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Tang W, Guo Y. Recurrent hematuria and painful necrotic purpura induced by acquired Protein S deficiency associated with monoclonal immunoglobulin. J Thromb Thrombolysis 2022; 54:156-161. [PMID: 35032256 DOI: 10.1007/s11239-022-02632-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/05/2023]
Abstract
Protein S deficiency is associated with an increased risk of thromboembolism, which may be caused by hereditary deficiency and several physiological and pathologic conditions, such as pregnancy, contraceptive use, liver diseases, inflammatory disease, and certain viruses infections. However, monoclonal immunoglobulin-mediated Protein S deficiency is rarely reported. Here we described a 49-year-old woman with a history of recurrent painful swelling in both lower extremities due to venous thrombosis for 7 years, accompanied by recurrent gross hematuria and multiple painful necrotic purpuras for 5 years, who was then diagnosed with acquired Protein S deficiency induced by the monoclonal immunoglobulin. Then she was successfully treated with rituximab combined with anticoagulation therapy. This case highlights the rare manifestations of Protein S deficiency and the influence of the monoclonal immunoglobulin produced by monoclonal B lymphocytes and monoclonal plasma cells on the activity of Protein S, which can be treated effectively with rituximab combined with anticoagulation therapy.
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Affiliation(s)
- Wenjiao Tang
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, No 37 Guoxue Alley, District Wuhou, Chengdu, 610041, Sichuan, China
| | - Yong Guo
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, No 37 Guoxue Alley, District Wuhou, Chengdu, 610041, Sichuan, China.
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2
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Nagaya S, Maruyama K, Watanabe A, Meguro-Horike M, Imai Y, Hiroshima Y, Horike SI, Kokame K, Morishita E. First report of inherited protein S deficiency caused by paternal PROS1 mosaicism. Haematologica 2021; 107:330-333. [PMID: 34647440 PMCID: PMC8719071 DOI: 10.3324/haematol.2021.278527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- Satomi Nagaya
- Department of Clinical Laboratory Science, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Keiko Maruyama
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Atsushi Watanabe
- Division of Clinical Genetics, Kanazawa University Hospital, Kanazawa, Ishikawa
| | | | - Yuta Imai
- Department of Clinical Laboratory Science, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Yuki Hiroshima
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Nagano
| | - Shin-Ichi Horike
- Advanced Science Research Center, Kanazawa University, Kanazawa, Ishikawa
| | - Koichi Kokame
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hematology, Kanazawa University Hospital, Kanazawa, Ishikawa.
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3
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Franchini M, Mannucci PM. Classic thrombophilic gene variants. Thromb Haemost 2017; 114:885-9. [DOI: 10.1160/th15-02-0141] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/26/2015] [Indexed: 11/05/2022]
Abstract
SummaryThrombophilia is defined as a condition predisposing to the development of venous thromboembolism (VTE) on the basis of a hypercoagu-lable state. Over the past decades, great advances in the pathogenesis of VTE have been made and nowadays it is well established that a thrombophilic state may be associated with acquired and/or inherited factors. The rare loss-of-function mutations of the genes encoding natural anticoagulant proteins (i. e. protein C, protein S and antithrombin) and the more common gain-of-function polymorphisms factor V Leiden and prothrombin G20210A are the main genetic determinants of thrombophilia. In addition, non-O blood group has been consistently demonstrated to be the most frequent inherited marker of an increased risk of VTE. The mechanism role of these inherited thrombophilia markers will be discussed in this narrative review.
