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Mohsenian S, Palla R, Menegatti M, Cairo A, Lecchi A, Casini A, Neerman-Arbez M, Asselta R, Scardo S, Siboni SM, Blatny J, Zapletal O, Schved JF, Giansily-Blaizot M, Halimeh S, Daoud MA, Platokouki H, Pergantou H, Schutgens REG, Van Haaften-Spoor M, Brons P, Laros-van Gorkom B, Van Pinxten E, Borhany M, Fatima N, Mikovic D, Saracevic M, Özdemir GN, Ay Y, Makris M, Lockley C, Mumford A, Harvey A, Austin S, Shapiro A, Williamson A, McGuinn C, Goldberg I, De Moerloose P, Peyvandi F. Congenital fibrinogen disorders: a retrospective clinical and genetic analysis of the Prospective Rare Bleeding Disorders Database. Blood Adv 2024; 8:1392-1404. [PMID: 38286442 PMCID: PMC10950829 DOI: 10.1182/bloodadvances.2023012186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
ABSTRACT Congenital fibrinogen deficiency (CFD) is a rare bleeding disorder caused by mutations in FGA, FGB, and FGG. We sought to comprehensively characterize patients with CFD using PRO-RBDD (Prospective Rare Bleeding Disorders Database). Clinical phenotypes, laboratory, and genetic features were investigated using retrospective data from the PRO-RBDD. Patients were classified from asymptomatic to grade 3 based on their bleeding severity. In addition, FGA, FGB, and FGG were sequenced to find causative variants. A total of 166 CFD cases from 16 countries were included, of whom 123 (30 afibrinogenemia, 33 hypofibrinogenemia, 55 dysfibrinogenemia, and 5 hypodysfibrinogenemia) were well characterized. Considering the previously established factor activity and antigen level thresholds, bleeding severity was correctly identified in 58% of the cases. The rates of thrombotic events among afibrinogenemic and hypofibrinogenemic patients were relatively similar (11% and 10%, respectively) and surprisingly higher than in dysfibrinogenemic cases. The rate of spontaneous abortions among 68 pregnancies was 31%, including 86% in dysfibrinogenemic women and 14% with hypofibrinogenemia. Eighty-six patients received treatment (69 on-demand and/or 17 on prophylaxis), with fibrinogen concentrates being the most frequently used product. Genetic analysis was available for 91 cases and 41 distinct variants were identified. Hotspot variants (FGG, p.Arg301Cys/His and FGA, p.Arg35Cys/His) were present in 51% of dysfibrinogenemia. Obstetric complications were commonly observed in dysfibrinogenemia. This large multicenter study provided a comprehensive insight into the clinical, laboratory, and genetic history of patients with CFDs. We conclude that bleeding severity grades were in agreement with the established factor activity threshold in nearly half of the cases with quantitative defects.
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Affiliation(s)
- Samin Mohsenian
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberta Palla
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marzia Menegatti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Andrea Cairo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Anna Lecchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marguerite Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Sara Scardo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Simona Maria Siboni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Jan Blatny
- Department of Paediatrics Haematology and Biochemistry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Ondrej Zapletal
- Department of Paediatrics Haematology and Biochemistry, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Jean-Francois Schved
- Department of Biological Hematology, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Muriel Giansily-Blaizot
- Department of Biological Hematology, CHU Montpellier, Université de Montpellier, Montpellier, France
| | | | | | - Helen Platokouki
- Haemophilia-Centre-Haemostasis Unit, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Helen Pergantou
- Haemophilia-Centre-Haemostasis Unit, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Roger E. G. Schutgens
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Monique Van Haaften-Spoor
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul Brons
- Department of Pediatric Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Elise Van Pinxten
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Munira Borhany
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Naveena Fatima
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Danijela Mikovic
- Hemostasis Department, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Marko Saracevic
- Hemostasis Department, Blood Transfusion Institute of Serbia, Belgrade, Serbia
| | - Gül Nihal Özdemir
- Pediatric Hematology Department, Istinye University, Istanbul, Turkey
| | - Yılmaz Ay
- University of Health Sciences Kartal Health Application and Research Center, Pediatric Hematology and Oncology Clinic, Istanbul, Turkey
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Caryl Lockley
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Andrew Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Andrew Harvey
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Steve Austin
- Department of Haematology, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Amy Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN
| | | | | | - Ilene Goldberg
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Philippe De Moerloose
- Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
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2
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Shagidov D, Guttmann-Raviv N, Cunat S, Frech L, Giansily-Blaizot M, Ghatpande N, Abelya G, Frank GA, Aguilar Martinez P, Meyron-Holtz EG. A newly identified ferritin L-subunit variant results in increased proteasomal subunit degradation, impaired complex assembly, and severe hypoferritinemia. Am J Hematol 2024; 99:12-20. [PMID: 37867341 DOI: 10.1002/ajh.27124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Ferritin is a hetero-oligomeric nanocage, composed of 24 subunits of two types, FTH1 and FTL. It protects the cell from excess reactive iron, by storing iron in its cavity. FTH1 is essential for the recruitment of iron into the ferritin nanocage and for cellular ferritin trafficking, whereas FTL contributes to nanocage stability and iron nucleation inside the cavity. Here we describe a female patient with a medical history of severe hypoferritinemia without anemia. Following inadequate heavy IV iron supplementation, the patient developed severe iron overload and musculoskeletal manifestations. However, her serum ferritin levels rose only to normal range. Genetic analyses revealed an undescribed homozygous variant of FTL (c.92A > G), which resulted in a Tyr31Cys substitution (FTLY31C ). Analysis of the FTL structure predicted that the Y31C mutation will reduce the variant's stability. Expression of the FTLY31C variant resulted in significantly lower cellular ferritin levels compared with the expression of wild-type FTL (FTLWT ). Proteasomal inhibition significantly increased the initial levels of FTLY31C , but could not protect FTLY31C subunits from successive degradation. Further, variant subunits successfully incorporated into hetero-polymeric nanocages in the presence of sufficient levels of FTH1. However, FTLY31C subunits poorly assembled into nanocages when FTH1 subunit levels were low. These results indicate an increased susceptibility of unassembled monomeric FTLY31C subunits to proteasomal degradation. The decreased cellular assembly of FTLY31C -rich nanocages may explain the low serum ferritin levels in this patient and emphasize the importance of a broader diagnostic approach of hypoferritinemia without anemia, before IV iron supplementation.
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Affiliation(s)
- Dayana Shagidov
- Laboratory of Molecular Nutrition, Faculty of Biotechnology and Food Engineering, Israel Institute of Technology-Technion, Haifa, Israel
| | - Noga Guttmann-Raviv
- Laboratory of Molecular Nutrition, Faculty of Biotechnology and Food Engineering, Israel Institute of Technology-Technion, Haifa, Israel
| | - Séverine Cunat
- Department of Hematology Biology, CHU and University of Montpellier, Hôpital Saint Eloi, Montpellier Cedex 5, France
| | - Liora Frech
- Laboratory of Molecular Nutrition, Faculty of Biotechnology and Food Engineering, Israel Institute of Technology-Technion, Haifa, Israel
| | - Muriel Giansily-Blaizot
- Department of Hematology Biology, CHU and University of Montpellier, Hôpital Saint Eloi, Montpellier Cedex 5, France
| | - Niraj Ghatpande
- Laboratory of Molecular Nutrition, Faculty of Biotechnology and Food Engineering, Israel Institute of Technology-Technion, Haifa, Israel
| | - Gili Abelya
- Department of Life Sciences, Marcus Family Campus, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gabriel A Frank
- Department of Life Sciences, Marcus Family Campus, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Ilse Katz Institute for Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The National Institute for Biotechnology in the Negev - NIBN, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Patricia Aguilar Martinez
- Department of Hematology Biology, CHU and University of Montpellier, Hôpital Saint Eloi, Montpellier Cedex 5, France
| | - Esther G Meyron-Holtz
- Laboratory of Molecular Nutrition, Faculty of Biotechnology and Food Engineering, Israel Institute of Technology-Technion, Haifa, Israel
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3
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Rousseau F, Guillet B, Mura T, Fournel A, Volot F, Chambost H, Suchon P, Frotscher B, Biron-Andréani C, Marlu R, Hezard N, Clayssens S, Boissier E, Blanc-Jouvan F, Chamouni P, Tieulie N, Rugeri L, Borel-Derlon A, de Raucourt E, Martin-Toutain I, Castet S, Lebreton A, Girault S, Helley-Russick D, D’Oiron R, Schved JF, Giansily-Blaizot M. Surgery in rare bleeding disorders: the prospective MARACHI study. Res Pract Thromb Haemost 2023; 7:102199. [PMID: 37867585 PMCID: PMC10585326 DOI: 10.1016/j.rpth.2023.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 10/24/2023] Open
Abstract
Background Despite the wide use of bleeding scores and the reliability of clotting factor level measurement, bleeding risk stratification before surgery remains challenging in patients with rare inherited bleeding disorders. Objectives This multicenter observational prospective study assessed in patients with rare coagulation factor deficiency, the perioperative hemostatic management choices by hemostasis experts and the bleeding outcomes after surgery. Methods One hundred seventy-eight patients with low coagulation activity level (factor [F] II, FV, combined FV-FVIII, FVII, FX, or FXI <50%) underwent 207 surgical procedures. The bleeding outcome, Tosetto's bleeding score, and perioperative hemostatic protocols were collected. Results Among the 81 procedures performed in patients with severe factor deficiency (level ≤10%), 27 were done without factor replacement (including 6 in patients at high bleeding risk), without any bleeding event. Factor replacement therapy was used mainly for orthopedic procedures. In patients with mild deficiency, 100/126 surgical procedures were carried out without perioperative hemostatic treatment. In patients with FVII or FXI deficiency, factor replacement therapy was in function of the procedure, bleeding risk, and to a lesser extent previous bleeding history. Tranexamic acid was used in almost half of the procedures, particularly in case of surgery in tissues with high fibrinolytic activity (76.8%). Conclusions The current perioperative hemostatic management of patients with rare bleeding disorders appears to be adapted. Among the 207 procedures, only 6 were associated with excessive bleeding. Our findings suggest that rather than the bleeding score, factor level and surgery type are the most relevant criteria for perioperative factor replacement therapy.
