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Willems SP, Simons A, Saes JL, Weiss M, Rijpma S, Schoormans S, Meijer K, Cnossen MH, Schutgens RE, van Es N, Nieuwenhuizen L, den Exter PL, Kruis IC, Blijlevens NM, van Heerde WL, Schols SE. Targeted exome analysis in patients with rare bleeding disorders: data from the Rare Bleeding Disorders in the Netherlands study. Res Pract Thromb Haemost 2024; 8:102477. [PMID: 39076726 PMCID: PMC11284956 DOI: 10.1016/j.rpth.2024.102477] [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: 01/19/2024] [Revised: 04/12/2024] [Accepted: 06/06/2024] [Indexed: 07/31/2024] Open
Abstract
Background Rare coagulation factor deficiencies and disorders of fibrinolysis (defined as rare bleeding disorders [RBDs]) present with a heterogeneous bleeding phenotype, and bleeding severity is difficult to predict. Objectives Describe underlying rare genetic variants in the Dutch RBD population and investigate the relationship between genotype, laboratory phenotype, and clinical phenotype. Methods The Rare Bleeding Disorders in the Netherlands is a cross-sectional, nationwide study conducted between October 1, 2017, and November 30, 2019. Bleeding scores and blood samples were collected during a single study visit. Coagulation factor levels were measured centrally, and targeted exome analysis was performed on 156 genes involved in thrombosis and hemostasis. Pathogenicity was assigned according to the Association for Clinical Genetic Science guidelines. Results Rare genetic variants specific to the diagnosed RBD were found in 132 of 156 patients (85%). Of the 214 rare genetic variants identified, 57% (n = 123) were clearly pathogenic, 19% (n = 40) were likely pathogenic, and 24% (n = 51) were variants of unknown significance. No explanatory genetic variants were found in patients with plasminogen activator inhibitor type 1 deficiency or hyperfibrinolysis. A correlation existed between factor activity levels and the presence of a genetic variant in the corresponding gene in patients with rare coagulation factor deficiencies and alpha-2-antiplasmin deficiency. Co-occurrence of multiple genetic variants was present in a quarter of patients, but effect on phenotype remains unclear. Conclusion Targeted exome analysis may offer advantages over single-gene analysis, emphasized by a number of combined deficiencies in this study. Further studies are required to determine the role of co-occurring hemostasis gene variants on the bleeding phenotype in RBDs.
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Affiliation(s)
- Sterre P.E. Willems
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Hemophilia Treatment Center, Nijmegen – Eindhoven – Maastricht, the Netherlands
| | - Annet Simons
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joline L. Saes
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Hemophilia Treatment Center, Nijmegen – Eindhoven – Maastricht, the Netherlands
| | - Marjan Weiss
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sanna Rijpma
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Selene Schoormans
- Department of Laboratory Medicine, Laboratory of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus Medical Centre Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Roger E.G. Schutgens
- Center for Benign Haematology, Thrombosis and Haemostasis, van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands
| | - Laurens Nieuwenhuizen
- Hemophilia Treatment Center, Nijmegen – Eindhoven – Maastricht, the Netherlands
- Department of Hematology, Máxima Medical Center Eindhoven, Eindhoven, the Netherlands
| | - Paul L. den Exter
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Ilmar C. Kruis
- Netherlands Hemophilia Society, Nijkerk, the Netherlands
| | | | - Waander L. van Heerde
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Hemophilia Treatment Center, Nijmegen – Eindhoven – Maastricht, the Netherlands
- Enzyre BV, Novio Tech Campus, Nijmegen, the Netherlands
| | - Saskia E.M. Schols
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
- Hemophilia Treatment Center, Nijmegen – Eindhoven – Maastricht, the Netherlands
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Kavosh Z, Mohammadzadeh Z, Alizadeh S, Sharifi MJ, Hajizadeh S, Choobineh H, Omidkhoda A. Factor VII R353Q (rs6046), FGA A6534G (rs6050), and FGG C10034T (rs2066865) Gene Polymorphisms and Risk of Recurrent Pregnancy Loss in Iranian Women. Indian J Hematol Blood Transfus 2024; 40:297-302. [PMID: 38708173 PMCID: PMC11065828 DOI: 10.1007/s12288-023-01691-w] [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: 05/02/2023] [Accepted: 08/10/2023] [Indexed: 05/07/2024] Open
Abstract
Recurrent pregnancy loss is a multi factorial and heterogeneous disorder defined as two or more consecutive pregnancy losses before 20 weeks' gestation. Gene polymorphisms including factor VII R353Q (rs6046), fibrinogen alpha chain A6534G (rs6050) and fibrinogen gamma chain C10034T (rs2066865) have potential role in thrombophilia and the relation between these three polymorphisms and an increased risk of venous thrombosis have been reported. As thrombophilia is associated with a considerable proportion of pregnancy loss and the association between these gene polymorphisms and recurrent pregnancy loss remains controversial, the aim of the present study was to evaluate the relation of these polymorphisms and recurrent pregnancy loss in Iranian women. A total of 144 women with a history of two or more consecutive miscarriages as the patient group and 150 healthy women with two live births and no history of pregnancy loss as the control group were included in the study. Polymerase chain reaction and restriction fragment length polymorphism were used for genotyping. The results were validated by DNA sequencing. The SPSS, SNPStats and Finch TV were used to analyze the results. Factor VII R353Q (rs6046) gene polymorphism showed a significant difference between RPL patients and the control group according to multiple logistic regression models [codominant (OR=0.38; 95% CI=0.23-0.63, P≤0.0001), dominant (OR=0.32; 95% CI=0.20-0.52, P≤0.0001), over dominant (OR=0.46; 95% CI=0.29-0.75, P=0.0017) and log-additive (OR=0.35; 95% CI=0.23-0.53, P≤0.0001)]. Fibrinogen alpha chain A6534G (rs6050) and fibrinogen gamma chain C10034T (rs2066865) gene polymorphisms showed no correlation with recurrent pregnancy loss. Factor VII R353Q (rs6046) gene polymorphism can be considered a risk factor for recurrent pregnancy loss. Further studies in larger populations are needed to confirm the findings.
