesis and activity of multiple R191 variants results in graded moderate-to-mild severity of the R191C>L>P>H substitutions. Recombinant expression may predict the absence in the HB mutation database of the benign R191Q/W/K and R226K substitutions. Equivalent changes at R191/R226 produced higher FIXag levels for R226Q/W/P substitutions, as also observed in p.R226W female carrier plasma. Pharmacokinetics analysis in patients suggested that infused FIX Alpha distribution and Beta elimination phases positively correlated with endogenous FIXag levels. Mean residence time was particularly prolonged (79.4 h, 95% confidence interval 44.3-114.5) in patients (n = 7) with the R191/R226 substitutions, which in regression analysis were independent predictors (β coefficient 0.699, P = .004) of Beta half-life, potentially prolonged by the increasing over time ratio between endogenous and infused FIX. CONCLUSIONS FIX activity and antigen levels and specific features of the dysfunctional R191/R226 variants may exert pleiotropic effects both on HB patients' phenotypes and substitutive treatment.
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Affiliation(s)
- Alessio Branchini
- Department of Life Sciences and Biotechnology and LTTA CentreUniversity of FerraraFerraraItaly
| | | | - Barbara Lunghi
- Department of Life Sciences and Biotechnology and LTTA CentreUniversity of FerraraFerraraItaly
| | - Donata Belvini
- Transfusion ServiceHaemophilia Centre and HaematologyCastelfranco Veneto HospitalCastelfranco VenetoItaly
| | - Paolo Radossi
- Oncohematology‐Oncologic Institute of VenetoCastelfranco Veneto HospitalCastelfranco VenetoItaly
| | - Loredana Bury
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Maria Luisa Serino
- Haemostasis and Thrombosis CentreUniversity Hospital of FerraraFerraraItaly
| | - Paola Giordano
- Paediatric SectionDepartment of Biomedicine and Human OncologyA. Moro” UniversityBariItaly
| | - Dorina Cultrera
- Haemophilia Regional Reference CenterVittorio Emanuele” University HospitalCataniaItaly
| | | | - Mariasanta Napolitano
- Haematology UnitThrombosis and Haemostasis Reference Regional Center and PROMISE DepartmentUniversity of PalermoPalermoItaly
| | - Elisabetta Bigagli
- Department of Neuroscience, PsychologyDrug Research and Child Health (NEUROFARBA)Section of Pharmacology and ToxicologyUniversity of FlorenceFlorenceItaly
| | - Giancarlo Castaman
- Department of Oncology, Center for Bleeding DisordersCareggi University HospitalFirenzeItaly
| | - Mirko Pinotti
- Department of Life Sciences and Biotechnology and LTTA CentreUniversity of FerraraFerraraItaly
| | - Francesco Bernardi
- Department of Life Sciences and Biotechnology and LTTA CentreUniversity of FerraraFerraraItaly
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Kloosterman F, Zwagemaker A, Abdi A, Gouw S, Castaman G, Fijnvandraat K. Hemophilia management: Huge impact of a tiny difference. Res Pract Thromb Haemost 2020; 4:377-385. [PMID: 32211572 PMCID: PMC7086468 DOI: 10.1002/rth2.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/27/2019] [Indexed: 12/22/2022] Open
Abstract
Hemophilia A and B are inherited X-linked disorders of hemostasis, associated with an increased bleeding tendency. Patients with severe hemophilia have undetectable clotting factor levels and experience spontaneous bleeds. In patients with nonsevere hemophilia, the clotting factor levels are 2% to 40% of normal and bleeds predominantly occur after provocative events such as trauma and surgery. Despite this milder phenotype, patients with nonsevere hemophilia may suffer from considerable morbidity and have an increased mortality risk. However, many aspects of the course of disease and treatment remain unclear. Information on the factors influencing interindividual differences in bleeding phenotype is lacking, and misdiagnosis may occur due to assay discrepancies in the diagnostic workup. Desmopressin is the preferred treatment modality, but some patients and indications require treatment with clotting factor concentrates. This may elicit inhibitor formation, which is associated with an increased burden of disease and a higher mortality rate. It has been found that patients with nonsevere hemophilia A carry a lifelong risk for this serious complication. In this review, we provide an overview of the current knowledge of the diagnosis and management of nonsevere hemophilia. A report of science presented at the International Society on Thrombosis and Haemostasis 2019 Annual Congress is also provided.
