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Vangenechten I, Smejkal P, Zavrelova J, Zapletal O, Wild A, Michiels JJ, Berneman Z, Blatny J, Batorova A, Prigancova T, Penka M, Gadisseur A. Analysis of von Willebrand Disease in the "Heart of Europe". TH OPEN: COMPANION JOURNAL TO THROMBOSIS AND HAEMOSTASIS 2022; 6:e335-e346. [PMID: 36299619 PMCID: PMC9581583 DOI: 10.1055/s-0042-1757635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
Background
von Willebrand disease (VWD) is a genetic bleeding disorder caused by defects of von Willebrand factor (VWF), quantitative (type 1 and 3) or qualitative (type 2). The laboratory phenotyping is heterogenic making diagnosis difficult.
Objectives
Complete laboratory analysis of VWD as an expansion of the previously reported cross-sectional family-based VWD study in the Czech Republic (BRNO-VWD) and Slovakia (BRA-VWD) under the name “Heart of Europe,” in order to improve the understanding of laboratory phenotype/genotype correlation.
Patients and Methods
In total, 227 suspected VWD patients were identified from historical records. Complete laboratory analysis was established using all available assays, including VWF multimers and genetic analysis.
Results
A total of 191 patients (from 119 families) were confirmed as having VWD. The majority was characterized as a type 1 VWD, followed by type 2. Multimeric patterns concordant with laboratory phenotypes were found in approximately 83% of all cases. A phenotype/genotype correlation was present in 84% (77% type 1, 99% type 2, and 61% type 3) of all patients. Another 45 candidate mutations (23 novel variations), not found in the initial study, could be identified (missense 75% and truncating 24%). An exon 1–3 gene deletion was identified in 14 patients where no mutation was found by direct DNA sequencing, increasing the linkage up to 92%, overall.
Conclusion
This study provides a cross-sectional overview of the VWD population in a part of Central Europe. It is an addition to the previously published BRNO-VWD study, and provides important data to the International Society of Thrombosis and Haemostasis/European Association for Haemophilia and Allied Disorders VWD mutation database with identification of novel causal mutations.
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Affiliation(s)
- Inge Vangenechten
- Haemostasis Unit, Antwerp University Hospital, Edegem, Belgium,Medicine and Health Sciences, Haemostasis Research Unit, Antwerp University, Antwerp, Belgium,Antwerp University, Antwerp, Belgium,Address for correspondence Inge Vangenechten Department of Haematology, Haemostasis Unit, Antwerp University HospitalWilrijkstraat 10, B - 2650 EdegemBelgium
| | - Petr Smejkal
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Zavrelova
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondrej Zapletal
- Department of Pediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Alexander Wild
- Department of Haematology, University F. D. Roosevelt Hospital, Banská Bystrica, Slovakia
| | - Jan Jacques Michiels
- Blood Coagulation and Vascular Medicine Center, Goodheart Institute & Foundation in Nature Medicine, Rotterdam, The Netherlands
| | - Zwi Berneman
- Antwerp University, Antwerp, Belgium,Department of Haematology, Antwerp University Hospital, Edegem, Belgium
| | - Jan Blatny
- Department of Pediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Angelika Batorova
- National Hemophilia Center, Department of Haematology and Blood Transfusion of the Medical School of the Comenius University, Bratislava, Slovakia
| | - Tatiana Prigancova
- National Hemophilia Center, Department of Haematology and Blood Transfusion of the Medical School of the Comenius University, Bratislava, Slovakia
| | - Miroslav Penka
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic,Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alain Gadisseur
- Haemostasis Unit, Antwerp University Hospital, Edegem, Belgium,Medicine and Health Sciences, Haemostasis Research Unit, Antwerp University, Antwerp, Belgium,Antwerp University, Antwerp, Belgium,Department of Haematology, Antwerp University Hospital, Edegem, Belgium
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Song J. Advances in laboratory assessment of thrombosis and hemostasis. Blood Res 2022; 57:93-100. [PMID: 35483933 PMCID: PMC9057656 DOI: 10.5045/br.2022.2022048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Technologies in laboratory diagnostics are changing fast with progress in understanding and therapy of diseases. Unfortunately, new analyzers are often needed to be installed in a clinical laboratory to implement such techniques. The demand for new hardware is a bottleneck in improving the diagnostic services for many facilities with limited resources. In this regard, hemostasis laboratories take a slightly different position. Because many in vitro diagnostic tests target the functional aspects of hemostasis, further meaningful information can be obtained from the same analyzers as in current use. Automated coagulometers are good candidates for such further utilization. Clot waveform analysis is a leading example. Behind the simple values reported as clotting time, clotting curves exist that represent the process of fibrin clot formation. Clot waveform analysis examines the clotting curves and derives new parameters other than clotting times. The clot waveform parameters are now in active use in assessing the hemostatic potential of hemorrhagic patients. Clinical application of coagulometers can also be widened by modifying the reagent formulation. For example, the chromogenic factor VIII assay with bovine source reagent compositions has recently been introduced for hemophilia A patients on emicizumab prophylaxis. Also, new immunoturbidimetric functional assays for von Willebrand factor have been developed recently. Thus, new clinically relevant information can be mined from the automated coagulometers that are based on old technology.