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Affiliation(s)
- Florence Rousseau
- Département d’hématologie biologique, CHU Montpellier, France
- CRC-MHC, CHU Montpellier, France
| | - Benoit Guillet
- Haemophilia Treatment Center, University Hospital, Rennes, France and Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Thibault Mura
- Département d’informatique médicale, CHU Montpellier, CHU Nîmes, Université de Montpellier FR 34090, France
| | - Alexandra Fournel
- Haemophilia Treatment Centre, University Hospital of Besançon, Besançon, France
| | | | | | - Pierre Suchon
- Aix Marseille University, Inserm, Inrae, C2VN, Marseille, France
| | - Brigit Frotscher
- Haemophilia Treatment Centre, University Hospital of Nancy, France
| | | | - Raphaël Marlu
- Hemostasis Unit, CHU Grenoble Alpes, Université Grenoble Alpes, France
| | - Nathalie Hezard
- Laboratoire d’hématologie, CHU Reims, France
- Laboratoire d’hématologie AP-HM Marseille, France
| | | | | | | | | | | | - Lucia Rugeri
- Unité Hémostase Clinique, Hospices Civils de Lyon, France
| | | | | | | | | | - Aurélien Lebreton
- Laboratoire d’hématologie, CHU Clermont Ferrand, Unité de Nutrition Humaine UMR1019, INRAE / Université Clermont Auvergne, Clermont-Ferrand, France
| | | | | | - Roseline D’Oiron
- Centre de référence de l’hémophilie et des maladies hémorragiques constitutionnelles, Hôpital Bicêtre, APHP and Hith, UMR_S1176, INSERM, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Jean-François Schved
- Département d’hématologie biologique, CHU Montpellier, France
- CRC-MHC, CHU Montpellier, France
| | - Muriel Giansily-Blaizot
- Département d’hématologie biologique, CHU Montpellier, France
- Université Montpellier d’excellence, Montpellier, France
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4
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Ranc A, Bru S, Mendez S, Giansily-Blaizot M, Nicoud F, Méndez Rojano R. Critical evaluation of kinetic schemes for coagulation. PLoS One 2023; 18:e0290531. [PMID: 37639392 PMCID: PMC10461854 DOI: 10.1371/journal.pone.0290531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
Two well-established numerical representations of the coagulation cascade either initiated by the intrinsic system (Chatterjee et al., PLOS Computational Biology 2010) or the extrinsic system (Butenas et al., Journal of Biological Chemistry, 2004) were compared with thrombin generation assays under realistic pathological conditions. Biochemical modifications such as the omission of reactions not relevant to the case studied, the modification of reactions related to factor XI activation and auto-activation, the adaptation of initial conditions to the thrombin assay system, and the adjustment of some of the model parameters were necessary to align in vitro and in silico data. The modified models are able to reproduce thrombin generation for a range of factor XII, XI, and VIII deficiencies, with the coagulation cascade initiated either extrinsically or intrinsically. The results emphasize that when existing models are extrapolated to experimental parameters for which they have not been calibrated, careful adjustments are required.
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Affiliation(s)
- Alexandre Ranc
- Department of Haematology Biology, CHU, Univ Montpellier, Montpellier, France
| | - Salome Bru
- Polytech, Univ Montpellier, Montpellier, France
| | - Simon Mendez
- IMAG, Univ Montpellier, CNRS, Montpellier, France
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5
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Stritt S, Nurden P, Nurden AT, Schved JF, Bordet JC, Roux M, Alessi MC, Trégouët DA, Mäkinen T, Giansily-Blaizot M. APOLD1 loss causes endothelial dysfunction involving cell junctions, cytoskeletal architecture, and Weibel-Palade bodies, while disrupting hemostasis. Haematologica 2023; 108:772-784. [PMID: 35638551 PMCID: PMC9973481 DOI: 10.3324/haematol.2022.280816] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
Vascular homeostasis is impaired in various diseases thereby contributing to the progression of their underlying pathologies. The endothelial immediate early gene Apolipoprotein L domain-containing 1 (APOLD1) helps to regulate endothelial function. However, its precise role in endothelial cell biology remains unclear. We have localized APOLD1 to endothelial cell contacts and to Weibel-Palade bodies (WPB) where it associates with von Willebrand factor (VWF) tubules. Silencing of APOLD1 in primary human endothelial cells disrupted the cell junction-cytoskeletal interface, thereby altering endothelial permeability accompanied by spontaneous release of WPB contents. This resulted in an increased presence of WPB cargoes, notably VWF and angiopoietin-2 in the extracellular medium. Autophagy flux, previously recognized as an essential mechanism for the regulated release of WPB, was impaired in the absence of APOLD1. In addition, we report APOLD1 as a candidate gene for a novel inherited bleeding disorder across three generations of a large family in which an atypical bleeding diathesis was associated with episodic impaired microcirculation. A dominant heterozygous nonsense APOLD1:p.R49* variant segregated to affected family members. Compromised vascular integrity resulting from an excess of plasma angiopoietin-2, and locally impaired availability of VWF may explain the unusual clinical profile of APOLD1:p.R49* patients. In summary, our findings identify APOLD1 as an important regulator of vascular homeostasis and raise the need to consider testing of endothelial cell function in patients with inherited bleeding disorders without apparent platelet or coagulation defects.
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Affiliation(s)
- Simon Stritt
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala
| | - Paquita Nurden
- Institut de Rythmologie et de Modélisation Cardiaque, Hôpital Xavier Arnozan, Pessac, France.
| | - Alan T Nurden
- Institut de Rythmologie et de Modélisation Cardiaque, Hôpital Xavier Arnozan, Pessac, France
| | - Jean-François Schved
- Department of Biological Hematology, CHU Montpellier, Université de Montpellier, Montpellier
| | - Jean-Claude Bordet
- Hematology, Hospices civils de Lyon, Bron biology center and Hemostasis- Thrombosis, Lyon-1 University, Lyon
| | | | | | - David-Alexandre Trégouët
- Laboratory of Excellence GENMED (Medical Genomics), Paris; University of Bordeaux, INSERM, Bordeaux Population Health Research Center, U1219, Bordeaux
| | - Taija Mäkinen
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Muriel Giansily-Blaizot
- Department of Biological Hematology, CHU Montpellier, Université de Montpellier, Montpellier
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Szepetowski S, Berger C, Joly P, Baron-Joly S, Huguenin Y, Cantais A, Brun S, Ged C, Badens C, Thuret I, Giansily-Blaizot M, Pissard S, Aguilar-Martinez P. Homozygosity for the hyperunstable hemoglobin variant Hb Agrinio (HBA2:c.89T>C) leads to severe antenatal anemia: Eight new cases in three families. Am J Hematol 2022; 97:E393-E395. [PMID: 36052950 DOI: 10.1002/ajh.26687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Sarah Szepetowski
- Pediatric Onco-Hematology Department, Reference Center on Rare Red Cell Disorders, La Timone Children's Hospital, APHM, Marseille, France
| | - Claire Berger
- Pediatric Onco-Hematology Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Philippe Joly
- Biology Center "Biochimie des pathologies érythrocytaires", Lyon Est Hospital Group, Bron, France
| | | | - Yoann Huguenin
- Pediatric Onco-Hematology Department, Bordeaux University Hospital, Bordeaux, France
| | - Aurélie Cantais
- Neonatal Pediatric Care unit, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Sophie Brun
- Department of Hematological biology, Nîmes University Hospital, Nîmes, France
| | - Cécile Ged
- Biochemistry Department, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Badens
- INSERM, Marseille Medical Genetics, Aix Marseille University, Marseille, France
| | - Isabelle Thuret
- Pediatric Onco-Hematology Department, Reference Center on Rare Red Cell Disorders, La Timone Children's Hospital, APHM, Marseille, France
| | - Muriel Giansily-Blaizot
- Department of Hematological biology, Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, Montpellier, France
| | - Serge Pissard
- Molecular Genetic Laboratory, Henri Mondor University Hospital, Créteil, France
| | - Patricia Aguilar-Martinez
- Department of Hematological biology, Reference Center on Rare Red Cell Disorders, Montpellier University Hospital, Montpellier, France
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7
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Filser M, Gardie B, Wemeau M, Aguilar-Martinez P, Giansily-Blaizot M, Girodon F. Importance of Sequencing HBA1, HBA2 and HBB Genes to Confirm the Diagnosis of High Oxygen Affinity Hemoglobin. Genes (Basel) 2022; 13:132. [PMID: 35052472 PMCID: PMC8774638 DOI: 10.3390/genes13010132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 12/03/2022] Open
Abstract
High oxygen affinity hemoglobin (HOAH) is the main cause of constitutional erythrocytosis. Mutations in the genes coding the alpha and beta globin chains (HBA1, HBA2 and HBB) strengthen the binding of oxygen to hemoglobin (Hb), bringing about tissue hypoxia and a secondary erythrocytosis. The diagnosis of HOAH is based upon the identification of a mutation in HBA1, HBA2 or HBB in specialized laboratories. Phenotypic studies of Hb are also useful, but electrophoretic analysis can be normal in 1/3 of cases. The establishment of the dissociation curve of Hb can be used as another screening test, a shift to the left indicating an increased affinity for Hb. The direct measurement of venous P50 using a Hemox Analyzer is of great importance, but due to specific analytic conditions, it is only available in a few specialized laboratories. Alternatively, an estimated measurement of the P50 can be obtained in most of the blood gas analyzers on venous blood. The aim of our study was therefore to determine whether a normal venous P50 value could rule out HOAH. We sequenced the HBB, HBA1 and HBA2 genes of 75 patients with idiopathic erythrocytosis. Patients had previously undergone an exhaustive medical check-up after which the venous P50 value was defined as normal. Surprisingly, sequencing detected HOAH in three patients (Hb Olympia in two patients, and Hb St Nazaire in another). A careful retrospective examination of their medical files revealed that (i) one of the P50 samples was arterial; (ii) there was some air in another sample; and (iii) the P50 measurement was not actually done in one of the patients. Our study shows that in real life conditions, due to pre-analytical contingencies, a venous P50 value that is classified as being normal may not be sufficient to rule out a diagnosis of HOAH. Therefore, we recommend the systematic sequencing of the HBB, HBA1 and HBA2 genes in the exploration of idiopathic erythrocytosis.
