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Jindal AK, Ahluwalia J, Suku R, Suri D, Nuytemans K, Ortel TL, Pericak-Vance MA, Vance JM, Singh S. Successful Management of Catastrophic Thrombotic Storm in a Young Boy: A Case Report From Northern India. J Pediatr Hematol Oncol 2021; 43:e1132-e1135. [PMID: 33560088 DOI: 10.1097/mph.0000000000002069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022]
Abstract
Thrombotic storm is a rare clinical entity characterized by acute to subacute thrombosis developing at multiple sites over a few days to a few weeks. An 11-year-old boy presented with headache and facial nerve palsy. He was found to have cortical sinus venous thrombosis and was initiated on low molecular weight heparin, but rapidly progressed with thromboses involving the pulmonary arteries and deep veins of the legs. Thereafter managed on high-dose unfractionated heparin, he eventually stabilized after a hospital stay of 34 days. Genetic analysis showed potentially pathogenic variants in the factor V and stabilin-2 genes.
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Affiliation(s)
| | - Jasmina Ahluwalia
- Department of Haematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Suku
- Department of Paediatrics, Allergy Immunology Unit
| | - Deepti Suri
- Department of Paediatrics, Allergy Immunology Unit
| | - Karen Nuytemans
- John P. Hussman Institute for Human Genomics and Dr John T. Macdonald Foundation Department of Human Genomics, University of Miami Miller School of Medicine, Miami, FL
| | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Duke Hemostasis and Thrombosis Center, Durham, NC
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics and Dr John T. Macdonald Foundation Department of Human Genomics, University of Miami Miller School of Medicine, Miami, FL
| | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics and Dr John T. Macdonald Foundation Department of Human Genomics, University of Miami Miller School of Medicine, Miami, FL
| | - Surjit Singh
- Department of Paediatrics, Allergy Immunology Unit
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2
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Cis-Segregation of c.1171C>T Stop Codon (p.R391*) in SERPINC1 Gene and c.1691G>A Transition (p.R506Q) in F5 Gene and Selected GWAS Multilocus Approach in Inherited Thrombophilia. Genes (Basel) 2021; 12:genes12060934. [PMID: 34207366 PMCID: PMC8234447 DOI: 10.3390/genes12060934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Inherited thrombophilia (e.g., venous thromboembolism, VTE) is due to rare loss-of-function mutations in anticoagulant factors genes (i.e., SERPINC1, PROC, PROS1), common gain-of-function mutations in procoagulant factors genes (i.e., F5, F2), and acquired risk conditions. Genome Wide Association Studies (GWAS) recently recognized several genes associated with VTE though gene defects may unpredictably remain asymptomatic, so calculating the individual genetic predisposition is a challenging task. We investigated a large family with severe, recurrent, early-onset VTE in which two sisters experienced VTE during pregnancies characterized by a perinatal in-utero thrombosis in the newborn and a life-saving pregnancy-interruption because of massive VTE, respectively. A nonsense mutation (CGA > TGA) generating a premature stop-codon (c.1171C>T; p.R391*) in the exon 6 of SERPINC1 gene (1q25.1) causing Antithrombin (AT) deficiency and the common missense mutation (c.1691G>A; p.R506Q) in the exon 10 of F5 gene (1q24.2) (i.e., FV Leiden; rs6025) were coinherited in all the symptomatic members investigated suspecting a cis-segregation further confirmed by STR-linkage-analyses [i.e., SERPINC1 IVS5 (ATT)5–18, F5 IVS2 (AT)6–33 and F5 IVS11 (GT)12–16] and SERPINC1 intragenic variants (i.e., rs5878 and rs677). A multilocus investigation of blood-coagulation balance genes detected the coexistence of FV Leiden (rs6025) in trans with FV HR2-haplotype (p.H1299R; rs1800595) in the aborted fetus, and F11 rs2289252, F12 rs1801020, F13A1 rs5985, and KNG1 rs710446 in the newborn and other members. Common selected gene variants may strongly synergize with less common mutations tuning potential life-threatening conditions when combined with rare severest mutations. Merging classic and newly GWAS-identified gene markers in at risk families is mandatory for VTE risk estimation in the clinical practice, avoiding partial risk score evaluation in unrecognized at risk patients.
