1
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Waqas Z, Rahman S, Khan S, Khan A, Ali Y, Haider I. Thrombosis of the Vein of Trolard: An Atypical Presentation of Protein C Deficiency. Cureus 2023; 15:e50943. [PMID: 38249248 PMCID: PMC10800082 DOI: 10.7759/cureus.50943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Cerebral venous thrombosis refers to complete or partial occlusion of the cerebral sinus/es or the feeding cortical veins, resulting in secondary effects of vascular congestion and focal or generalized neurological deficits. One of the important causes of venous thromboembolism is inherited thrombophilia. Our case is of a 34-year-old male with no previous comorbidity who presented to the emergency department with complaints of sudden onset left-sided weakness, seizures, and loss of consciousness for one day. Thrombosis of the vein of Trolard was diagnosed based on magnetic resonance venography (MRV) film. His MRI with MRV revealed an attenuated caliber of the vein of Trolard along with abnormal signal intensity in the right fronto-parietal region and the right falcine location. He was managed with intravenous medication, including levetiracetam and topiramate. Once the diagnosis was established, he was commenced on subcutaneous Enoxaparin. Consequently, his GCS improved from 6/15 to 15/15 within the first 24 hours, and he could move his limbs on the day of discharge without any significant disability.
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Affiliation(s)
- Zeeshan Waqas
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Saima Rahman
- Radiology, Hayatabad Medical Complex, Peshawar, PAK
| | - Sajid Khan
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Arooba Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Yasir Ali
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Iqbal Haider
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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2
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Gao Y, Wang B, Hu S, Zhu T, Zhang JZH. An efficient method to predict protein thermostability in alanine mutation. Phys Chem Chem Phys 2022; 24:29629-29639. [PMID: 36449314 DOI: 10.1039/d2cp04236c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The relationship between protein sequence and its thermodynamic stability is a critical aspect of computational protein design. In this work, we present a new theoretical method to calculate the free energy change (ΔΔG) resulting from a single-point amino acid mutation to alanine in a protein sequence. The method is derived based on physical interactions and is very efficient in estimating the free energy changes caused by a series of alanine mutations from just a single molecular dynamics (MD) trajectory. Numerical calculations are carried out on a total of 547 alanine mutations in 19 diverse proteins whose experimental results are available. The comparison between the experimental ΔΔGexp and the calculated values shows a generally good correlation with a correlation coefficient of 0.67. Both the advantages and limitations of this method are discussed. This method provides an efficient and valuable tool for protein design and engineering.
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Affiliation(s)
- Ya Gao
- School of Mathematics, Physics and Statistics, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Bo Wang
- Shanghai Engineering Research Center of Molecular Therapeutics & New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, China.
| | - Shiyu Hu
- NYU-ECNU Center for Computational Chemistry at NYU Shanghai, Shanghai 200062, China
| | - Tong Zhu
- Shanghai Engineering Research Center of Molecular Therapeutics & New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, China. .,NYU-ECNU Center for Computational Chemistry at NYU Shanghai, Shanghai 200062, China
| | - John Z H Zhang
- Shanghai Engineering Research Center of Molecular Therapeutics & New Drug Development, School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200062, China. .,NYU-ECNU Center for Computational Chemistry at NYU Shanghai, Shanghai 200062, China.,Shenzhen Institute of Synthetic Biology, Faculty of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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3
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Recurrent superficial venous thrombophlebitis because of mutations in the protein C and fibrinogen genes in a young Argentinian female. Blood Coagul Fibrinolysis 2019; 30:80-84. [PMID: 30632992 DOI: 10.1097/mbc.0000000000000790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
: Hypodysfibrinogenemia and protein C deficiency are coagulopathies and in this report, we describe a young patient with both defects confirmed by molecular genetic tests. The patient was a 24-year-old woman referred for recurrent thrombophlebitis and finally deep venous thrombosis. Routine coagulation studies revealed mild decrease of protein C (0.49 IU, reference values 0.7-1.40 IU) and hypodysfibrinogenemia (0.88 g/l and 1.83 g/l for activity and antigen, respectively, reference values 2.0-4.0 g/l). Direct sequencing analyses were performed on FGA, FGB, and FGG genes to confirm hypodysfibrinogenemia and on the protein C gene to confirm protein C deficiency. As a result, the patient was shown to be heterozygous p.Ala82Gly in the FGG gene (Fibrinogen Dunedin) and for compound heterozygous missense mutation in protein C gene. To our knowledge, this is the first report on a case of combined dysfibrinogenemia and protein C deficiency confirmed by molecular genetic tests.