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Affiliation(s)
- Mathilde Filser
- Biology Division, Department of Biological Hematology, Dijon Hospital, 21000 Dijon, France;
| | - Betty Gardie
- Thorax Institute, Nantes Hospital, CNRS, Inserm, Nantes University, 44000 Nantes, France;
- Ecole Pratique des Hautes Etudes, EPHE, Science and Letters Paris University, 75014 Paris, France
- Laboratory of Excellence GR-Ex, 75015 Paris, France
| | - Mathieu Wemeau
- Blood Disease Department, Claude Huriez Hospital, Lille Hospital, 59000 Lille, France;
| | - Patricia Aguilar-Martinez
- Department of Biological Hematology, Saint Eloi Hospital, Montpellier Hospital & Montpellier University, 34000 Montpellier, France; (P.A.-M.); (M.G.-B.)
| | - Muriel Giansily-Blaizot
- Department of Biological Hematology, Saint Eloi Hospital, Montpellier Hospital & Montpellier University, 34000 Montpellier, France; (P.A.-M.); (M.G.-B.)
| | - François Girodon
- Biology Division, Department of Biological Hematology, Dijon Hospital, 21000 Dijon, France;
- Laboratory of Excellence GR-Ex, 75015 Paris, France
- Inserm U1231, Bourgogne University, 21000 Dijon, France
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8
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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: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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McVey JH, Rallapalli PM, Kemball-Cook G, Hampshire DJ, Giansily-Blaizot M, Gomez K, Perkins SJ, Ludlam CA. The European Association for Haemophilia and Allied Disorders (EAHAD) Coagulation Factor Variant Databases: Important resources for haemostasis clinicians and researchers. Haemophilia 2020; 26:306-313. [PMID: 32166871 DOI: 10.1111/hae.13947] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/15/2020] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Advances in genomic sequencing have facilitated the sequencing of genes associated with disorders of haemostasis. The identification of variants within genes and access to curated data incorporating structural, functional, evolutionary as well as phenotypic data has become increasingly important in order to ascribe pathogenicity. AIM The European Association for Haemophilia and Allied Disorders (EAHAD) Coagulation Factor Variant Database Project aims to provide a single port of entry to a web-accessible resource for variants in genes involved in clinical bleeding disorders. RESULTS New databases have evolved from previously developed single gene variant coagulation database projects, incorporating new data, new analysis tools and a new common database architecture with new interfaces and filters. These new databases currently present information about the genotype, phenotype (laboratory and clinical) and structural and functional effects of variants described in the genes of factor (F) VII (F7), FVIII (F8), FIX (F9) and von Willebrand factor (VWF). CONCLUSION The project has improved the quality and quantity of information available to the haemostasis research and clinical communities, thereby enabling accurate classification of disease severity in order to make assessments of likely pathogenicity.
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Affiliation(s)
- John H McVey
- School of Bioscience and Medicine, University of Surrey, Guildford, UK
| | - Pavithra M Rallapalli
- Department of Structural and Molecular Biology, University College London, London, UK
| | - Geoffrey Kemball-Cook
- Katherine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | | | | | - Keith Gomez
- Katherine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - Stephen J Perkins
- Department of Structural and Molecular Biology, University College London, London, UK
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10
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Ferraresi P, Balestra D, Guittard C, Buthiau D, Pan-Petesh B, Maestri I, Farah R, Pinotti M, Giansily-Blaizot M. Next-generation sequencing and recombinant expression characterized aberrant splicing mechanisms and provided correction strategies in factor VII deficiency. Haematologica 2019; 105:829-837. [PMID: 31273093 PMCID: PMC7049351 DOI: 10.3324/haematol.2019.217539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/02/2019] [Indexed: 01/22/2023] Open
Abstract
Despite the exhaustive screening of F7 gene exons and exon-intron boundaries and promoter region, a significant proportion of mutated alleles remains unidentified in patients with coagulation factor VII deficiency. Here, we applied next-generation sequencing to 13 FVII-deficient patients displaying genotype-phenotype discrepancies upon conventional sequencing, and identified six rare intronic variants. Computational analysis predicted splicing effects for three of them, which would strengthen (c.571+78G>A; c.806-329G>A) or create (c.572-392C>G) intronic 5′ splice sites (5′ss). In F7 minigene assays, the c.806-329G>A was ineffective while the c.571+78G>A change led to usage of the +79 cryptic 5′ss with only trace levels of correct transcripts (3% of wild-type), in accordance with factor VII activity levels in homozygotes (1-3% of normal). The c.572-392C>G change led to pseudo-exonization and frame-shift, but also substantial levels of correct transcripts (approx. 70%). However, this variant was associated with the common F7 polymorphic haplotype, predicted to further decrease factor VII levels; this provided some kind of explanation for the 10% factor VII levels in the homozygous patient. Intriguingly, the effect of the c.571+78G>A and c.572-392C>G changes, and particularly of the former (the most severe and well-represented in our cohort), was counteracted by antisense U7snRNA variants targeting the intronic 5′ss, thus demonstrating their pathogenic role. In conclusion, the combination of next-generation sequencing of the entire F7 gene with the minigene expression studies elucidated the molecular bases of factor VII deficiency in 10 of 13 patients, thus improving diagnosis and genetic counseling. It also provided a potential therapeutic approach based on antisense molecules that has been successfully exploited in other disorders.
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Affiliation(s)
- Paolo Ferraresi
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Dario Balestra
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Caroline Guittard
- Department of Biological Haematology, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Delphine Buthiau
- Department of Biological Haematology, CHU Montpellier, Université Montpellier, Montpellier, France
| | | | - Iva Maestri
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Roula Farah
- Department of Pediatrics, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Mirko Pinotti
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Muriel Giansily-Blaizot
- Department of Biological Haematology, CHU Montpellier, Université Montpellier, Montpellier, France
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Borhany M, Ranc A, Fretigny M, Moulis G, Abid M, Shamsi T, Giansily-Blaizot M. Molecular analysis of eight severe FV-deficient patients in Pakistan: A large series of homozygous for frameshift mutations. Haemophilia 2019; 25:e278-e281. [PMID: 30924984 DOI: 10.1111/hae.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Munira Borhany
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Alexandre Ranc
- Department of Biological Haematology, University of Montpellier, Montpellier, France
| | - Mathilde Fretigny
- Service d'Hématologie Biologique, Hospices Civils de Lyon, Lyon, France
| | - Grégory Moulis
- Department of Biological Haematology, University of Montpellier, Montpellier, France
| | - Madiha Abid
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | - Tahir Shamsi
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
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12
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Méndez Rojano R, Mendez S, Lucor D, Ranc A, Giansily-Blaizot M, Schved JF, Nicoud F. Kinetics of the coagulation cascade including the contact activation system: sensitivity analysis and model reduction. Biomech Model Mechanobiol 2019; 18:1139-1153. [DOI: 10.1007/s10237-019-01134-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/16/2019] [Indexed: 12/14/2022]
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13
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Orvain C, Da Costa L, Van Wijk R, Pissard S, Picard V, Mansour-Hendili L, Cunat S, Giansily-Blaizot M, Cartron G, Schved JF, Aguilar-Martinez P. Inherited or acquired modifiers of iron status may dramatically affect the phenotype in dehydrated hereditary stomatocytosis. Eur J Haematol 2018; 101:566-569. [DOI: 10.1111/ejh.13135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Corentin Orvain
- Department of Haematology Biology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
- Department of Blood Diseases; Angers University Hospital; Angers France
- CRCINA, INSERM; Université de Nantes; Université d'Angers; Angers France
| | - Lydie Da Costa
- Department of Biological Haematology; AP-HP; Robert Debré University Hospital; Paris France
| | - Richard Van Wijk
- Department of Clinical Chemistry and Haematology; Utrecht University Medical Center; Utrecht The Netherlands
| | - Serge Pissard
- Department of Molecular Genetics; AP-HP; Henri Mondor University Hospital; Créteil France
| | - Véronique Picard
- Laboratory of Haematology; AP-HP; Bicêtre University Hospital; Le Kremlin-Bicêtre France
| | - Lamisse Mansour-Hendili
- Department of Haematology Biology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
- Department of Molecular Genetics; AP-HP; Henri Mondor University Hospital; Créteil France
| | - Séverine Cunat
- Department of Haematology Biology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
| | - Muriel Giansily-Blaizot
- Department of Haematology Biology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
| | - Guillaume Cartron
- Department of Clinical Haematology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
| | - Jean-François Schved
- Department of Haematology Biology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
| | - Patricia Aguilar-Martinez
- Department of Haematology Biology; Saint Eloi Hospital; Montpellier University Hospital; Montpellier France
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14
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Abstract
SummaryDue to the wide molecular and clinical heterogeneities of inherited factor VII (FVII) deficiency, consensus guidelines for management of this coagulation disorder are not currently well established. Therefore, potential clinical, plasmatic or genetic criteria, that could be predictive for bleeding tendency in this condition, have been evaluated. Genotypic criteria including FVII genotypes and thrombophilic mutations are of particular interest to better understand some of the variations observed in bleeding phenotypes but they are still poorly informative for the management of surgery in FVII-deficient patients. Up to now, no plasma parameters have been found to be reliable predictors of bleeding risk. Nevertheless, tissue factor and platelet pathways remain to be explored. Finally, clinical history appears to be the best predictor of bleeding risk after haemostatic challenges in inherited FVII deficiencies. Furthermore, the absence of history of bleeding or mild bleeding phenotypes including menorrhagia, bruises and epistaxis (not inducing iron deficiency anaemia or requiring blood substitutive treatment) could enable minor surgery to be performed in FVII-deficient patients without blood replacement therapy.
