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Naz A, Biswas A, Khan TN, Goodeve A, Ahmed N, Saqlain N, Ahmed S, Ujjan ID, Shamsi TS, Oldenburg J. Identification of novel mutations in congenital afibrinogenemia patients and molecular modeling of missense mutations in Pakistani population. Thromb J 2017; 15:24. [PMID: 28912669 PMCID: PMC5594472 DOI: 10.1186/s12959-017-0143-3] [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: 11/09/2016] [Accepted: 06/28/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Congenital afibrinogenemia (OMIM #202400) is a rare coagulation disorder that was first described in 1920. It is transmitted as an autosomal recessive trait that is characterized by absent levels of fibrinogen (factor I) in plasma. Consanguinity in Pakistan and its neighboring countries has resulted in a higher number of cases of congenital fibrinogen deficiency in their respective populations. This study focused on the detection of mutations in fibrinogen genes using DNA sequencing and molecular modeling of missense mutations in all three genes [Fibrinogen gene alpha (FGA), beta (FGB) and gamma (FGG)] in Pakistani patients. METHODS This descriptive and cross sectional study was conducted in Karachi and Lahore and fully complied with the Declaration of Helsinki. Patients with fibrinogen deficiency were screened for mutations in the Fibrinogen alpha (FGA), beta (FGB) and gamma (FGG) genes by direct sequencing. Molecular modeling was performed to predict the putative structure functional impact of the missense mutations identified in this study. RESULTS Ten patients had mutations in FGA followed by three mutations in FGB and three mutations in FGG, respectively. Twelve of these mutations were novel. The missense mutations were predicted to result in a loss of stability because they break ordered regions and cause clashes in the hydrophobic core of the protein. CONCLUSIONS Congenital afibrinogenemia is a rapidly growing problem in regions where consanguinity is frequently practiced. This study illustrates that mutations in FGA are relatively more common in Pakistani patients and molecular modeling of the missense mutations has shown damaging protein structures which has profounding effect on phenotypic bleeding manifestations in these patients.
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Affiliation(s)
- Arshi Naz
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi University of Bonn, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan
| | - Arijit Biswas
- Institute of Experimental Hematology and Transfusion Medicine, Bonn, Germany.,Institute of Experimental Hematology and Transfusion Medicine, AG, FXIII Room No. 2.308 Sigmund Freud Street-25, 53127 Bonn, Germany
| | - Tehmina Nafees Khan
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi University of Bonn, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan.,National Institute of blood diseases and bone marrow transplantation, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan
| | - Anne Goodeve
- University of Shieffield, Shiefield, United Kingdom.,Clinical Scientist and Professor of Molecular Medicine, Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH UK
| | - Nisar Ahmed
- Children's Hospital, Resident, Paediatric hematology, Main Ferozpur Road, Lahore, Pakistan
| | - Nazish Saqlain
- Children's Hospital, Resident, Paediatric hematology, Main Ferozpur Road, Lahore, Pakistan
| | - Shariq Ahmed
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi University of Bonn, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan.,National Institute of blood diseases and bone marrow transplantation, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan
| | - Ikram Din Ujjan
- Liaquat university of medical and health sciences, Jamshoro, Pakistan
| | - Tahir S Shamsi
- National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi University of Bonn, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan.,National Institute of blood diseases and bone marrow transplantation, ST 2/A, Block-17, Gulshan-e-Iqbal KDA scheme, 24, Karachi, Pakistan
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, Bonn, Germany.,Institute of Experimental Hematology and Transfusion Medicine, Sigmund Freud Street-25, 53127 Bonn, Germany
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Zhou J, Xin Y, Ding Q, Jiang L, Chen Y, Dai J, Lu Y, Wu X, Liang Q, Wang H, Wang X. Thromboelastography predicts risks of obstetric complication occurrence in (hypo)dysfibrinogenemia patients under non-pregnant state. Clin Exp Pharmacol Physiol 2016; 43:149-56. [PMID: 26510121 DOI: 10.1111/1440-1681.12509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 12/17/2022]
Abstract