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A novel mutation (Ser951LeufsTer8) in F5 gene leads to hereditary coagulation factor V deficiency. Blood Coagul Fibrinolysis 2021; 32:140-145. [PMID: 33443922 DOI: 10.1097/mbc.0000000000001003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current study aims to explore the phenotype and genotype of a novel mutation (Ser951LeufsTer8) of F5 gene combined with polymorphism (R485K) in a family of hereditary coagulation factor V deficiency. The factor V activity and antigen were tested with clotting assay and ELISA. The F5 gene was amplified by PCR with direct sequencing and TA-clone-sequenced. The protein structure and harmfulness of the mutation were studied by Swiss-PdbViewer and bioinformatics software. The prothrombin time and activated partial thromboplastin time of proband were significantly prolonged, factor V activity and factor V antigen both were reduced to less than 20%. Sequencing analysis detected proband with Ser951LeufsTer8 and R485K (Arg513Lys), four family members with novel mutation and their factor V activity and factor V antigen were all decreased about 50%. The Ser951LeufsTer8 is associated with decrease in the factor V level of the family, and it is the first mutation report in the position (Ser951LeufsTer8) with factor V deficiency.
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Amara A, Mrad M, Sayeh A, Haggui A, Lahideb D, Fekih-Mrissa N, Haouala H, Nsiri B. Association of FV G1691A Polymorphism but not A4070G With Coronary Artery Disease. Clin Appl Thromb Hemost 2017; 24:330-337. [PMID: 29179580 PMCID: PMC6714679 DOI: 10.1177/1076029617744320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Coronary artery disease (CAD) is one of the chief causes of death in the world. Several
hypotheses have been promoted as for the origin of the disease, among which are genetic
predispositions and/or environmental factors. The aim of this study was to determine the
effect of factor V (FV) gene polymorphisms (Leiden, G1691A [FVL] and HR2 A4070G) and to
analyze their association with traditional risk factors in assessing the risk of CAD. Our
study population included 200 Tunisian patients with symptomatic CAD and a control group
of 300 participants matched for age and sex. All participants were genotyped for the FVL
and HR2 polymorphisms. Multivariate logistic regression was applied to analyze independent
factors associated with the risk of CAD. Our analysis showed that the FVL A allele
frequency (P < 10–3, odds ratio [OR] = 2.81, 95% confidence
interval [CI] = 1.6-4.9) and GA genotype (P < 10–3, OR =
4.03, 95% CI = 2.1-7.6) are significantly more prevalent among patients with CAD compared
to those controls and may be predisposing to CAD. We further found that the FVL mutation
is an independent risk factor whose effect is not modified by other factors (smoking,
diabetes, hypertension, dyslipidemia, and a family history of CAD) in increasing the risk
of the disease. However, analysis of FV HR2 variation does not show any statistically
significant association with CAD. The FVL polymorphism may be an independent risk factor
for CAD. However, further investigations on these polymorphisms and their possible
synergisms with traditional risk factors for CAD could help to ascertain better
predictability for CAD susceptibility.
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Affiliation(s)
- Ahmed Amara
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,2 Université Tunis el Manar, Faculté des Sciences de Tunis, Tunisie
| | - Meriem Mrad
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,2 Université Tunis el Manar, Faculté des Sciences de Tunis, Tunisie
| | - Aicha Sayeh
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,2 Université Tunis el Manar, Faculté des Sciences de Tunis, Tunisie
| | - Abdeddayem Haggui
- 3 Hôpital Militaire de Tunis, Service de Cardiologie, Montfleury, Tunisie.,4 Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - Dhaker Lahideb
- 3 Hôpital Militaire de Tunis, Service de Cardiologie, Montfleury, Tunisie.,4 Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - Najiba Fekih-Mrissa
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,5 Académie Militaire Fondouk Jédid, Nabeul, Tunisie
| | - Habib Haouala
- 3 Hôpital Militaire de Tunis, Service de Cardiologie, Montfleury, Tunisie.,4 Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
| | - Brahim Nsiri
- 1 Hôpital Militaire de Tunis, Service d'Hématologie, Laboratoire de Biologie Moléculaire, Montfleury, Tunisie.,6 Université de Monastir, Faculté de Pharmacie, Monastir, Tunisie
