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Singh S, Pezeshkpoor B, Jamil MA, Dodt J, Sharma A, Ramar V, Ivaskevicius V, Hethershaw E, Philippou H, Pavlova A, Oldenburg J, Biswas A. Heterozygosity in factor XIII genes and the manifestation of mild inherited factor XIII deficiency. J Thromb Haemost 2024; 22:379-393. [PMID: 37832789 DOI: 10.1016/j.jtha.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND The characterization of inherited mild factor XIII deficiency is more imprecise than its rare, inherited severe forms. It is known that heterozygosity at FXIII genetic loci results in mild FXIII deficiency, characterized by circulating FXIII activity levels ranging from 20% to 60%. There exists a gap in information on 1) how genetic heterozygosity renders clinical bleeding manifestations among these individuals and 2) the reversal of unexplained bleeding upon FXIII administration in mild FXIII-deficient individuals. OBJECTIVES To assess the prevalence and burden of mild FXIII deficiency among the apparently healthy German-Caucasian population and correlate it with genetic heterozygosity at FXIII and fibrinogen gene loci. METHODS Peripheral blood was collected from 752 donors selected from the general population with essentially no bleeding complications to ensure asymptomatic predisposition. These were assessed for FXIII and fibrinogen activity, and FXIII and fibrinogen genes were resequenced using next-generation sequencing. For comparison, a retrospective analysis was performed on a cohort of mild inherited FXIII deficiency patients referred to us. RESULTS The prevalence of mild FXIII deficiency was high (∼0.8%) among the screened German-Caucasian population compared with its rare-severe forms. Although no new heterozygous missense variants were found, certain combinations were relatively dominant/prevalent among the mild FXIII-deficient individuals. CONCLUSION This extensive, population-based quasi-experimental approach revealed that the burden of heterozygosity in FXIII and fibrinogen gene loci causes the clinical manifestation of inherited mild FXIII deficiency, resulting in ''unexplained bleeding'' upon provocation.
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Affiliation(s)
- Sneha Singh
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Behnaz Pezeshkpoor
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Muhammad Ahmer Jamil
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | | | - Amit Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Vasanth Ramar
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Vytautas Ivaskevicius
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Emma Hethershaw
- Division of Cardiovascular and Diabetes Research, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Helen Philippou
- Division of Cardiovascular and Diabetes Research, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Anna Pavlova
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Johannes Oldenburg
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany
| | - Arijit Biswas
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital of Bonn, Bonn, North-Rheine Westfalen, Germany.
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Hardy LJ, Bohinc D, Bane KL, Heal SL, Hethershaw E, Ali M, Palmer-Dench T, Foster R, Longstaff C, Renné T, Stavrou EX, Philippou H. Glycated albumin modulates the contact system with implications for the kallikrein-kinin and intrinsic coagulation systems. J Thromb Haemost 2022; 21:814-827. [PMID: 36990522 DOI: 10.1016/j.jtha.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/23/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Human serum albumin (HSA) is the most abundant plasma protein and is sensitive to glycation in vivo. The chronic hyperglycemic conditions in patients with diabetes mellitus (DM) induce a nonenzymatic Maillard reaction that denatures plasma proteins and forms advanced glycation end products (AGEs). HSA-AGE is a prevalent misfolded protein in patients with DM and is associated with factor XII activation and downstream proinflammatory kallikrein-kinin system activity without any associated procoagulant activity of the intrinsic pathway. OBJECTIVES This study aimed to determine the relevance of HSA-AGE toward diabetic pathophysiology. METHODS The plasma obtained from patients with DM and euglycemic volunteers was probed for activation of FXII, prekallikrein (PK), and cleaved high-molecular-weight kininogen by immunoblotting. Constitutive plasma kallikrein activity was determined via chromogenic assay. Activation and kinetic modulation of FXII, PK, FXI, FIX, and FX via in vitro-generated HSA-AGE were explored using chromogenic assays, plasma-clotting assays, and an in vitro flow model using whole blood. RESULTS Plasma obtained from patients with DM contained increased plasma AGEs, activated FXIIa, and resultant cleaved cleaved high-molecular-weight kininogen. Elevated constitutive plasma kallikrein enzymatic activity was identified, which positively correlated with glycated hemoglobin levels, representing the first evidence of this phenomenon. HSA-AGE, generated in vitro, triggered FXIIa-dependent PK activation but limited the intrinsic coagulation pathway activation by inhibiting FXIa and FIXa-dependent FX activation in plasma. CONCLUSION These data indicate a proinflammatory role of HSA-AGEs in the pathophysiology of DM via FXII and kallikrein-kinin system activation. A procoagulant effect of FXII activation was lost through the inhibition of FXIa and FIXa-dependent FX activation by HSA-AGEs.