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Affiliation(s)
- Jaewoo Song
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
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Von Willebrand Factor and Platelet Aggregation: from Bench to Clinical Practice. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Avdonin PP, Tsvetaeva NV, Goncharov NV, Rybakova EY, Trufanov SK, Tsitrina AA, Avdonin PV. Von Willebrand Factor in Health and Disease. BIOCHEMISTRY (MOSCOW), SUPPLEMENT SERIES A: MEMBRANE AND CELL BIOLOGY 2021. [DOI: 10.1134/s1990747821040036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract—
Von Willebrand factor (vWF), the key component of hemostasis, is synthesized in endothelial cells and megakaryocytes and released into the blood as high molecular weight multimeric glycoproteins weighing up to 20 million Daltons. Blood plasma metalloprotease ADAMTS13 cleaves ultra-large vWF multimers to smaller multimeric and oligomeric molecules. The vWF molecules attach to the sites of damage at the surface of arterioles and capillaries and unfold under conditions of shear stress. On the unfolded vWF molecule, the regions interacting with receptors on the platelet membrane are exposed. After binding to the vWF filaments, platelets are activated; platelets circulating in the vessels are additionally attached to them, leading to thrombus formation, blocking of microvessels, and cessation of bleeding. This review describes the history of the discovery of vWF, presents data on the mechanisms of vWF secretion and its structure, and characterizes the processes of vWF metabolism in the body under normal and pathological conditions.
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Wilson E, Hanna F, Hyppa A, Orlowski E, Dawar HU, Sanga Z, Dennis A, Pavlov T, Khalafallah AA. Assessment of von Willebrand disease and pregnancy outcomes at regional Australian hospitals. Eur J Haematol 2021; 106:456-466. [PMID: 33289927 DOI: 10.1111/ejh.13562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/03/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND von Willebrand disease (vWD) is a heterogeneous hereditary bleeding disorder and is associated with risk of primary postpartum haemorrhage (PPH). DESIGN AND METHODS An observational study at a tertiary referral centre in Australia of 16 women with 23 deliveries with a median age of 27.5 years (range, 21-39; IQR = 9). Median gestational age at delivery was 39 weeks (range, 35-41; IQR = 1.1). RESULTS All cases had type 1 vWD, apart from one case with type 2. Patients were managed in combined obstetrics and haematology clinics. PPH occurred in ten deliveries (44%). Intravenous desmopressin was administered in 6 cases, and IV human vWF was administered in 4 cases. Two cases with mild vWD had received oral tranexamic acid. The median Apgar score at 1 and 5 min was 9 (IQR = 1.0), while the median Apgar score at 10 min was 10.0 (IQR = 0.0). One case required transfusion of blood products postdelivery. There were no other significant complications observed. CONCLUSIONS vWD was associated with a high incidence of primary PPH. Individualised treatment to restore haemostasis, according to the severity of the disease, could achieve as possible, normal haemostasis with favourable outcomes for both mothers and their infants. Further studies to confirm our findings are warranted.