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Nuytemans K, Ortel TL, Gomez L, Hofmann N, Alves N, Dueker N, Beecham A, Whitehead P, Hahn Estabrooks S, Kitchens CS, Erkan D, Brandão LR, James AH, Kulkarni R, Manco-Johnson MJ, Pericak-Vance MA, Vance JM. Variants in chondroitin sulfate metabolism genes in thrombotic storm. Thromb Res 2017; 161:43-51. [PMID: 29178990 DOI: 10.1016/j.thromres.2017.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/24/2017] [Accepted: 11/19/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Thrombotic storm (TS) presents as a severe, acute thrombotic phenotype, characterized by multiple clotting events and frequently affecting younger adults. Understanding the extensive hypercoagulation of an extreme phenotype as TS will also provide insight into the pathogenesis of a wider spectrum of thrombotic disorders. MATERIAL AND METHODS We completed whole exome sequencing on 26 TS patients, including 1 multiplex family, 13 trios and 12 isolated TS patients. We examined both dominant and recessive inheritance models for known thrombotic factors as well as performed a genome-wide screen. Identified genes of interest in the family and trios were screened in the remaining TS patients. Variants were filtered on frequency (<5% in 1000 genomes), conservation and function in gene and were annotated for effect on protein and overall functionality. RESULTS We observed an accumulation of variants in genes linked to chondroitin sulfate (CS), but not heparan sulfate metabolism. Sixteen conserved, rare missense and nonsense variants in genes involved in CS metabolism (CHPF, CHPF2, CHST3, CHST12, CHST15, SLC26A2, PAPSS2, STAB2) were identified in over one-third of the TS patients. In contrast, we identified only seven variants in known thrombosis genes (including FV Leiden). CONCLUSIONS As CS has multiple functions in the glycocalyx protecting the endothelial cells, reduced availability of CS could diminish the normal control mechanisms for blood coagulation, making these CS metabolism genes strong potential risk factors for TS. Overall, no single gene was identified with strong evidence for TS causality; however, our data suggest TS is mediated by an accumulation of rare pro-thrombotic risk factors.
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Affiliation(s)
- Karen Nuytemans
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Thomas L Ortel
- Duke University Medical Center, Division of Hematology, Duke Hemostasis and Thrombosis Center, 40 Duke Medicine Circle, Durham, NC 27710, United States.
| | - Lissette Gomez
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Natalia Hofmann
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Natalie Alves
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Nicole Dueker
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Ashley Beecham
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Patrice Whitehead
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Susan Hahn Estabrooks
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Craig S Kitchens
- University of Florida, Division of Hematology and Oncology, 2000 SW Archer Rd, Gainesville, FL 32608, United States.
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Stm, New York, NY 10021, United States.
| | - Leonardo R Brandão
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Andra H James
- Duke University Medical Center, Division of Hematology, Duke Hemostasis and Thrombosis Center, 40 Duke Medicine Circle, Durham, NC 27710, United States.
| | - Roshni Kulkarni
- Michigan State University Centers for Bleeding and Clotting Disorders, 788 Service Rd B-216, East Lansing, MI 48824, United States.
| | - Marilyn J Manco-Johnson
- University of Colorado Hemophilia and Thrombosis Center, 13199 E. Montview Blvd Suite 100, Aurora, CO 80045, United States.
| | - Margaret A Pericak-Vance
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
| | - Jeffery M Vance
- University of Miami, John P. Hussman Institute for Human Genomics, Miller School of Medicine, Biomedical Research Building, 1501 NW 10th Ave, Miami, FL 33136, United States.
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Sharma A, Bhakuni T, Biswas A, Ranjan R, Kumar R, Kishore K, Mahapatra M, Jairajpuri MA, Saxena R. Prevalence of Factor V Genetic Variants Associated With Indian APCR Contributing to Thrombotic Risk. Clin Appl Thromb Hemost 2015; 23:596-600. [PMID: 26699866 DOI: 10.1177/1076029615623376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Phenotypic resistance to activated protein C (APC) is a complex mechanism associated with increased thrombosis risk. Activated protein C resistance (APCR) is mainly influenced by FVLeiden mutation, and various other single nucleotide polymorphisms (SNPs) in FV gene are known to be associated with APCR. The aim of present study was to investigate the incidence and assess possible mechanisms of APCR in Indian patients with deep vein thrombosis (DVT). Three hundred and ten Doppler-proven patients with DVT were screened for APCR, and 50 APCR positive patients and 50 controls were typed for FVLeiden, Hong Kong, Cambridge, HR2 haplotype, Glu666Asp, Ala485Lys, and Liverpool using either polymerase chain reaction (PCR)-restriction fragment length polymorphism or allele specific PCR. FVLeiden was commonest cause of APCR (50%) in Indian patients with DVT being statistically significant ( P = .001) compared to controls. FV Liverpool, FV Glu666Asp and FV Ala485Lys were studied for the first time in Indian population. FV Liverpool, FV Glu666Asp, Hong Kong, and Cambridge were found to be absent. High frequency of Ala485Lys in patients shows that it might be a risk factor contributing to APCR in Indian patients with DVT. HR2 haplotype was not associated with APCR; however, presence of homozygous HR2 haplotype in patients only indicates the role it might play in Indian APCR population. In conclusion, contribution of FVLeiden causing APCR in Indian population is not as strong as previously reported in Western countries. The presence of other SNPs observed in the present study requires such studies on larger sample size to understand the molecular basis of defect.