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4
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Bhatti UF, Williams AM, Raghavendran K, Georgoff PE. Four-extremity amputation following disseminated intravascular coagulation and purpura fulminans. BMJ Case Rep 2019; 12:12/3/e228028. [PMID: 30898966 DOI: 10.1136/bcr-2018-228028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpura fulminans (PF) is a rare but serious complication of septic shock in adults. The complex disease course makes it challenging to manage the condition. Here, we present the case of a healthy young woman who presented with sepsis and new-onset erythematous lesions 4 days after the vaginal delivery of a healthy baby. The infectious source could not be identified, and the patient was started on antibiotics and resuscitated. However, her condition worsened, and she developed disseminated intravascular coagulation and PF. The septic episode slowly decreased in severity, but she sustained extensive ischaemic injuries to her extremities, for which she underwent four-limb amputation.
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Affiliation(s)
- Umar F Bhatti
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron M Williams
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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5
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Activated Protein C in Cutaneous Wound Healing: From Bench to Bedside. Int J Mol Sci 2019; 20:ijms20040903. [PMID: 30791425 PMCID: PMC6412604 DOI: 10.3390/ijms20040903] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 12/12/2022] Open
Abstract
Independent of its well-known anticoagulation effects, activated protein C (APC) exhibits pleiotropic cytoprotective properties. These include anti-inflammatory actions, anti-apoptosis, and endothelial and epithelial barrier stabilisation. Such beneficial effects have made APC an attractive target of research in a plethora of physiological and pathophysiological processes. Of note, the past decade or so has seen the emergence of its roles in cutaneous wound healing-a complex process involving inflammation, proliferation and remodelling. This review will highlight APC's functions and mechanisms, and detail its pre-clinical and clinical studies on cutaneous wound healing.
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6
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Sirachainan N, Chuansumrit A, Sasanakul W, Yudhasompop N, Mahaklan L, Vaewpanich J, Charoenkwan P, Kanjanapongkul S, Visudtibhan A, Wongwerawattanakoon P. R147W in PROC Gene Is a Risk Factor of Thromboembolism in Thai Children. Clin Appl Thromb Hemost 2017; 24:263-267. [PMID: 28511552 DOI: 10.1177/1076029617709085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The p.R147W mutation, the c.C6152T in exon 7, causing a change in amino acid from arginine to tryptophan of the PROC gene has been reported as a common mutation in Taiwanese populations with venous thromboembolism (VTE). The present study aimed to identify the prevalence of p.R147W in the Thai population and children with TE and the risk of developing TE. Patients aged ≤18 years diagnosed with TE were enrolled. The PROC gene was amplified by polymerase chain reaction using a specific primer in exon 7. The restriction fragment length polymorphism was designed using MwoI restriction enzyme. A total of 184 patients and 690 controls were enrolled. The most common diagnosis of TE was arterial ischemic stroke (AIS), at 100 (54.3%), followed by VTE, at 38 (20.6%), and cerebral venous sinus thrombosis (CVST), at 23 (12.5%). The prevalence of heterozygous and homozygous p.R147W in patients and controls was 9.5% versus 5.8% and 2.7% versus 0.1%, respectively. Heterozygous p.R147W had odds ratios (ORs) of 1.8 (95% confidence interval [CI]: 1.0-3.2, P = .04), 3.2 (95% CI: 1.2-8.2, P = .009), and 4.5 (95% CI: 1.6-12.8, P = .002) of developing overall TE, VTE, and CVST, respectively. Homozygous p.R147W had ORs of 20.2 (95% CI: 2.3-173.7, P < .001), 21.4 (95% CI: 2.2-207.9, P < .001), and 43.3 (95% CI: 3.8-490.6, P < .001) of developing overall TE, AIS, and CVST, respectively. This study suggested that p.R147W is a common mutation and increased risk of TE in Thai children.