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Chen SW, Schved JF, Pellequer JL, Giansily-Blaizot M. Model of a Ternary Complex between Activated Factor VII, Tissue Factor and Factor IX. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryUpon binding to tissue factor, FVIIa triggers coagulation by activating vitamin K-dependent zymogens, factor IX (FIX) and factor X (FX). To understand recognition mechanisms in the initiation step of the coagulation cascade, we present a three-dimensional model of the ternary complex between FVIIa:TF:FIX. This model was built using a full-space search algorithm in combination with computational graphics. With the known crystallographic complex FVIIa:TF kept fixed, the FIX docking was performed first with FIX Gla-EGF1 domains, followed by the FIX protease/EGF2 domains. Because the FIXa crystal structure lacks electron density for the Gla domain, we constructed a chimeric FIX molecule that contains the Gla-EGF1 domains of FVIIa and the EGF2-protease domains of FIXa. The FVIIa:TF:FIX complex has been extensively challenged against experimental data including site-directed mutagenesis, inhibitory peptide data, haemophilia B database mutations, inhibitor antibodies and a novel exosite binding inhibitor peptide. This FVIIa:TF:FIX complex provides a powerful tool to study the regulation of FVIIa production and presents new avenues for developing therapeutic inhibitory compounds of FVIIa:TF:substrate complex.
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16
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Giansily-Blaizot M, Flory-Pigagniol L, Favier R, Farah RA, Martin-Toutain I, Verdy E, Schved JF. Accurate characterization of the IVS7 repeat polymorphism of FVII gene and identification of three novel allelic forms. Thromb Haemost 2017; 96:95-7. [PMID: 16807660 DOI: 10.1160/th05-10-0706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Pfeiffer C, Batorova A, Giansily-Blaizot M, Schved J, Mariani G, Pinotti M, Branchini A, Baroni M, Bernardi F. Coagulation factor VII variants resistant to inhibitory antibodies. Thromb Haemost 2017; 112:972-80. [DOI: 10.1160/th14-03-0198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/19/2014] [Indexed: 11/05/2022]
Abstract
SummaryReplacement therapy is currently used to prevent and treat bleeding episodes in coagulation factor deficiencies. However, structural differences between the endogenous and therapeutic proteins might increase the risk for immune complications. This study was aimed at identifying factor (F)VII variants resistant to inhibitory antibodies developed after treatment with recombinant activated factor VII (rFVIIa) in a FVII-deficient patient homozygous for the p.A354V-p.P464Hfs mutation, which predicts trace levels of an elongated FVII variant in plasma. We performed fluorescent bead-based binding, ELISA-based competition as well as fluorogenic functional (activated FX and thrombin generation) assays in plasma and with recombinant proteins. We found that antibodies displayed higher affinity for the active than for the zymogen FVII (half-maximal binding at 0.54 ± 0.04 and 0.78 ± 0.07 BU/ml, respectively), and inhibited the coagulation initiation phase with a second-order kinetics. Isotypic analysis showed a polyclonal response with a large predominance of IgG1. We hypothesised that structural differences in the carboxyl-terminus between the inherited FVII and the therapeutic molecules contributed to the immune response. Intriguingly, a naturally-occurring, poorly secreted and 5-residue truncated FVII (FVII-462X) escaped inhibition. Among a series of truncated rFVII molecules, we identified a well-secreted and catalytically competent variant (rFVII-464X) with reduced binding to antibodies (half-maximal binding at 0.198 ± 0.003 BU/ml) as compared to the rFVII-wt (0.032 ± 0.002 BU/ml), which led to a 40-time reduced inhibition in activated FX generation assays. Taken together our results provide a paradigmatic example of mutation-related inhibitory antibodies, strongly support the FVII carboxyl-terminus as their main target and identify inhibitor-resistant FVII variants.
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18
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Giansily-Blaizot M, Schved JF. Recombinant human factor VIIa (rFVIIa) in hemophilia: mode of action and evidence to date. Ther Adv Hematol 2017; 8:345-352. [PMID: 29204261 DOI: 10.1177/2040620717737701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022] Open
Abstract
Recombinant activated factor VII (rFVIIa) is a bypassing agent widely used both in the treatment and prevention of hemorrhagic complications due to hemophilia with inhibitor. In such cases, antihemophilic factors cannot be used. The normal physiology of factor VII/ factor VIIa (FVII/FVIIa) in the hemostatic process requires the presence of tissue factor (TF) that links to FVII leading to a FVIIa-TF complex which activates both factor X and factor IX. The therapeutic use of rFVIIa requires high amount of FVIIa. Some studies demonstrate that FVIIa at high doses still requires tissue factor for function, whereas others suggest that FVIIa activates FX directly on the platelet surface, in a TF-independent manner. In the present article, we discuss the arguments supporting both TF-dependent and TF-independent modes of action. Finally, the coexistence of both TF-dependent and TF-independent mechanisms cannot be excluded.
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Affiliation(s)
| | - Jean-François Schved
- Hemophilia Treatment Centre, Hôpital Saint-Eloi, CHU Montpellier, 80 avenue A Fliche, 34295 Montpellier Cedex 5, France
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19
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Diaz I, Bolloré K, Tuaillon E, Lapalud P, Giansily-Blaizot M, Vendrell JP, Schved JF, Lavigne-Lissalde G. Circulating FVIII-specific IgG, IgA and IgM memory B cells from haemophilia A patients. Haemophilia 2016; 22:799-805. [DOI: 10.1111/hae.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 01/02/2023]
Affiliation(s)
- I. Diaz
- Laboratory of Hematology; University Hospital of Montpellier; Montpellier France
- Institute of Research in Biotherapy; Montpellier France
| | - K. Bolloré
- Institute of Research in Biotherapy; Montpellier France
- INSERM U1058; Montpellier 1 University; Montpellier France
| | - E. Tuaillon
- Institute of Research in Biotherapy; Montpellier France
- INSERM U1058; Montpellier 1 University; Montpellier France
| | - P. Lapalud
- UMR 3145 SysDiag CNRS/Biorad; Montpellier France
| | | | - J. P. Vendrell
- INSERM U1058; Montpellier 1 University; Montpellier France
| | - J. F. Schved
- Laboratory of Hematology; University Hospital of Montpellier; Montpellier France
- Regional Hemophilia Treatment Center; Montpellier France
| | - G. Lavigne-Lissalde
- UMR 3145 SysDiag CNRS/Biorad; Montpellier France
- Regional Hemophilia Treatment Center; Montpellier France
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20
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Napolitano M, Di Minno MND, Batorova A, Dolce A, Giansily-Blaizot M, Ingerslev J, Schved JF, Auerswald G, Kenet G, Karimi M, Shamsi T, Ruiz de Sáez A, Dolatkhah R, Chuansumrit A, Bertrand MA, Mariani G. Women with congenital factor VII deficiency: clinical phenotype and treatment options from two international studies. Haemophilia 2016; 22:752-9. [PMID: 27338009 DOI: 10.1111/hae.12978] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A paucity of data exists on the incidence, diagnosis and treatment of bleeding in women with inherited factor VII (FVII) deficiency. AIM Here we report results of a comprehensive analysis from two international registries of patients with inherited FVII deficiency, depicting the clinical picture of this disorder in women and describing any gender-related differences. METHODS A comprehensive analysis of two fully compatible, international registries of patients with inherited FVII deficiency (International Registry of Factor VII deficiency, IRF7; Seven Treatment Evaluation Registry, STER) was performed. RESULTS In our cohort (N = 449; 215 male, 234 female), the higher prevalence of mucocutaneous bleeds in females strongly predicted ensuing gynaecological bleeding (hazard ratio = 12.8, 95% CI 1.68-97.6, P = 0.014). Menorrhagia was the most prevalent type of bleeding (46.4% of patients), and was the presentation symptom in 12% of cases. Replacement therapies administered were also analysed. For surgical procedures (n = 50), a receiver operator characteristic analysis showed that the minimal first dose of rFVIIa to avoid postsurgical bleeding during the first 24 hours was 22 μg kg(-1) , and no less than two administrations. Prophylaxis was reported in 25 women with excellent or effective outcomes when performed with a total weekly rFVIIa dose of 90 μg kg(-1) (divided as three doses). CONCLUSION Women with FVII deficiency have a bleeding disorder mainly characterized by mucocutaneous bleeds, which predicts an increased risk of ensuing gynaecological bleeding. Systematic replacement therapy or long-term prophylaxis with rFVIIa may reduce the impact of menorrhagia on the reproductive system, iron loss and may avoid unnecessary hysterectomies.