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Affiliation(s)
- Amit Sharma
- 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Teena Bhakuni
- 2 Protein Conformation and Enzymology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Arijit Biswas
- 3 Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Ravi Ranjan
- 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Kumar
- 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kishore
- 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamad Aman Jairajpuri
- 2 Protein Conformation and Enzymology Lab, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Renu Saxena
- 1 Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Jiang J, Jiao Y, Ding X, Zhang B. Association between genetic polymorphisms and deep vein thrombosis in a Chinese population. Thromb Res 2015; 136:687-689. [PMID: 26233570 DOI: 10.1016/j.thromres.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/01/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, P. R. China.
| | - Yang Jiao
- Department of Vascular Surgery, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, P. R. China
| | - Xiangjiu Ding
- Department of Vascular Surgery, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, P. R. China
| | - Baigen Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, P. R. China
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Guzmán N, Larama G, Ávila A, Salazar LA. Three novel variants in the coagulation factor V gene associated with deep venous thrombosis in Chilean patients with Amerindian ethnic background. Clin Chim Acta 2015; 444:24-8. [DOI: 10.1016/j.cca.2015.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/28/2015] [Accepted: 02/03/2015] [Indexed: 12/30/2022]
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Peng KT, Huang KC, Huang TW, Lee YS, Hsu WH, Hsu RWW, Ueng SWN, Lee MS. Single nucleotide polymorphisms other than factor V Leiden are associated with coagulopathy and osteonecrosis of the femoral head in Chinese patients. PLoS One 2014; 9:e104461. [PMID: 25119470 PMCID: PMC4131902 DOI: 10.1371/journal.pone.0104461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/09/2014] [Indexed: 12/25/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) of factor V Leiden have been associated with osteonecrosis of the femoral head (ONFH) in Caucasians but remains controversial in Asians. We used an SNP microarray to screen 55 loci of factor V gene in patients with ONFH of Chinese. Significantly different candidate SNPs at 14 loci were analyzed in 146 patients and 116 healthy controls using MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight) mass spectrometry and gene sequencing. The factor V Leiden (rs6025) was not found in all participants. Six SNP loci (rs9332595, rs6020, rs9332647, rs3766110, rs10919186, and rs12040141) were confirmed with significant differences in patients but not in controls. The rs6020 G-to-A polymorphism was found in 88.9% of the patients. In addition, a high percentage (87.6%) of the patients had an abnormal coagulation profile that included hyperfibrinogen, elevated fibrinogen degradation products, elevated D-dimer, abnormal protein S, abnormal protein C, or a decrease in anti-thrombin III. Patients with the rs6020 G-to-A polymorphism (mutation) had a higher risk (odds ratio: 4.62; 95% confidence interval: 1.44-14.8) of having coagulation abnormalities than did those without the mutation (wild-type) (χ(2) p = 0.006). Our findings suggested that the rs6020 polymorphism might be the genetic trait that accounts for the higher prevalence of ONFH in the Chinese population than in Westerners. Exposure to risk factors such as alcohol and steroids in patients with the rs6020 polymorphism causes coagulation abnormalities and, subsequently, thromboembolisms in the femoral head.