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Affiliation(s)
- Nongnuch Sirachainan
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ampaiwan Chuansumrit
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Werasak Sasanakul
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Najwa Yudhasompop
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,2 Department of Pediatrics, Hatyai Hospital, Hatyai, Songkhla, Thailand
| | - Lalita Mahaklan
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jarin Vaewpanich
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimlak Charoenkwan
- 3 Faculty of Medicine, Department of Pediatrics, Chiang Mai University, Chiang Mai, Thailand
| | - Somjai Kanjanapongkul
- 4 Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Anannit Visudtibhan
- 1 Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pakawan Wongwerawattanakoon
- 5 Faculty of Medicine, Division of Pediatric Nursing, Nursing Department, Ramathibodi Hospital, Bangkok, Thailand
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7
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Healy LD, Puy C, Fernández JA, Mitrugno A, Keshari RS, Taku NA, Chu TT, Xu X, Gruber A, Lupu F, Griffin JH, McCarty OJT. Activated protein C inhibits neutrophil extracellular trap formation in vitro and activation in vivo. J Biol Chem 2017; 292:8616-8629. [PMID: 28408624 DOI: 10.1074/jbc.m116.768309] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/11/2017] [Indexed: 12/11/2022] Open
Abstract
Activated protein C (APC) is a multifunctional serine protease with anticoagulant, cytoprotective, and anti-inflammatory activities. In addition to the cytoprotective effects of APC on endothelial cells, podocytes, and neurons, APC cleaves and detoxifies extracellular histones, a major component of neutrophil extracellular traps (NETs). NETs promote pathogen clearance but also can lead to thrombosis; the pathways that negatively regulate NETosis are largely unknown. Thus, we studied whether APC is capable of directly inhibiting NETosis via receptor-mediated cell signaling mechanisms. Here, by quantifying extracellular DNA or myeloperoxidase, we demonstrate that APC binds human leukocytes and prevents activated platelet supernatant or phorbol 12-myristate 13-acetate (PMA) from inducing NETosis. Of note, APC proteolytic activity was required for inhibiting NETosis. Moreover, antibodies against the neutrophil receptors endothelial protein C receptor (EPCR), protease-activated receptor 3 (PAR3), and macrophage-1 antigen (Mac-1) blocked APC inhibition of NETosis. Select mutations in the Gla and protease domains of recombinant APC caused a loss of NETosis. Interestingly, pretreatment of neutrophils with APC prior to induction of NETosis inhibited platelet adhesion to NETs. Lastly, in a nonhuman primate model of Escherichia coli-induced sepsis, pretreatment of animals with APC abrogated release of myeloperoxidase from neutrophils, a marker of neutrophil activation. These findings suggest that the anti-inflammatory function of APC at therapeutic concentrations may include the inhibition of NETosis in an EPCR-, PAR3-, and Mac-1-dependent manner, providing additional mechanistic insight into the diverse functions of neutrophils and APC in disease states including sepsis.
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Affiliation(s)
- Laura D Healy
- From the Departments of Cell, Developmental & Cancer Biology and
| | - Cristina Puy
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97230
| | - José A Fernández
- the Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California 92037, and
| | - Annachiara Mitrugno
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97230
| | - Ravi S Keshari
- the Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma 73104
| | - Nyiawung A Taku
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97230
| | - Tiffany T Chu
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97230
| | - Xiao Xu
- the Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California 92037, and
| | - András Gruber
- Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97230
| | - Florea Lupu
- the Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma 73104
| | - John H Griffin
- the Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California 92037, and
| | - Owen J T McCarty
- From the Departments of Cell, Developmental & Cancer Biology and.,Biomedical Engineering, Oregon Health & Science University, Portland, Oregon 97230
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8
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Chugh RK, Olorunnisomo V, Fowle EJ, Modica I, Meisels I, Gupta M. Renal Papillary Necrosis Caused by Protein C Deficiency Leading to Recurrent Hydronephrosis. J Endourol Case Rep 2016; 2:36-7. [PMID: 27579411 PMCID: PMC4996589 DOI: 10.1089/cren.2016.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A patient with history of a solitary functioning kidney and protein C deficiency (PCD) presented with recurrent severe hydronephrosis causing acute kidney injury upon chronic kidney disease. Work-up with endoscopic evaluation revealed renal papillary necrosis (RPN) and sloughed renal papillae to be the true cause of the recurrent obstruction. Pathologic evaluation of the sloughed tissue confirmed the diagnosis of RPN. This is the first case reported in the literature illustrating the unique presentation of RPN in the setting of PCD.