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Affiliation(s)
- Emily Wilson
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | - Fayez Hanna
- Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | | | - Ella Orlowski
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | | | - Zar Sanga
- Augusta Medical Centre, Hobart, TAS, Australia
| | - Amanda Dennis
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | - Toly Pavlov
- Department of Obstetrics and Gynaecology, Launceston General Hospital, Launceston, TAS, Australia
| | - Alhossain A Khalafallah
- Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia.,Specialist Care Australia, Launceston, TAS, Australia
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Vangenechten I, Gadisseur A. Improving diagnosis of von Willebrand disease: Reference ranges for von Willebrand factor multimer distribution. Res Pract Thromb Haemost 2020; 4:1024-1034. [PMID: 32864553 PMCID: PMC7443431 DOI: 10.1002/rth2.12408] [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: 02/18/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Phenotypic von Willebrand disease (VWD) classification requires multiple tests including analysis of multimeric distributions von Willebrand factor (VWF) and evaluation of its structure. VWF multimer analysis is labor intensive, nonstandardized, and limited to specialized laboratories. A commercial semiautomatic assay, HYDRAGEL VW multimer assay (H5/11VWM, Sebia), has become available. OBJECTIVES Establishment of reference ranges for H5/11VWM to improve VWD classification. METHODS Implementation validation, establishment and validation of normal and pathological reference intervals (NRIs/PRIs), comparison with in-house method using 40 healthy volunteers and 231 VWD patients. RESULTS Qualitative and quantitative validation of NRI obtained sensitivity of 88% and 79%, respectively, for type 2. Comparison of the two methods showed an overall concordance of 86% with major conflicting results in all atypical 2B (n = 7) and 50% 2M-GPIb (n = 41) showing quantitative and qualitative multimeric loss, that was not detected with in-house method. We were able to use established PRIs, with 73% validity in type 2 cases, to distinguish individual type 2A subtypes (IIA, IIC, IID, IIE) from 2M and 2B. CONCLUSION H5/11VWM could be used for all clinical purposes because its reliability and its rapid and accurate diagnostic ability and reduced observer bias. Although H5/11VWM cannot evaluate triplet structures, we were able to define 2A subtypes by stripping back to the percentage of intermediate/high-molecular-weight multimers. H5/11HWM could be an efficient and widely available alternative for the "gold standard" technique.
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Affiliation(s)
- Inge Vangenechten
- Haemostasis UnitDepartment of HaematologyAntwerp University HospitalEdegemBelgium
- CSL Behring Chair in von Willebrand DiseaseAntwerp UniversityAntwerpBelgium
| | - Alain Gadisseur
- Haemostasis UnitDepartment of HaematologyAntwerp University HospitalEdegemBelgium
- CSL Behring Chair in von Willebrand DiseaseAntwerp UniversityAntwerpBelgium
- Haemostasis Research UnitAntwerp UniversityAntwerpBelgium
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Vangenechten I, Mayger K, Smejkal P, Zapletal O, Michiels JJ, Moore GW, Gadisseur A. A comparative analysis of different automated von Willebrand factor glycoprotein Ib-binding activity assays in well typed von Willebrand disease patients. J Thromb Haemost 2018; 16:1268-1277. [PMID: 29742318 DOI: 10.1111/jth.14145] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 12/13/2022]
Abstract
Essentials Von Willebrand ristocetin cofactor activity (VWF:RCo) is not a completely reliable assay. Three automated VWF activity assays were compared within a von Willebrand disease (VWD) cohort. Raw values for all three assays were virtually the same. An overall problem within type 2A/IIE VWD using VWF:GPIb-binding activity/VWF:Ag was observed. SUMMARY Background von Willebrand disease (VWD) is an inherited bleeding disorder caused by quantitative (type 1 and 3) or qualitative (type 2) von Willebrand factor (VWF) defect. VWD diagnosis and classification require numerous laboratory tests. VWF: glycoprotein Ib (GPIb)-binding activity assays are used to distinguish type 1 from type 2 VWD. Objectives Three different automated VWF:GPIb-binding activity assays were compared. Patients and methods BC-VWF:RCo (Siemens Healthcare Diagnostics), HemosIL® VWF:RCo (Instrumentation Laboratory) and INNOVANCE® VWF:Ac (Siemens Healthcare Diagnostics) were performed in a well typed VWD cohort (n = 142). Results Based on the three most used VWD parameters (FVIII:C, VWF:Ag and VWF:GPIb-binding activity) and using a cut-off of <0.70 for type 2 VWD revealed sensitivity and specificity of, respectively, 92% and 72.4% for VWF:RCo/VWF:Ag, 84% and 89.7% for VWF:GPIbR/VWF:Ag, and 92% and 85.1% for VWF:GPIbM/VWF:Ag, whereas a lowered cut-off of < 0.60 resulted in reduced sensitivity with increased specificity for all assays. Conclusion VWD classification based on FVIII:C, VWF:Ag and VWF:GPIb-binding activity revealed an overall problem with normal VWF:GPIb-binding activity/VWF:Ag within type 2, especially type 2A/IIE. Although all assays were practically identical, BC-VWF:RCo had higher %CV compared with both new assays but comparable lower limit of quantification (LLOQ) ~4 IU dL-1 . No clear improved distinction between type 1 and 2 VWD with new assays was seen. BC-VWF RCo and HemosIL® are ristocetin dependent, whereas INNOVANCE® does not rely upon ristocetin and is not influenced by VWF polymorphisms increasing VWF:GPIb-binding activity levels. INNOVANCE® seems to be the best choice as a first-line VWF:GPIb-binding activity assay, providing the best balance between sensitivity and specificity for type 2 VWD.