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Affiliation(s)
- Zeinab Kavosh
- Hematology and Transfusion Science Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohammadzadeh
- Hematology and Transfusion Science Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaban Alizadeh
- Hematology and Transfusion Science Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sonia Hajizadeh
- Hematology and Transfusion Science Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Choobineh
- Laboratory Science Department, Allied School of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Omidkhoda
- Hematology and Transfusion Science Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Shams M, Hassani S, Dorgalaleh A, Zamani F, Ahmadi A. Factor VII Padua in Iran: clinical and laboratory findings of three unrelated patients. Blood Coagul Fibrinolysis 2023; 34:156-160. [PMID: 36719811 DOI: 10.1097/mbc.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The congenital factor VII (FVII) deficiency with an estimated incidence of one per 300 000 is the most common rare congenital bleeding disorder. The heterogeneous clinical pictures, including asymptomatic to life-threatening manifestations, are seen in patients with FVII deficiency. A variety of gene variants throughout the FVII ( F7 ) gene have been reported so far. In this setting, very rare FVII Padua polymorphism provokes an interesting condition in which results of prothrombin time and FVII activity are different based on the thromboplastin sources used in these tests. The current study aimed to report the phenotype and genotyping of patients with Padua variant. During the workup of the laboratory for FVII deficiency for diagnosis of FVII Padua, all patients with FVII deficiency who had prolonged prothrombin time, normal activated partial thromboplastin time, and variable FVII activity results using different sources of thromboplastin were included. Demographic data and clinical findings were recorded. For the molecular study, the F7 gene sequencing was performed using the Sanger sequencing technique. Five patients with FVII Padua and a history of mild-to-moderate bleeding, including easy bruising, epistaxis, gingivorrhagia, and bleeding after surgical challenges (including dental extraction and tonsillectomy), were detected during the study. DNA sequencing revealed a heterozygote CGG to CAG (Arg364Gln) variant in exon 9 at nucleotide position 1091, consistent with the genetic variant of FVII Padua. Timely diagnosis of FVII Padua is vital to avoid unnecessary exposure of patients to replacement therapy.
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Affiliation(s)
- Mahmood Shams
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol
| | - Saeed Hassani
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak
| | | | - Fatemeh Zamani
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj
| | - Abbas Ahmadi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj
- Department of Molecular Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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4
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Sharma R, Jamwal M, Senee HK, Singh N, Kumar N, Hans C, Kler A, Bansal D, Trehan A, Malhotra P, Ahluwalia J, Das R. Molecular spectrum of inherited FVII deficiency in North India revealed a recurrent variant with a founder effect. Haemophilia 2023; 29:591-599. [PMID: 36571800 DOI: 10.1111/hae.14730] [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: 05/28/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Inherited Factor VII (FVII) deficiency is commonest among the rare bleeding disorders. A small number of patients present in infancy with severe bleeding, and many may remain asymptomatic but detected before surgery/invasive procedures. Genetic testing may be helpful in predictive testing/prenatal diagnosis in severe cases. AIM Characterisation of clinical and genotypic spectrum of patients with inherited FVII deficiency. METHODS Retro-prospectively, 35 cases with prolonged prothrombin time and FVII activity (FVII:C) <50 IU/dl were subjected to targeted resequencing. After in-silico analysis, variant/s were validated by Sanger sequencing in index cases and family members. Haplotype analysis was done for F7 polymorphisms. RESULTS Severe FVII deficiency was found in 50% of patients (FVII:C ≤1 IU/dl), and 42.9% were asymptomatic. Clinical severity assessment revealed 17% severe, 17% moderate and 22.9% patients with mild bleeds. FVII levels ranged from .3 to 38 IU/dl. Molecular analysis revealed variants in 30/35 cases, of which 17 were homozygous, 10 were compound heterozygous and 3 were heterozygous. Twelve genetic variants were identified, one promoter variant c.-30A>C; seven missense (c.215C>G, c.244T>C, c.253G>C, c.904G>A, c.961C>T, c.1109G>T, c.1211G>A), two deletions (c.21delG, c.868_870delATC), and one each of nonsense c.634C>T and splice-site variant c.316+1G>A. Recurrent variants c.1109G>T and c.215C>G were found in 17 and 8 cases, 12 of the former cases were homozygous. They had the same haplotype, indicating the founder effect in North Indians. CONCLUSION This is the largest cohort of FVII genotyping from India, confirming heterogeneity in terms of clinical manifestations, FVII activity and zygosity of the variants with a limited genotypic phenotypic correlation.