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Affiliation(s)
- Rohit Kumar Chugh
- Department of Urology, Mount Sinai Health System , New York, New York
| | | | - Evan James Fowle
- Department of Pathology, Mount Sinai Health System , New York, New York
| | - Ippolito Modica
- Department of Pathology, Mount Sinai Health System , New York, New York
| | - Ira Meisels
- Department of Nephrology, Mount Sinai Health System , New York, New York
| | - Mantu Gupta
- Department of Urology, Mount Sinai Health System , New York, New York
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9
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Wang Z, Wang T, Chang J, Li H, Wang C, Li Y, Lang X, Jing S, Zhang G, Wang Y. Genetic association of PROC variants with pulmonary embolism in Northern Chinese Han population. SPRINGERPLUS 2016; 5:147. [PMID: 27026844 PMCID: PMC4764599 DOI: 10.1186/s40064-016-1801-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022]
Abstract
To evaluate SNPs (single nucleotide polymorphism) in PROC (protein C gene) associated with pulmonary embolism (PE) susceptibility in North Chinese Han population. A case-control study design was used, and patients with PE and healthy participants were enrolled from the Emerging Department of the several hospitals in Weifang, Shandong, China. SNPs in PROC were genotyped using Mass ARRAY system. The allele frequency of rs199469469 was significantly different between PE patients and the control [OR (95 % CI) = 5.00 (1.66-15.12), P = 0.004], and the difference remained significantly after controlling for age and gender [OR (95 % CI) = 5.34 (1.47-19.39), P = 0.011). The G(del)G in the haplotype includes rs1799809|rs199469469|rs2069928 was of a significantly difference (P = 0.016) among PE patients and the controls, and remained significant (P = 0.015) after adjustment for age and sex. Our study reports that PROC SNPs (rs199469469) might be associated with PE susceptibility, with the G allele of rs199469469 serving as the protective factors for incidence of PE. These findings may contribute to the understanding and primary prevention of PE.
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Affiliation(s)
- Zengliang Wang
- Department of Thorax, Anqiu People's Hospital, Weifang, 262100 China
| | - Tianhe Wang
- Department of Brain EMG, Anqiu People's Hospital, Weifang, 262100 China
| | - Jianyong Chang
- Department of Neurosurgery, Weifang People's Hospital, Weifang, 261021 China
| | - Hua Li
- Department of Neurology, Anqiu People's Hospital, Weifang, 262100 China
| | - Chengdong Wang
- Key Laboratory of Weifang Brain Hospital, Weifang People's Hospital, Weifang, 261021 China
| | - Yongyong Li
- Department of Surgery, Anqiu Municipal Hospital, Weifang, 262100 China
| | - Xuhe Lang
- Department of Nephrology, Anqiu People's Hospital, Weifang, 262100 China
| | - Shimei Jing
- Department of Neurosurgery, Weifang People's Hospital, Weifang, 261021 China
| | - Guoqing Zhang
- Department of Neurosurgery, People's Hospital of Weifang High Tech Industry Development Zone, Weifang, 261041 China
| | - Yuting Wang
- Department of Neurosurgery, Weifang People's Hospital, Weifang, 261021 China
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10
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Tairaku S, Taniguchi-Ikeda M, Okazaki Y, Noguchi Y, Nakamachi Y, Mori T, Kubokawa I, Hayakawa A, Shibata A, Emoto T, Kurahashi H, Toda T, Kawano S, Yamada H, Morioka I, Iijima K. Prenatal genetic testing for familial severe congenital protein C deficiency. Hum Genome Var 2015; 2:15017. [PMID: 27081530 PMCID: PMC4785544 DOI: 10.1038/hgv.2015.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/25/2015] [Accepted: 04/26/2015] [Indexed: 11/29/2022] Open
Abstract
Severe congenital protein C (PC) deficiency is an autosomal recessive hereditary thrombophilia caused by mutations in PROC. The case manifested severe purpura fulminans, intracranial thrombosis or hemorrhage within 4 days after birth, resulting in blindness. We report the identification of inherited compound heterozygous mutations, including a novel nonsense mutation in PROC, and a prenatal genetic test for a subsequent pregnancy. Prenatal diagnosis may facilitate preemptive and radical therapy for severe PC deficiency.
