VON WILLEBRAND DISEASE: CLINICAL, COAGULOGICAL, MOLECULAR AND GENETIC DATA COMPARISON
https://doi.org/10.35754/0234-5730-2019-64-3-246-255
Abstract
Introduction. Von Willebrand disease (vWD) — one of the most common coagulopathies — is characterised by a rather complicated inheritance pattern, which can be either dominant or recessive depending on the disease type. Aim. To compare clinical, coagulological and molecular genetic data obtained when examining patients with various types of vWD.
Materials and methods. The vWF gene exons were sequenced in 16 patients suffering from VWD using the Sanger method.
Results. In total, 12 various mutations were identified, one of which (Pro2527His) has not been previously observed in the world population. The c.2435delC microdeletion being a major mutation in many European countries was found to be the most common. This microdeletion was observed in 9 patients, 6 of whom had the most severe recessive form of the disease — type 3 (3 homozygotes). In two patients, this disorder was accompanied by the missense mutation Thr791Met, which allowed the authors to diagnose a rather rare recessive variant of vWD — 2N. In general, the data obtained by molecular genetic analysis correlated with the differential diagnosis of the vWD type, which is based on the clinical picture of the disease and coagulological properties. In only one case, the Arg1374Cys mutation characteristic of type 2 VWD (A/M) was observed in a patient with the alleged type 1 vWD. Most of the mutations were found in exons 18 (mainly c.2435delC deletion) and 28 which makes them the most perspective exons for the mutation search.
Conclusion. The search for mutations in the vWF gene should start from exons 18 and 28. The obtained information provides a basis for developing an economical algorithm aimed at searching for mutations in the vWF gene in our counrtry vWD patients.
About the Authors
D. M. ChernetskayaRussian Federation
Researcher, Laboratory of genetic engineering,
125167, Moscow
E. A. Likhacheva
Russian Federation
Cand. Sci. (Med.), Hematologist, Scientific and consulting department of coagulopathies,
125167, Moscow
O. S. Pshenichnikova
Russian Federation
Senior Researcher, Laboratory of genetic engineering,
125167, Moscow
V. L. Surin
Russian Federation
Senior Researcher, Laboratory of genetic engineering,
125167, Moscow
N. I. Zozulya
Russian Federation
Hematologist, Head of the Scientific and consulting department of coagulopathies,
125167, Moscow
References
1. Rodeghiero F., Castaman G., Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood. 1987; 69: 454–9.
2. Werner E.J., Broxson E.H., Tucker E.L. et al. Prevalence of von Willebrand disease in children: a multiethnic study. J Pediatr. 1993; 123: 893–8.
3. Zimmerman T., Ruggeri Z. Von Willebrand disease. Human Pathology. 1987; 18(2): 140–52. DOI: 10.1016/S0046-8177(87)80332-5
4. Mancuso D.J., Turley E.A., Westfi eld L.A. et al. Structure of the gene for human von Willebrand factor. J Biol Chem. 1989; 264(33): 19514–27.
5. Mancuso D.J., Tuley E.A., Westfi eld L.A. et al. Human von Willebrand factor gene and pseudogene: structural analysis and differentiation by polymerase chain reaction. Biochemistry. 1991; 30(1): 253–69. DOI: 10.1021/bi00215a036
6. Sadler J. A Revised Classifi cation of von Willebrand Disease. Thromb Haemost. 1994; 72(04): 520–5. DOI: 10.1055/s-0038-1642471
7. Federici A.B., Castaman G., Thompson A., Berntorp E. Von Willebrand’s disease: clinical management. Haemophilia. 2006; 12(3): 152–8.
8. Federici A.B., Mannucci P.M. Diagnosis and management of von Willebrand diasease. Haemophilia. 1999; 5(2): 28–37.
9. Blomback M., Eikenboom J., Lane D. et al. Von Willebrand disease biology. Haemophilia. 2012; 18(4): 141–7.
10. Barkagan З.С. Willebrand Disease. In: Manual of Hematology. Vorobiev A.I., ed. Moscow: Newdiamed. 2005; 3: 71–3 (In Russian).
11. Drewke E., Krey S., Schneppenheim R., Budde U. A variant of von Willebrand disease (Type 2N) resembling phenotypically mild or moderately severe haemophilia. Infusionsther Transfusionsmed. 1995; 22 (1): 48–50.
12. Papayan L.P., Golovina O.G. Variant forms of von Willebrand disease. Therapeutic Archive. 1990; 7: 86–92 (In Russian).
13. Mazurier C. Von Willebrand disease masquerading as haemophilia A. Thromb. Haemost. 1992; 67: 391–6.
14. Goodeve A.C. The genetic bases of von Willebrand disease. Blood Reviews. 2010; 24: 123–4. DOI: 10.1016/j.blre.2010.03.003
15. Flood V.H. New insights into genotype and phenotype of VWD. Hematology. 2014; 2014(1): 531–5. DOI: 10.1182/asheducation-2014.1.531
16. Likhacheva E.A., Polyanskaya T.Yu., Zorenko V.Yu., ed. acad. Savchenko V.G. Clinical recommendations for von Willebrand disease diagnosis and treatment. Moscow: National hematological society. 2014.