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Affiliation(s)
- Ritika Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Jamwal
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hari Kishan Senee
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Singh
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chander Hans
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anita Kler
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatrics (Hematology-Oncology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics (Hematology-Oncology Unit), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Giansily-Blaizot M, Rallapalli PM, Perkins SJ, Kemball-Cook G, Hampshire DJ, Gomez K, Ludlam CA, McVey JH. The EAHAD blood coagulation factor VII variant database. Hum Mutat 2020; 41:1209-1219. [PMID: 32333443 DOI: 10.1002/humu.24025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/17/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022]
Abstract
Hereditary blood coagulation factor VII (FVII) deficiency is a rare autosomal recessive bleeding disorder resulting from variants in the gene encoding FVII (F7). Integration of genetic variation with functional consequences on protein function is essential for the interpretation of the pathogenicity of novel variants. Here, we describe the integration of previous locus-specific databases for F7 into a single curated database with enhanced features. The database provides access to in silico analyses that may be useful in the prediction of variant pathogenicity as well as cross-species sequence alignments, structural information, and functional and clinical severity described for each variant, where appropriate. The variant data is shared with the F7 Leiden Open Variation Database. The updated database now includes 221 unique variants, representing gene variants identified in 728 individuals. Single nucleotide variants are the most common type (88%) with missense representing 74% of these variants. A number of variants are found with relatively high minor allele frequencies that are not pathogenic but contribute significantly to the likely pathogenicity of coinherited variants due to their effect on FVII plasma levels. This comprehensive collection of curated information significantly aids the assessment of pathogenicity.
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Affiliation(s)
| | - Pavithra M Rallapalli
- Department of Structural and Molecular Biology, University College London, London, UK
| | - Stephen J Perkins
- Department of Structural and Molecular Biology, University College London, London, UK
| | - Geoffrey Kemball-Cook
- Katherine Dormandy Haemophilia Centre Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | | | - Keith Gomez
- Katherine Dormandy Haemophilia Centre Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Christopher A Ludlam
- Clinical Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - John H McVey
- Department of Biochemical Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
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Shahbazi S, Mahdian R, Karimi K, Mashayekhi A. Molecular Characterization of Iranian Patients with Inherited Coagulation Factor VII Deficiency. Balkan J Med Genet 2018; 20:19-26. [PMID: 29876229 PMCID: PMC5972499 DOI: 10.1515/bjmg-2017-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coagulation factor VII (FVII) is a key enzyme of the extrinsic coagulation cascade that is predominantly produced by hepatocytes. The F7 gene mutations cause FVII deficiency with considerable molecular and phenotypic heterogeneity. We characterized the molecular alterations of the F7 gene and their corresponding mRNA transcripts in Iranian patients from eight unrelated families. The mutations were detected by polymerase chain reaction (PCR)-sequencing of all F7 gene exons, their flanking intronic sequences, as well as their corresponding cDNA fragments. Homozygous P303T, C91S and R304Q mutations were detected in patient 2, patient 5, and patient 6, respectively. Patient 7 was a compound heterozygote for S282R and H348R and patient 8 was a compound heterozygote for R304Q and IVS7+7A>G mutations. Furthermore, our investigation revealed three heterozygous individuals, patient 1 and patient 3 with the A244V mutation who were symptomatic and patient 4 with V(-39)I mutation who was also asymptomatic. The F7 mRNA expression analysis revealed that, except the transcript of V(-39)I, other mutation-harboring transcripts were expressed at detectable levels. In conclusion, this report reinforces the genetic and phenotypic heterogeneity of FVII deficiency. The findings of the mRNA study implied that decreased FVII protein activity subsequent to missense mutations does not completely reflect the degradation of mutation-harboring mRNA.
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Affiliation(s)
- S Shahbazi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University Tehran, Tehran, Iran
- Dr. Shirin Shahbazi, Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Al-e-Ahmad and Chamran Cross, POB 14115-111Tehran, Iran. Tel: +98-21-82-884-556. Fax: +98-21-82-884-555.
| | - R Mahdian
- Molecular Medicine Department, Pasteur Institute of Iran, Tehran, Iran
| | - K Karimi
- Clinic of Hematology and Oncology, School of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - A Mashayekhi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University Tehran, Tehran, Iran
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Belozerceva LA, Voronina EN, Kokh NV, Tsvetovskay GA, Momot AP, Lifshits GI, Filipenko ML, Shevela AI, Vlasov VV. Personalized approach of medication by indirect anticoagulants tailored to the patient-Russian context: what are the prospects? EPMA J 2012; 3:10. [PMID: 23016735 PMCID: PMC3492156 DOI: 10.1186/1878-5085-3-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/19/2012] [Indexed: 11/26/2022]
Abstract
Indirect anticoagulants such as warfarin are the ‘gold standard’ for prevention and treatment of thromboembolic complications in patients at risk (in atrial fibrillation of valvular and nonvalvular etiology, the presence of artificial heart valves, orthopedic and trauma interventions, and other pathological conditions). A wide range of doses required to achieve a therapeutic effect indicates the need for a personalized approach to the appointment of warfarin. In addition to the dependence on the patient's clinical characteristics (sex, age, smoking status, diagnosis), there is a clear association between the warfarin dose and the carriage of certain allelic variants of key genes that makes it possible to apply molecular genetic testing for individual dose adjustment. This provides a more rapid target anticoagulant effect and also reduces the risk of bleeding associated with a possible overdose of warfarin. Implementation of this approach will allow more wide and safe application of indirect anticoagulants in Russia for needy patients.
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Affiliation(s)
- Liliya Alexandrovna Belozerceva
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences (RAS ICBFM), Ac, Lavrentiev 8, Novosibirsk, 630090, Russia.