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Affiliation(s)
- I Vangenechten
- Haemostasis Unit, Department of Haematology, Antwerp University Hospital, Edegem, Belgium
- Haemostasis Research Unit, Antwerp University, Antwerp, Belgium
- Blood Coagulation and Vascular Medicine Center, Goodheart Institute and Foundation in Nature Medicine, Rotterdam, the Netherlands
| | - K Mayger
- Diagnostic Haemostasis and Thrombosis Laboratory, Viapath Analytics, St Thomas' Hospital, London, UK
| | - P Smejkal
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - O Zapletal
- Department of Paediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - J J Michiels
- CSL Behring Chair in von Willebrand Disease, Antwerp University, Antwerp, Belgium
| | - G W Moore
- Diagnostic Haemostasis and Thrombosis Laboratory, Viapath Analytics, St Thomas' Hospital, London, UK
| | - A Gadisseur
- Haemostasis Unit, Department of Haematology, Antwerp University Hospital, Edegem, Belgium
- Haemostasis Research Unit, Antwerp University, Antwerp, Belgium
- CSL Behring Chair in von Willebrand Disease, Antwerp University, Antwerp, Belgium
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8
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Postpartum Hemorrhage in Women with Von Willebrand Disease - A Retrospective Observational Study. PLoS One 2016; 11:e0164683. [PMID: 27780267 PMCID: PMC5079555 DOI: 10.1371/journal.pone.0164683] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022] Open
Abstract
Introduction von Willebrand disease (VWD) is a hereditary bleeding disorder, caused by a deficiency in the levels and/or function of von Willebrand factor (VWF). Women with VWD appear to be at increased risk of experiencing postpartum hemorrhage (PPH), though the levels of VWF increase during pregnancy. There is limited knowledge of how PPH is associated with the subtype of VWD, plasma levels of other coagulations factors than VWF and given hemostatic treatment. Aims The aims were to investigate the incidence of PPH in women with VWD and to analyse the correlation between PPH and: (1) type of VWD, (2) laboratory monitoring of VWF and FVIII and (3) hemostatic drug treatment. Methods This was a retrospective observational study. The study participants (n = 34) were recruited from the Coagulation Unit, Karolinska University hospital. Fifty-nine deliveries, which occurred in 14 different obstetrics units (years 1995–2012) were included in the study. Results The incidence of primary PPH was 44%, severe primary PPH 20% and secondary PPH 12%. VWD type 3 was associated with a higher risk of experiencing severe primary PPH compared to other subtypes. FVIII:C in pregnancy was inversely correlated to blood loss during delivery. There was a significantly higher incidence of secondary PPH when the VWD diagnosis was unknown at time of delivery. Conclusions The women with VWD are at higher risk of PPH, especially those with type 3 VWD or when diagnosis is unknown prior to delivery. Identification of pregnant women with undiagnosed VWD may be of importance in order to prevent PPH.
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Michiels JJ, Batorova A, Prigancova T, Smejkal P, Penka M, Vangenechten I, Gadisseur A. Changing insights in the diagnosis and classification of autosomal recessive and dominant von Willebrand diseases 1980-2015. World J Hematol 2016; 5:61-74. [DOI: 10.5315/wjh.v5.i3.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/18/2016] [Indexed: 02/05/2023] Open
Abstract
The European Clinical Laboratory and Molecular (ECLM) criteria define 10 distinct Willebrand diseases (VWD): recessive type 3, severe 1, 2C and 2N; dominant VWD type 1 secretion/clearance defect, 2A, 2B, 2E, 2M and 2D; and mild type 1 VWD (usually carriers of recessive VWD). Recessive severe 1 and 2C VWD are characterized by secretion and multimerization defects caused by mutations in the D1-D2 domain. Recessive 2N VWD is a mild hemophilia due to D’-FVIII-von Willebrand factor (VWF) binding site mutations. Dominant 2E VWD caused by heterozygous missense mutations in the D3 domain is featured by a secretion-clearance-multimerization VWF defect. Dominant VWD type 2M due to loss of function mutations in the A1 domain is characterized by decreased ristocetin-induced platelet aggregation and VWF:RCo, normal VWF multimers and VWF:CB, a poor response of VWF:RCo and good response of VWF:CB to desmopressin (DDAVP). Dominant VWD type 2A induced by heterozygous mutations in the A2 domain results in hypersensitivity of VWF for proteolysis by ADAMTS13 into VWF degradation products, resulting in loss of large VWF multimers with triplet structure of each individual VWF band. Dominant VWD type 2B due to a gain of function mutation in the A1 domain is featured by spontaneous interaction between platelet glycoprotein Ib (GPIb) and mutated VWF A1 followed by increased proteolysis with loss of large VWF multimers and presence of each VWF band. A new category of dominant VWD type 1 secretion or clearance defect due to mutations in the D3 domain or D4-C1-C5 domains consists of two groups: Those with normal or smeary pattern of VWF multimers.
