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In silico features of ADAMTS13 contributing to plasmatic ADAMTS13 levels in neonates with congenital heart disease. Thromb Res 2020; 193:66-76. [PMID: 32531546 DOI: 10.1016/j.thromres.2020.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Risk factors contributing to heightened thrombosis in pediatric congenital heart disease (CHD) patients are not fully understood. Among the neonatal CHD population, those presenting with single ventricular physiology are at the highest risk for perioperative thrombosis. The von Willebrand factor and ADAMTS13 interactions have emerged as causative risk factors for pediatric stroke and could contribute to heightened thrombosis in CHD neonates. METHODS This study investigates a cohort of children with single ventricle physiology and undergoing cardiac surgery, during which some patients developed thrombosis. In this cohort, we analyzed the relationship of several molecular features of ADAMTS13 with the plasma and activity levels in patients at risk of thrombosis. Additionally, in light of the natural antithrombotic activity of ADAMTS13, we have sequenced the ADAMTS13 gene for each patient and evaluated the role of genetic variants in determining the plasma ADAMTS13 levels using a series of in silico tools including Hidden Markov Models, EVmutation, and Rosetta. RESULTS Lower ADAMTS13 levels were found in patients that developed thrombosis. A novel in silico analysis to assess haplotype effect of co-occurring variants identified alterations in relative surface area and solvation energy as important contributors. Our analysis suggested that beneficial or deleterious effect of a variant can be reasonably predicted by comprehensive analysis of in silico assessment and in vitro and/or in vivo data. CONCLUSION Findings from this study add to our understanding the role of genetic features of ADAMTS13 in patients at high risk of thrombosis related to an imbalanced relation between VWF and ADAMTS13.
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Fidalgo T, Martinho P, Pinto CS, Oliveira AC, Salvado R, Borràs N, Coucelo M, Manco L, Maia T, Mendes MJ, Del Orbe Barreto R, Corrales I, Vidal F, Ribeiro ML. Combined study of ADAMTS13 and complement genes in the diagnosis of thrombotic microangiopathies using next-generation sequencing. Res Pract Thromb Haemost 2017; 1:69-80. [PMID: 30046676 PMCID: PMC6058207 DOI: 10.1002/rth2.12016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/15/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The 2 main forms of thrombotic microangiopathy (TMA) are thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS). Deficiency of ADAMTS13 and dysregulation of the complement pathway result in TTP and aHUS, respectively; however, overlap of their clinical characteristics makes differential diagnosis challenging. OBJECTIVES AND METHODS We aimed to develop a TMA diagnosis workflow based on ADAMTS13 activity and screening of ADAMTS13 and complement genes using a custom next-generation sequencing (NGS) gene panel. PATIENTS For this, from a cohort of 154 Portuguese patients with acute TMA, the genotype-phenotype correlations were analyzed in 7 hereditary TTP (ADAMTS13 activity <10%, no inhibitor), 36 acquired TTP (ADAMTS13 activity <10%, presence of an inhibitor), and in 34 presumable aHUS. RESULTS In total, 37 different rare variants, 8 of which novel (in ADAMTS13,CFH, and CD46), were identified across 7 genes. Thirteen TTP patients were homozygous (n=6), compound heterozygous (n=2), and heterozygous (n=5) for 11 ADAMTS13 variants (6 pathogenic mutations). Among the 34 aHUS patients, 17 were heterozygous for 23 variants in the different complement genes with distinct consequences, ranging from single pathogenic mutations associated with complete disease penetrance to benign variants that cause aHUS only when combined with other variants and/or CFH and CD46 risk haplotypes or CFHR1-3 deletion. CONCLUSIONS Our study provides evidence of the usefulness of the NGS panel as an excellent technology that enables more rapid diagnosis of TMA, and is a valuable asset in clinical practice to discriminate between TTP and aHUS.