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8
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Turfan M, Poyraz F, Kaymak AÖ, Ergun MA, Tavil Y, Gursel T, Abaci A. Plasma Levels and Distribution of Gene Polymorphisms of Factor VII in Turkish Population. Clin Appl Thromb Hemost 2012; 20:164-8. [DOI: 10.1177/1076029612459676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three factor VII (FVII) promoter haplotypes are associated with stratified plasma FVII levels. To our knowledge, this is the first study examining the distribution of FVII gene polymorphism and levels in Turkish population. The study population was classified into 3 groups according to the absence of coronary arterial disease and presence or absence of a history of myocardial infarction. It was found that the levels of FVII coagulant activity (FVIIc) were higher in the event group than that of the other groups. Participants with high FVIIc levels were found to have 2-fold increased risk for myocardial infarction. The alleles at the FVII loci in all cases are similar. In conclusion, our results indicate that FVIIc levels have an important predictive role in cardiovascular events. The distribution of FVII gene polymorphisms in the Turkish population shows significant differences when compared with European populations.
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Affiliation(s)
- Murat Turfan
- Department of Cardiology, Bezmialem University, Istanbul, Turkey
| | - Fatih Poyraz
- Department of Cardiology, Gazi University, Ankara, Turkey
| | | | - Mehmet Ali Ergun
- Department of Medical Biology and Genetic, Gazi University, Ankara, Turkey
| | - Yusuf Tavil
- Department of Cardiology, Gazi University, Ankara, Turkey
| | - Turkiz Gursel
- Department of Pediatric Hematology, Gazi University, Ankara, Turkey
| | - Adnan Abaci
- Department of Cardiology, Gazi University, Ankara, Turkey
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Marchetti G, Pinotti M, Lunghi B, Casari C, Bernardi F. Functional genetics. Thromb Res 2011; 129:336-40. [PMID: 22100315 DOI: 10.1016/j.thromres.2011.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 09/26/2011] [Accepted: 10/25/2011] [Indexed: 12/14/2022]
Abstract
How genetic variations mediate normal and abnormal biological function is a major issue in biology and medicine. The enormous number of genomic sequences, and their frequent and rare variations identified in humans, require efficient approaches aimed at dissecting functional correlates. In this review we will focus on the importance of the assessment of well-defined intermediate phenotypes, on the set up of transcriptomic approaches in diseased cells and on the modulation of expression by sequence variations modulating mRNA splicing or influencing protein multimerization. These information provide the molecular bases of associations discovered through genomic approaches, and might open new avenues toward the design of novel and specific diagnostic, prophylactic or therapeutic interventions. Taking into account our previous and current experimental activities we shall focus on a few examples and open issues in cardiovascular disorders, the main clinical topic of this short review.
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Affiliation(s)
- Giovanna Marchetti
- Department of Biochemistry and Molecular Biology, University of Ferrara, Ferrara, Italy
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10
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Polymorphisms in the factor VII gene and ischemic stroke in young adults. Blood Coagul Fibrinolysis 2010; 21:442-7. [DOI: 10.1097/mbc.0b013e3283389513] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sobti RC, Maithil N, Thakur H, Sharma Y, Talwar KK. Association of ACE and FACTOR VII gene variability with the risk of coronary heart disease in north Indian population. Mol Cell Biochem 2010; 341:87-98. [PMID: 20364300 DOI: 10.1007/s11010-010-0440-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
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12
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Sakowicz A, Fendler W, Lelonek M, Gluba A, Pietrucha T. Two polymorphisms of the FVII gene and their impact on the risk of myocardial infarction in poles under 45 years of age. Mol Biol 2010. [DOI: 10.1134/s0026893310020032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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A novel homozygous missense mutation in the factor VII gene of severe factor VII deficiency in a newborn baby. Blood Coagul Fibrinolysis 2009; 20:161-4. [PMID: 19786945 DOI: 10.1097/mbc.0b013e3283258028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A term male infant born to nonconsanguineous parents was admitted to the hospital for evaluation of lethargy and a pale appearance on the third day of life. He had anemia from an intracranial hemorrhage, and his coagulation factor assay revealed that his bleeding episode was due to severe congenital factor VII deficiency (5% of normal activity). An A-to-G point mutation in the acceptor splice site of intron 5 was identified at nucleotide position 9418. Sequence analysis of the factor VII gene in the parents revealed that they were both heterozygous for a G-to-A transversion at nucleotide position 9418 (IVS5-1) between intron 5 and exon 6. A genetic study involving a patient with a congenitally inherited disease and the parents can confirm the genetic background of the disease and can be used for prenatal guidance to exclude severe bleeding disorders.
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MARTY S, BARRO C, CHATELAIN B, FIMBEL B, TRIBOUT B, REYNAUD J, SCHVED JF, GIANSILY-BLAIZOT M. The paradoxical association between inherited factor VII deficiency and venous thrombosis. Haemophilia 2008; 14:564-70. [DOI: 10.1111/j.1365-2516.2007.01647.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Small nuclear U1-RNAs (snRNAs), the spliceosome components selectively recognizing donor splice sites (5′ss), were engineered to restore correct mRNA processing in a cellular model of severe coagulation factor VII (FVII) deficiency, caused by the IVS7 9726 + 5g/a change. Three U1-snRNAs, complementary to the mutated 5′ss (U1 + 5a) or to neighboring sequences were expressed with FVII minigenes in a hepatoma cell line. The U1-snRNAs reduced from 80% to 40% the exon 7 skipping, thus increasing exon definition. The U1 + 5a construct also dramatically increased recognition of the correct 5′ss over the 37-bp downstream cryptic site preferentially activated by the mutation, thus inducing appreciable synthesis of normal transcripts (from barely detectable to 50%). This effect, which was dose-dependent, clearly demonstrated that impaired recognition by the U1-snRNA was the mechanism responsible for FVII deficiency. These findings suggest compensatory U1-snRNAs as therapeutic tools in coagulation factor deficiencies caused by mutations at 5′ss, a frequent cause of severe defects.
