Congenital deficiency of factor XIII caused by two missense mutations in a Dutch family

Haemophilia ◽  
2005 ◽  
Vol 11 (5) ◽  
pp. 539-547 ◽  
Author(s):  
W. Onland ◽  
A. N. Boing ◽  
A. B. Meijer ◽  
M. C. L. Schaap ◽  
R. Nieuwland ◽  
...  
Haemophilia ◽  
2015 ◽  
Vol 21 (3) ◽  
pp. 380-385 ◽  
Author(s):  
B. Brand-Staufer ◽  
M. Carcao ◽  
B. A. Kerlin ◽  
A. Will ◽  
M. Williams ◽  
...  

Blood ◽  
1996 ◽  
Vol 87 (1) ◽  
pp. 141-151 ◽  
Author(s):  
H Mikkola ◽  
VC Yee ◽  
M Syrjala ◽  
R Seitz ◽  
R Egbring ◽  
...  

Abstract The characterization of naturally occurring mutations is one way to approach functionally significant domains of polypeptides. About 10 mutations have been reported in factor XIII (FXIII) A-subunit deficiency, but very little is known about the effects of the mutations on the expression or the structure of this enzyme. In this study, the recent crystallization of FXIII A-subunit and determination of the three-dimensional model were used for the first time to pursue the structural consequences of mutations in the A-subunit. The molecular analysis of four families from Sweden, Germany, and Denmark revealed four previously unreported point mutations. Three of the mutations were missense mutations, Arg326-->Gln, Arg252-->Ile, and Leu498-->Pro, and one was a nonsense mutation, a deletion of thymidine in codon for Phe8 resulting in early frameshift and premature termination of the polypeptide chain. In the case of the nonsense mutation, delT Phe8, the steady-state mRNA level of FXIII A-subunit was reduced, as quantitated by reverse transcriptase-polymerase chain reaction and solid-phase minisequencing. In contrast, none of the missense mutations affected mRNA levels, indicating the possible translation of the mutant polypeptides. However, by enzyme-linked immunosorbent analysis and immunofluorescence, all the patients demonstrated a complete lack of detectable factor XIIIA antigen in their platelets. In the structural analysis, we included the mutations described in this work and the Met242-->Thr mutation reported earlier by us. Interestingly, in the three-dimensional model, all four missense mutations are localized in the evolutionarily conserved catalytic core domain. The substitutions are at least 15 A away from the catalytic cleft and do not affect any of the residues known to be directly involved in the enzymatic reaction. The structural analyses suggest that the mutations are most likely interfering with proper folding and stability of the protein, which is in agreement with the observed absence of detectable FXIIIA antigen. Arg326, Arg252, and Met242 are all buried within the molecule. The Arg326-->Gln and Arg252-->Ile mutations are substitutions of smaller, neutral amino acids for large, charged residues. They disrupt the electrostatic balance and hydrogen-bonding interactions in structurally significant areas. The Met242-->Thr mutation is located in the same region of the core domain as the Arg252-->Ile site and is expected to have a destabilizing effect due to an introduction of a smaller, polar residue in a tightly packed hydrophobic pocket. The substitution of proline for Leu498 is predicted to cause unfavorable interatomic contacts and a disruption of the alpha-helix mainchain hydrogen-bonding pattern; it is likely to form a kink in the helix next to the dimer interface and is expected to impair proper dimerization of the A-subunits. In the case of all four missense mutations studied, the knowledge achieved from the three-dimensional model of crystallized FXIII A-subunit provides essential information about the structural significance of the specific residues and aids in understanding the biologic consequences of the mutations observed at the cellular level.


Haemophilia ◽  
2015 ◽  
Vol 21 (3) ◽  
pp. e253-e256 ◽  
Author(s):  
H. Handrkova ◽  
M. Borhany ◽  
V. Schroeder ◽  
N. Fatima ◽  
A. Hussain ◽  
...  