Congenital (hypo)dysfibrinogenemia patients may have obstetric complications during their pregnancies. This study aimed to evaluate thromboelastography (TEG) as a potential tool for assessing the tendency for obstetric complications in those patients in a non-pregnant state. A total of 22 female subjects with congenital (hypo)dysfibrinogenemia were recruited. Nine subjects had histories of obstetric complications and the other 13 subjects had at least one uneventful pregnancy without obstetric complications as yet. Detailed clinical investigation and phenotype/genotype detection were carried out, and both kaolin-activated TEG and functional fibrinogen TEG (FF-TEG) were applied in all subjects. Significant differences were identified in all TEG parameters except for R and angle between these two groups (P < 0.05) by covariance analysis. Receiver operating characteristic (ROC) analysis of discrimination between these two groups of patients was performed for TEG parameters. Significantly high odds ratio (OR) of obstetric complications occurrence were demonstrated in K ≥ 3.8 min, maximum amplitude (MA) ≤ 54.2 mm, comprehensive index (CI) ≤ -3 (11.67, 95% CI 1.527-89.121, P < 0.05 in all), and MA-CFF ≤ 12.1 mm (20.00, 95% confidence interval (95% CI) 1.967-203.322, P = 0.002). Moreover, MA-CFF had better prognostic performance, with a corresponding area under the receiver operating curve of 0.923 (range 0.815-1.031, P = 0.001). This study suggests that (hypo)dysfibrinogenemia patients with values outside of the cut-off values of TEG assays under non-pregnant state may have a higher risk of obstetric complications occurring when they are pregnant. No parameters under non-pregnant state in clinical laboratory have ever been reported to be risk factors for obstetric complication occurrence in (hypo)dysfibrinogenemia patients. This study explored such parameters in TEG assays and found that parameters of TEG assays under non-pregnant status might predict the occurrence of obstetric complications, which could provide physicians with important information about whether fibrinogen replacement therapy is required, so as to prevent the occurrence of obstetric complications, especially for patients who are asymptomatic in daily life.
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Affiliation(s)
- Jingyi Zhou
- State Key Laboratory of Medical Genomics, Shanghai Institute of Haematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xin
- Department of Laboratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Qiulan Ding
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linlin Jiang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Haematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaopeng Chen
- Department of Laboratory Medicine, The 303 Hospital of Chinese People's Liberation Army, Nanning, China
| | - Jing Dai
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yeling Lu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Wu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Liang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongli Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Haematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuefeng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhou J, Ding Q, Chen Y, Ouyang Q, Jiang L, Dai J, Lu Y, Wu X, Liang Q, Wang H, Wang X. Clinical features and molecular basis of 102 Chinese patients with congenital dysfibrinogenemia. Blood Cells Mol Dis 2015; 55:308-15. [PMID: 26460252 DOI: 10.1016/j.bcmd.2015.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/08/2015] [Accepted: 06/10/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Congenital dysfibrinogenemia (CD) is a rare qualitative disorder of fibrinogen (Fg) with heterogeneous clinical manifestations. We aimed to analyze clinical phenotype and molecular basis of 102 Chinese CD patients and to evaluate the application of thromboelastography (TEG). MATERIALS AND METHODS Clinical manifestations were recorded and quantified using the consensus ISTH bleeding assessment tool. Kaolin activated TEG and functional Fg TEG were applied in 30 patients. Genetic analysis of Fg genes were performed by direct sequencing. RESULTS 27.5% patients experienced bleeding, 3.9% had thrombosis and 68.6% were asymptomatic. Females were more prone to experience bleeding (P=0.01). Significant difference (P<0.05) in TEG results were found between patients with hot-spot mutations at AαArg35(16) and γArg301(275), but were not identified between patients with and without bleeding. Normal TEG results were found in patients with mutations at AαArg35(16), AαPro37(18) or AαArg38(19). Six novel mutations were identified, including AαGly33(14)del, AαAsp57(38)_Trp60(41)delIVS2+1_+2GTdel, AαPhe742(723)Tyr, γAsn334(308)Thr, γGly335(309)Cys and γTrp395(369)Leu. CONCLUSIONS CD patients have similar clinical manifestations and hot-spot mutations worldwide with no ethnic difference. TEG results could not indicate the bleeding risk in patients, but priority of mutation screening at thrombin cleavage site or polymerization site on Aа chain may be given if TEG results are normal.