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Martinelli N, Trabetti E, Pinotti M, Olivieri O, Sandri M, Friso S, Pizzolo F, Bozzini C, Caruso PP, Cavallari U, Cheng S, Pignatti PF, Bernardi F, Corrocher R, Girelli D. Combined effect of hemostatic gene polymorphisms and the risk of myocardial infarction in patients with advanced coronary atherosclerosis. PLoS One 2008; 3:e1523. [PMID: 18253477 PMCID: PMC2211406 DOI: 10.1371/journal.pone.0001523] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 01/02/2008] [Indexed: 12/16/2022] Open
Abstract
Background Relative little attention has been devoted until now to the combined effects of gene polymorphisms of the hemostatic pathway as risk factors for Myocardial Infarction (MI), the main thrombotic complication of Coronary Artery Disease (CAD). The aim of this study was to evaluate the combined effect of ten common prothrombotic polymorphisms as a determinant of MI. Methodology/Principal Findings We studied a total of 804 subjects, 489 of whom with angiographically proven severe CAD, with or without MI (n = 307; n = 182; respectively). An additive model considering ten common polymorphisms [Prothrombin 20210G>A, PAI-1 4G/5G, Fibrinogen β -455G>A, FV Leiden and “R2”, FVII -402G>A and -323 del/ins, Platelet ADP Receptor P2Y12 -744T>C, Platelet Glycoproteins Ia (873G>A), and IIIa (1565T>C)] was tested. The prevalence of MI increased linearly with an increasing number of unfavorable alleles (χ2 for trend = 10.68; P = 0.001). In a multiple logistic regression model, the number of unfavorable alleles remained significantly associated with MI after adjustment for classical risk factors. As compared to subjects with 3-7 alleles, those with few (≤2) alleles had a decreased MI risk (OR 0.34, 95%CIs 0.13–0.93), while those with more (≥8) alleles had an increased MI risk (OR 2.49, 95%CIs 1.03–6.01). The number of procoagulant alleles correlated directly (r = 0.49, P = 0.006) with endogenous thrombin potential. Conclusions The combination of prothrombotic polymorphisms may help to predict MI in patients with advanced CAD.
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Affiliation(s)
- Nicola Martinelli
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Elisabetta Trabetti
- Section of Biology and Genetics, Department of Mother and Child and Biology–Genetics, University of Verona, Verona, Italy
| | - Mirko Pinotti
- Department of Biochemistry and Molecular Biology, University of Ferrara , Ferrara, Italy
| | - Oliviero Olivieri
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Marco Sandri
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Simonetta Friso
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Francesca Pizzolo
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Claudia Bozzini
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Pier Paolo Caruso
- Department of Biochemistry and Molecular Biology, University of Ferrara , Ferrara, Italy
| | - Ugo Cavallari
- Section of Biology and Genetics, Department of Mother and Child and Biology–Genetics, University of Verona, Verona, Italy
| | - Suzanne Cheng
- Department of Human Genetics, Roche Molecular Systems, Inc., Alameda, California, United States of America
| | - Pier Franco Pignatti
- Section of Biology and Genetics, Department of Mother and Child and Biology–Genetics, University of Verona, Verona, Italy
| | - Francesco Bernardi
- Department of Biochemistry and Molecular Biology, University of Ferrara , Ferrara, Italy
| | - Roberto Corrocher
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
| | - Domenico Girelli
- Department of Clinical and Experimental Medicine, University of Verona, Verona, Italy
- * To whom correspondence should be addressed. E-mail:
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17
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Cha MH, Shin HD, Kim KS, Lee BH, Yoon Y. The effects of uncoupling protein 3 haplotypes on obesity phenotypes and very low-energy diet-induced changes among overweight Korean female subjects. Metabolism 2006; 55:578-86. [PMID: 16631432 DOI: 10.1016/j.metabol.2005.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 11/02/2005] [Indexed: 11/18/2022]
Abstract
Responses to energy restriction tend to vary within the population because of genetic differences. In this study, we have genotyped 6 uncoupling protein 3 (UCP-3) polymorphisms (-55C/T, Int2-143G/C, Tyr99Tyr, Int3-47G/A, Int4-498C/T, and Tyr210Tyr) among 214 overweight Korean female subjects recruited from an obesity clinic. Three major haplotypes, identified with frequencies in excess of 0.04, were constructed from 6 single nucleotide polymorphisms. Association studies were then undertaken, involving the measurement of anthropometric characteristics and body composition both before and after 1 month of a energy-restriction regimen. At baseline, haplotype 1 (ht1) [CGTACC] was associated with elevated anthropometric characteristics, including body weight, waist-hip ratio, and body mass index, as well as body components, including body fat mass and body fat-free mass. After the completion of the 1-month weight control program, which involved a very low-energy (2900 kJ/d) diet, we analyzed the outcomes according to the UCP-3 genetic polymorphisms. Among the 3 principal haplotypes, ht1 [CGTACC] was significantly associated with an increased reduction in body weight, in the codominant (P=.022), dominant (P=.016), and recessive (P=.041) models. Body mass index reduction was associated with the ht1 haplotype in a similar fashion. Among the body components, changes in body fat mass were significantly associated with ht1 [CGTACC] (P=.028), but changes in body fat-free mass were not significantly associated with the UCP-3 polymorphism.