2017 ◽  
Vol 20 (1) ◽  
pp. 9-17
Author(s):  
Akbar Dorgalaleh ◽  
Samira Esmaeili Reykandeh ◽  
Moreza Shamsizadeh ◽  
Behnaz Tavasoli ◽  
Eshagh Moradi ◽  
...  

1976 ◽  
Vol 7 (1) ◽  
pp. 36-40
Author(s):  
Toshiyasu TSUKADA ◽  
Motoji KIMOTO ◽  
Hisomu YAMAGUCHI ◽  
Ichitaro ASAI ◽  
Masu SAIGO ◽  
...  

2018 ◽  
Vol 22 (3) ◽  
Author(s):  
Izabela Romanowska ◽  
Paweł Łaguna ◽  
Katarzyna Koch ◽  
Michał Matysiak

Factor XIII deficiency is very rare bleeding disorder with an incidence of one per several milions of population. It can be congenital or acquired in several medical conditions, for example in malignancies, autoimmune diseases and after some medications. The level of factor XIII < 5% causes clinical manifestations. It presents not only with mucosal, cutaneous and soft tissue bleeding, poor wound healing but also with intracranial haemorrhage. The congenital deficiency in women is the reason reccurent miscarriages. The diagnosis of factor XIII deficiency requires specialistic tests because routine screening tests are normal. The patients are treated with fresh frozen plasma, cryoprecipitate and FXIII concentrates. We present the latest diagnostic methods for factor XIII deficiency and treatment during bleeding episodes as well as prophylactic procedures.


Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4632-4632
Author(s):  
Maissaa Janbain ◽  
Cindy A. Leissinger

Abstract Abstract 4632 Background: FXIII is an essential component of normal hemostasis. Congenital deficiency of FXIII activity is a rare autosomal recessive bleeding disorder with an estimated incidence of one in 3–5 million. A fibrin-stabilizing FXIII concentrate that provides both A and B subunits of FXIII was FDA approved last year for routine prophylactic treatment of congenital FXIII deficiency. There are few data available on replacement of FXIII concentrate in patients with congenital deficiency undergoing surgery and there is no published information on managing FXIII deficient patients undergoing cardiopulmonary bypass (CPB) surgery. It is known that FXIII levels decrease in normal individuals who are placed on the cardiopulmonary bypass pump. Patients/Methods: A 52 year old man with congenital FXIII deficiency (baseline level 20%) underwent an aortic valve replacement. On the day of surgery, immediately prior to intubation, he was given a dose of FXIII concentrate (42 U/kg) which had previously been shown to correct his FXIII level to 100%. Early in surgery, the patient became hypotensive and did not respond to vasopressors, so the chest was opened urgently, internal CPR was performed and the patient was placed on cardiopulmonary bypass. He experienced heavy, poorly controlled bleeding intraoperatively. Factor XIII levels were checked intraoperatively at 3 hrs and 7 hrs post administration of the pre-op FXIII dose, and were 40% and 43% respectively. These levels were considerably lower than expected based on FXIII pharmacokinetic studies done 2 weeks prior to surgery. He received an additional dose of FXIII concentrate (42 U/kg) 8 hours after the original pre-op dose. During surgery he also received 9 units of PRBCs, 3 units of platelets, 7 units of FFP and a single dose of rFVIIa (90 mcg/kg) during the period of excessive bleeding, with ultimate control of bleeding; the patient was transferred to the surgical ICU 6 hours after the surgery was started. He recovered uneventfully and his post-operative FXIII levels were consistent with the published FXIII concentrate half-life of 6–8 days. Discussion: Studies have shown that plasma levels of FXIII decrease by 10–33% in a general population of patients undergoing CPB surgery which is presumed to be due to FXIII consumption during extracorporeal circulation. This raises concerns for effective replacement of FXIII in cases of congenital FXIII deficiency. In the case presented, FXIII levels were approximately 60% lower than anticipated based on pre-surgical pharmacokinetic testing of exogenous FXIII concentrate, and likely resulted in significant clinical bleeding intraoperatively. Further information is needed on surgical management, especially in cases involving extracorporeal circulation; collection of such cases in a registry may be helpful to improve our understanding on how to care for these patients. For now, we recommend using an increased dose of FXIII prior to such surgeries as the 100% correction dose determined in a preoperative challenge test was not enough to restore this patient's FXIII levels during surgery and prevent intraoperative bleeding. Disclosures: Off Label Use: FXIII CONCENTRATE IN SURGERY. Leissinger:CSL Behring: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.