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Affiliation(s)
- M Napolitano
- Haematology Unit, Thrombosis and Hemostasis Reference Regional Center, University of Palermo, Palermo, Italy.
| | - M N D Di Minno
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - A Batorova
- The National Haemophilia Centre, Institute of Haematology and Blood Transfusion, School of Medicine of Comenius University, University Hospital, Bratislava, Slovakia
| | - A Dolce
- National Institute of Statistics, Palermo, Italy
| | | | - J Ingerslev
- Centre for Haemophilia & Thrombosis, University Hospital Skejby, Aarhus, Denmark
| | - J-F Schved
- Laboratory of Haematology, University Hospital, Montpellier, France
| | - G Auerswald
- Klinikum Bremen-Mitte, Prof.-Hess Kinderklinik, Bremen, Germany
| | - G Kenet
- National Hemophilia Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - T Shamsi
- National Institute of Blood Diseases & Bone Marrow Transplantation, Karachi, Pakistan
| | - A Ruiz de Sáez
- Centro Nacional de Hemophilia, Banco Municipal de Sangre, Caracas, Venezuela
| | - R Dolatkhah
- Haematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Chuansumrit
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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21
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Giansily-Blaizot M, Kolaitis N, Borhany M, Moulis G, Guillot O, Shamsi T. Two new double mutant alleles of the F7 gene and a literature review on alleles with two mutations in FVII deficiency. Haemophilia 2016; 22:e304-6. [PMID: 27227566 DOI: 10.1111/hae.12897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/30/2022]
Affiliation(s)
- M Giansily-Blaizot
- Laboratoire d'Hématologie, CHU Montpellier, Hôpital Saint-Eloi, Montpellier, France
| | - N Kolaitis
- Haematology Laboratory, Ioannina University Hospital, Ioannina, Greece
| | - M Borhany
- Department of Haematology, Haemostasis & Thrombosis, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
| | - G Moulis
- Laboratoire d'Hématologie, CHU Montpellier, Hôpital Saint-Eloi, Montpellier, France
| | - O Guillot
- Laboratoire d'Hématologie, CHU Montpellier, Hôpital Saint-Eloi, Montpellier, France
| | - T Shamsi
- Department of Haematology, Haemostasis & Thrombosis, National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Karachi, Pakistan
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22
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Funakoshi N, Chaze I, Alary AS, Tachon G, Cunat S, Giansily-Blaizot M, Bismuth M, Larrey D, Pageaux GP, Schved JF, Donnadieu-Rigole H, Blanc P, Aguilar-Martinez P. The role of genetic factors in patients with hepatocellular carcinoma and iron overload - a prospective series of 234 patients. Liver Int 2016; 36:746-54. [PMID: 26474245 DOI: 10.1111/liv.12984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 10/03/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Iron overload (IO) in HFE-related hereditary haemochromatosis is associated with increased risk of liver cancer. This study aimed to investigate the role of other genes involved in hereditary IO among patients with hepatocellular carcinoma (HCC). METHODS Patients with HCC diagnosed in our institution were included in this prospective study. Those with ferritin levels ≥300 μg/L (males) or ≥200 μg/L (females) and/or transferrin saturation ≥50% (males) or ≥45% (females) had liver iron concentration (LIC) evaluated by MRI. HFE C282Y and H63D mutations were screened. Genetic analyses of genes involved in hereditary IO (HFE, HJV/HFE2, HAMP, TFR2, SLC40A1, GNPAT) were performed in patients with increased LIC. RESULTS A total of 234 patients were included; 215 (92%) had common acquired risk factors of HCC (mainly alcoholism or chronic viral hepatitis). 119 patients had abnormal iron parameters. Twelve (5.1%) were C282Y homozygotes, three were compound C282Y/H63D heterozygotes. LIC was measured by MRI in 100 patients. Thirteen patients with a LIC>70 μmol/g were enrolled in further genetic analyses: two unrelated patients bore the HAMP:c.-153C>T mutation at the heterozygous state, which is associated with increased risk of IO and severe haemochromatosis. Specific haplotypes of SLC40A1 were also studied. CONCLUSIONS Additional genetic risk factors of IO were found in 18 patients (7.7%) among a large series of 234 HCC patients. Screening for IO and the associated at-risk genotypes in patients who have developed HCC, is useful for both determining etiologic diagnosis and enabling family screening and possibly primary prevention in relatives.
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Affiliation(s)
- Natalie Funakoshi
- Department of Hepato-Gastroenterology B, CHRU de Montpellier, Hôpital Saint Eloi, France
| | - Iphigénie Chaze
- Department of Hepato-Gastroenterology B, CHRU de Montpellier, Hôpital Saint Eloi, France.,Department of Internal Medicine E, CHRU de Montpellier, Hôpital Saint Eloi, France
| | - Anne-Sophie Alary
- Laboratory of Hematology, CHRU de Montpellier, Hôpital Saint Eloi, France
| | - Gaëlle Tachon
- Laboratory of Hematology, CHRU de Montpellier, Hôpital Saint Eloi, France
| | - Séverine Cunat
- Laboratory of Hematology, CHRU de Montpellier, Hôpital Saint Eloi, France
| | | | - Michael Bismuth
- Department of Hepato-Gastroenterology B, CHRU de Montpellier, Hôpital Saint Eloi, France
| | - Dominique Larrey
- Department of Hepato-Gastroenterology A, CHRU de Montpellier, Hôpital Saint Eloi, France
| | | | | | | | - Pierre Blanc
- Department of Hepato-Gastroenterology B, CHRU de Montpellier, Hôpital Saint Eloi, France
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Pfeiffer C, Mathieu-Dupas E, Logghe P, Lissalde-Lavigne G, Balicchi J, Caliskan U, Valentin T, Laune D, Molina F, Schved JF, Giansily-Blaizot M. Isotypic analysis of antibodies against activated Factor VII in patients with Factor VII deficiency using the x-MAP technology. Thromb Res 2016; 141:22-7. [DOI: 10.1016/j.thromres.2016.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/16/2022]
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24
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Napolitano M, Dolce A, Batorova A, Giansily-Blaizot M, Ingerslev J, Mirbehbahani N, Di Minno MND, Lopez Fernandez MF, Karimi M, Charoenkwan P, Kavakli K, Mariani G. Replacement therapy in inherited factor VII deficiency: occurrence of adverse events and relation with surgery. Haemophilia 2015; 21:e513-e517. [PMID: 26249164 DOI: 10.1111/hae.12782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 06/04/2023]
Affiliation(s)
- M Napolitano
- Haematology Unit, Thrombosis and Hemostasis Reference Regional Center, Università di Palermo, Palermo, Italy
| | - A Dolce
- National Institute of Statistics, Palermo, Italy
| | - A Batorova
- The National Haemophilia Centre, Institute of Haematology and Blood Transfusion, University Hospital, Bratislava, Slovakia
| | | | - J Ingerslev
- Centre for Haemophilia & Thrombosis, University Hospital Skejby, Aarhus, Denmark
| | - N Mirbehbahani
- Hematology and Oncology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - M N D Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - M Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Charoenkwan
- Division of Hematology, Chiang Mai University, Chiang Mai, Thailand
| | - K Kavakli
- Children's Hospital, Ege University Faculty of Medicine, Izmir, Turkey
| | - G Mariani
- Università di Ferrara Medical School, Ferrara, Italy
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25
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Borhany M, Delbes C, Giansily-Blaizot M, Zubair M, Ahmed MS, Fatima N, Shamsi T. A new report of FVII-inhibitor in a patient suffering from severe congenital FVII deficiency. Haemophilia 2015; 21:e336-8. [PMID: 25955166 DOI: 10.1111/hae.12708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M Borhany
- Department of Haematology, Haemostasis & Thrombosis, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - C Delbes
- Département d'hématologie biologique, CHU de Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - M Giansily-Blaizot
- Département d'hématologie biologique, CHU de Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - M Zubair
- Military Hospital Rawalpindi, Rawalpindi, Pakistan
| | - M S Ahmed
- Military Hospital Rawalpindi, Rawalpindi, Pakistan
| | - N Fatima
- Department of Haematology, Haemostasis & Thrombosis, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - T Shamsi
- Department of Haematology, Haemostasis & Thrombosis, National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
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26
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Farah R, Al Danaf J, Braiteh N, Costa JM, Farhat H, Mariani G, Giansily-Blaizot M. Life-threatening bleeding in factor VII deficiency: the role of prenatal diagnosis and primary prophylaxis. Br J Haematol 2014; 168:452-5. [PMID: 25179859 DOI: 10.1111/bjh.13106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Roula Farah
- Department of Paediatrics, Saint George Hospital University Medical Centre, Beirut, Lebanon.