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Affiliation(s)
- Min Ho Cha
- Department of Medical Research, Korea Institute of Oriental Medicine, Daejon 305-811, and School of Life Sciences and Biotechnology, Korea University, Seoul 136-701, South Korea
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18
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González-Conejero R, Marín F, Corral J, Roldán V. Fluctuations in coagulation activity among patients with atrial fibrillation who are stably anticoagulated. Future Cardiol 2006; 2:197-203. [DOI: 10.2217/14796678.2.2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Atrial fibrillation is an important independent risk factor for stroke and increases the risk of systemic embolism. The individual risk depends on several clinical, environmental and biological factors. Additionally, a hypercoagulable state with abnormalities of hemostasia, thrombosis and platelet function have been observed in atrial fibrillation. This arrhythmia is also influenced by a disrupted circadian rhythm of hypercoagulable status implicated in the genesis of cardiovascular and cerebral diseases. The beneficial effect of oral anticoagulation therapy in atrial fibrillation has been confirmed by several studies. However, circadian variations in the degree of anticoagulation in these patients have also been described. In this review, the authors analyze the factors that might condition diurnal variations in thrombogenesis, hypercoagulability, and the extent of anticoagulation in patients with atrial fibrillation.
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Affiliation(s)
| | | | - Javier Corral
- Centro Regional de Hemodonación, Universidad de Murcia, Murcia, Spain
| | - Vanessa Roldán
- Centro Regional de Hemodonación, Universidad de Murcia, Murcia, Spain
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19
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Sabater-Lleal M, Soria JM, Bertranpetit J, Almasy L, Blangero J, Fontcuberta J, Calafell F. Human F7 sequence is split into three deep clades that are related to FVII plasma levels. Hum Genet 2005; 118:741-51. [PMID: 16292673 DOI: 10.1007/s00439-005-0045-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 08/01/2005] [Indexed: 01/04/2023]
Abstract
It is widely accepted that FVII levels are strongly, consistently, and independently related to cardiovascular risk. These levels are influenced by genetic and environmental factors. Among the genetic factors, only a limited number of polymorphisms in the F7 gene have been reported, and they explain only a small proportion of the genetic variability. Recently, we have accomplished the complete dissection of the F7 quantitative trait locus responsible for all of the genetic variability observed in FVII levels. Now, we present the thorough study of the haplotype organization of F7 DNA sequence variation among individuals and the evolutionary processes that produced this variation, by sequencing 15 kb of genomic DNA sequence from the F7 locus in 40 unrelated individual (80 chromosomes) from the genetic analysis of idiopathic thrombophilia (GAIT) project as well as four non-human primate species. Our study revealed 49 polymorphisms, of which 39 SNPs were further considered. Genotyping of these DNA variations in the whole family-based GAIT sample helped resolve linkage phases, and a total of 37 distinct haplotypes were identified.Tajima's D was significantly positive in this sample, suggesting balancing selection. This parameter was a reflection of the phylogenetic structure of F7 haplotype, which was deeply split into three well-supported clades or haplogroups, suggesting that functional differences among F7 variants do not depend on a few single-site variations. Moreover, haplogroup 2 was associated with high FVII levels and haplogroup 3 with low levels. In this study, we have for the first time established a clear relation between genotypic variability structure and phenotypic variability of a particular quantitative trait involved in a complex disease.
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Affiliation(s)
- Maria Sabater-Lleal
- Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, 08005 Barcelona, Spain
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20
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Duttaroy AK. Postprandial activation of hemostatic factors: role of dietary fatty acids. Prostaglandins Leukot Essent Fatty Acids 2005; 72:381-91. [PMID: 15919609 DOI: 10.1016/j.plefa.2005.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 01/05/2005] [Accepted: 03/30/2005] [Indexed: 11/18/2022]
Abstract
Intake of dietary fat is an important determinant of the plasma concentration of triacylglycerol-rich lipoproteins, and the degree of alimentary lipemia is reported to have effects on hemostatic status including platelet function. Although association between the amount of dietary fat intake, lipemic response and certain cardiovascular disease (CVD) risk factors (VIIa and PAI-1) has been reported, the significance of the fatty acid composition of ingested fat for the postprandial lipid concentrations and the hemostatic factors is still unclear. Accumulating evidence suggests a relationship between dietary fatty acids and emerging hemostatic CVD risk factors, although much of this evidence is incomplete or conflicting. In order to improve our knowledge in this area, sufficient sample size in future studies are required to take into account of the genetic variation (gene polymorphisms for VII, PAI-1), sex, physical activity, stage of life factors, and sufficient duration to account for adaptation for definitive conclusions.
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Affiliation(s)
- Asim K Duttaroy
- Department of Nutrition, Faculty of Medicine, University of Oslo, POB 1046 Blindern, N-0316 Oslo, Norway.