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Affiliation(s)
- Lewis J Hardy
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Dillon Bohinc
- Department of Medicine, Hematology and Oncology Division, CWRU School of Medicine, Cleveland, OH, USA
| | - Kara L Bane
- Department of Medicine, Hematology and Oncology Division, CWRU School of Medicine, Cleveland, OH, USA
| | - Samantha L Heal
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Emma Hethershaw
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Majid Ali
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Thomas Palmer-Dench
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Richard Foster
- School of Chemistry, University of Leeds, Leeds, West Yorkshire, UK
| | - Colin Longstaff
- Biotherapeutics Group, Haemostasis Section, National Institute for Biological Standards and Control, South Mimms, Hertfordshire, United Kingdom
| | - Thomas Renné
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Evi X Stavrou
- Department of Medicine, Hematology and Oncology Division, CWRU School of Medicine, Cleveland, OH, USA; Medicine Service, Section of Hematology-Oncology, Louis Stokes Veterans Administration Medical Center, Cleveland, Ohio, USA
| | - Helen Philippou
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom.
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Singh S, Dodt J, Volkers P, Hethershaw E, Philippou H, Ivaskevicius V, Imhof D, Oldenburg J, Biswas A. Structure functional insights into calcium binding during the activation of coagulation factor XIII A. Sci Rep 2019; 9:11324. [PMID: 31383913 PMCID: PMC6683118 DOI: 10.1038/s41598-019-47815-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/24/2019] [Indexed: 01/25/2023] Open
Abstract
The dimeric FXIII-A2, a pro-transglutaminase is the catalytic part of the heterotetrameric coagulation FXIII-A2B2 complex that upon activation by calcium binding/thrombin cleavage covalently cross-links preformed fibrin clots protecting them from premature fibrinolysis. Our study characterizes the recently disclosed three calcium binding sites of FXIII-A concerning evolution, mutual crosstalk, thermodynamic activation profile, substrate binding, and interaction with other similarly charged ions. We demonstrate unique structural aspects within FXIII-A calcium binding sites that give rise to functional differences making FXIII unique from other transglutaminases. The first calcium binding site showed an antagonistic relationship towards the other two. The thermodynamic profile of calcium/thrombin-induced FXIII-A activation explains the role of bulk solvent in transitioning its zymogenic dimeric form to an activated monomeric form. We also explain the indirect effect of solvent ion concentration on FXIII-A activation. Our study suggests FXIII-A calcium binding sites could be putative pharmacologically targetable regions.
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Affiliation(s)
- Sneha Singh
- Institute of Experimental Hematology and Transfusion medicine, University Hospital of Bonn, Bonn, 53127, Germany
| | | | | | - Emma Hethershaw
- Discovery and Translational Science Department, University of Leeds, Leeds, LS29JT, United Kingdom
| | - Helen Philippou
- Discovery and Translational Science Department, University of Leeds, Leeds, LS29JT, United Kingdom
| | - Vytautus Ivaskevicius
- Institute of Experimental Hematology and Transfusion medicine, University Hospital of Bonn, Bonn, 53127, Germany
| | - Diana Imhof
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, An der Immenburg 4, Bonn, 53121, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion medicine, University Hospital of Bonn, Bonn, 53127, Germany
| | - Arijit Biswas
- Institute of Experimental Hematology and Transfusion medicine, University Hospital of Bonn, Bonn, 53127, Germany.
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Al Ghaithi R, Mori J, Nagy Z, Maclachlan A, Hardy L, Philippou H, Hethershaw E, Morgan NV, Senis YA, Harrison P. Evaluation of the Total Thrombus-Formation System (T-TAS): application to human and mouse blood analysis. Platelets 2018; 30:893-900. [PMID: 30365350 DOI: 10.1080/09537104.2018.1535704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 12/26/2022]
Abstract
The Total Thrombus-formation Analyser System (T-TAS) is a whole blood flow chamber system for the measurement of in vitro thrombus formation under variable shear stress conditions. Our current study sought to evaluate the potential utility of the T-TAS for the measurement of thrombus formation within human and mouse whole blood. T-TAS microchips (collagen, PL chip; collagen/tissue thromboplastin, AR chip) were used to analyze platelet (PL) or fibrin-rich thrombus formation, respectively. Blood samples from humans (healthy and patients with mild bleeding disorders) and wild-type (WT), mice were tested. Light transmission lumi-aggregometer (lumi-LTA) was performed in PRP using several concentrations of ADP, adrenaline, arachidonic acid, collagen, PAR-1 peptide and ristocetin. Thrombus growth (N = 22) increased with shear within PL (4:40 ± 1.11, 3:25 ± 0.43 and 3:12 ± 0.48 mins [1000, 1500 and 2000s-1]) and AR chips (3:55 ± 0.42 and 1:49 ± 0.19 [240s-1 and 600s-1]). The area under the curve (AUC) on the PL chip was also reduced at 1000s-1 compared to 1500/2000s-1 (260 ± 51.7, 317 ± 55.4 and 301 ± 66.2, respectively). In contrast, no differences in the AUC between 240s-1 and 600s-1 were observed in the AR chip (1593 ± 122 and 1591 ± 158). The intra-assay coefficient of variation (CV) (n = 10) in the PL chip (1000s-1) and AR chip (240s-1) were T1014.1%, T6016.7%, T10-6022.8% and AUC1024.4% or T10 9.03%, T808.64%, T10-8023.8% and AUC305.1%. AR chip thrombus formation was inhibited by rivaroxaban (1 µM), but not with ticagrelor (10 µM). In contrast, PL chip thrombus formation was totally inhibited by ticagrelor. T-TAS shows an overall agreement with lumi-LTA in 87% of patients (n = 30) with normal PL counts recruited into the genotyping and phenotyping of platelet (GAPP) study and suspected to have a PL function defect. The onset (T10) of thrombus formation in WT mice (N = 4) was shorter when compared to humans e.g. PL chip (1000s-1) T10 were 02:02 ± 00:23 and 03:30 ± 0:45, respectively). T-TAS measures in vitro thrombus formation and can be used for monitoring antithrombotic therapy, investigating patients with suspected PL function defects and monitoring PL function within mice.