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Affiliation(s)
- Fabienne Kloosterman
- Pediatric HematologyAmsterdam UMCEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
| | - Anne‐Fleur Zwagemaker
- Pediatric HematologyAmsterdam UMCEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
| | - Amal Abdi
- Pediatric HematologyAmsterdam UMCEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
| | - Samantha Gouw
- Pediatric HematologyAmsterdam UMCEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Giancarlo Castaman
- Department of OncologyCenter for Bleeding DisordersCareggi University HospitalFlorenceItaly
| | - Karin Fijnvandraat
- Pediatric HematologyAmsterdam UMCEmma Children's HospitalUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Molecular Cellular HemostasisSanquin ResearchAmsterdamThe Netherlands
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6
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Manderstedt E, Nilsson R, Lind-Halldén C, Ljung R, Astermark J, Halldén C. Targeted re-sequencing of F8, F9 and VWF: Characterization of Ion Torrent data and clinical implications for mutation screening. PLoS One 2019; 14:e0216179. [PMID: 31026269 PMCID: PMC6485758 DOI: 10.1371/journal.pone.0216179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022] Open
Abstract
Mutations are not identified in ~5% of hemophilia A and 10–35% of type 1 VWD patients. The bleeding tendency also varies among patients carrying the same causative mutation, potentially indicating variants in additional genes modifying the phenotype that cannot be identified by routine single-gene analysis. The F8, F9 and VWF genes were analyzed in parallel using an AmpliSeq strategy and Ion Torrent sequencing. Targeting all exonic positions showed an average read depth of >2000X and coverage close to 100% in 24 male patients with known disease-causing mutations. Discrimination between reference alleles and alternative/indel alleles was adequate at a 25% frequency threshold. In F8, F9 and VWF there was an absolute majority of all reference alleles at allele frequencies >95% and the average alternative allele and indel frequencies never reached above 10% and 15%, respectively. In VWF, 4–5 regions showed lower reference allele frequencies; in two regions covered by the pseudogene close to the 25% cut-off for reference alleles. All known mutations, including indels, gross deletions and substitutions, were identified. Additional VWF variants were identified in three hemophilia patients. The presence of additional mutations in 2 out of 16 (12%) randomly selected hemophilia patients indicates a potential mutational contribution that may affect the disease phenotype and counseling in these patients. Parallel identification of disease-causing mutations in all three genes not only confirms the deficiency, but differentiates phenotypic overlaps and allows for correct genetic counseling.