Blood ◽  
1996 ◽  
Vol 87 (1) ◽  
pp. 141-151 ◽  
Author(s):  
H Mikkola ◽  
VC Yee ◽  
M Syrjala ◽  
R Seitz ◽  
R Egbring ◽  
...  

The characterization of naturally occurring mutations is one way to approach functionally significant domains of polypeptides. About 10 mutations have been reported in factor XIII (FXIII) A-subunit deficiency, but very little is known about the effects of the mutations on the expression or the structure of this enzyme. In this study, the recent crystallization of FXIII A-subunit and determination of the three-dimensional model were used for the first time to pursue the structural consequences of mutations in the A-subunit. The molecular analysis of four families from Sweden, Germany, and Denmark revealed four previously unreported point mutations. Three of the mutations were missense mutations, Arg326-->Gln, Arg252-->Ile, and Leu498-->Pro, and one was a nonsense mutation, a deletion of thymidine in codon for Phe8 resulting in early frameshift and premature termination of the polypeptide chain. In the case of the nonsense mutation, delT Phe8, the steady-state mRNA level of FXIII A-subunit was reduced, as quantitated by reverse transcriptase-polymerase chain reaction and solid-phase minisequencing. In contrast, none of the missense mutations affected mRNA levels, indicating the possible translation of the mutant polypeptides. However, by enzyme-linked immunosorbent analysis and immunofluorescence, all the patients demonstrated a complete lack of detectable factor XIIIA antigen in their platelets. In the structural analysis, we included the mutations described in this work and the Met242-->Thr mutation reported earlier by us. Interestingly, in the three-dimensional model, all four missense mutations are localized in the evolutionarily conserved catalytic core domain. The substitutions are at least 15 A away from the catalytic cleft and do not affect any of the residues known to be directly involved in the enzymatic reaction. The structural analyses suggest that the mutations are most likely interfering with proper folding and stability of the protein, which is in agreement with the observed absence of detectable FXIIIA antigen. Arg326, Arg252, and Met242 are all buried within the molecule. The Arg326-->Gln and Arg252-->Ile mutations are substitutions of smaller, neutral amino acids for large, charged residues. They disrupt the electrostatic balance and hydrogen-bonding interactions in structurally significant areas. The Met242-->Thr mutation is located in the same region of the core domain as the Arg252-->Ile site and is expected to have a destabilizing effect due to an introduction of a smaller, polar residue in a tightly packed hydrophobic pocket. The substitution of proline for Leu498 is predicted to cause unfavorable interatomic contacts and a disruption of the alpha-helix mainchain hydrogen-bonding pattern; it is likely to form a kink in the helix next to the dimer interface and is expected to impair proper dimerization of the A-subunits. In the case of all four missense mutations studied, the knowledge achieved from the three-dimensional model of crystallized FXIII A-subunit provides essential information about the structural significance of the specific residues and aids in understanding the biologic consequences of the mutations observed at the cellular level.


PEDIATRICS ◽  
1970 ◽  
Vol 46 (6) ◽  
pp. 848-848
Author(s):  
Mary Hanna

In the article, "Deficiency of Factor XIII: Report of a Family from Newfoundland with Associated Mild Deficiency of Factor XII," by Dr. Mary Hanna (Pediatrics, 46: 611), on page 617, the XII under Effect of Transfusions should have been XIII. The correction has been made in the author's reprints.


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