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27
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Mourey G, Tachon G, Pellequer JL, Zawadzki C, Trossaërt M, Bertrand MA, Schved JF, Giansily-Blaizot M. A Haut-Doubs FVII variant depending on species-derived-thromboplastin reagent (F7:p.Arg337His). Haemophilia 2014; 20:e347-9. [DOI: 10.1111/hae.12455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- G. Mourey
- Laboratoire d'hémostase; Etablissement Français du Sang; Besançon France
| | - G. Tachon
- Département d'hématologie biologique; CHU de Montpellier; Hôpital Saint Eloi; Montpellier France
| | - J.-L. Pellequer
- CEA, iBEB; Service de Biochimie et Toxicologie Nucléaire; Bagnols sur Cèze France
| | - C. Zawadzki
- Laboratoire d'Hématologie; Centre de Biologie et Pathologie EA-2693; Centre Hospitalier Régional et Universitaire; Lille France
| | - M. Trossaërt
- Centre Régional de Traitement de l'Hémophilie; Laboratoire hématologie; CHU Hôtel-Dieu; Nantes France
| | - M.-A. Bertrand
- Centre Régional de Traitement de l'Hémophilie; Service d'hématologie CHU Besançon; Besançon France
| | - J.-F. Schved
- Département d'hématologie biologique; CHU de Montpellier; Hôpital Saint Eloi; Montpellier France
| | - M. Giansily-Blaizot
- Département d'hématologie biologique; CHU de Montpellier; Hôpital Saint Eloi; Montpellier France
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28
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Morfini M, Batorova A, Mariani G, Auerswald G, Bernardi F, Di Minno G, Dolce A, Fede C, Giansily-Blaizot M, Ingerslev J, Martinowitz U, Napolitano M, Pinotti M, Schved JF. Pharmacokinetic properties of recombinant FVIIa in inherited FVII deficiency account for a large volume of distribution at steady state and a prolonged pharmacodynamic effect. Thromb Haemost 2014; 112:424-5. [PMID: 24763923 DOI: 10.1160/th13-12-1045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/11/2014] [Indexed: 12/17/2022]
Affiliation(s)
- M Morfini
- Massimo Morfini, Agency for Hemophilia and Regional Reference Center for Inherited Bleeding Disorders, Azienda Ospedalieriero, Universitaria Careggi, Florence, Italy, Tel.: +39 055 7947587, Fax: +39 055 7947794, E-mail:
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29
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Borhany M, Boijout H, Pellequer JL, Shamsi T, Moulis G, Aguilar-Martinez P, Schved JF, Giansily-Blaizot M. Genotype and phenotype relationships in 10 Pakistani unrelated patients with inherited factor VII deficiency. Haemophilia 2013; 19:893-7. [DOI: 10.1111/hae.12186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M. Borhany
- Department of Haematology, Haemostasis & Thrombosis; National Institute of Blood Disease & Bone Marrow Transplantation (NIBD); Karachi Pakistan
| | - H. Boijout
- CHU Montpellier, Département d'Hématologie Biologique; Hôpital Saint-Eloi; Montpellier France
| | - J.-L. Pellequer
- CEA, DSV, iBEB, Service de Biochimie et Toxicologie Nucléaire; Bagnols sur Cèze France
| | - T. Shamsi
- Department of Haematology, Haemostasis & Thrombosis; National Institute of Blood Disease & Bone Marrow Transplantation (NIBD); Karachi Pakistan
| | - G. Moulis
- CHU Montpellier, Département d'Hématologie Biologique; Hôpital Saint-Eloi; Montpellier France
| | - P. Aguilar-Martinez
- CHU Montpellier, Département d'Hématologie Biologique; Hôpital Saint-Eloi; Montpellier France
| | - J.-F. Schved
- CHU Montpellier, Département d'Hématologie Biologique; Hôpital Saint-Eloi; Montpellier France
| | - M. Giansily-Blaizot
- CHU Montpellier, Département d'Hématologie Biologique; Hôpital Saint-Eloi; Montpellier France
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30
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Kurnatowska I, Grzelak P, Masajtis-Zagajewska A, Kaczmarska M, Stefanczyk L, Nowicki M, Wyskida K, Zak-Golab A, Labuzek K, Ficek R, Pospiech K, Olszanecka-Glinianowicz M, Okopien B, Wiecek A, Chudek J, Morena M, Cristol JP, Jaussent I, Chenine L, Brugueirolle C, Leray-Moragues H, Schved JF, Canaud B, Dupuy AM, Giansily-Blaizot M, Brandenburg VM, Specht P, Floege J, Ketteler M, Hwang IH, Lee KN, Kim IY, Lee DW, Lee SB, Shin MJ, Rhee H, Yang BY, Seong EY, Kwak IS, Chitalia N, Ismail T, Tooth L, Boa F, Goldsmith D, Kaski J, Banerjee D, Iimori S, Noda Y, Okado T, Naito S, Rai T, Uchida S, Sasaki S, Daenen K, Fourneau I, Verbeken E, Hoylaerts MF, Bammens B, Daenen K, Fourneau I, Opdenakker G, Hoylaerts MF, Bammens B, Christensson A, Melander OS, Fjellstedt E, Berglund G, Andersson-Ohlsson M, Shima H, Shoji T, Naganuma T, Nakatani S, Mori K, Ishimura E, Emoto M, Okamura M, Nakatani T, Inaba M, Hafez MH, Mostafa MA, Harash EL, Okely AEL, Hendi YM, Anan MI, Temraz MEL, Fouad MY, Nassar WF, Barrios C, Otero S, Soler M, Rodriguez E, Collado S, Faura A, Mojal S, Betriu A, Fernandez E, Pascual J, Kudo K, Suzuki K, Ichikawa K, Konta T, Kubota I, Abdalla AA, Weiland A, Casserly LF, Cronin CJ, Hannigan A, Nguyen HT, Stack AG, Naito S, Iimori S, Okado T, Noda Y, Rai T, Uchida S, Sasaki S, Bolignano D, Tripepi R, Leonardis D, Mallamaci F, Zoccali C, Giansily-Blaizot M, Jaussent I, Cristol JP, Chenine L, Brugueirolle C, Leray-Moragues H, Schved JF, Canaud B, Dupuy AM, Morena M, Sugahara M, Sugimoto I, Uchida L, Chikamori M, Honda T, Miura R, Tsuchiya A, Kanemitsu T, Kobayashi M, Kotera N, Ishizawa K, Sakurai Y, Mise N, Park HC, Park SK, Lee JE, Ha SK, Choi HY. Epidemiology - cardiovascular outcomes. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Bonhomme F, Schved JF, Giansily-Blaizot M, Samama CM, de Moerloose P. Déficits rares de la coagulation et gestes invasifs. ACTA ACUST UNITED AC 2013; 32:198-205. [DOI: 10.1016/j.annfar.2013.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
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32
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Napolitano M, Giansily-Blaizot M, Dolce A, Schved JF, Auerswald G, Ingerslev J, Bjerre J, Altisent C, Charoenkwan P, Michaels L, Chuansumrit A, Di Minno G, Caliskan U, Mariani G. Prophylaxis in congenital factor VII deficiency: indications, efficacy and safety. Results from the Seven Treatment Evaluation Registry (STER). Haematologica 2013; 98:538-44. [PMID: 23403322 DOI: 10.3324/haematol.2012.074039] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Because of the very short half-life of factor VII, prophylaxis in factor VII deficiency is considered a difficult endeavor. The clinical efficacy and safety of prophylactic regimens, and indications for their use, were evaluated in factor VII-deficient patients in the Seven Treatment Evaluation Registry. Prophylaxis data (38 courses) were analyzed from 34 patients with severe factor VII deficiency (<1-45 years of age, 21 female). Severest phenotypes (central nervous system, gastrointestinal, joint bleeding episodes) were highly prevalent. Twenty-one patients received recombinant activated factor VII (24 courses), four received plasma-derived factor VII, and ten received fresh frozen plasma. Prophylactic schedules clustered into "frequent" courses (three times weekly, n=23) and "infrequent" courses (≤ 2 times weekly, n=15). Excluding courses for menorrhagia, "frequent" and "infrequent" courses produced 18/23 (78%) and 5/12 (41%) "excellent" outcomes, respectively; relative risk, 1.88; 95% confidence interval, 0.93-3.79; P=0.079. Long term prophylaxis lasted from 1 to >10 years. No thrombosis or new inhibitors occurred. In conclusion, a subset of patients with factor VII deficiency needed prophylaxis because of severe bleeding. Recombinant activated factor VII schedules based on "frequent" administrations (three times weekly) and a 90 μg/kg total weekly dose were effective. These data provide a rationale for long-term, safe prophylaxis in factor VII deficiency.
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Affiliation(s)
- Mariasanta Napolitano
- University of L'Aquila, Dipartimento di Medicina Interna e Sanità Pubblica, L'Aquila, Italy.
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33
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Giansily-Blaizot M, Cunat S, Moulis G, Schved JF, Aguilar-Martinez P. Homozygous mutation of the 5'UTR region of the L-Ferritin gene in the hereditary hyperferritinemia cataract syndrome and its impact on the phenotype. Haematologica 2013; 98:e42-3. [PMID: 23300176 DOI: 10.3324/haematol.2012.077198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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34
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Giansily-Blaizot M, Lopez E, Viart V, Chafa O, Tapon-Bretaudière J, Claustres M, Taulan M. Lethal factor VII deficiency due to novel mutations in the F7 promoter: functional analysis reveals disruption of HNF4 binding site. Thromb Haemost 2012; 108:277-83. [PMID: 22628013 DOI: 10.1160/th11-09-0638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 05/02/2012] [Indexed: 12/15/2022]
Abstract
Hereditary factor VII (FVII) deficiency is a rare autosomal recessive disorder. Deleterious mutations that prevent the synthesis of any amount of functional FVII have been associated with life-threatening haemorrhage in neonates. Here we report two infants, of Maghrebian origin, who suffered a fatal spontaneous cerebral haemorrhage. Investigation of the molecular basis for their severe FVII deficiency revealed novel mutations in a homozygous state within the F7 gene promoter: a single nucleotide substitution (c.-65G>C) and a 2bp deletion (c.-60_-59delTT). To determine whether these promoter variants were responsible for the FVII deficiency, computer-assisted sequence analyses were performed. The data predicted a disrupted binding of both HNF4 and COUP-TF transcription factors with each variant. Concordantly, experimental results revealed an altered HNF4-induced transactivation in the promoter mutated variants. The execution of functional tests is critical to ensuring a complete understanding of the effect of any promoter mutant on FVII deficiency. Only then can an accurate molecular diagnosis be made and further genetic counselling and prenatal diagnosis be offered.
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Affiliation(s)
- Muriel Giansily-Blaizot
- CHU Montpellier, Laboratoire de Génétique Moléculaire, Montpellier, 641 Avenue du Doyen Gaston Giraud, 34095 Montpellier Cedex 5, France.
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Peyvandi F, Palla R, Menegatti M, Siboni SM, Halimeh S, Faeser B, Pergantou H, Platokouki H, Giangrande P, Peerlinck K, Celkan T, Ozdemir N, Bidlingmaier C, Ingerslev J, Giansily-Blaizot M, Schved JF, Gilmore R, Gadisseur A, Benedik-Dolničar M, Kitanovski L, Mikovic D, Musallam KM, Rosendaal FR. Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European Network of Rare Bleeding Disorders. J Thromb Haemost 2012; 10:615-21. [PMID: 22321862 DOI: 10.1111/j.1538-7836.2012.04653.x] [Citation(s) in RCA: 278] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The European Network of Rare Bleeding Disorders (EN-RBD) was established to bridge the gap between knowledge and practise in the care of patients with RBDs. OBJECTIVES To explore the relationship between coagulation factor activity level and bleeding severity in patients with RBDs. PATIENTS/METHODS Cross-sectional study using data from 489 patients registered in the EN-RBD. Coagulation factor activity levels were retrieved. Clinical bleeding episodes were classified into four categories according to severity. RESULTS The mean age of patients at data collection was 31 years (range, 7 months to 95 years), with an equal sex distribution. On linear regression analysis, there was a strong association between coagulation factor activity level and clinical bleeding severity for fibrinogen, factor (F) X, FXIII, and combined FV and FVIII deficiencies. A weaker association was present for FV and FVII deficiencies. There was no association between coagulation factor activity level and clinical bleeding severity for FXI. The coagulation factor activity levels that were necessary for patients to remain asymptomatic were: fibrinogen, > 100 mg dL(-1); FV, 12 U dL(-1); combined FV + VIII, 43 U dL(-1); FVII, 25 U dL(-1); FX, 56 U dL(-1) ; FXI, 26 U dL(-1); FXIII, 31 U dL(-1). Moreover, coagulation factor activity levels that corresponded with Grade III bleeding were: undetectable levels for fibrinogen, FV and FXIII, < 15 U dL(-1) for combined FV + VIII; < 8 U dL(-1) for FVI; < 10 U dL(-1) for FX; and < 25 U dL(-1) for FXI. CONCLUSIONS There is a heterogeneous association between coagulation factor activity level and clinical bleeding severity in different RBDs. A strong association is only observed in fibrinogen, FX and FXIII deficiencies.