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Affiliation(s)
- Kou-Ti Peng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Robert W. W. Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Steve W. N. Ueng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mel S. Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Biotechnology, Ming-Chuan University, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Factor V deficiency caused by a novel nonsense mutation (Gln2031stop) in a Chinese patient. Blood Coagul Fibrinolysis 2014; 25:283-5. [PMID: 24675695 DOI: 10.1097/mbc.0000000000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital factor V deficiency is a rare bleeding disorder characterized by low coagulant activity, associated with variable phenotypic expression. Among rare inherited coagulopathies, the molecular basis of factor V deficiency is rarely described because of its relatively low prevalence in the general population. Recently, we detected two genetic variations in factor V of a Chinese patient with hereditary factor V deficiency. One was a heterozygous nonsense mutation, C67868T in exon 22, which resulted in Gln2031stop substitution in the C1 domain of factor V. The other was a previously described polymorphism, G1618A in exon10, leading to Arg485Lys substitution. We deduced that the nonsense mutation is responsible for the factor V deficiency, whereas the Arg485Lys polymorphism is expected to compensate for the low plasma factor V levels. Of note, the nonsense mutation has been confirmed to be a novel mutation.
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Buurma A, Turner R, Driessen J, Mooyaart A, Schoones J, Bruijn J, Bloemenkamp K, Dekkers O, Baelde H. Genetic variants in pre-eclampsia: a meta-analysis. Hum Reprod Update 2013; 19:289-303. [DOI: 10.1093/humupd/dms060] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Targeted Next-Generation Resequencing of Gene Identifies Novel Multiple Variants Pattern in Severe Hereditary Factor V Deficiency. Case Rep Genet 2013; 2013:941684. [PMID: 23662219 PMCID: PMC3639706 DOI: 10.1155/2013/941684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/19/2013] [Indexed: 11/18/2022] Open
Abstract
The present study investigated the genetic defects underlying severe Factor V deficiency in a 26-year-old Columbian (South America) female and her immediate family (both parents and newborn child) by next generation sequencing (NGS) of the entire F5 gene locus. Five mutations in the coding sequence of F5, including three missense single-nucleotide variants (R2102H, R513K, D107H) and two synonymous variants (A135A , S184S), were identified and confirmed by the Sanger sequencing in the investigated proband (homozygote for all detected mutations), her parents, and her newborn child (all heterozygotic carriers for identified mutations). Each of the three missense variants was previously associated with separate phenotypes, including Factor V deficiency (R2102H), thrombosis (R513K) and frequent miscarriages (D107H). In addition, at least 75 additional single-nucleotide variants (including six novels) were identified in untranslated region of F5.
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Segers O, Simioni P, Tormene D, Bulato C, Gavasso S, Rosing J, Castoldi E. Genetic modulation of the FV(Leiden)/normal FV ratio and risk of venous thrombosis in factor V Leiden heterozygotes. J Thromb Haemost 2012; 10:73-80. [PMID: 22044617 DOI: 10.1111/j.1538-7836.2011.04546.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The factor (F)V Leiden mutation causes activated protein C (APC) resistance by decreasing the susceptibility of FVa to APC-mediated inactivation and by impairing the APC-cofactor activity of FV in FVIIIa inactivation. However, APC resistance and the risk of venous thromboembolism (VTE) vary widely among FV Leiden heterozygotes. Common F5 genetic variation probably contributes to this variability. PATIENTS/METHODS APC resistance was determined in 250 FV Leiden heterozygotes and 133 normal relatives using the prothrombinase-based assay, which specifically measures the susceptibility of plasma FVa to APC. The effects of 12 F5 single-nucleotide polymorphisms (SNPs) on the normalized APC sensitivity ratio (nAPCsr) and on FV levels were determined by multiple regression analysis. RESULTS In FV Leiden heterozygotes,VTE risk increased with increasing nAPCsr, reaching an odds ratio (OR) of 9.9 (95% confidence interval [CI] 1.2–80.5) in the highest nAPCsr quartile. The minor alleles of several F5 SNPs, including 327 A/G (Q51Q), 409 G/C (D79H), 2663 A/G(K830R, T2 haplotype), 6533 T/C (M2120T) and 6755 A/G (D2194G, R2 haplotype), increased the nAPCsr in FV Leiden heterozygotes, but not in their normal relatives. Most of these effects could be attributed to a shift in the FV(Leiden)/normal FV ratio. Four FV Leiden heterozygotes with extremely high nAPCsr turned out to be pseudo-homozygotes, i.e. they carried a deleterious mutation on the non-Leiden allele. CONCLUSIONS In FV Leiden heterozygotes, the prothrombinase-based nAPCsr is a marker of VTE risk and is modulated by common F5 SNPs that affect the FV(Leiden)/normal FV ratio in plasma.
