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Wang HL, Ruan DD, Wu M, Ji YY, Hu XX, Wu QY, Zhang YP, Lin B, Hu YN, Wang H, Tang Y, Fang ZT, Luo JW, Liao LS, Gao MZ. Identification and characterization of two SERPINC1 mutations causing congenital antithrombin deficiency. Thromb J 2023; 21:3. [PMID: 36624481 PMCID: PMC9830717 DOI: 10.1186/s12959-022-00443-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Antithrombin (AT) is the main physiological anticoagulant involved in hemostasis. Hereditary AT deficiency is a rare autosomal dominant thrombotic disease mainly caused by mutations in SERPINC1, which was usually manifested as venous thrombosis and pulmonary embolism. In this study, we analyzed the clinical characteristics and screened for mutant genes in two pedigrees with hereditary AT deficiency, and the functional effects of the pathogenic mutations were evaluated. METHODS Candidate gene variants were analyzed by next-generation sequencing to screen pathogenic mutations in probands, followed by segregation analysis in families by Sanger sequencing. Mutant and wild-type plasmids were constructed and transfected into HEK293T cells to observe protein expression and cellular localization of SERPINC1. The structure and function of the mutations were analyzed by bioinformatic analyses. RESULTS The proband of pedigree A with AT deficiency carried a heterozygous frameshift mutation c.1377delC (p.Asn460Thrfs*20) in SERPINC1 (NM000488.3), a 1377C base deletion in exon 7 resulting in a backward shift of the open reading frame, with termination after translation of 20 residues, and a different residue sequence translated after the frameshift. Bioinformatics analysis suggests that the missing amino acid sequence caused by the frameshift mutation might disrupt the disulfide bond between Cys279 and Cys462 and affect the structural function of the protein. This newly discovered variant is not currently included in the ClinVar and HGMD databases. p.Arg229* resulted in a premature stop codon in exon 4, and bioinformatics analysis suggests that the truncated protein structure lost its domain of interaction with factor IX (Ala414 site) after the deletion of nonsense mutations. However, considering the AT truncation protein resulting from the p.Arg229* variant loss a great proportion of the molecule, we speculate the variant may affect two functional domains HBS and RCL and lack of the corresponding function. The thrombophilia and decreased-AT-activity phenotypes of the two pedigrees were separated from their genetic variants. After lentiviral plasmid transfection into HEK293T cells, the expression level of AT protein decreased in the constructed c.1377delC mutant cells compared to that in the wild-type, which was not only reduced in c.685C > T mutant cells but also showed a significant band at 35 kDa, suggesting a truncated protein. Immunofluorescence localization showed no significant differences in protein localization before and after the mutation. CONCLUSIONS The p.Asn460Thrfs*20 and p.Arg229* variants of SERPINC1 were responsible for the two hereditary AT deficiency pedigrees, which led to AT deficiency by different mechanisms. The p.Asn460Thrfs*20 variant is reported for the first time.
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Affiliation(s)
- Han-lu Wang
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Dan-dan Ruan
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Min Wu
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Yuan-yuan Ji
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Xing-xing Hu
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Cardiovascular Medicine, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Qiu-yan Wu
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Yan-ping Zhang
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Bin Lin
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Ya-nan Hu
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China
| | - Hang Wang
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Yi Tang
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Zhu-ting Fang
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Jie-wei Luo
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Li-sheng Liao
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Hematology, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Mei-zhu Gao
- grid.415108.90000 0004 1757 9178Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Nephrology, Fujian Provincial Hospital, Fuzhou, 350001 China
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de la Morena-Barrio B, Orlando C, Sanchis-Juan A, García JL, Padilla J, de la Morena-Barrio ME, Puruunen M, Stouffs K, Cifuentes R, Borràs N, Bravo-Pérez C, Benito R, Cuenca-Guardiola J, Vicente V, Vidal F, Hernández-Rivas JM, Ouwehand W, Jochmans K, Corral J. Molecular Dissection of Structural Variations Involved in Antithrombin Deficiency. J Mol Diagn 2022; 24:462-475. [PMID: 35218943 DOI: 10.1016/j.jmoldx.2022.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 12/30/2022] Open
Abstract
Inherited antithrombin deficiency, the most severe form of thrombophilia, is predominantly caused by variants in SERPINC1. Few causal structural variants have been described, usually detected by multiplex ligation-dependent probe amplification or cytogenetic arrays, which only define the gain or loss and the approximate size and location. This study has done a complete dissection of the structural variants affecting SERPINC1 of 39 unrelated patients with antithrombin deficiency using multiplex ligation-dependent probe amplification, comparative genome hybridization array, long-range PCR, and whole genome nanopore sequencing. Structural variants, in all cases only affecting one allele, were deleterious and caused a severe type I deficiency. Most defects were deletions affecting exons of SERPINC1 (82.1%), but the whole cohort was heterogeneous, as tandem duplications, deletion of introns, or retrotransposon insertions were also detected. Their size was also variable, ranging from 193 bp to 8 Mb, and in 54% of the cases involved neighboring genes. All but two structural variants had repetitive elements and/or microhomologies in their breakpoints, suggesting a common mechanism of formation. This study also suggested regions recurrently involved in structural variants causing antithrombin deficiency and found three structural variants with a founder effect: the insertion of a retrotransposon, duplication of exon 6, and a 20-gene deletion. Finally, nanopore sequencing was determined to be the most appropriate method to identify and characterize all structural variants at nucleotide level, independently of their size or type.