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Affiliation(s)
- Shinya Tairaku
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Genetic Counseling, Kobe University Hospital, Kobe, Japan
| | - Mariko Taniguchi-Ikeda
- Division of Genetic Counseling, Kobe University Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoko Okazaki
- Department of Clinical Laboratory, Kobe University Hospital , Kobe, Japan
| | - Yoriko Noguchi
- Department of Clinical Laboratory, Kobe University Hospital , Kobe, Japan
| | - Yuji Nakamachi
- Department of Clinical Laboratory, Kobe University Hospital , Kobe, Japan
| | - Takeshi Mori
- Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Ikuko Kubokawa
- Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Akira Hayakawa
- Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Akio Shibata
- Department of Pediatrics, Hyogo College of Medicine , Nishinomiya, Japan
| | - Tomomi Emoto
- Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University , Toyoake, Aichi, Japan
| | - Tatsushi Toda
- Division of Genetic Counseling, Kobe University Hospital, Kobe, Japan; Department of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seiji Kawano
- Department of Medical Education, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Genetic Counseling, Kobe University Hospital, Kobe, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine , Kobe, Japan
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11
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Boey JP, Jolley A, Nicholls C, Lerda N, Duncan E, Gallus A, Ross DM, Sobieraj-Teague M. Novel protein C gene mutation in a compound heterozygote resulting in catastrophic thrombosis in early adulthood: diagnosis and long-term treatment with subcutaneous protein C concentrate. Br J Haematol 2015; 172:811-3. [DOI: 10.1111/bjh.13538] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jir P. Boey
- Haematology; Flinders Medical Centre; Adelaide SA Australia
- Haematology and Genetic Pathology; Flinders University; Adelaide SA Australia
- Haematology; SA Pathology; Adelaide SA Australia
| | - Alexandra Jolley
- Genetic and Molecular Pathology; SA Pathology; Adelaide SA Australia
| | | | - Nancy Lerda
- Genetic and Molecular Pathology; SA Pathology; Adelaide SA Australia
| | | | - Alexander Gallus
- Haematology; Flinders Medical Centre; Adelaide SA Australia
- Haematology and Genetic Pathology; Flinders University; Adelaide SA Australia
- Haematology; SA Pathology; Adelaide SA Australia
| | - David M. Ross
- Haematology; Flinders Medical Centre; Adelaide SA Australia
- Haematology and Genetic Pathology; Flinders University; Adelaide SA Australia
- Haematology; SA Pathology; Adelaide SA Australia
| | - Magdalena Sobieraj-Teague
- Haematology; Flinders Medical Centre; Adelaide SA Australia
- Haematology; SA Pathology; Adelaide SA Australia
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12
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Abstract
PURPOSE To study the underlying factors in a young patient having central retinal venous obstruction with central retinal arterial obstruction and its effects on visual outcome. METHODS A 33-year-old man presented with a complaint of sudden loss of vision in his right eye. A complete ophthalmic evaluation with fundus angiography showed combined central retinal venous obstruction with central retinal arterial obstruction. Detailed investigations revealed reduced (20%) functional assay of protein C suggestive of the diagnosis of severe Type II protein C deficiency with Factor V Leiden mutation. This ocular event was the first sign of the underlying disorder. RESULTS The ophthalmic event rapidly progressed to no perception of light. Anticoagulant therapy was started to prevent life-threatening systemic complications. Despite antiglaucoma medications, intraocular pressure was high and cyclocryotherapy was advised. CONCLUSION Retinal vascular disorders in the younger population have different underlying risk factors than in the older age group. Clinical presentation, severity, and management also depend on causative factors. Combined retinal artery and vein occlusion is very uncommon. Combined cases have mostly been attributed to rheological causes like thrombophilia, vessel wall inflammation, and mechanical compression. Protein C deficiency has mainly been linked to vein occlusions and there is no reference to protein C deficiency as a cause of combined central retinal venous obstruction and central retinal arterial obstruction. Combined cases usually present with severe visual loss and have rapid progression. Young patients having such presentation should be thoroughly evaluated to diagnose underlying factors and initiate appropriate management at the earliest.