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Affiliation(s)
- Eric Manderstedt
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Rosanna Nilsson
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
- * E-mail:
| | - Christina Lind-Halldén
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
| | - Rolf Ljung
- Department of Clinical Sciences–Pediatrics and Malmö Center for Thrombosis and Hemostasis, Skåne University Hospital, Malmö, Sweden
| | - Jan Astermark
- Department for Hematology Oncology and Radiation Physics, Center for Thrombosis and Hemostasis, Skåne University Hospital, Malmö, Sweden
| | - Christer Halldén
- Department of Environmental Science and Bioscience, Kristianstad University, Kristianstad, Sweden
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7
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Lassalle F, Marmontel O, Zawadzki C, Fretigny M, Bouvagnet P, Vinciguerra C. Recurrent F8
and F9
gene variants result from a founder effect in two large French haemophilia cohorts. Haemophilia 2018; 24:e213-e221. [DOI: 10.1111/hae.13480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 12/29/2022]
Affiliation(s)
- F. Lassalle
- Centre de Biologie Pathologie; Laboratoire d'Hématologie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - O. Marmontel
- Département de Biochimie et Biologie Moléculaire; Centre de Biologie Pathologie Est; Groupe Hospitalier Est; Hospices Civils de Lyon; Bron France
| | - C. Zawadzki
- Centre de Biologie Pathologie; Laboratoire d'Hématologie; Centre Hospitalier Régional Universitaire de Lille; Lille France
| | - M. Fretigny
- Centre de Biologie Pathologie Est; Service d'Hématologie Biologique; Groupe Hospitalier Est; Hospices Civils de Lyon; Bron France
| | - P. Bouvagnet
- Laboratoire de Cardiogénétique; Hospices Civils de Lyon; Université Lyon 1; Lyon France
| | - C. Vinciguerra
- Centre de Biologie Pathologie Est; Service d'Hématologie Biologique; Groupe Hospitalier Est; Hospices Civils de Lyon; Bron France
- Hémostase et Cancer; Université Lyon 1; Lyon France
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8
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Surin VL, Demidova EY, Selivanova DS, Luchinina YA, Salomashkina VV, Pshenichnikova OS, Likhacheva EA. Mutational analysis of hemophilia B in Russia: Molecular-genetic study. RUSS J GENET+ 2016. [DOI: 10.1134/s1022795416040116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Mårtensson A, Letelier A, Halldén C, Ljung R. Mutation analysis of Swedish haemophilia B families – high frequency of unique mutations. Haemophilia 2015; 22:440-5. [DOI: 10.1111/hae.12854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 01/19/2023]
Affiliation(s)
- A. Mårtensson
- Department of Clinical Sciences Lund University Malmö Sweden
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis Skåne University Hospital Lund University Malmö Sweden
| | - A. Letelier
- Department of Clinical Sciences Lund University Malmö Sweden
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis Skåne University Hospital Lund University Malmö Sweden
| | - C. Halldén
- Biomedicine Kristianstad University Kristianstad Sweden
| | - R. Ljung
- Department of Clinical Sciences Lund University Malmö Sweden
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis Skåne University Hospital Lund University Malmö Sweden
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10
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Abstract
Hemophilia B is an X-chromosome-linked inherited bleeding disorder primarily affecting males, but those carrier females with reduced factor IX activity (FIX:C) levels may also experience some bleeding. Genetic analysis has been undertaken for hemophilia B since the mid-1980s, through linkage analysis to track inheritance of an affected allele, and to enable determination of the familial mutation. Mutation analysis using PCR and Sanger sequencing along with dosage analysis for detection of large deletions/duplications enables mutation detection in > 97% of patients with hemophilia B. The risk of the development of inhibitory antibodies, which are reported in ~ 2% of patients with hemophilia B, can be predicted, especially in patients with large deletions, and these individuals are also at risk of anaphylaxis, and nephrotic syndrome if they receive immune tolerance induction. Inhibitors also occur in patients with nonsense mutations, occasionally in patients with small insertions/deletions or splice mutations, and rarely in patients with missense mutations (p.Gln237Lys and p.Gln241His). Hemophilia B results from several different mechanisms, and those associated with hemophilia B Leyden, ribosome readthrough of nonsense mutations and apparently 'silent' changes that do not alter amino acid coding are explored. Large databases of genetic variants in healthy individuals and patients with a range of disorders, including hemophilia B, are yielding useful information on sequence variant frequency to help establish possible variant pathogenicity, and a growing range of algorithms are available to help predict pathogenicity for previously unreported variants.
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Affiliation(s)
- A C Goodeve
- Haemostasis Research Group, Department of Cardiovascular Science, Sheffield Children's NHS Foundation Trust, University of Sheffield and Sheffield Diagnostic Genetics Service, Sheffield, UK
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