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Affiliation(s)
- Teresa Fidalgo
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Patrícia Martinho
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Catarina S. Pinto
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Ana C. Oliveira
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Ramon Salvado
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Nina Borràs
- Congenital CoagulopathiesBlood and Tissue BankBarcelonaSpain
- Molecular Diagnosis and TherapyVall d'Hebron Research InstituteUniversitat Autònoma de Barcelona (VHIR‐UAB)BarcelonaSpain
| | - Margarida Coucelo
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Licínio Manco
- Research Centre for Anthropology and Health (CIAS), Department of Life SciencesUniversity of CoimbraCoimbraPortugal
| | - Tabita Maia
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - M. João Mendes
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | | | - Irene Corrales
- Congenital CoagulopathiesBlood and Tissue BankBarcelonaSpain
- Molecular Diagnosis and TherapyVall d'Hebron Research InstituteUniversitat Autònoma de Barcelona (VHIR‐UAB)BarcelonaSpain
| | - Francisco Vidal
- Congenital CoagulopathiesBlood and Tissue BankBarcelonaSpain
- Molecular Diagnosis and TherapyVall d'Hebron Research InstituteUniversitat Autònoma de Barcelona (VHIR‐UAB)BarcelonaSpain
| | - M. Letícia Ribeiro
- Department of Clinical HaematologyCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
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Stoll M, Rühle F, Witten A, Barysenka A, Arning A, Strauss C, Nowak-Göttl U. Rare Variants in the ADAMTS13 Von Willebrand Factor-Binding Domain Contribute to Pediatric Stroke. ACTA ACUST UNITED AC 2016; 9:357-67. [PMID: 27412500 DOI: 10.1161/circgenetics.115.001184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently, we reported a gene network of ADAMTS (A Disintegrin-like and Metalloprotease with Thrombospondin motifs) genes as central component of the genetic risk contributing to pediatric stroke. ADAMTS13 is a prime example for such a key component as it cleaves von Willebrand factor multimers, reduces platelet adhesion and aggregation, and downregulates thrombus formation and inflammation. METHODS AND RESULTS We characterized the genetic architecture of ADAMTS13 through targeted next-generation sequencing of 48 affected children and their unaffected siblings and identified in total 241 variants (single nucleotide polymorphisms or insertions/deletions) in the ADAMTS13 gene. From these, based on significance in the sibship disequilibrium test (P<0.05) or protein-altering properties, we selected 21 common variants covering the complete ADAMTS13 gene for genotyping in 270 trios and subsequent association analyses. Transmission disequilibrium testing was performed for affection status and ADAMTS13 activity levels using PLINK and FBAT, respectively. Ten single nucleotide polymorphisms were significantly associated with pediatric stroke (P<0.05 to P<0.001), 2 of which (rs2285489 and rs28793911) were also significantly associated with ADAMTS13 levels (P=0.0004 and P=0.0092). The resulting protective haplotype H1.1. (T:U 95.5: 144.4; P=0.0016) is associated with increased ADAMTS13 levels (age-adjusted P=0.0108). Haplotype association using a sliding window approach assigns this association to the ADAMTS13 von Willebrand factor-binding domain (P=1.2×10(-4)). CONCLUSIONS Our data provide a link between the genetic architecture of ADAMTS13, ADAMTS13 levels, and stroke susceptibility. Altogether, these studies render ADAMTS13 an attractive candidate for functional studies and may contribute to personalized diagnosis and treatment options in future.
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Affiliation(s)
- Monika Stoll
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.).
| | - Frank Rühle
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.)
| | - Anika Witten
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.)
| | - Andrei Barysenka
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.)
| | - Astrid Arning
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.)
| | - Christina Strauss
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.)
| | - Ulrike Nowak-Göttl
- From the Institute of Human Genetics, Genetic Epidemiology, University of Münster, Münster, Germany (M.S., F.R., A.W., A.B., A.A., C.S.); and Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Center, University Hospital Schleswig-Holstein, Kiel, Germany (U.N.-G.)
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