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Affiliation(s)
- F Peyvandi
- UOS Dipartimentale per la Diagnosi e la Terapia delle Coagulopatie, A Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano and Luigi Villa Foundation, Milan, Italy.
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Branchini A, Rizzotto L, Mariani G, Napolitano M, Lapecorella M, Giansily-Blaizot M, Mari R, Canella A, Pinotti M, Bernardi F. Natural and engineered carboxy-terminal variants: decreased secretion and gain-of-function result in asymptomatic coagulation factor VII deficiency. Haematologica 2011; 97:705-9. [PMID: 22180436 DOI: 10.3324/haematol.2011.049403] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report 2 asymptomatic homozygotes for the nonsense p.R462X mutation affecting the carboxy-terminus of coagulation factor VII (FVII, 466 aminoacids). FVII levels of 3-5% and 2.7 ± 0.4% were found in prothrombin time-based and activated factor X (FXa) generation assays with human thromboplastins. Noticeably, FVII antigen levels were barely detectable (0.7 ± 0.2%) which suggested a gain-of-function effect. This effect was more pronounced with bovine thromboplastin (4.8 ± 0.9%) and disappeared with rabbit thromboplastin (0.7 ± 0.2%). This suggests that the mutation influences tissue factor/FVII interactions. Whereas the recombinant rFVII-462X variant confirmed an increase in specific activity (~400%), a panel of nonsense (p.P466X, p.F465X, p.P464X, p.A463X) and missense (p.R462A, p.R462Q, p.R462W) mutations of the FVII carboxy-terminus resulted in reduced secretion but normal specific activity. These data provide evidence for counteracting pleiotropic effects of the p.R462X mutation, which explains the asymptomatic FVII deficiency, and contributes to our understanding of the role of the highly variable carboxy-terminus of coagulation serine proteases.
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Affiliation(s)
- Alessio Branchini
- Dipartimento di Biochimica e Biologia Molecolare and LTTA Centre, Università degli Studi di Ferrara, Ferrara, Italy
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Jouannelle C, Giansily-Blaizot M, Monpoux F, Casagrande F, Poirée M, Bérard E. Spontaneous umbilical cord haematoma and congenital factor VII deficiency. Haemophilia 2011; 18:e24-5. [PMID: 21967451 DOI: 10.1111/j.1365-2516.2011.02664.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tokgoz H, Caliskan U, Lavigne-Lissalde G, Giansily-Blaizot M. Successful prophylactic use of recombinant activated factor VII (rFVIIa) in a patient with congenital FVII deficiency and inhibitors to FVII. Haemophilia 2011; 18:e25-7. [PMID: 21973016 DOI: 10.1111/j.1365-2516.2011.02666.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benlakhal F, Mura T, Schved JF, Giansily-Blaizot M. A retrospective analysis of 157 surgical procedures performed without replacement therapy in 83 unrelated factor VII-deficient patients. J Thromb Haemost 2011; 9:1149-56. [PMID: 21486425 DOI: 10.1111/j.1538-7836.2011.04291.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inherited factor (F)VII deficiency is the commonest of the rare bleeding disorders, with a wide set of hemorrhagic features. Other than for the severe clinical forms (for which treatment guidelines are well defined), consistent recommendations regarding perioperative replacement management do not exist for mild and asymptomatic FVII-deficient patients. OBJECTIVES The present study aimed to evaluate the influence of bleeding history, FVII procoagulant activity levels (FVII:C) and the type of surgical procedure on the management of inherited FVII-deficient patients before surgery. PATIENTS One hundred and fifty-seven surgical procedures, performed without replacement therapy, in 83 unrelated FVII-deficient patients (median FVII:C=5%, range 0.6%-35%) were analyzed. RESULTS The overall bleeding rate was 15.3%. We found a significant relationship between previous deep traumatic hematomas and bleeding at surgery, although relationships with previous common epistaxis, easy bruising and menorrhagia were not significant. The receiver-operating characteristic (ROC) curve analysis performed on the first 83 procedures allowed us to define a cut-off value of 7% with a sensitivity of 87% (negative predictive value: 94%). To enhance the sensitivity, and to take into account the potential variation resulting from non-standardized FVII:C measurements, we would suggest applying a threshold of 10%. CONCLUSION We have proposed recommendations for the perioperative management of FVII-deficient patients based on FVII:C levels, a thorough bleeding history and the type of surgery involved. By applying these recommendations, minor procedures that risk only external or controlled hemorrhage can be performed in asymptomatic or mildly affected adults, even those with FVII:C levels below 10%.
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Affiliation(s)
- F Benlakhal
- Laboratoire d'hématologie, CHRU de Montpellier, 80 avenue Augustin Fliche, 34095 Montpellier Cedex 5, France
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Abstract
Although less common than hemophilia or von Willebrand disease, inherited rare bleeding disorders, comprising afibrinogenemia and deficiencies in factors II, V, VII, X, XI, XIII or V plus VIII combined, or in vitamin K-dependent coagulation factors, may lead to severe bleeding episodes such as recurrent hemarthroses and neonatal intracranial or gastrointestinal hemorrhage. Consanguinity significantly increases the risk of the occurrence of all rare bleeding disorders that are associated with an autosomal recessive pattern of inheritance. Each of the disorders is characterized by a wide interindividual variation in clinical phenotype and a large mutational spectrum with no clear correlation between the phenotype and genotype. Replacement therapy relies on specific molecules or concentrates (afibrinogenemia, factor VII, XI and XIII deficiencies), on a mixture of different concentrates that are otherwise known as a prothrombin complex, which contains factors II, VII, IX and X, or on fresh frozen plasma. International consensus guidelines for treatment modalities are progressing; however, guidelines for prophylaxis, especially in pediatric patients, are lacking.
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Affiliation(s)
- Muriel Giansily-Blaizot
- Laboratoire d’hématologie, CHU de Montpellier, 80 avenue Augustin Fliche, 34095 Montpellier Cedex 5, France
| | - Jean-François Schved
- Laboratoire d’hématologie, CHU de Montpellier, 80 avenue Augustin Fliche, 34095 Montpellier Cedex 5, France
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Aguilar-Martinez P, Bismuth M, Blanc F, Blanc P, Cunat S, Dereure O, Dujols P, Giansily-Blaizot M, Jorgensen C, Konate A, Larrey D, Le Quellec A, Mura T, Raingeard I, Ramos J, Renard E, Rousseau F, Schved JF, Picot MC. The Southern French registry of genetic hemochromatosis: a tool for determining clinical prevalence of the disorder and genotype penetrance. Haematologica 2010; 95:551-6. [PMID: 20145272 DOI: 10.3324/haematol.2009.014431] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite great progress in understanding the mechanisms underlying genetic hemochromatosis, data on the prevalence and the penetrance of the disorder are conflicting. DESIGN AND METHODS A registry of patients with genetic hemochromatosis was established in the South of France and a regional health network was developed to allow the inclusion of all the diagnosed patients. C282Y homozygous patients classified in stages 2 (biological iron overload), 3 and 4 (clinical manifestations of iron overload, stage 4 being the more severe) according to the classification of the French National Authority for Health were included in the registry over a 6-year period. RESULTS A total of 352 symptomatic C282Y homozygotes were identified, resulting in a total prevalence of 1.83 per 10,000 (95% CI: 1.63 to 2.02) in subjects over 20 years and 2.40 per 10,000 (95% CI, 2.15 to 2.65) among subjects of European descent. Among Europeans, the total calculated penetrance was 15.8% in stage 2 or higher, 12.1% in stage 3 or 4 and 2.9% in stage 4. The penetrance was slightly higher in males (18.7%) than in females (13.2%). It was 19.9% for individuals over 40 years of age (24.1% and 16.3% in males and females, respectively) with a maximum of 31% in subjects between 50 and 54 years old. Among 249 patients with complete records, 24% were in stage 2, the majority (58%) were in stage 3, and 18% in stage 4. There was a higher proportion of males, and excessive alcohol intake was more prevalent in stage 4 than in stages 2 and 3 combined. CONCLUSIONS A French Mediterranean regional hemochromatosis registry with strict inclusion criteria is a useful tool for characterizing the history of this disease, particularly for the most severely affected patients, as defined by the disease severity classification. The total prevalence of symptomatic C282Y homozygotes in the region was found to be low. However, clinical penetrance (stages 3 and 4) was not negligible.
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Affiliation(s)
- Patricia Aguilar-Martinez
- CHU of Montpellier Laboratory of Hematology, Hôpital Saint Eloi, Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France.