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Affiliation(s)
- Belén de la Morena-Barrio
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - Christelle Orlando
- Department of Haematology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Alba Sanchis-Juan
- Department of Haematology, University of Cambridge, National Health Service (NHS) Blood and Transplant Centre, Cambridge, United Kingdom; National Institute for Health Research BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Juan L García
- Cancer Research Center (Instituto Universitario de Biología Molecular y Celular del Cáncer) Consejo Superior de Investigaciones Científicas-University of Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica, Department of Hematology, University Hospital of Salamanca, Department of Medicine, University of Salamanca, Salamanca, Spain
| | - José Padilla
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - María E de la Morena-Barrio
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - Marija Puruunen
- National Heart, Lung, and Blood Institute Framingham Heart Study, Framingham, Massachusetts
| | - Katrien Stouffs
- Center for Medical Genetics, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Rosa Cifuentes
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - Nina Borràs
- Laboratori de Coagulopaties Congènites, Banc de Sang i Teixits, Barcelona, Medicina Transfusional, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto Carlos III, Barcelona, Spain
| | - Carlos Bravo-Pérez
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - Rocio Benito
- Cancer Research Center (Instituto Universitario de Biología Molecular y Celular del Cáncer) Consejo Superior de Investigaciones Científicas-University of Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica, Department of Hematology, University Hospital of Salamanca, Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Javier Cuenca-Guardiola
- Departamento de Informática y Sistemas, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia, Spain
| | - Vicente Vicente
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain
| | - Francisco Vidal
- Laboratori de Coagulopaties Congènites, Banc de Sang i Teixits, Barcelona, Medicina Transfusional, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto Carlos III, Barcelona, Spain
| | - Jesús M Hernández-Rivas
- Cancer Research Center (Instituto Universitario de Biología Molecular y Celular del Cáncer) Consejo Superior de Investigaciones Científicas-University of Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica, Department of Hematology, University Hospital of Salamanca, Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Willem Ouwehand
- Department of Haematology, University of Cambridge, National Health Service (NHS) Blood and Transplant Centre, Cambridge, United Kingdom; National Institute for Health Research BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Kristin Jochmans
- Department of Haematology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Javier Corral
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Centro de Investigación Biomédica en Red de Enfermedades Raras, Murcia, Spain.
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4
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Bravo-Pérez C, Vicente V, Corral J. Management of antithrombin deficiency: an update for clinicians. Expert Rev Hematol 2019; 12:397-405. [PMID: 31116611 DOI: 10.1080/17474086.2019.1611424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction. Antithrombin is a serpin that inhibits multiple procoagulant serine proteases and acts as an endogenous anticoagulant. Thus, congenital antithrombin deficiency constitutes a major thrombophilic state, the most severe so far. Areas covered. In the present work, we globally review the biology, genetics, diagnosis, and management of congenital antithrombin deficiency, and also discuss puzzling questions and future perspectives regarding this severe inherited thrombophilia. Expert opinion. Although this disorder exerts high clinical heterogeneity, many carriers will need careful and long-term anticoagulation and/or thromboprophylaxis, especially in high-risk situations, such as surgery and pregnancy. Notably, antithrombin concentrates constitute a considerable arsenal for both treatment and prevention of acute venous thrombosis in subjects with antithrombin deficiency. Current evidences are based almost exclusively on retrospective case series, so an integrated functional, biochemical and molecular characterization will be of clinical relevance and guide hematologists' personalized decisions.
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Affiliation(s)
- Carlos Bravo-Pérez
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, IMIB-Arrixaca, CIBERER , Murcia , Spain
| | - Vicente Vicente
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, IMIB-Arrixaca, CIBERER , Murcia , Spain
| | - Javier Corral
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, IMIB-Arrixaca, CIBERER , Murcia , Spain
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5
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De la Morena‐Barrio B, Borràs N, Rodríguez‐Alén A, Morena‐Barrio ME, García‐Hernández JL, Padilla J, Bravo‐Pérez C, Miñano A, Rollón N, Corral J, Vidal F, Vicente V. Identification of the first large intronic deletion responsible of type I antithrombin deficiency not detected by routine molecular diagnostic methods. Br J Haematol 2019; 186:e82-e86. [DOI: 10.1111/bjh.15913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Belén De la Morena‐Barrio
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
| | - Nina Borràs
- Banc de Sang i TeixitsBarcelonaSpain
- Vall d'Hebron Research Institute Universitat Autònoma de Barcelona (VHIR‐UAB) BarcelonaSpain
| | | | - María E. Morena‐Barrio
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
| | - Juan L. García‐Hernández
- Instituto de Investigación Biomédica de Salamanca (IBSAL) Hospital Universitario de SalamancaSalamancaSpain
| | - José Padilla
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
| | - Carlos Bravo‐Pérez
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
| | - Antonia Miñano
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
| | - Noelia Rollón
- Servicio de Hematología Hospital Virgen de la Salud ToledoSpain
| | - Javier Corral
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
| | - Francisco Vidal
- Banc de Sang i TeixitsBarcelonaSpain
- Vall d'Hebron Research Institute Universitat Autònoma de Barcelona (VHIR‐UAB) BarcelonaSpain
- Instituto de Biología Molecular y Celular del Cáncer Consejo Superior de Investigaciones Científicas (CSIC) Universidad de Salamanca SalamancaSpain
- CIBER de Enfermedades Cardiovasculares Madrid Spain
| | - Vicente Vicente
- Servicio de Hematología y Oncología Médica Hospital Universitario Morales Meseguer Centro Regional de Hemodonación Universidad de Murcia IMIB‐Arrixaca, Murcia, CIBERER MurciaSpain
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