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Affiliation(s)
- Jingyi Zhou
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Qiulan Ding
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yaopeng Chen
- Department of Laboratory Medicine, The 303 Hospital of Chinese People's Liberation Army, China
| | - Qi Ouyang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Linlin Jiang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Jing Dai
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yeling Lu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Xi Wu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Qian Liang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Hongli Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Xuefeng Wang
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China.
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Takezawa Y, Matsuda K, Terasawa F, Sugano M, Honda T, Okumura N. siRNA down-regulation of FGA mRNA in HepG2 cells demonstrated that heterozygous abnormality of the Aα-chain gene does not affect the plasma fibrinogen level. Thromb Res 2013; 131:342-8. [DOI: 10.1016/j.thromres.2013.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/06/2012] [Accepted: 01/02/2013] [Indexed: 11/30/2022]
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Takezawa Y, Terasawa F, Matsuda K, Sugano M, Tanaka A, Fujiwara M, Kainuma K, Okumura N. Molecular analysis of afibrinogenemic mutations caused by a homozygous FGA1238 bp deletion, and a compound heterozygous FGA1238 bp deletion and novel FGA c.54+3A>C substitution. Int J Hematol 2012; 96:39-46. [PMID: 22639050 DOI: 10.1007/s12185-012-1100-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/08/2012] [Accepted: 05/11/2012] [Indexed: 11/28/2022]
Abstract
We identified two afibrinogenemic girls in two Japanese families and performed molecular analysis to clarify the mechanisms of fibrinogen defects. Genetic analyses were performed by PCR amplification of the fibrinogen gene and DNA sequence analysis. To analyze the mechanisms of mature fibrinogen defects in plasma, we cloned minigenes from the proposita's PCR-amplified DNA, transfected them into CHO cells, and sequenced the cDNA amplified with the RT reaction followed by PCR. Sequence analyses indicated that one was caused by a homozygous 1238 bp deletion of the fibrinogen Aα-chain gene (FGAΔ1238) and the other was a compound heterozygous FGAΔ1238 and novel FGA c.54+3A>C substitution. The minigene corresponding to FGAΔ1238 generates two aberrant mRNAs, both of which may induce a frameshift and terminate prematurely. In contrast, the minigene corresponding to FGA c.54+3A>C generates two aberrant mRNAs, one of which may induce a frameshift and terminate prematurely, and the other uses a cryptic 5' splice site in exon 1, resulting in the deletion of six amino acids in signal peptides. Molecular analyses of both genetic variants suggest that the lack of a mature Aα-chain, impaired assembly, and/or secretion of the fibrinogen molecule may lead to afibrinogenemia.
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Affiliation(s)
- Yuka Takezawa
- Department of Health and Medical Sciences, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
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Recurrence of the ‘deep-intronic’ FGG IVS6-320A>T mutation causing quantitative fibrinogen deficiency in the Italian population of Veneto. Blood Coagul Fibrinolysis 2009; 20:381-4. [DOI: 10.1097/mbc.0b013e3283256024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spena S, Asselta R, Platé M, Castaman G, Duga S, Tenchini ML. Pseudo-exon activation caused by a deep-intronic mutation in the fibrinogen ?-chain gene as a novel mechanism for congenital afibrinogenaemia. Br J Haematol 2007; 139:128-32. [PMID: 17854317 DOI: 10.1111/j.1365-2141.2007.06758.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Congenital afibrinogenaemia, characterized by severe fibrinogen deficiency, is caused by mutations within FGA, FGB or FGG. Conventional sequencing of coding regions and splice signals of these three genes did not reveal any mutation in an afibrinogenaemic proband. After confirming disease co-segregation with the fibrinogen cluster, full intron sequencing was tackled leading to the identification of a novel transvertion within FGG intron 6 (IVS6-320A-->T). Its effect on mRNA processing was evaluated in-vitro: the in-frame inclusion of a 75-bp pseudo-exon carrying a premature stop was found, representing the first report of pseudo-exon activation as a mechanism leading to afibrinogenaemia.
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Affiliation(s)
- Silvia Spena
- Department of Biology and Genetics for Medical Sciences, University of Milan, Milan, Italy
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