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Affiliation(s)
- O Segers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands
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14
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Abstract
The phenotypic heterogeneity of sickle cell disease continues to puzzle clinicians and investigators more than half a century after the elucidation of its molecular basis. Although advances have been made in understanding the influences of globin gene-related factors such as alpha-thalassemia (thal) and high Hb F determinants, these are far from providing a satisfactory explanation to the variation and clinical diversity of sickle cell disease in many cases. The sequencing of the human genome and the development of novel technologies such as high throughput genotyping and analysis of gene expression through cDNA microarrays has made it possible to investigate this diversity with these approaches and identify novel genetic modifiers of sickle cell disease. This brief review focuses on the recent advances in our understanding of the impact of non globin genetic modifiers on the phenotypic diversity of the disease.
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Affiliation(s)
- Abdullah Kutlar
- Sickle Cell Center, Medical College of Georgia, Augusta, Georgia 30912-3680, USA.
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15
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Kutlar A. Sickle cell disease: a multigenic perspective of a single gene disorder. ACTA ACUST UNITED AC 2006; 10 Suppl 1:92-9. [PMID: 16188647 DOI: 10.1080/10245330512331390069] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Abdullah Kutlar
- Medical College of Georgia, Sickle Cell Center, Augusta, GA, USA
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16
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Abstract
DNA variations in the Factor V gene have played a major role in thrombosis research ever since the discovery of Factor V Leiden. Here, all relatively common DNA variations in the coding regions of the Factor V gene are discussed. Many of them have been associated with venous thrombosis or related diseases. However, most variations have been studied separately, without taking the presence of other variations in the same gene into account. This means that their association with disease should be interpreted with caution, as it may reflect linkage with another variation. An approach in which a haplotype-based analysis of the Factor V gene is combined with in vitro assays of recombinant proteins is advocated. Finally, a possible reason for the relatively polymorphic nature of the Factor V protein is discussed.
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Affiliation(s)
- H L Vos
- Haemostasis and Thrombosis Research Center, Department of Haematology C2R-139, Leiden University Medical Center.
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17
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Kutlar A. Sickle cell disease: a multigenic perspective of a single-gene disorder. Med Princ Pract 2005; 14 Suppl 1:15-9. [PMID: 16103709 DOI: 10.1159/000086180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 04/19/2005] [Indexed: 11/19/2022] Open
Abstract
Although significant progress has been made in our understanding of sickle cell disease (SCD) and in the development of new therapies, many questions are still unanswered, and a cure remains elusive. This is particularly evident in the clinical heterogeneity of the disease. Studies have shown the importance of high hemoglobin F determinants and alpha-thalassemia as modifiers of disease severity, but these alone do not explain the diversity that is seen. This paper focuses on recent advances on the effect of nonglobin genetic modifiers on the SCD phenotype. The roles of polymorphic variants of (1) methylenetetrahydrofolate reductase gene in the pathogenesis of avascular necrosis, (2) factor V R485K and risk of venous thrombosis, and (3) UDP glucuronosyltransferase-1 polymorphism on serum bilirubin levels in SCD are discussed. Mention is made of genetic polymorphisms that might predispose to stroke. The application of gene expression profiling to the study of SCD is very promising and some preliminary data are provided.
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Affiliation(s)
- Abdullah Kutlar
- Sickle Cell Center, Medical College of Georgia, Augusta, GA 30912, USA.
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18
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Jääskeläinen E, Toivonen S, Romppanen EL, Helisalmi S, Keski-Nisula L, Punnonen K, Heinonen S. M385T polymorphism in the factor V gene, but not Leiden mutation, is associated with placental abruption in Finnish women. Placenta 2004; 25:730-4. [PMID: 15450391 DOI: 10.1016/j.placenta.2004.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2004] [Indexed: 11/29/2022]
Abstract
This study determines whether genetic variability in the gene encoding factor V contributes to differences in susceptibility to placental abruption. Allele and genotype frequencies of three single nucleotide polymorphisms (SNPs) in the factor V gene leading to nonsynonymous changes (M385T in exon 8, and R485K and R506Q [Leiden mutation] in exon 10) were studied in 116 Caucasian women with placental abruption and 112 healthy controls. Single-point analysis was expanded to haplotype analysis and haplotype frequencies were estimated using an expectation-maximisation (EM) algorithm. Comparison of single-point allele and genotype distributions of SNPs in exon 8 and exon 10 of the factor V gene revealed statistically significant differences in M385T allele (P = 0.021) and genotype ( P = 0.013) frequencies between the patients and the control subjects. The C allele of SNP M385T was significantly less frequent among the patients (7%) vs. the control subjects (13%), at an odds ratio of 0.48 (95% CI 0.25-0.91). Allele and genotype differences between the patients and control subjects as regards R485K and Leiden mutation were not significant. In haplotype estimation analysis, there was a significantly lower frequency of haplotype T-R-R encoding the T385-R485-R506 variant in the group with placental abruption vs. the control group (P = 0.038) at an odds ratio of 0.519 (95% CI 0.272-0.987). We conclude that T385 is less frequent among the patient group than in the control group. The M385T variant in the factor V gene other than the Leiden mutation may play a role in disease susceptibility.