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Denis CV, Lenting PJ. von Willebrand factor: at the crossroads of bleeding and thrombosis. Int J Hematol 2012; 95:353-61. [PMID: 22477538 PMCID: PMC3677142 DOI: 10.1007/s12185-012-1041-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 01/19/2012] [Accepted: 02/06/2012] [Indexed: 02/06/2023]
Abstract
Hemostasis and thrombosis represent two sides of the same coin. Hemostasis maintains blood fluidity in the vascular system while allowing for rapid thrombus formation to prevent excessive hemorrhage after blood vessel injury. Thrombosis is a pathologic extension of the normal hemostatic mechanism, occurring when unwanted clot formation develops in certain pathological situations. The molecular mechanisms underlying both phenomena are fundamentally identical. One of the key players in both processes is the plasma glycoprotein von Willebrand factor, which perfectly illustrates this duality between hemostatic and thrombotic mechanisms. The purpose of this review is to discuss novel findings on the role of von Willebrand factor at this interface, and how some of these findings may help develop new therapeutic strategies.
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Affiliation(s)
- Cécile V Denis
- INSERM U770, 80 rue du General Leclerc, 94276 Le Kremlin-Bicêtre, France.
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Schneppenheim R. The pathophysiology of von Willebrand disease: therapeutic implications. Thromb Res 2011; 128 Suppl 1:S3-7. [DOI: 10.1016/s0049-3848(12)70002-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Akin M, Karapinar DY, Balkan C, Ay Y, Kavakli K. An Evaluation of the DDAVP Infusion Test With PFA-100 and vWF Activity Assays to Distinguish vWD Types in Children. Clin Appl Thromb Hemost 2010; 17:441-8. [DOI: 10.1177/1076029610366440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
von Willebrand disease (vWD) is classified into partial (type 1), qualitative (type 2), and total deficiency (type 3).The aims of the study were to evaluate prospectively the potency of the DDAVP infusion test together with von Willebrand factor (vWF) ristocetin cofactor (vWF:RCo), vWF antigen (vWF:Ag), factor VIII coagulant activity (FVIII:C), and platelet function analyzer (PFA)-100 to distinguish vWD types. Genetic analysis and multimeric analysis of vWF was not applied. We classified the 112 patients and 47 healthy children phenotypically according to the laboratory test results and bleeding severity score. PFA-100 closure times (CT), FVIII:C, vWF:RCo, vWF:Ag, ristocetin-induced platelet aggregation (RIPA), and the response of FVIII:C and vWF parameters to desmopressin (DDAVP) were used to define types 1, 2, and 3 vWD. Type 1 vWD is mild in 34 cases (vWF:RCo % 40-55), moderate in 29 (vWF:RCo %27-40), severe type 1 vWD or nonclassical type 2 vWD in 12 cases (vWF:RCo % 4-16), and type 2 vWD in 23 cases (vWF:RCo %4-38).The response to DDAVP of vWF parameters is normal in all patients with mild/moderate type 1 vWD, 6 patients with severe type 1 vWD or nonclassical type 2 vWD and 11 patients with type 2 vWD. In conclusion, this study showed that measurement of vWF:RCo, vWF:Ag, FVIII:C, and PFA-100 parameters can differentiate vWD types but not severe type 1 vWD or nonclassical type 2 vWD. In the differentiation of severe type 1 vWD and nonclassical type 2 vWD, DDAVP response may be used.
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Affiliation(s)
- Mehmet Akin
- Department of Pediatric Hematology, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Can Balkan
- Department of Pediatric Hematology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yilmaz Ay
- Department of Pediatric Hematology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Kaan Kavakli
- Department of Pediatric Hematology, Ege University Faculty of Medicine, Izmir, Turkey
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Abstract
Platelet-adhesive mechanisms play a well-defined role in hemostasis and thrombosis, but evidence continues to emerge for a relevant contribution to other pathophysiological processes, including inflammation, immune-mediated responses to microbial and viral pathogens, and cancer metastasis. Hemostasis and thrombosis are related aspects of the response to vascular injury, but the former protects from bleeding after trauma, while the latter is a disease mechanism. In either situation, adhesive interactions mediated by specific membrane receptors support the initial attachment of single platelets to cellular and extracellular matrix constituents of the vessel wall and tissues. In the subsequent steps of thrombus growth and stabilization, adhesive interactions mediate platelet-to-platelet cohesion (i.e., aggregation) and anchoring to the fibrin clot. A key functional aspect of platelets is their ability to circulate in a quiescent state surveying the integrity of the inner vascular surface, coupled to a prompt reaction wherever alterations are detected. In many respects, therefore, platelet adhesion to vascular wall structures, to one another, or to other blood cells are facets of the same fundamental biological process. The adaptation of platelet-adhesive functions to the effects of blood flow is the main focus of this review.