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4
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Seo JY, Lee KO, Kim SH, Oh D, Kim DK, Kim HJ. The genomic architecture of the PROS1 gene underlying large tandem duplication mutation that causes thrombophilia from hereditary protein S deficiency. Gene 2014; 547:295-9. [DOI: 10.1016/j.gene.2014.06.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 12/01/2022]
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5
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Hwang ET, Kang WS, Park JW, Lee JH, Han HJ, Shin SY, Kim HJ, Choi JS. Portal-Splenic-Mesenteric Venous Thrombosis in a Patients with Protein S Deficiency due to NovelPROS1Gene Mutation. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:110-4. [DOI: 10.4166/kjg.2014.64.2.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Eui Tae Hwang
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Won Sik Kang
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jin Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Ji Hyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Hyun Jeong Han
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Sang Yong Shin
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ja Sung Choi
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
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6
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Tang L, Jian XR, Hamasaki N, Guo T, Wang HF, Lu X, Wang QY, Hu Y. Molecular basis of protein S deficiency in China. Am J Hematol 2013; 88:899-905. [PMID: 23813890 DOI: 10.1002/ajh.23525] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 11/07/2022]
Abstract
Protein S (ProS) is a physiological inhibitor of coagulation with an important function in the down-regulation of thrombin generation. ProS deficiency is a major risk factor for venous thrombosis. This study enrolled 40 ProS-deficient probands to investigate the molecular basis of hereditary ProS deficiency in Chinese patients. A mutation analysis was performed by resequencing the PROS1 gene. Large deletions were identified by multiplex ligation-dependent probe amplification (MLPA) analysis. A total of 20 different mutations, including 15 novel mutations, were identified in 21 of the 40 index probands. Small mutations were detected in 18 (45.0%) probands, and large deletions were found in 3 (7.5%) probands, leaving 19 (47.5%) patients without causative variants. To evaluate the functional consequences of 2 novel missense variants, ex vivo thrombin-generation assays, bioinformatics tools, and in vitro expression studies were employed. The p.Asn365Lys ProS variant was found to have moderately impaired secretion and reduced activated protein C cofactor activity. In contrast, the p.Pro410His mutant appeared to have severely impaired secretion but full anticoagulant activity. This study is the largest investigation of ProS deficiency in China and the first investigation of the influence of Type I ProS missense mutations on the global level of coagulation function. The p.K196E mutation, which is common in the neighboring Japanese population, was not found in our Chinese population, and null mutations were common in our Chinese population but not common in Japan. Further genetic analysis is warranted to understand the causes of ProS deficiency in patients without a genetic explanation.
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Affiliation(s)
- Liang Tang
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
| | - Xiao-Rong Jian
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
| | - Naotaka Hamasaki
- Department of Pharmaceutical Science; Nagasaki International University, 2825-7 Huis Ten Bosch Sasebo; Nagasaki Japan
| | - Tao Guo
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
| | - Hua-Fang Wang
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
| | - Xuan Lu
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
| | - Qing-Yun Wang
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
| | - Yu Hu
- Institute of Hematology; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; Hubei China
- Hubei Clinical and Research Center of Thrombosis and Haemostasis, Wuhan; Hubei China
- Targeted Biotherapy Key Laboratory of Ministry of Education, Wuhan; Hubei China
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7
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Wypasek E, Alhenc-Gelas M, Undas A. First report of a large PROS1 deletion from exon 1 through 12 detected in Polish patients with deep-vein thrombosis. Thromb Res 2013; 132:143-4. [DOI: 10.1016/j.thromres.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
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8
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Hamasaki N, Kuma H, Tsuda H. Activated protein C anticoagulant system dysfunction and thrombophilia in Asia. Ann Lab Med 2012; 33:8-13. [PMID: 23301217 PMCID: PMC3535202 DOI: 10.3343/alm.2013.33.1.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/21/2012] [Accepted: 11/15/2012] [Indexed: 11/19/2022] Open
Abstract
Thrombophilia that is common among Caucasians is caused by genetic polymorphisms of coagulation factor V Leiden (R506Q) and prothrombin G20210A. Unlike that in Caucasians, thrombophilia that is common in the Japanese and Chinese involve dysfunction of the activated protein C (APC) anticoagulant system caused by abnormal protein S and protein C molecules. Approximately 50% of Japanese and Chinese individuals who develop venous thrombosis have reduced activities of protein S. The abnormal sites causing the protein S molecule abnormalities are distributed throughout the protein S gene, PROS1. One of the most common abnormalities is protein S Tokushima (K155E), which accounts for about 30% of the protein S molecule abnormalities in the Japanese. Whether APC dysfunction occurs in other Asian countries is an important aspect of mapping thrombophilia among Asians. International surveys using an accurate assay system are needed to determine this.