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Affiliation(s)
- E Jääskeläinen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, 70211 Kuopio, Finland
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19
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Mumford AD, McVey JH, Morse CV, Gomez K, Steen M, Norstrom EA, Tuddenham EGD, Dahlback B, Bolton-Maggs PHB. Factor V I359T: a novel mutation associated with thrombosis and resistance to activated protein C. Br J Haematol 2003; 123:496-501. [PMID: 14617013 DOI: 10.1046/j.1365-2141.2003.04624.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a kindred in which two siblings suffered spontaneous venous thromboses in the second decade of life. Further investigation showed reduced coagulation factor V (FV) activity and activated protein C resistance (APCR) ratio but no other thrombophilic abnormalities. The reduction in APCR ratio persisted in a modified APCR assay in which FV activity was normalized between test and control plasmas. Analysis of the FV gene showed that the thrombotic individuals had a complex genotype that included two novel point mutations c.529G>T and c.1250T>C resulting in FV E119X and FV I359T substitutions inherited on different alleles. Individuals in the kindred with FV E119X or FV I359T substitutions alone were asymptomatic. We suggest that the FV I359T substitution confers pro-thrombotic risk and APCR, but that this is only clinically manifest when co-inherited with the FV E119X allele. The FV I359T substitution creates a new consensus sequence for N-linked glycosylation within the FV heavy chain and we speculate that this abnormal glycosylation may disrupt activated protein C-mediated proteolysis of the variant FV and FVa.
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Affiliation(s)
- A D Mumford
- Department of Haematology, Bristol Royal Infirmary, Bristol, UK
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20
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Faisel F, Romppanen EL, Hiltunen M, Helisalmi S, Laasanen J, Punnonen K, Salonen JT, Heinonen S. Susceptibility to pre-eclampsia in Finnish women is associated with R485K polymorphism in the factor V gene, not with Leiden mutation. Eur J Hum Genet 2003; 12:187-91. [PMID: 14673478 DOI: 10.1038/sj.ejhg.5201124] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This study determines whether genetic variability in the gene-encoding factor V contributes to differences in pre-eclampsia susceptibility. Allele and genotype frequencies of three single-nucleotide polymorphisms (SNPs) in the factor V gene leading to nonsynonymous changes (M385T in exon 8, and R485K and R506Q (Leiden mutation) in exon 10) were studied in 133 Caucasian women with pre-eclampsia and 112 healthy controls. Single-point analysis was expanded to haplotype analysis, and haplotype frequencies were estimated using an expectation-maximization algorithm. Comparison of single-point allele and genotype distributions of SNPs in exons 8 and 10 of the factor V gene revealed statistically significant differences in R485K allele (P=0.003) and genotype (P=0.03) frequencies between the patients and the control subjects. The A allele of SNP R485K was over-represented among the patients (12%) vs the control subjects (4%), at an odds ratio (OR) of 2.8 (95% confidence interval (CI) 1.2-6.2) for combined A genotypes (GA+AA vs GG). Allele and genotype differences between the patients and control subjects as regards M385T and Leiden mutation were not significant. In haplotype estimation analysis, there was a significantly elevated frequency of haplotype T-A-G encoding the M385-K485-R506 variant in the pre-eclamptic group vs the control group (P=0.01), at an OR of 2.6 (95% CI 1.2-5.5). We conclude that the T-A-G haplotype was more frequent among the patient group than in the control group, and genetic variations in the factor V gene other than the Leiden mutation may play a role in disease susceptibility.