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Lee CA, Aledort LM. Bleeding and clotting: new therapies and old issues revisited. Haemophilia 2009; 15:592-596. [PMID: 19335754 DOI: 10.1111/j.1365-2516.2009.01991.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- C A Lee
- Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK.
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15
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Postoperative Blutung trotz „normaler“ Gerinnungsdiagnostik? Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-008-1825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schneppenheim R, Budde U. Von-Willebrand- und Upshaw-Schulman-Syndrom. MED GENET-BERLIN 2008. [DOI: 10.1007/s11825-008-0106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Quantitative und qualitative Defekte des Von-Willebrand-Faktors (VWF) sind für die häufigste hereditäre Blutungsneigung, das Von-Willebrand-Syndrom (VWS), ursächlich, welches überwiegend autosomal-dominant, aber auch -rezessiv vererbt wird. Entsprechend der modularen Struktur des VWF, mit verschiedenen funktionell und strukturell wichtigen Domänen, besteht eine hochgradige Heterogenität sowohl der klinischen Symptomatik als auch der Pathomechanismen. Eine Überfunktion des VWF beruht auf der fehlenden Größenregulation durch seine spezifische Protease ADAMTS13, die mit dem lebensbedrohlichen Krankheitsbild der thrombotisch-thrombozytopenischen Purpura korreliert, einer Störung der Mikrozirkulation durch hyaline Thromben. Deren autosomal-rezessiv vererbte Form, das Upshaw-Schulman-Syndrom, steht auf der anderen Seite der vom VWF verursachten Störungen der Blutgerinnung. Das heutige Wissen um die Pathophysiologie des VWF und seiner Protease ADAMTS13 ermöglicht neben einer rationalen Therapie auch die Erfassung seiner Beteiligung an vaskulären Erkrankungen.
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Affiliation(s)
- R. Schneppenheim
- Aff1_106 grid.13648.38 0000000121803484 Klinik für Pädiatrische Hämatologie und Onkologie Universitätsklinikum Hamburg-Eppendorf Martinistraße 52 20246 Hamburg Deutschland
| | - U. Budde
- Aff2_106 AescuLabor Hamburg, Gerinnungslabor Hamburg Deutschland
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Marx I, Lenting PJ, Adler T, Pendu R, Christophe OD, Denis CV. Correction of Bleeding Symptoms in von Willebrand Factor–Deficient Mice by Liver-Expressed von Willebrand Factor Mutants. Arterioscler Thromb Vasc Biol 2008; 28:419-24. [DOI: 10.1161/atvbaha.107.159442] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Isabelle Marx
- From the Institut National de la Santé et de la Recherche Médicale (INSERM) U770 (I.M., T.A., O.D.C., C.V.D.), Le Kremlin-Bicêtre, F-94276 France; Univ Paris-Sud, Le Kremlin-Bicêtre, F-94276 France; and the Laboratory for Thrombosis and Haemostasis (P.J.L., R.P.), Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, The Netherlands
| | - Peter J. Lenting
- From the Institut National de la Santé et de la Recherche Médicale (INSERM) U770 (I.M., T.A., O.D.C., C.V.D.), Le Kremlin-Bicêtre, F-94276 France; Univ Paris-Sud, Le Kremlin-Bicêtre, F-94276 France; and the Laboratory for Thrombosis and Haemostasis (P.J.L., R.P.), Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, The Netherlands
| | - Thure Adler
- From the Institut National de la Santé et de la Recherche Médicale (INSERM) U770 (I.M., T.A., O.D.C., C.V.D.), Le Kremlin-Bicêtre, F-94276 France; Univ Paris-Sud, Le Kremlin-Bicêtre, F-94276 France; and the Laboratory for Thrombosis and Haemostasis (P.J.L., R.P.), Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, The Netherlands
| | - Ronan Pendu
- From the Institut National de la Santé et de la Recherche Médicale (INSERM) U770 (I.M., T.A., O.D.C., C.V.D.), Le Kremlin-Bicêtre, F-94276 France; Univ Paris-Sud, Le Kremlin-Bicêtre, F-94276 France; and the Laboratory for Thrombosis and Haemostasis (P.J.L., R.P.), Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, The Netherlands
| | - Olivier D. Christophe
- From the Institut National de la Santé et de la Recherche Médicale (INSERM) U770 (I.M., T.A., O.D.C., C.V.D.), Le Kremlin-Bicêtre, F-94276 France; Univ Paris-Sud, Le Kremlin-Bicêtre, F-94276 France; and the Laboratory for Thrombosis and Haemostasis (P.J.L., R.P.), Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, The Netherlands
| | - Cécile V. Denis
- From the Institut National de la Santé et de la Recherche Médicale (INSERM) U770 (I.M., T.A., O.D.C., C.V.D.), Le Kremlin-Bicêtre, F-94276 France; Univ Paris-Sud, Le Kremlin-Bicêtre, F-94276 France; and the Laboratory for Thrombosis and Haemostasis (P.J.L., R.P.), Department of Clinical Chemistry & Haematology, University Medical Center Utrecht, The Netherlands
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Finke J, Bertz H, Kaskel AK, Heinz J, Thomas A, Berger DP, Engelhardt R, Schmah O. Hematology and Hemostasis. CONCISE MANUAL OF HEMATOLOGY AND ONCOLOGY 2008. [PMCID: PMC7120532 DOI: 10.1007/978-3-540-73277-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- David J Schneider