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21
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Mtiraoui N, Aboud N, Bouraoui H, Haizem S, Gris JC, Busson M, Tamim H, Almawi WY, Mahjoub T. Reduction in coagulation factor VII plasma levels by R353Q but not the -323P0/10 promoter polymorphism in healthy Tunisians. Am J Hematol 2005; 79:11-6. [PMID: 15952268 DOI: 10.1002/ajh.20328] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The association between the R353Q and -323P0/10 (10-bp insertion in the promoter region at position -323) factor VII mutations and plasma factor VII levels was investigated in a group of 214 healthy Tunisians. The frequency for the Q allele was 0.253 and that for the 10-bp allele was 0.206, and their distribution was variable, with a high prevalence of the 10-bp allele (0.306) seen in North Tunisia and a high prevalence of the Q allele (0.288) see in the Sahel region. No significant linkage disequilibrium was observed between the two mutations, and the most prevalent haplotype was -323P0/353R (0.589 +/- 0.054). Carriers of the R353Q (P < 0.001), but not -323P0/10 (P = 0.088), factor VII mutations had lower mean factor VII serum concentrations. This reduction in mean serum factor VII was more pronounced among homozygous (Q/Q) carriers and among males (49.9%) compared to females (32.7%). Adjusting for all other variables in the linear regression analysis (sex, age, region, smoking, and R353Q and -323P0/10 mutations), heterozygous carriers of the -323P0/10 and R353Q mutation had on average reductions of 10 units (P = 0.005) and 30 units (P < 0.001) in plasma factor VII, respectively, compared to noncarriers, while homozygote carriers of the R353Q (-43.3, P < 0.001), but not carriers of the -323P0/10 (-6.30, P = 0.356), had significantly lower levels of mean plasma factor VII. These data suggest that part of the previously described effects on FVIIc levels associated with the R/Q polymorphism may be explained by genetic variation in the promoter region of the FVII gene.
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Affiliation(s)
- Nabil Mtiraoui
- Hematological and Autoimmune Diseases Research Unit, Faculté de Pharmacie de Monastir, Université du Centre, Tunisia
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22
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Cutler JA, Patel R, Mitchell MJ, Savidge GF. The significance of published polymorphisms in 14 cases of mild factor VII deficiency. Blood Coagul Fibrinolysis 2005; 16:91-5. [PMID: 15741795 DOI: 10.1097/01.mbc.0000161561.51517.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Factor VII (FVII) plays a critical role in the initiation of blood coagulation, and patients with dysfunctional or reduced levels of this protein are susceptible to mucosal bleeding. There is poor correlation between the clinical presentation and the phenotypic data; and in cases of a mild bleeding tendency, mild to moderate reductions in both FVII antigen and activity may be overlooked. The prevalence of FVII deficiency may therefore be underestimated. Polymorphic differences throughout the FVII gene are associated with variations in plasma FVII antigen and activity levels. This study highlights the significance of mild FVII deficiency, and examines the importance of seven previously published polymorphisms in such patients.
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Affiliation(s)
- Jacqueline A Cutler
- Centre for Haemostasis and Thrombosis (Haemophilia Reference Centre), St Thomas' Hospital, London, UK.
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23
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Knight JC. Regulatory polymorphisms underlying complex disease traits. J Mol Med (Berl) 2005; 83:97-109. [PMID: 15592805 PMCID: PMC3132451 DOI: 10.1007/s00109-004-0603-7] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 09/15/2004] [Indexed: 01/08/2023]
Abstract
There is growing evidence that genetic variation plays an important role in the determination of individual susceptibility to complex disease traits. In contrast to coding sequence polymorphisms, where the consequences of non-synonymous variation may be resolved at the level of the protein phenotype, defining specific functional regulatory polymorphisms has proved problematic. This has arisen for a number of reasons, including difficulties with fine mapping due to linkage disequilibrium, together with a paucity of experimental tools to resolve the effects of non-coding sequence variation on gene expression. Recent studies have shown that variation in gene expression is heritable and can be mapped as a quantitative trait. Allele-specific effects on gene expression appear relatively common, typically of modest magnitude and context specific. The role of regulatory polymorphisms in determining susceptibility to a number of complex disease traits is discussed, including variation at the VNTR of INS, encoding insulin, in type 1 diabetes and polymorphism of CTLA4, encoding cytotoxic T lymphocyte antigen, in autoimmune disease. Examples where regulatory polymorphisms have been found to play a role in mongenic traits such as factor VII deficiency are discussed, and contrasted with those polymorphisms associated with ischaemic heart disease at the same gene locus. Molecular mechanisms operating in an allele-specific manner at the level of transcription are illustrated, with examples including the role of Duffy binding protein in malaria. The difficulty of resolving specific functional regulatory variants arising from linkage disequilibrium is demonstrated using a number of examples including polymorphism of CCR5, encoding CC chemokine receptor 5, and HIV-1 infection. The importance of understanding haplotypic structure to the design and interpretation of functional assays of putative regulatory variation is highlighted, together with discussion of the strategic use of experimental tools to resolve regulatory polymorphisms at a transcriptional level. A number of examples are discussed including work on the TNF locus which demonstrate biological and experimental context specificity. Regulatory variation may also operate at other levels of control of gene expression and the modulation of splicing at PTPRC, encoding protein tyrosine phosphatase receptor-type C, and of translational efficiency at F12, encoding factor XII, are discussed.
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Affiliation(s)
- Julian C Knight
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK.