17. Zhang Z.P., Falk G., Blombäck M. et al. A single cytosine deletion in exon 18 of the von Willebrand factor gene is the most common mutation in Swedish vWD type III patients. Hum Mol Genet. 1992; 1(9): 767–8.
18. Schneppenheim R., Krey S., Bergmann F. et al. Genetic heterogeneity of severe von Willebrand disease type III in the German population. Hum Genet. 1994; 94 (6): 640–52.
19. Jokela V., Lassila R., Szanto T. et al. Phenotypic and genotypic characterization of 10 Finnish patients with von Willebrand disease type 3: discovery of two main mutations. Haemophilia. 2013; 19(6): 344–8. DOI: 10.1111/hae.12225
20. Gaucher C., Jorieux S., Mercier B. et al. The “Normandy” variant of von Willebrand disease: characterization of a point mutation in the von Willebrand factor gene. Blood. 1991; 77(9): 1937–41.
21. Casonato A., Galletta E., Sarolo L., Daidone V. Type 2N von Willebrand disease: Characterization and diagnostic diffi culties. Haemophilia. 2018; 24(1): 134–40. DOI: 10.1111/hae.13366
22. Allen S., Abuzenadah A.M., Hinks J. et al. A novel von Willebrand diseasecausing mutation (Arg273Trp) in the von Willebrand factor propeptide that results in defective multimerization and secretion. Blood. 2000; 96(2): 560–8.
23. Bowman M., Tuttle A., Notley C. et al. The genetics of Canadian type 3 von Willebrand disease: further evidence for co-dominant inheritance of mutant alleles. J Thromb Haemost. 2013; 11(3): 512–20. DOI: 10.1111/jth.12130
24. Hilbert L., Gaucher C., Mazurier C. Identifi cation of two mutations (Arg611Cys and Arg611His) in the A1 loop of von Willebrand factor (vWF) responsible for type 2 von Willebrand disease with decreased platelet-dependent function of vWF. Blood. 1995; 86(3): 1010–8.
25. Goodeve A., Eikenboom J., Castaman G. et al. Phenotype and genotype of a cohort of families historically diagnosed with type 1 von Willebrand disease in the European study, Molecular and Clinical Markers for the Diagnosis and Management of Type 1 von Willebrand Disease (MCMDM-1VWD). Blood. 2007; 109(1): 112–21.
26. Gadisseur A., Berneman Z., Schroyens W. et al. Laboratory diagnosis of von Willebrand disease type 1/2E (2A subtype IIE), type 1 Vicenza and mild type 1 caused by mutations in the D3, D4, B1–B3 and C1–C2 domains of the von Willebrand factor gene. Role of von Willebrand factor multimers and the von Willebrand factor propeptide/antigen ratio. Acta Haematol. 2009;121(2- 3):128–38. Doi: 10.1159/000214853.
27. James P.D., Notley C., Hegadorn C. et al. The mutational spectrum of type 1 von Willebrand disease: Results from a Canadian cohort study. Blood. 2007; 109(1):145–54.
28. Pérez-Casal M., Daly M., Peake I. et al. A de novo mutation in exon 28 of the von Willebrand factor gene in a patient with type IIA von Willebrand’s disease coincides with an MboI polymorphism in the von Willebrand factor pseudogene. Hum Mol Genet. 1993;2(12):2159–61.
29. Ginsburg D., Konkle B.A., Gill J.C. et al. Molecular basis of human von Willebrand disease: analysis of platelet von Willebrand factor mRNA. Proc Natl Acad Sci U S A. 1989;86(10):3723–7.
30. Donnér M., Kristoffersson A.C., Berntorp E. et al. Two new candidate mutations in type IIA von Willebrand’s disease (Arg834-->Gly, Gly846-->Arg) and one polymorphism (Tyr821-->Cys) in the A2 region of the von Willebrand factor. Eur J Haematol. 1993;51(1):38–44.
31. Cumming A., Grundy P., Keeney S. et al. An investigation of the von Willebrand factor genotype in UK patients diagnosed to have type 1 von Willebrand disease. Thromb Haemost. 2006;96(5):630–41.
Review
For citations:
Chernetskaya D.M., Likhacheva E.A., Pshenichnikova O.S., Surin V.L., Zozulya N.I. VON WILLEBRAND DISEASE: CLINICAL, COAGULOGICAL, MOLECULAR AND GENETIC DATA COMPARISON. Russian journal of hematology and transfusiology. 2019;64(3):246-255. (In Russ.) https://doi.org/10.35754/0234-5730-2019-64-3-246-255