- Cardiology Division and Cardiovascular Research Institute, University of Vermont, Burlington, USA
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Butwick AJ, Carvalho B. Neuraxial anesthesia for cesarean delivery in a parturient with type 1 von Willebrand disease and scoliosis. J Clin Anesth 2007; 19:230-3. [PMID: 17531735 DOI: 10.1016/j.jclinane.2006.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 08/06/2006] [Accepted: 08/09/2006] [Indexed: 11/28/2022]
Abstract
We present the case of a parturient with von Willebrand disease and scoliosis who required cesarean delivery. Neuraxial anesthesia was used for the patient. The indications for neuraxial anesthesia with regard to type 1 von Willebrand disease are reviewed.
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Affiliation(s)
- Alexander J Butwick
- Department of Anesthesia, Lucile Packard Children's Hospital and Stanford University School of Medicine, Stanford, CA 94305, USA
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Leonard AL, Hanke CW, Greist A. Perioperative management of von Willebrand disease in dermatologic surgery. Dermatol Surg 2007; 33:403-9. [PMID: 17430373 DOI: 10.1111/j.1524-4725.2007.33086.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Von Willebrand disease (VWD) is the most common inherited bleeding disorder, affecting an estimated 0.1% to 1% of the population. It is caused by a qualitative or quantitative defect of von Willebrand factor. Primary manifestations include intractable mucocutaneous bleeding after surgery or trauma. OBJECTIVE The objective was to review the pathophysiology and clinical features of VWD and to propose a perioperative management strategy for patients with this condition undergoing dermatologic surgery. METHODS AND MATERIALS Literature is reviewed. RESULTS The various types and clinical manifestations of this condition are reviewed, and a perioperative strategy is presented for managing patients with VWD who undergo cutaneous oncologic or cosmetic surgical procedures. CONCLUSIONS In most cases, dermatologic surgery can be safely performed in patients with VWD. The use of appropriate therapeutic prophylaxis in conjunction with a hematologist is indicated in high-risk, nonelective procedures.
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Affiliation(s)
- Aimee L Leonard
- Laser and Skin Surgery Center of Indiana, Carmel, Indiana 46032, USA.
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Perioperative Management of von Willebrand Disease in Dermatologic Surgery. Dermatol Surg 2007. [DOI: 10.1097/00042728-200704000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rayes J, Hommais A, Legendre P, Tout H, Veyradier A, Obert B, Ribba AS, Girma JP. Effect of von Willebrand disease type 2B and type 2M mutations on the susceptibility of von Willebrand factor to ADAMTS-13. J Thromb Haemost 2007; 5:321-8. [PMID: 17087728 DOI: 10.1111/j.1538-7836.2007.02296.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND von Willebrand disease (VWD) type 2 is associated with mutations in von Willebrand factor (VWF) that affect its secretion, multimeric pattern, affinity for platelet receptors and clearance of the protein. While increased proteolysis by a disintegrin-like and metalloprotease with thrombospondin type 1 motifs-13 (ADAMTS-13) has been clearly established for VWF type 2A, only little is known about VWF types 2B and 2M in this regard. OBJECTIVES Sensitivity of wild-type (WT) and mutated recombinant (r) VWF to proteolysis by ADAMTS-13 was investigated to better understand the role of this process in the pathophysiology of VWD. METHODS We used human rADAMTS-13-WT to digest 11 full-length recombinant forms of VWF carrying molecular abnormalities identified in patients with VWD type 2A (E1638K and P1648S), type 2B (InsM1303, R1306W, R1308P and V1314F) and type 2M (G1324A, E1359K, K1362T, R1374H and I1425F). RESULTS Using low ionic strength conditions, all mutations induced increased proteolysis of rVWF by rADAMTS-13 as compared with rVWF-WT. The susceptibility of mutants decreased in the following order: type 2A > type 2B > type 2M > rVWF-WT. At physiological salt concentration (150 mm NaCl) the sensitivity of all rVWF to rADAMTS-13 was significantly decreased. However, type 2A and type 2B mutants still exhibited a significantly higher susceptibility to rADAMTS-13 than rVWF-WT, whereas type 2M mutants normalized. CONCLUSIONS Type 2M mutants and rVWF-WT exhibit a similar sensitivity to rADAMTS-13-mediated proteolysis, in agreement with the normal multimeric pattern in vivo. In VWD type 2B, the spontaneous binding to platelets and excessive degradation by ADAMTS-13 of VWF high-molecular-weight multimers may account for their clearance from plasma.