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24
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Shikata E, Ieiri I, Ishiguro S, Aono H, Inoue K, Koide T, Ohgi S, Otsubo K. Association of pharmacokinetic (CYP2C9) and pharmacodynamic (factors II, VII, IX, and X; proteins S and C; and gamma-glutamyl carboxylase) gene variants with warfarin sensitivity. Blood 2003; 103:2630-5. [PMID: 14656880 DOI: 10.1182/blood-2003-09-3043] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We analyzed mutations of 7 vitamin K-dependent protein and cytochrome P450 2C9 genes in 45 patients and investigated whether any contribute to the large interpatient variability in the warfarin dose-effect relationship. Total clearance and daily dose, INR and INR/Cp, were used as pharmacokinetic and pharmacodynamic indexes, respectively. Patients were grouped by genotype based on a single polymorphism and combinations of polymorphisms. Among the 30 sequence variants identified, CYP2C9*3, 165Thr-->Met of the factor II gene, -402G-->A, (37-bp repeat)n, and -746T-->C of the factor VII gene, and (CAA repeat)n of the gamma-glutamyl carboxylase gene were selected as candidate polymorphisms. As the analysis of single polymorphisms implied, the highest INR/Cp mean values and the lowest warfarin maintenance doses were observed in patients homozygous for the 165Met, -402G, (37-bp repeat)6 and -746T alleles. Multiple regression analysis revealed that warfarin sensitivity was independently associated with -402G-->A, (CAA repeat)n, CYP2C9*3, and 165Thr-->Met, which accounted for 50% of variance. These results suggest that part of the considerable interpatient variation is attributable to genetic variation, and the combined genotyping of CYP2C9 and certain vitamin K-dependent protein genes is useful for predicting anticoagulant responses.
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Affiliation(s)
- Eriko Shikata
- Department of Hospital Pharmacy, Faculty of Medicine, Tottori University, Yonago, Japan
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25
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Castoldi E, Govers-Riemslag JWP, Pinotti M, Bindini D, Tans G, Berrettini M, Mazzucconi MG, Bernardi F, Rosing J. Coinheritance of Factor V (FV) Leiden enhances thrombin formation and is associated with a mild bleeding phenotype in patients homozygous for the FVII 9726+5G>A (FVII Lazio) mutation. Blood 2003; 102:4014-20. [PMID: 12881304 DOI: 10.1182/blood-2003-04-1199] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We investigated the role of thrombophilic mutations as possible modifiers of the clinical phenotype in severe factor VII (FVII) deficiency. Among 7 patients homozygous for a cross-reacting material-negative (CRM-) FVII defect (9726+5G>A, FVII Lazio), the only asymptomatic individual carried FV Leiden. Differential modulation of FVII levels by intragenic polymorphisms was excluded by a FVII to factor X (FX) gene haplotype analysis. The coagulation efficiency in the FV Leiden carrier and a noncarrier was evaluated by measuring FXa, FVa, and thrombin generation after extrinsic activation of plasma in the absence and presence of activated protein C (APC). In both patients coagulation factor activation was much slower and resulted in significantly lower amounts of FXa and thrombin than in a normal control. However, more FXa and thrombin were formed in the plasma of the patient carrying FV Leiden than in the noncarrier, especially in the presence of APC. These results were confirmed in FV-FVII doubly deficient plasma reconstituted with purified normal FV or FV Leiden. The difference in thrombin generation between plasmas reconstituted with normal FV or FV Leiden gradually decreased at increasing FVII concentration. We conclude that coinheritance of FV Leiden increases thrombin formation and can improve the clinical phenotype in patients with severe FVII deficiency.
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Affiliation(s)
- Elisabetta Castoldi
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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26
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Abstract
Arterial thrombosis is a complex disorder that involves multiple genetic and environmental factors interacting to produce the characteristic phenotype. In the past decades, investigators have focused on the molecular genetics of arterial vascular disorders and have identified numerous polymorphisms and mutations in genes related to the hemostatic system and to enzymes involved in the synthesis and bioavailability of nitric oxide (NO); however, the relation between most polymorphisms and the risk of coronary artery disease, ischemic stroke, and peripheral vascular disease remains highly controversial. In this review, we describe the most common genetic variations involved in the pathogenesis of arterial thrombosis, their functional implications, and their association with disease risk. Specifically, we consider polymorphisms in coagulation factors (fibrinogen, prothrombin, FV Leiden, FVII, and FXIII); fibrinolytic factors (tissue-type plasminogen activator, plasminogen activator inhibitor-1, and thrombin-activatable fibrinolysis inhibitor); platelet surface receptors; methylenetetrahydrofolate reductase; endothelial NO synthase; and the antioxidant enzymes paraoxonase and plasma glutathione peroxidase. Overall, there seems to be a modest contribution of individual genetic variants in the hemostatic and antioxidant systems to the risk of arterial thrombosis. Thus, future research ought to focus on identifying novel genetic determinants and on the interaction of these genetic risk factors with each other and the environment to understand better the pathobiology and susceptibility to arterial thrombotic disease.
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Affiliation(s)
- Barbara Voetsch
- Whitaker Cardiovascular Institute, Boston University School of Medicine, 715 Albany St, W507, Boston, MA 02118, USA
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27
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Affiliation(s)
- David J Perry
- Haemophilia Centre and Haemostasis Unit, Royal Free and University College Medical School, London, UK
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28
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NAGAIZUMI K, INABA H, ITHO T, YAMANAKA K, SUZUKI T, NISHIDA Y, HAGIWARA T, AMANO K, KAGAWA K, ARAI M, FUKUTAKE K. Identification of Missense Mutations in the FVII Gene of Three FVII Deficiencies. ACTA ACUST UNITED AC 2001. [DOI: 10.2491/jjsth.12.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Hiroshi INABA
- Department of Clinical Pathology, Tokyo Medical University
| | - Takeyoshi ITHO
- First Department of Internal Medicine, Nihon University, School of Medicine
| | - Ko YAMANAKA
- Department of Clinical Pathology, Tokyo Medical University
| | - Takashi SUZUKI
- Department of Clinical Pathology, Tokyo Medical University
| | | | | | - Kagehiro AMANO
- Department of Clinical Pathology, Tokyo Medical University
| | | | - Morio ARAI
- Department of Clinical Pathology, Tokyo Medical University
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