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13
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D’Ursi P, Orro A, Morra G, Moscatelli M, Trombetti G, Milanesi L, Rovida E. Molecular dynamics and docking simulation of a natural variant of Activated Protein C with impaired protease activity: implications for integrin-mediated antiseptic function. J Biomol Struct Dyn 2013; 33:85-92. [DOI: 10.1080/07391102.2013.851033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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14
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Hypercoagulability in a newborn with concomitant homozygous factor V Leiden and severe homozygous protein C deficiency type 1. Blood Coagul Fibrinolysis 2013; 24:777-9. [PMID: 24056294 DOI: 10.1097/mbc.0b013e328364194b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is a case report of a female newborn presented with skin necrotic lesions 1 week after delivery. Laboratory investigations revealed severe homozygous protein C deficiency associated with homozygous factor V Leiden, although her pregnancy and perinatal periods were otherwise uneventful, with negative family history of thrombotic or bleeding disorders. Patient stabilization was established by supportive measures and long-term administration of fresh frozen plasma and warfarin.
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15
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Yamanouchi J, Hato T, Niiya T, Hayashi T, Yasukawa M. Novel causative and neutral mutations in a patient with protein C deficiency. Thromb Res 2013; 131:466-8. [DOI: 10.1016/j.thromres.2013.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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16
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Lu X, Tang L, Xu K, Ma J, Guo T, Mei H, Yang R, Yu J, Wang Q, Yang Y, Jian X, Hu Y. Novel association of a PROC variant with ischemic stroke in a Chinese Han population. Hum Genet 2012; 132:69-77. [PMID: 22976599 DOI: 10.1007/s00439-012-1225-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/30/2012] [Indexed: 12/25/2022]
Abstract
Protein C (PC) is a well-characterized anticoagulant enzyme. However, the association between PC and ischemic stroke (IS) remains controversial. The aim of the present study was to investigate whether any genetic variant in the human protein C gene (PROC) was associated with susceptibility to IS in the Chinese Han population. All exons and the 5'- and 3'-untranslated regions of PROC were initially sequenced to identify informative variants. Potential abnormal variants were analyzed in a population of 788 IS patients and 1,200 healthy controls. The analysis was stratified by stroke etiology, and the results were replicated in 262 IS patients and 288 healthy controls. Finally, functional studies were performed to evaluate the effects of the variant. A three-nucleotide duplication/deletion variant (c.574_576del) was identified and found to be significantly associated with IS (OR 2.56, 95 % CI 1.45-4.52, P = 0.001). Stratification by stroke etiology after adjustment for IS risk factors showed that this association persisted in the lacunar and cardioembolic subtypes (P < 0.001 and P = 0.008, respectively) but not in the atherothrombotic and undetermined subtypes (P = 0.070 and P = 0.998, respectively). The functional studies showed a significant difference in the anticoagulant activity of PC in c.574_576del carriers and non-carriers (P < 0.001). Our results suggested that the novel PROC c.574_576del variant is a possible genetic determinant of an increased risk of IS and diminished anticoagulant activity of PC.
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Affiliation(s)
- Xuan Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Protein C anticoagulant and cytoprotective pathways. Int J Hematol 2012; 95:333-45. [PMID: 22477541 DOI: 10.1007/s12185-012-1059-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 03/09/2012] [Accepted: 03/14/2012] [Indexed: 12/11/2022]
Abstract
Plasma protein C is a serine protease zymogen that is transformed into the active, trypsin-like protease, activated protein C (APC), which can exert multiple activities. For its anticoagulant action, APC causes inactivation of the procoagulant cofactors, factors Va and VIIIa, by limited proteolysis, and APC's anticoagulant activity is promoted by protein S, various lipids, high-density lipoprotein, and factor V. Hereditary heterozygous deficiency of protein C or protein S is linked to moderately increased risk for venous thrombosis, while a severe or total deficiency of either protein is linked to neonatal purpura fulminans. In recent years, the beneficial direct effects of APC on cells which are mediated by several specific receptors have become the focus of much attention. APC-induced signaling can promote multiple cytoprotective actions which can minimize injuries in various preclinical animal injury models. Remarkably, pharmacologic therapy using APC demonstrates substantial neuroprotective effects in various murine injury models, including ischemic stroke. This review summarizes the molecules that are central to the protein C pathways, the relationship of pathway deficiencies to venous thrombosis risk, and mechanisms for the beneficial effects of APC.