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Aguilar-Martinez P, Giansily-Blaizot M, Bismuth M, Cunat S, Igual H, Schved JF. HAMP promoter mutation nc.-153C>T in non p.C282Y homozygous patients with iron overload. Haematologica 2009; 95:687-8. [PMID: 20007134 DOI: 10.3324/haematol.2009.018028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Liu N, Aldea S, François D, Cherqui-Michel M, Giansily-Blaizot M, Fischler M. Recombinant activated factor VII for a patient with factor VII deficiency undergoing urgent intracerebral haematoma evacuation with underlying cavernous angioma. Br J Anaesth 2009; 103:858-60. [DOI: 10.1093/bja/aep293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aguilar-Martinez P, Jourdan E, Brun S, Cunat S, Giansily-Blaizot M, Pissard S, Schved JF. A novel mutation of the beta-globin gene promoter (-102 C>A) and pitfalls in family screening. Am J Hematol 2007; 82:1088-90. [PMID: 17665502 DOI: 10.1002/ajh.21000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe a family with beta-thalassemia in which several pitfalls of genetic diagnoses were present. These include coherent family phenotypes with discrepancies in molecular findings because of nonpaternity, and a false beta-globin gene homozygous genotype due to a large deletion in the second locus. These findings underline the difficulties of family genetic studies and the need for tight relationship between professionals involved in laboratory studies and those in-charge of the clinical follow-up and genetic counselling. In this family, we also report a new silent beta-thalassemia mutation, -102 (C>A), in the distal CACCC box of the beta-globin gene promoter.
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Cunat S, Giansily-Blaizot M, Bismuth M, Blanc F, Dereure O, Larrey D, Quellec AL, Pouderoux P, Rose C, Raingeard I, Renard E, Schved JF, Aguilar-Martinez P. Global sequencing approach for characterizing the molecular background of hereditary iron disorders. Clin Chem 2007; 53:2060-9. [PMID: 17951290 DOI: 10.1373/clinchem.2007.090605] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND New genetic forms of hereditary hemochromatosis (HH) or hereditary hyperferritinemia (HF) have been identified over the last few years, and abnormalities of various genes may interact in a single patient. This study aimed to develop a rapid automated method for sequencing the main genes involved. METHODS We used a standard 96-well microplate with a single PCR condition in an adaptation of the SCAIP (single-condition amplification with internal primer) method to sequence the HFE (hemochromatosis), HAMP (hepcidin antimicrobial peptide), HFE2/HJV [hemochromatosis type 2 (juvenile)], SLC40A1 (ferroportin), and TFR2 (transferrin receptor 2) genes, and the 5' untranslated region of the FTL (ferritin, light polypeptide) gene. To further simplify the method, we adjusted PCR conditions to avoid the use of an internal primer and applied this single-condition amplification method to 38 selected, unrelated patients. We tailored the genetic investigation according to the clinical picture, with the patients falling into 2 groups. Group 1 consisted of patients with hyperferritinemia and high transferrin saturation (TS) (classic adult and juvenile HH forms, groups 1A and 1B, respectively), and group 2 consisted of patients with hyperferritinemia and low, typical, or slightly increased TS, with or without iron overload (groups 2A and 2B, respectively). RESULTS With this strategy we identified single-gene and multigene abnormalities, including 6 previously undescribed abnormalities in HFE (c.794dupA), HFE2 (c.-89-4dupT), and SLC40A1 (c.262A>G, c.533G>A, c.1468G>A, and c.-59_-45del). CONCLUSION This method is a simple approach for investigating hereditary iron overload or HF and allows rapid evaluation of patients.
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Affiliation(s)
- Séverine Cunat
- Laboratory of Haematology, CHU of Montpellier, Montpellier, France
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Giansily-Blaizot M, Thorel D, Khau Van Kien P, Behar C, Romey MC, Mugneret F, Schved JF, Claustres M. Characterisation of a large complex intragenic re-arrangement in the FVII gene (F7) avoiding misdiagnosis in inherited factor VII deficiency. Br J Haematol 2007; 138:359-65. [PMID: 17614823 DOI: 10.1111/j.1365-2141.2007.06660.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inherited factor VII (FVII) deficiency is a rare autosomal recessive bleeding disorder mostly caused by point mutations. Large genomic re-arrangements at F7 locus could account for a fraction of mutant alleles that remain unidentified after DNA sequencing, because they escape conventional polymerase chain reaction (PCR)-based techniques. We report the first systematic screening of F7 for large re-arrangements, by semi-quantitative multiplex PCR of fluorescent fragments targeting the 9 exons and the promoter region. A well-characterised cohort of 43 unrelated patients either apparently homozygous for a F7 point mutation or carrying at least one unidentified F7 mutant allele participated in this study. Two large F7 re-arrangements were identified in two FVII-deficient pedigrees, including a discontinuous deletion involving two distinct portions of F7 whose proximal and distal end junctions were characterised. A simple and efficient method for the routine detection of gross alterations of F7, which accounted for 2.3% of mutant alleles in our sample, is now available in inherited FVII deficiency. This test should complement conventional PCR-based techniques not only in unsolved cases, but also where inheritance pattern analysis is not achievable.
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Affiliation(s)
- Muriel Giansily-Blaizot
- Inserm, U827, Laboratoire de Génétique de Maladies Rares: Pathologie Moléculaire, Etudes Fonctionnelles et Banques de Données Génétiques, Montpellier, France.
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Farah RA, Hamod D, Melick N, Giansily-Blaizot M, Sallah S. Successful prophylaxis against intracranial hemorrhage using weekly administration of activated recombinant factor VII in a newborn with severe factor VII deficiency. J Thromb Haemost 2007; 5:433-4. [PMID: 17109737 DOI: 10.1111/j.1538-7836.2007.02318.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Giansily-Blaizot M, Schved JF. Potential predictors of bleeding risk in inherited factorVII deficiency. Clinical, biological and molecular criteria. Thromb Haemost 2005; 94:901-6. [PMID: 16363229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Due to the wide molecular and clinical heterogeneities of inherited factor VII (FVII) deficiency, consensus guidelines for management of this coagulation disorder are not currently well established. Therefore, potential clinical, plasmatic or genetic criteria, that could be predictive for bleeding tendency in this condition, have been evaluated. Genotypic criteria including FVII genotypes and thrombophilic mutations are of particular interest to better understand some of the variations observed in bleeding phenotypes but they are still poorly informative for the management of surgery in FVII-deficient patients. Up to now, no plasma parameters have been found to be reliable predictors of bleeding risk. Nevertheless, tissue factor and platelet pathways remain to be explored. Finally, clinical history appears to be the best predictor of bleeding risk after haemostatic challenges in inherited FVII deficiencies. Furthermore, the absence of history of bleeding or mild bleeding phenotypes including menorrhagia, bruises and epistaxis (not inducing iron deficiency anaemia or requiring blood substitutive treatment) could enable minor surgery to be performed in FVII-deficient patients without blood replacement therapy.
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Giansily-Blaizot M, Verdier R, Biron-Adréani C, Schved JF, Bertrand MA, Borg JY, Le Cam-Duchez V, LeCam-Duchez V, Briquel ME, Chambost H, Pouymayou K, Dutrillaux F, Favier R, Martin-Toutain I, Verdy E, Gay V, Goudemand J, Navarro R, Durin A, d'Oiron R, Lambert T, Pernod G, Barrot C, Peynet J, Bastenaire B, Sie P, Stieltjes N, Torchet MF, de Moerloose P. Analysis of biological phenotypes from 42 patients with inherited factor VII deficiency: can biological tests predict the bleeding risk? Haematologica 2004; 89:704-9. [PMID: 15194538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Inherited factor VII (FVII) deficiency is a rare bleeding disorder characterized by a poor relationship between reported FVII clotting activity (FVII:C) and bleeding tendency. Our study was aimed at defining biological parameters that are possibly predictive for bleeding risk in this condition. DESIGN AND METHODS Forty-two FVII-deficient patients (FVII:C <30%) were classified into two opposite clinical groups defined as severe and non-or-mild bleeders. For each patient, plasma samples were collected and then investigated for FVII:C (using a sensitive method and human recombinant thromboplastin as the reagent), FVII antigen, activated FVII coagulant activity (FVIIa:C) and the free-form of tissue factor pathway inhibitor. RESULTS None of these tests could be used as highly accurate predictors of bleeding. Nevertheless, both FVII:C and FVIIa:C differed significantly between the two clinical groups. Using ROC-curve analysis, two critical values of 8% and 3mIU/mL for FVII:C and FVIIa:C, respectively, could be proposed to discriminate between severe bleeders and non-or-mild bleeders. INTERPRETATION AND CONCLUSIONS A highly accurate diagnostic test for predicting bleeding tendency in inherited FVII deficiency still eludes definition, highlighting the fact that factors other than FVII itself interfere with the expression of bleeding phenotypes in this condition. Nevertheless, potential critical values using sensitive FVII:C and FVIIa:C methods may be useful in clinical laboratories for FVII-deficient patients. Those patients with FVII:C levels higher than 8% FVII:C or FVIIa:C higher than 3 mIU/mL, with no other hemostatic defect, seem to have a minimal risk of severe bleeding. Extended clinical studies are needed to support these findings.
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Giansily-Blaizot M, Al Dieri R, Schved JF. Thrombin generation measurement in factor VII-depleted plasmas compared to inherited factor VII-deficient plasmas. Pathophysiol Haemost Thromb 2004; 33:36-42. [PMID: 12853711 DOI: 10.1159/000071640] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2003] [Accepted: 03/20/2003] [Indexed: 11/19/2022]
Abstract
Activated factor VII (FVIIa)/tissue factor enzyme complex is the initiator of the coagulation cascade in vivo. FVIIa is of particular interest because it has been found to induce haemostasis in various bleeding disorders. In order to evaluate the FVII threshold that is required to initiate the clotting cascade, we measured thrombin generation in FVII-depleted plasmas spiked with increasing amounts of normal pooled plasma and in inherited FVII-deficient plasmas. According to the literature, only trace amounts of FVII are sufficient to initiate blood coagulation in vitro. By contrast, results on inherited FVII-deficient plasmas showed a wide variety of the amounts of thrombin generated in plasmas with the same FVII coagulant activity levels. This suggests that the threshold of FVII required to initiate haemostasis in vivo depends on one or more, hitherto unknown, plasmatic or cellular factors.
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