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Affiliation(s)
- J Rayes
- INSERM U770 and Université Paris-Sud, Faculté de Médecine IFR93, Le Kremlin-Bicêtre, France
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Tjernberg P, Castaman G, Vos HL, Bertina RM, Eikenboom JCJ. Homozygous C2362F von Willebrand factor induces intracellular retention of mutant von Willebrand factor resulting in autosomal recessive severe von Willebrand disease. Br J Haematol 2006; 133:409-18. [PMID: 16643449 DOI: 10.1111/j.1365-2141.2006.06055.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The missense mutation of cysteine 2362 to a phenylalanine in von Willebrand factor (VWF) has been detected in several Italian families with autosomal recessive, severe von Willebrand disease. We investigated how this amino acid change in VWF may lead to a predominantly quantitative defect. This mutation was studied in vitro by transient expression of the full-length mutant VWF-C2362F protein and in vivo by analysis of plasma VWF after infusion of 1-deamino-8-d-arginine vasopressin (DDAVP) in a patient homozygous for this mutation. Single transfections of pSVHVWF-C2362F and co-transfections of mutant and wild-type constructs resulted in 8% and 50% VWF antigen, respectively, in conditioned medium. These reduced levels are in accordance with observations in homozygous and heterozygous carriers of the mutation. In addition, VWF-C2362F was retained intracellularly. Similar results were obtained for C2362F and C2362A. After infusion of DDAVP in a homozygous patient, a twofold decrease in half-life of plasma VWF-C2362F was observed. This was not explained by increased susceptibility of recombinant VWF-C2362F to ADAMTS13. It was concluded that VWF-C2362F causes reduced VWF plasma levels due to impaired secretion and intracellular retention. Furthermore, it is the loss of cysteine 2362 rather than the introduction of the bulky amino acid side chain that causes these effects.
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Affiliation(s)
- P Tjernberg
- Haemostasis and Thrombosis Research Centre, Department of Haematology, Leiden University Medical Centre, Leiden, the Netherlands
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Hassenpflug WA, Budde U, Obser T, Angerhaus D, Drewke E, Schneppenheim S, Schneppenheim R. Impact of mutations in the von Willebrand factor A2 domain on ADAMTS13-dependent proteolysis. Blood 2005; 107:2339-45. [PMID: 16322474 DOI: 10.1182/blood-2005-04-1758] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Classical von Willebrand disease (VWD) type 2A, the most common qualitative defect of VWD, is caused by loss of high-molecular-weight multimers (HMWMs) of von Willebrand factor (VWF). Underlying mutations cluster in the A2 domain of VWF around its cleavage site for ADAMTS13. We investigated the impact of mutations commonly found in patients with VWD type 2A on ADAMTS13-dependent proteolysis of VWF. We used recombinant human ADAMTS13 (rhuADAMTS13) to digest recombinant full-length VWF and a VWF fragment spanning the VWF A1 through A3 domains, harboring 13 different VWD type 2A mutations (C1272S, G1505E, G1505R, S1506L, M1528V, R1569del, R1597W, V1607D, G1609R, I1628T, G1629E, G1631D, and E1638K). With the exception of G1505E and I1628T, all mutations in the VWF A2 domain increased specific proteolysis of VWF independent of the expression level. Proteolytic susceptibility of mutant VWF in vitro closely correlated with the in vivo phenotype in patients. The results imply that increased VWF susceptibility for ADAMTS13 is a constitutive property of classical VWD type 2A, thus explaining the pronounced proteolytic fragments and loss of HMWM seen in multimer analysis in patients.
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Affiliation(s)
- Wolf Achim Hassenpflug
- Dept of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
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