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Mathonnet A, Cunat S, Allias F, Caillot S, Thonnon C, Till M, Attié-Bitach T, Touraine R, Meunier S, Cartellier C, Rossi M, Attia J, Putoux A. GGCX-related congenital combined vitamin K-dependent clotting factors deficiency-1: Description of a fetus with chondrodysplasia punctata. Am J Med Genet A 2021; 188:314-318. [PMID: 34558179 DOI: 10.1002/ajmg.a.62503] [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: 03/03/2021] [Revised: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022]
Abstract
Congenital combined vitamin K-dependent clotting factors deficiency (VKCFD) is a rare autosomal recessive disease resulting in hemorrhagic symptoms usually associated with developmental disorders and bone abnormalities. Pathogenic variants in two genes encoding enzymes of the vitamin K cycle, GGCX and VKORC1, can lead to this disorder. We present the case of a male fetus with a brachytelephalangic chondrodysplasia punctata (CDP), absence of nasal bone, growth restriction, and bilateral ventriculomegaly at 18 weeks of gestation. Pathological examination showed a Binder phenotype, hypoplastic distal phalanges, stippled epiphyses, and brain abnormalities suggestive of a brain hemorrhage. Two GGCX pathogenic variants inherited respectively from the mother and the father were identified. To our knowledge, this is the first prenatal description of VKCFD. Even if it remains a rare etiology, which is mostly described in children or adult patients, VKCFD should be considered in fetuses with CDP.
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Affiliation(s)
- Alix Mathonnet
- Hospices Civils de Lyon, Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Séverine Cunat
- Département d'Hématologie Biologique, Hôpital Saint Eloi, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Fabienne Allias
- Hospices Civils de Lyon, Service d'Anatomo-Pathologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Sandrine Caillot
- Hospices Civils de Lyon, Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Cyrielle Thonnon
- Hospices Civils de Lyon, Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Marianne Till
- Hospices Civils de Lyon, Service de Génétique, Centre de Référence Anomalies du Développement et Centre de Compétence Maladies Osseuses Constitutionnelles, Groupement Hospitalier Est, Bron, France
| | - Tania Attié-Bitach
- Service d'Histologie-Embryologie-Cytogenetique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM UMR1163, Imagine Institute, Université de Paris, Paris, France
| | | | - Sandrine Meunier
- Hospices Civils de Lyon, Unité d'Hémostase Clinique, Centre de Référence Maladies Hémorragiques Constitutionnelles (CR-MHC), Hôpital Cardiologique, Bron, France
| | - Charline Cartellier
- Hospices Civils de Lyon, Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant, Bron, France
| | - Massimiliano Rossi
- Hospices Civils de Lyon, Service de Génétique, Centre de Référence Anomalies du Développement et Centre de Compétence Maladies Osseuses Constitutionnelles, Groupement Hospitalier Est, Bron, France.,Équipe GENDEV, Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | - Jocelyne Attia
- Hospices Civils de Lyon, Centre Pluridisciplinaire de Diagnostic Prénatal, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Audrey Putoux
- Hospices Civils de Lyon, Service de Génétique, Centre de Référence Anomalies du Développement et Centre de Compétence Maladies Osseuses Constitutionnelles, Groupement Hospitalier Est, Bron, France.,Équipe GENDEV, Centre de Recherche en Neurosciences de Lyon, INSERM U1028 CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
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Hao Z, Jin DY, Chen X, Schurgers LJ, Stafford DW, Tie JK. γ-Glutamyl carboxylase mutations differentially affect the biological function of vitamin K-dependent proteins. Blood 2021; 137:533-543. [PMID: 33507293 PMCID: PMC7845004 DOI: 10.1182/blood.2020006329] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
γ-Glutamyl carboxylase (GGCX) is an integral membrane protein that catalyzes posttranslational carboxylation of a number of vitamin K-dependent (VKD) proteins involved in a wide variety of physiologic processes, including blood coagulation, vascular calcification, and bone metabolism. Naturally occurring GGCX mutations are associated with multiple distinct clinical phenotypes. However, the genotype-phenotype correlation of GGCX remains elusive. Here, we systematically examined the effect of all naturally occurring GGCX mutations on the carboxylation of 3 structure-function distinct VKD proteins in a cellular environment. GGCX mutations were transiently introduced into GGCX-deficient human embryonic kidney 293 cells stably expressing chimeric coagulation factor, matrix Gla protein (MGP), or osteocalcin as VKD reporter proteins, and then the carboxylation efficiency of these reporter proteins was evaluated. Our results show that GGCX mutations differentially affect the carboxylation of these reporter proteins and the efficiency of using vitamin K as a cofactor. Carboxylation of these reporter proteins by a C-terminal truncation mutation (R704X) implies that GGCX's C terminus plays a critical role in the binding of osteocalcin but not in the binding of coagulation factors and MGP. This has been confirmed by probing the protein-protein interaction between GGCX and its protein substrates in live cells using bimolecular fluorescence complementation and chemical cross-linking assays. Additionally, using a minigene splicing assay, we demonstrated that several GGCX missense mutations affect GGCX's pre-messenger RNA splicing rather than altering the corresponding amino acid residues. Results from this study interpreted the correlation of GGCX's genotype and its clinical phenotypes and clarified why vitamin K administration rectified bleeding disorders but not nonbleeding disorders.