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Affiliation(s)
- Naotaka Hamasaki
- Department of Clinical Chemistry, Faculty of Pharmaceutical Sciences, Natagaki International University, Nagasaki, Japan.
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Lind-Halldén C, Dahlen A, Hillarp A, Zöller B, Dahlbäck B, Halldén C. Small and large PROS1 deletions but no other types of rearrangements detected in patients with protein S deficiency. Thromb Haemost 2012; 108:94-100. [PMID: 22627709 DOI: 10.1160/th12-01-0040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 04/19/2012] [Indexed: 11/05/2022]
Abstract
Protein S deficiency is a dominantly inherited disorder that results from mutations in the PROS1 gene. Previous sequencing of the gene failed to detect mutations in eight out of 18 investigated Swedish families, whereas segregation analyses detected large deletions in three out of the eight families. The present study investigates more thoroughly for the presence of deletions but also for other types of rearrangements. FISH analysis confirmed the existence of the three previously identified large deletions, but failed to identify any other type of rearrangement among the eight analysed families. MLPA analysis of the PROS1 gene revealed two smaller deletions covering two and four exons, respectively. Thus, deletions could be found in five out of eight families where no point mutations could be found despite sequencing of the gene. Twelve additional, not previously analysed, families were subsequently analysed using MLPA. The analysis identified two smaller deletions (3 and 4 exons). Including all PS-deficient families, i.e. also the 10 families where sequencing found a causative point mutation, deletions were identified in seven out of 30 PS-deficient families. A strategy of sequencing followed by MLPA analysis in mutation-negative families identified the causative mutation in 15 out of 18 of Swedish PS-deficient families. Most deletions were different as determined by their sizes, locations and flanking haplotypes. FISH (8 families) and MLPA analysis (20 families) failed to identify other types of rearrangements.
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10
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Caspers M, Pavlova A, Driesen J, Harbrecht U, Klamroth R, Kadar J, Fischer R, Kemkes-Matthes B, Oldenburg J. Deficiencies of antithrombin, protein C and protein S - practical experience in genetic analysis of a large patient cohort. Thromb Haemost 2012; 108:247-57. [PMID: 22627591 DOI: 10.1160/th11-12-0875] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/22/2012] [Indexed: 11/05/2022]
Abstract
Deficiencies of natural anticoagulant proteins including antithrombin (AT), protein C (PC) and protein S (PS) are important causes of inherited thrombophilia. This study aimed to report on the practical experience gained in performing genetic analyses of a large cohort of patients with AT, PC and PS deficiencies and to relate this knowledge to clinical application. We genotyped a large cohort of 709 unrelated patients with AT (231), PC (234) and PS (244) deficiencies referred to us by physicians throughout Germany. Mutations were detected by direct sequencing and multiplex ligation-dependent probe amplification (MLPA). The highest mutation detection rate (MDR) was found for the SERPINC1 gene (83.5%), followed by the PROC (69%) and PROS1 (43%) genes. Even at AT activities close to the normal range (75%), the MDR was 70%. Contrastingly, for PC and PS deficiencies, the MDR dropped significantly and mildly lowered to subnormal values. At PS activities >55% for PS no mutations were detected. Mutation profiles of all three genes were similar with the highest prevalence for missense mutations (63-78%), followed by nonsense (7-11%), splice-site mutations (7-13%), small deletions (1-8%), small insertions/duplications (1-4%) and large deletions (3-6%). In conclusion, genetic testing is a useful diagnostic tool for diagnosing thrombophilia. Based on our data, genetic analysis for patients with AT deficiency is indicated for all subnormal activities. In contrast, genotyping is not advisable for PC activities >70% and for PS activities >55%.