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Abstract
Neonatal purpura fulminans is a rare, life-threatening condition, caused by congenital or acquired deficiencies of protein C or S. The condition is often fatal unless there is early recognition of the clinical symptoms, prompt diagnosis, and judicious replacement therapy is initiated. The clinical presentation is that of acute disseminated intravascular coagulation and hemorrhagic skin necrosis. The management includes an acute phase of replacement therapy with fresh frozen plasma or protein C concentrate and a maintenance therapy that includes anticoagulation with warfarin or low molecular weight heparin. This review focuses on the management of severe protein C deficiency.
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Tjeldhorn L, Iversen N, Sandvig K, Bergan J, Sandset PM, Skretting G. Protein C mutation (A267T) results in ER retention and unfolded protein response activation. PLoS One 2011; 6:e24009. [PMID: 21901152 PMCID: PMC3162024 DOI: 10.1371/journal.pone.0024009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 07/29/2011] [Indexed: 12/05/2022] Open
Abstract
Background Protein C (PC) deficiency is associated with a high risk of venous thrombosis. Recently, we identified the PC-A267T mutation in a patient with PC deficiency and revealed by in vitro studies decreased intracellular and secreted levels of the mutant. The aim of the present study was to characterize the underlying mechanism(s). Methodology/Principal Findings CHO-K1 cells stably expressing the wild-type (PC-wt) or the PC mutant were generated. In order to examine whether the PC mutant was subjected to increased intracellular degradation, the cells were treated with several inhibitors of various degradation pathways and pulse-chase experiments were performed. Protein-chaperone complexes were analyzed by treating the cells with a cross-linker followed by Western blotting (WB). Expression levels of the immunoglobulin-binding protein (BiP) and the phosphorylated eukaryotic initiation factor 2α (P-eIF2α), both common ER stress markers, were determined by WB to examine if the mutation induced ER stress and unfolded protein response (UPR) activation. We found no major differences in the intracellular degradation between the PC variants. The PC mutant was retained in the endoplasmic reticulum (ER) and had increased association with the Grp-94 and calreticulin chaperones. Retention of the PC-A267T in ER resulted in UPR activation demonstrated by increased expression levels of the ER stress markers BiP and P-eIF2α and caused also increased apoptotic activity in CHO-K1 cells as evidenced by elevated levels of DNA fragmentation. Conclusions/Significance The reduced intracellular level and impaired secretion of the PC mutant were due to retention in ER. In contrast to other PC mutations, retention of the PC-A267T in ER resulted in minor increased proteasomal degradation, rather it induced ER stress, UPR activation and apoptosis.
