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Pardos-Gea J, Martin-Fernandez L, Closa L, Ferrero A, Marzo C, Rubio-Rivas M, Mitjavila F, González-Porras JR, Bastida JM, Mateo J, Carrasco M, Bernardo Á, Astigarraga I, Aguinaco R, Corrales I, Garcia-Martínez I, Vidal F. Key Genes of the Immune System and Predisposition to Acquired Hemophilia A: Evidence from a Spanish Cohort of 49 Patients Using Next-Generation Sequencing. Int J Mol Sci 2023; 24:16372. [PMID: 38003562 PMCID: PMC10671092 DOI: 10.3390/ijms242216372] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by the presence of autoantibodies against factor VIII (FVIII). As with other autoimmune diseases, its etiology is complex and its genetic basis is unknown. The aim of this study was to identify the immunogenetic background that predisposes individuals to AHA. HLA and KIR gene clusters, as well as KLRK1, were sequenced using next-generation sequencing in 49 AHA patients. Associations between candidate genes involved in innate and adaptive immune responses and AHA were addressed by comparing the alleles, genotypes, haplotypes, and gene frequencies in the AHA cohort with those in the donors' samples or Spanish population cohort. Two genes of the HLA cluster, as well as rs1049174 in KLRK1, which tags the natural killer (NK) cytotoxic activity haplotype, were found to be linked to AHA. Specifically, A*03:01 (p = 0.024; odds ratio (OR) = 0.26[0.06-0.85]) and DRB1*13:03 (p = 6.8 × 103, OR = 7.56[1.64-51.40]), as well as rs1049174 (p = 0.012), were significantly associated with AHA. In addition, two AHA patients were found to carry one copy each of the low-frequency allele DQB1*03:09 (nallele = 2, 2.04%), which was completely absent in the donors. To the best of our knowledge, this is the first time that the involvement of these specific alleles in the predisposition to AHA has been proposed. Further molecular and functional studies will be needed to unravel their specific contributions. We believe our findings expand the current knowledge on the genetic factors involved in susceptibility to AHA, which will contribute to improving the diagnosis and prognosis of AHA patients.
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Affiliation(s)
- Jose Pardos-Gea
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Laura Martin-Fernandez
- Congenital Coagulopathies Laboratory, Blood and Tissue Bank, 08005 Barcelona, Spain
- Transfusional Medicine Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - Laia Closa
- Transfusional Medicine Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- Histocompatibility and Immunogenetics Laboratory, Blood and Tissue Bank, 08005 Barcelona, Spain
| | - Ainara Ferrero
- Hematology Service, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Cristina Marzo
- Hematology Service, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (M.R.-R.)
| | - Francesca Mitjavila
- Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (M.R.-R.)
| | - José Ramón González-Porras
- Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomedica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca (USAL), 37007 Salamanca, Spain
| | - José María Bastida
- Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomedica de Salamanca (IBSAL), Facultad de Medicina, Universidad de Salamanca (USAL), 37007 Salamanca, Spain
| | - José Mateo
- Thrombosis and Hemostasis Unit, Sant Pau Campus Salut Barcelona, 08025 Barcelona, Spain
| | - Marina Carrasco
- Thrombosis and Hemostasis Unit, Sant Pau Campus Salut Barcelona, 08025 Barcelona, Spain
| | - Ángel Bernardo
- Hematology Service, Central University Hospital of Asturias, 33011 Oviedo, Spain
| | - Itziar Astigarraga
- Department of Pediatrics, Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country UPV/EHU, 48903 Barakaldo, Spain
| | - Reyes Aguinaco
- Hematology Service, University Hospital Joan XXIII, 43002 Tarragona, Spain
| | - Irene Corrales
- Congenital Coagulopathies Laboratory, Blood and Tissue Bank, 08005 Barcelona, Spain
- Transfusional Medicine Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Carlos III (ISCIII), 28029 Madrid, Spain
| | - Iris Garcia-Martínez
- Congenital Coagulopathies Laboratory, Blood and Tissue Bank, 08005 Barcelona, Spain
- Transfusional Medicine Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona (VHIR-UAB), 08035 Barcelona, Spain
| | - Francisco Vidal
- Congenital Coagulopathies Laboratory, Blood and Tissue Bank, 08005 Barcelona, Spain
- Transfusional Medicine Group, Vall d’Hebron Research Institute, Autonomous University of Barcelona (VHIR-UAB), 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Carlos III (ISCIII), 28029 Madrid, Spain
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