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Affiliation(s)
- Michael Caspers
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
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Duebgen S, Kauke T, Marschall C, Giebl A, Lison S, Hart C, Dick A, Spannagl M. Genotype and laboratory and clinical phenotypes of protein s deficiency. Am J Clin Pathol 2012; 137:178-84. [PMID: 22261441 DOI: 10.1309/ajcp40uxnbtxgkux] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The diagnosis of thrombophilia caused by protein S deficiency remains difficult. From 2005 to 2010, we documented 135 patients with suspected hereditary protein S deficiency for whom mutational analysis of the PROS1 gene had been performed by direct double-stranded sequencing of the amplified 15 exons including splice sites. Multiplex ligation-dependent probe amplification was performed on 12 of 15 exons in cases with no mutation found but a large deletion in the PROS1 gene was suspected. Mutations were identified in 49 patients, 9 by familial screening. Altogether, 17 new and 11 previously described mutations of PROS1 were identified among the 49 patients. After the exclusion of acquired protein S deficiency due to pregnancy or hormonal contraceptives, there remained only 1 case with protein S activity levels less than 40% that could not be explained by sequence variations or deletions in the examined regions of the PROS1 gene. After the exclusion of conditions associated with acquired protein S deficiency, persistently low protein S activity levels are highly indicative of a genetic alteration in PROS1. We observed a clear correlation between the laboratory phenotype and the type of mutation.
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Kitchens WH, Yeh H, Van Cott EM, Elias N, Kawai T, Markmann JF, Hertl M. Protein S deficiency in a living liver donor. Transpl Int 2011; 25:e23-6. [DOI: 10.1111/j.1432-2277.2011.01404.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Kunogi M, Kurihara M, Ikegami TS, Kobayashi T, Shindo N, Kumasaka T, Gunji Y, Kikkawa M, Iwakami SI, Hino O, Takahashi K, Seyama K. Clinical and genetic spectrum of Birt-Hogg-Dube syndrome patients in whom pneumothorax and/or multiple lung cysts are the presenting feature. J Med Genet 2010; 47:281-7. [PMID: 20413710 PMCID: PMC2981024 DOI: 10.1136/jmg.2009.070565] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Birt-Hogg-Dubé syndrome (BHDS) is an inherited autosomal genodermatosis characterised by fibrofolliculomas of the skin, renal tumours and multiple lung cysts. Genetic studies have disclosed that the clinical picture as well as responsible germline FLCN mutations are diverse. OBJECTIVES BHDS may be caused by a germline deletion which cannot be detected by a conventional genetic approach. Real-time quantitative polymerase chain reaction (qPCR) may be able to identify such a mutation and thus provide us with a more accurate clinical picture of BHDS. METHODS This study analysed 36 patients with multiple lung cysts of undetermined causes. Denaturing high performance liquid chromatography (DHPLC) was applied for mutation screening. If no abnormality was detected by DHPLC, the amount of each FLCN exon in genome was quantified by qPCR. RESULTS An FLCN germline mutation was found in 23 (63.9%) of the 36 patients by DHPLC and direct sequencing (13 unique small nucleotide alterations which included 11 novel mutations). A large genomic deletion was identified in two of the remaining 13 patients by qPCR (one patient with exon 14 deletion and one patient with a deletion encompassing exons 9 to 14). Mutations including genomic deletions were most frequently identified in the 3'-end of the FLCN gene including exons 12 and 13 (13/25=52.0%). The BHDS patients whose multiple cysts prompted the diagnosis in this study showed a very low incidence of skin and renal involvement. CONCLUSIONS BHDS is due to large deletions as well as small nucleotide alterations. Racial differences may occur between Japanese and patients of European decent in terms of FLCN mutations and clinical manifestations.