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Affiliation(s)
- Lena Tjeldhorn
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Clinic of Specialized Medicine and Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Iversen
- Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Kirsten Sandvig
- Department of Biochemistry, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Centre for Cancer Biomedicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Molecular Biosciences, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Jonas Bergan
- Department of Biochemistry, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Centre for Cancer Biomedicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Molecular Biosciences, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Clinic of Specialized Medicine and Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Grethe Skretting
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- * E-mail:
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Tjeldhorn L, Iversen N, Sandvig K, Bergan J, Sandset PM, Skretting G. Functional characterization of the protein C A267T mutation: evidence for impaired secretion due to defective intracellular transport. BMC Cell Biol 2010; 11:67. [PMID: 20815936 PMCID: PMC2942808 DOI: 10.1186/1471-2121-11-67] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 09/06/2010] [Indexed: 11/30/2022] Open
Abstract
Background Activated protein C (PC) is a serine protease that regulates blood coagulation by inactivating coagulation factors Va and VIIIa. PC deficiency is an autosomally inherited disorder associated with a high risk of recurrent venous thrombosis. The aim of the study was to explore the mechanisms responsible for severe PC deficiency in a patient with the protein C A267T mutation by in-vitro expression studies. Results Huh7 and CHO-K1 cells were transiently transfected with expression vectors containing wild-type (WT PC) and mutated PC (A267T PC) cDNAs. PC mRNA levels were assessed by qRT-PCR and the PC protein levels were measured by ELISA. The mRNA levels of WT PC and A267T PC were similar, while the intracellular protein level of A267T PC was moderately decreased compared to WT PC. The secretion of A267T PC into the medium was severely impaired. No differences in molecular weights were observed between WT and A267T PC before and after treatment with endo-β-N-acetylglucosaminidase. Proteasomal and lysosomal degradations were examined using lactacystin and bafilomycin, respectively, and revealed that A267T PC was slightly more susceptible for proteasomal degradation than WT PC. Intracellular co-localization analysis indicated that A267T PC was mainly located in the endoplasmic reticulum (ER), whereas WT PC was observed in both ER and Golgi. Conclusions In contrast to what has been reported for other PC mutants, intracellular degradation of A267T PC was not the main/dominant mechanism underlying the reduced intracellular and secretion levels of PC. Our results indicate that the A267T mutation most likely caused misfolding of PC, which might lead to increased retention of the mutated PC in ER.
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Affiliation(s)
- Lena Tjeldhorn
- Department of Hematology, Oslo University Hospital, Oslo, Norway
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Sirachainan N, Sasanakul W, Parapakpenjune S, Wongwerawattanakoon P, Visudibhan A, Chuansumrit A. Protein C deficiency in Thai children with thromboembolism: A report of clinical presentations and mutation analysis. Thromb Res 2010; 125:200-2. [DOI: 10.1016/j.thromres.2009.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 09/28/2009] [Accepted: 10/26/2009] [Indexed: 11/17/2022]
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Bereczky Z, Kovács KB, Muszbek L. Protein C and protein S deficiencies: similarities and differences between two brothers playing in the same game. Clin Chem Lab Med 2010; 48 Suppl 1:S53-66. [DOI: 10.1515/cclm.2010.369] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Castro-Marrero J, Balada E, Vilardell-Tarrés M, Ordi-Ros J. Genetic risk factors of thrombosis in the antiphospholipid syndrome. Br J Haematol 2009; 147:289-96. [DOI: 10.1111/j.1365-2141.2009.07831.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Saunders RE, Perkins SJ. CoagMDB: a database analysis of missense mutations within four conserved domains in five vitamin K-dependent coagulation serine proteases using a text-mining tool. Hum Mutat 2008; 29:333-44. [PMID: 18058827 DOI: 10.1002/humu.20629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Central repositories of mutations that combine structural, sequence, and phenotypic information in related proteins will facilitate the diagnosis and molecular understanding of diseases associated with them. Coagulation involves the sequential activation of serine proteases and regulators in order to yield stable blood clots while maintaining hemostasis. Five coagulation serine proteases-factor VII (F7), factor IX (F9), factor X (F10), protein C (PROC), and thrombin (F2)-exhibit high sequence similarities and all require vitamin K. All five of these were incorporated into an interactive database of mutations named CoagMDB (http://www.coagMDB.org; last accessed: 9 August 2007). The large number of mutations involved (especially for factor IX) and the increasing problem of out-of-date databases required the development of new database management tools. A text mining tool automatically scans full-length references to identify and extract mutations. High recall rates between 96 and 99% and precision rates of 87 to 93% were achieved. Text mining significantly reduces the time and expertise required to maintain the databases and offers a solution to the problem of locus-specific database management and upkeep. A total of 875 mutations were extracted from 1,279 literature sources. Of these, 116 correspond to Gla domains, 86 to the N-terminal EGF domain, 73 to the C-terminal EGF domain, and 477 to the serine protease domain. The combination of text mining and consensus domain structures enables mutations to be correlated with experimentally-measurable phenotypes based on either low protein levels (Type I) or reduced functional activities (Type II), respectively. A tendency for the conservation of phenotype with structural location was identified.
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Affiliation(s)
- Rebecca E Saunders
- Department of Biochemistry and Molecular Biology, University College London, London, United Kingdom
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