Molecular basis and thrombotic manifestations of antithrombin deficiency in 15 unrelated Chinese patients |
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Authors: | Qiulan Ding Min Wang Guanqun Xu Xu Ye Xiaodong Xi Tingting Yu Xuefeng Wang Hongli Wang |
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Institution: | 1. Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;2. Department of Hematology, Second affiliated Hospital of Guangzhou Medical University, Guangzhou, China;3. State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;4. Institute for Pediatric Translational Medicine, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China |
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Abstract: | IntroductionAntithrombin (AT) deficiency is associated with an increasing risk of thrombosis.Materials and methods15 unrelated patients with AT deficiency defined by thrombophilic assays were recruited and detailed clinical information about patients, focusing on the personal and family history of thromboembolism (TE), were recorded. Mutation analysis was performed by direct sequencing of an AT gene (SERPINC1) in the patients and their family members.ResultsA total of 15 heterozygous causative mutations, each being identified in one family, were identified. Five mutations (33.3%) were reported here for the first time, including three null mutations (Ser36X, Lys70X and Try307X) and two missense mutations (Phe123Cys and Leu340Phe) probably impairing the structural integrity and stability of protein based on the AT structural analysis. Of the 15 patients, 33.3% (5/15) had additional risk factors and only one patient presented with additional genetic alteration causing an early onset of thrombosis. Fourteen patients (93.9%) suffered from multisite recurrent thrombotic episodes after a first episode of thrombosis. 93.3% of the patients experienced deep vein thrombosis (DVT) and 40.0% presented with mesenteric venous thrombosis (MVT). In addition, both venous and arterial thrombosis was present in two unrelated patients. 51.0% subjects with AT deficiency in the 15 unrelated pedigrees experienced TE events.ConclusionsProphylactic anticoagulation may be suggested in AT-deficient patients to avoid the recurrent and multisite thrombosis. The association of primary MVT and AT deficiency is highlighted. |
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Keywords: | SERPINC1 AT gene AT antithrombin TE thromboembolism VTE venous thromboembolism DVT deep venous thrombosis FXa activated factor X MVT mesenteric venous thrombosis PROC protein C gene PE pulmonary embolism PROS protein S gene AT:A activity of antithrombin AT:Ag antigen of antithrombin CT computed tomography MI myocardial infarction ECG electrocardiogram PC:A activity of protein C PC:Ag antigen of protein C PLG plasminogen t-PA tissue plasminogen activator PAI-1 plasminogen activator inhibitor-1 LA lupus anticoagulant ACA anticardiolipin antibody anti-β2GPI anti-β2 glycoprotein 1 Fg fibrinogen FVIII:C activity of factor VIII Hcy homocysteine FPS:A free protein S activity PPP platelet poor plasma HGVS the Human Genome Variation Society |
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