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Affiliation(s)
- Makiko Kunogi
- Department of Respiratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Gross deletions/duplications in PROS1 are relatively common in point mutation-negative hereditary protein S deficiency. Hum Genet 2009; 126:449-56. [PMID: 19466456 PMCID: PMC3774415 DOI: 10.1007/s00439-009-0687-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/14/2009] [Indexed: 12/03/2022]
Abstract
Hereditary protein S (PS) deficiency is an autosomal disorder caused by mutations in the PS gene (PROS1). Conventional PCR-based mutation detection identifies PROS1 point mutations in approximately 50% of the cases. To verify if gross copy number variations (CNVs) are often present in point mutation-negative hereditary PS deficiency we used multiplex ligation-dependent probe amplification (MLPA) as a detection tool in samples from individuals with a high probability of having true PS deficiency. To this end, DNA samples from nine PS deficient probands with family members (seven type I and two type III) and nine isolated probands (three type I and six type III), in whom PROS1 mutations were not found by DNA sequencing, were evaluated. An independent quantitative PCR (qPCR) was performed to confirm the findings of the MLPA assay. Family members were also tested when DNA was available. Gross abnormalities of PROS1 were found in six out of eighteen probands. In three probands complete deletion of the gene was detected. Two probands had a partial deletion involving different parts of the gene (one from exon 4 through 9 and another from exon 9 through 11). One family showed a duplication of part of PROS1. qPCR analysis was in accordance with these results. In conclusion, this study substantiates that gross gene abnormalities in PROS1 are relatively common in hereditary PS deficient patients and that MLPA is a useful tool for direct screening of CNVs in PROS1 point mutation-negative individuals.
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Yoo JH, Kim HJ, Maeng HY, Kim YA, Sun YK, Song JW, Choi JR, Kim SH, Lee KA. Hereditary protein S deficiency from a novel large deletion mutation of the PROS1 gene detected by multiplex ligation-dependent probe amplification (MLPA). Thromb Res 2009; 123:793-5. [DOI: 10.1016/j.thromres.2008.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/25/2008] [Accepted: 12/05/2008] [Indexed: 11/15/2022]
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Choung HS, Kim HJ, Gwak GY, Kim SH, Kim DK. Inherited protein S deficiency as a result of a large duplication mutation of the PROS1 gene detected by multiplex ligation-dependent probe amplification. J Thromb Haemost 2008; 6:1430-2. [PMID: 18489710 DOI: 10.1111/j.1538-7836.2008.03026.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ten Kate MK, Platteel M, Mulder R, Terpstra P, Nicolaes GA, Reitsma PH, van der Steege G, van der Meer J. PROS1analysis in 87 pedigrees with hereditary protein S deficiency demonstrates striking genotype-phenotype associations. Hum Mutat 2008; 29:939-47. [DOI: 10.1002/humu.20687] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Protein S (PS) is an extensively studied protein with an important function in the down-regulation of thrombin generation. Because of the presence of a pseudogene and two different forms of PS in plasma, a bound and a free form, it is one of the most difficult thrombophilias to study. A deficiency of PS predisposes subjects to (recurrent) venous thromboembolism (VTE) and foetal loss. However, the conundrum of diagnosing PS deficiency has led to conflicting reports of PS as a risk factor for VTE. In this review, we aim to present a clinical perspective of PS deficiency.
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Affiliation(s)
- M K ten Kate
- Division of Haemostasis, Thrombosis, and Rheology, Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
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The effect of pedigree structure on detection of deletions and other null alleles. Eur J Hum Genet 2008; 16:1225-34. [PMID: 18414511 DOI: 10.1038/ejhg.2008.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Deletions and other null alleles for genetic markers can be detected as a special case of non-Mendelian inheritance, ie when a parent and a child appear to be homozygous for different alleles. The probability to detect a deletion for a fixed overall number of investigated individuals was calculated for biallelic and multiallelic markers with varying allele frequencies. To determine the effect of increasing the number of parents and grandparents, the probability for this event was derived for a parent and one child, a trio, a trio with one grandparent and a trio with two grandparents. The results for biallelic markers show that for a fixed total number of individuals, a sample of trios with two grandparents is always more efficient than the other family types, despite a lower total number of founder chromosomes in the sample. For multiallelic markers the outcome varies. The effect of adding additional children to a nuclear family was also investigated. For nuclear families, the optimal number of children is two or three, depending on the allele frequencies. It is shown that adding children is more efficient than adding grandparents.
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