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Affiliation(s)
- Fareeza Faisel
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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21
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Rupert JL, Monsalve MV, Kidd KK, Tan C, Hochachka PW, Devine DV. Selective pressure has not acted against hypercoagulability alleles in high-altitude Amerindians. Ann Hum Genet 2003; 67:426-32. [PMID: 12940916 DOI: 10.1046/j.1469-1809.2003.00043.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Elevated hematocrit increases blood oxygen carrying capacity in high-altitude populations, but blood viscosity and coaguability may increase concomitantly. Alleles of the beta-fibrinogen gene (FGB) associated with lower fibrinogen levels are more common in highland Amerindians (Quechua) than lowland Amerindians (Na-Dene). Although genetic drift could account for this, selection may have acted against transmission of hypercoagulability alleles at high altitude. To test this hypothesis, we compared allele frequencies between Quechua and more closely related lowlanders (Maya) at loci in the genes encoding beta-fibrinogen (FGB), factors V (F5), VII (F7) and XIII (F13), alpha2-integrin (ITGA2) and plasminogen activator inhibitor type 1 (PAI-1; SERPINE1). No significant differences in allele frequencies were found except 485arg in the gene encoding factor V, which was more common in the Quechua. These data do not support the hypothesis that selection has acted to eliminate alleles associated with hypercoagulability in Andean highlanders.
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Affiliation(s)
- J L Rupert
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, B.C., Canada.
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22
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Abstract
There is substantial evidence that genetic factors contribute to coronary artery disease (CAD). Currently, family history collection and interpretation is the best method for identifying individuals with genetic susceptibility to CAD. Family history reflects not only genetic susceptibility, but also interactions between genetic, environmental, cultural, and behavioral factors. Stratification of familial risk into different risk categories (e.g., average, moderate, or high) is possible by considering the number of relatives affected with CAD and their degree of relationship, the ages of CAD onset, the occurrence of associated conditions, and the gender of affected relatives. Familial risk stratification should improve standard CAD risk assessment methods and treatment guidelines (e.g., Framingham CAD risk prediction score and Adult Treatment Panel III guidelines). Individuals with an increased familial risk for CAD should be targeted for aggressive risk factor modification. Individuals with a high familial risk might also benefit from early detection strategies and biochemical and DNA-based testing, which can further refine risk for CAD. In addition, individuals with the highest familial risk might have mendelian disorders associated with a large magnitude of risk for premature CAD. In these cases, referral for genetic evaluation should be considered, including pedigree analysis, risk assessment, genetic counseling and education, discussion of available genetic tests, and recommendations for risk-appropriate screening and preventive interventions. Research is needed to assess the feasibility, clinical validity, clinical utility, and ethical, legal, and social issues of an approach that uses familial risk stratification and genetic evaluation to enhance CAD prevention efforts.
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Affiliation(s)
- Maren T Scheuner
- Cedars-Sinai Medical Center, Associate Professor of Medicine, David Geffen School of Medicine, UCLA, CDC Office of Genomics and Disease Prevention, Los Angeles, California, USA
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23
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Dogulu CF, Kansu T, Leung MYK, Baxendale V, Wu SM, Ozguc M, Chan WY, Rennert OM. Evidence for genetic susceptibility to thrombosis in idiopathic intracranial hypertension. Thromb Res 2003; 111:389-95. [PMID: 14698658 DOI: 10.1016/j.thromres.2003.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cigdem F Dogulu
- Laboratory of Clinical Genomics, National Institute of Child Health and Development, National Institute of Health, MSC 4429, Bethesda, MD 20892-4429, USA.
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24
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25
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Abstract
Understanding the genetic basis of coronary artery disease (CAD) can improve management and prevention. Family and twin studies, animal models and gene association studies support a genetic basis for CAD. Genes contribute to CAD development and progression, and response to risk factor modification and lifestyle choices. Family history is the best indicator of a predisposition to CAD and further refinement is possible with biochemical and DNA testing. Many inherited cardiovascular risk factors can be modified, such as LDL cholesterol, homocysteine and lipoprotein(a). Early detection of CAD might lead to earlier intervention for genetically susceptible individuals. However, data are lacking regarding the efficacy of this approach in preventing clinical events. Despite this lack of evidence, knowledge of genetic CAD susceptibility has value in providing risk information and guiding decision making. Further research that investigates outcomes regarding genetic risk assessment for CAD is necessary.
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Affiliation(s)
- M T Scheuner
- Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, California 90048, USA.
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