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Affiliation(s)
- Rashid Al Ghaithi
- Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
- Institute of Cardiovascular Sciences, Institute for Biomedical Research, University of Birmingham , Birmingham , UK
- Haematology and Blood Transfusion Department, The Royal Hospital, Ministry of Health , Muscat , Sultanate of Oman
| | - Jun Mori
- Institute of Cardiovascular Sciences, Institute for Biomedical Research, University of Birmingham , Birmingham , UK
| | - Zoltan Nagy
- Institute of Cardiovascular Sciences, Institute for Biomedical Research, University of Birmingham , Birmingham , UK
| | - Annabel Maclachlan
- Institute of Cardiovascular Sciences, Institute for Biomedical Research, University of Birmingham , Birmingham , UK
| | - Lewis Hardy
- Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds , Leeds , West Yorkshire , UK
| | - Helen Philippou
- Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds , Leeds , West Yorkshire , UK
| | - Emma Hethershaw
- Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds , Leeds , West Yorkshire , UK
| | - Neil V Morgan
- Institute of Cardiovascular Sciences, Institute for Biomedical Research, University of Birmingham , Birmingham , UK
| | - Yotis A Senis
- Institute of Cardiovascular Sciences, Institute for Biomedical Research, University of Birmingham , Birmingham , UK
| | - Paul Harrison
- Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
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Thomas A, Biswas A, Dodt J, Philippou H, Hethershaw E, Ensikat HJ, Ivaskevicius V, Oldenburg J. Cover Image, Volume 37, Issue 10. Hum Mutat 2016. [DOI: 10.1002/humu.23115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Thomas A, Biswas A, Dodt J, Philippou H, Hethershaw E, Ensikat HJ, Ivaskevicius V, Oldenburg J. Coagulation Factor XIIIA Subunit Missense Mutations Affect Structure and Function at the Various Steps of Factor XIII Action. Hum Mutat 2016; 37:1030-41. [PMID: 27363989 DOI: 10.1002/humu.23041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 06/06/2016] [Accepted: 06/17/2016] [Indexed: 11/06/2022]
Abstract
Inherited defects of coagulation Factor XIII (FXIII) can be categorized into severe and mild forms based on their genotype and phenotype. Heterozygous mutations occurring in F13A1 and F13B genes causing mild FXIII deficiency have been reported only in the last few years primarily because the mild FXIII deficiency patients are often asymptomatic unless exposed to some kind of a physical trauma. However, unlike mutations causing severe FXIII deficiency, many of these mutations have not been comprehensively characterized based on expression studies. In our current article, we have transiently expressed 16 previously reported missense mutations detected in the F13A1 gene of patients with mild FXIII deficiency and analyzed their respective expression phenotype. Complimentary to expression analysis, we have used in silico analysis to understand and explain some of the in vitro findings. The expression phenotype has been evaluated with a number of expression phenotype determining assays. We observe that the mutations influence different aspects of FXIII function and can be functionally categorized on the basis of their expression phenotype. We identified mutations which even in heterozygous form would have strong impact on the functional status of the protein (namely mutations p.Arg716Gly, p.Arg704Gln, p.Gln602Lys, p.Leu530Pro, p.His343Tyr, p.Pro290Arg, and p.Arg172Gln).
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Affiliation(s)
- Anne Thomas
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Arijit Biswas
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany.
| | | | - Helen Philippou
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Emma Hethershaw
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Vytautas Ivaskevicius
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany.
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