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Affiliation(s)
- Zhenyu Hao
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Da-Yun Jin
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Xuejie Chen
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Leon J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Darrel W Stafford
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Jian-Ke Tie
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
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Gao W, Xu Y, Liu H, Gao M, Cao Q, Wang Y, Cui L, Huang R, Shen Y, Li S, Yang H, Chen Y, Li C, Yu H, Li W, Shen G. Characterization of missense mutations in the signal peptide and propeptide of FIX in hemophilia B by a cell-based assay. Blood Adv 2020; 4:3659-3667. [PMID: 32766856 PMCID: PMC7422117 DOI: 10.1182/bloodadvances.2020002520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022] Open
Abstract
Many mutations in the signal peptide and propeptide of factor IX (FIX) cause hemophilia B. A FIX variants database reports 28 unique missense mutations in these regions that lead to FIX deficiency, but the underlying mechanism is known only for the mutations on R43 that interfere with propeptide cleavage. It remains unclear how other mutations result in FIX deficiency and why patients carrying the same mutation have different bleeding tendencies. Here, we modify a cell-based reporter assay to characterize the missense mutations in the signal peptide and propeptide of FIX. The results show that the level of secreted conformation-specific reporter (SCSR), which has a functional γ-carboxyglutamate (Gla) domain of FIX, decreases significantly in most mutations. The decreased SCSR level is consistent with FIX deficiency in hemophilia B patients. Moreover, we find that the decrease in the SCSR level is caused by several distinct mechanisms, including interfering with cotranslational translocation into the endoplasmic reticulum, protein secretion, γ-carboxylation of the Gla domain, and cleavage of the signal peptide or propeptide. Importantly, our results also show that the SCSR levels of most signal peptide and propeptide mutations increase with vitamin K concentration, suggesting that the heterogeneity of bleeding tendencies may be related to vitamin K levels in the body. Thus, oral administration of vitamin K may alleviate the severity of bleeding tendencies in patients with missense mutations in the FIX signal peptide and propeptide regions.
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Affiliation(s)
- Wenwen Gao
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Yaqi Xu
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Hongli Liu
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Meng Gao
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Qing Cao
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Yiyi Wang
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Longteng Cui
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Rong Huang
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Yan Shen
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Sanqiang Li
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Haiping Yang
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
- First Affiliated Hospital, Henan University of Science and Technology, Luoyang, People's Republic of China
| | - Yixiang Chen
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
| | - Chaokun Li
- Sino-UK Joint Laboratory for Brain Function and Injury, School of Basic Medical Sciences, and
| | - Haichuan Yu
- Department of Biochemistry and Molecular Biology, School of Medical Laboratory, Xinxiang Medical University, Xinxiang, People's Republic of China; and
| | - Weikai Li
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO
| | - Guomin Shen
- Department of Medical Genetics, Institute of Hemostasis and Thrombosis, School of Basic Medical Sciences, and
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Abstract
Vitamin K (VK) is an essential cofactor for the post-translational conversion of peptide-bound glutamate to γ-carboxyglutamate. The resultant vitamin K-dependent proteins are known or postulated to possess a variety of biological functions, chiefly in the maintenance of hemostasis. The vitamin K cycle is a cellular pathway that drives γ-carboxylation and recycling of VK via γ-carboxyglutamyl carboxylase (GGCX) and vitamin K epoxide reductase (VKOR), respectively. In this review, we show how novel molecular biological approaches are providing new insights into the pathophysiological mechanisms caused by rare mutations of both GGCX and VKOR. We also discuss how other protein regulators influence the intermediary metabolism of VK, first through intestinal absorption and second through a pathway that converts some dietary phylloquinone to menadione, which is prenylated to menaquinone-4 (MK-4) in target tissues by UBIAD1. The contribution of MK-4 synthesis to VK functions is yet to be revealed.
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Affiliation(s)
- Martin J Shearer
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom;
| | - Toshio Okano
- Department of Hygienic Sciences, Kobe Pharmaceutical University, Kobe 658-8558 Japan;
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