Characterisation of large F9 deletions in seven unrelated patients with severe haemophilia B

2014 ◽  
Vol 112 (09) ◽  
pp. 459-465 ◽  
Author(s):  
Qiulan Ding ◽  
Guoling You ◽  
Jing Dai ◽  
Xiaodong Xi ◽  
Hongli Wang ◽  
...  
Keyword(s):  
Large Deletion ◽  
The Other ◽  
Severe Haemophilia ◽  
End Joining ◽  
Haemophilia B ◽  
Large Deletions ◽  
Non Homologous End Joining ◽  
Break Induced Replication ◽  
Long Interspersed Nuclear Element ◽  
Female Carriers

SummaryLarge deletions in the F9 gene are detected in approximately 5% of patients with severe haemophilia B, but only a few deletion breakpoints have been characterised precisely until now. In this study we identified a total of seven large F9 deletions in the index patients and nine female carriers by the AccuCopy technique. We also successfully characterised the exact breakpoints for each large deletion including four deletions encompassing the entire F9 gene by the genome walking method combined with primer walking strategy. The extents of deletion regions ranged from 11.1 to 884 kb. Microhomologies ranged from 2 to 6 bp were identified in the breakpoint junctions of six deletions. The other deletion occurred between two highly homologous sequences of the same long interspersed nuclear element 1 (LINE/L1). Non-homologous end joining (NHEJ) and microhomology-mediated break-induced replication (MMBIR) may be the main causative mechanisms for the six large deletions with microhomologies. Non-allelic homologous recombination (NAHR) may mediate the deletion occurred between the two tandem LINEs in the other large deletion. Repetitive elements and non-B DNA forming motifs identified in the junction regions may contribute to DNA breakage leading to large deletions.

scholarly journals Cas9-induced large deletions and small indels are controlled in a convergent fashion

2020 ◽  
Author(s):  
Michael Kosicki ◽  
Felicity Allen ◽  
Allan Bradley
Keyword(s):  
Embryonic Stem ◽  
Basic Research ◽  
Large Deletion ◽  
End Joining ◽  
Small Indels ◽  
Repair Processes ◽  
Large Deletions ◽  
Non Homologous End Joining ◽  
Deletion Frequency ◽  
In Cells

Repair of Cas9-induced double-stranded breaks results primarily in formation of small indels, but can also cause potentially harmful large deletions. While mechanisms leading to the creation of small indels are relatively well understood, very little is known about the origins of large deletions. Using a novel library of clonal mouse embryonic stem cells bona fide deficient for 32 DNA repair genes, we have shown that large deletion frequency increases in cells impaired for non-homologous end joining and decreases in cells deficient for the central resection gene Nbn and the microhomology-mediated end joining gene Polq. Across deficient clones, increase in large deletion frequency was closely correlated with the increase in the extent of microhomology and the size of small indels, implying a continuity of repair processes across different genomic scales. Furthermore, by targeting diverse genomic sites, we identified examples of repair processes that were highly locus-specific, discovering a novel role for exonuclease Trex1. Finally, we present evidence that indel sizes increase with the overall efficiency of Cas9 mutagenesis. These findings may have impact on both basic research and clinical use of CRISPR-Cas9, in particular in conjunction with repair pathway modulation.

scholarly journals Sequence and Structure Characteristics of 22 Deletion Breakpoints in Intron 44 of the DMD Gene Based on Long-Read Sequencing

2021 ◽  
Vol 12 ◽  
Author(s):  
Chang Geng ◽  
Yuanren Tong ◽  
Siwen Zhang ◽  
Chao Ling ◽  
Xin Wu ◽  
...  
Keyword(s):  
Becker Muscular Dystrophy ◽  
Repetitive Elements ◽  
Loop Formation ◽  
End Joining ◽  
Origin Firing ◽  
Large Deletions ◽  
Long Read ◽  
Non Homologous End Joining ◽  
Dmd Gene ◽  
Palindromic Sequences

Purpose: Exon deletions make up to 80% of mutations in the DMD gene, which cause Duchenne and Becker muscular dystrophy. Exon 45-55 regions were reported as deletion hotspots and intron 44 harbored more than 25% of deletion start points. We aimed to investigate the fine structures of breakpoints in intron 44 to find potential mechanisms of large deletions in intron 44.Methods: Twenty-two dystrophinopathy patients whose deletion started in intron 44 were sequenced using long-read sequencing of a DMD gene capture panel. Sequence homology, palindromic sequences, and polypyrimidine sequences were searched at the breakpoint junctions. RepeatMasker was used to analyze repetitive elements and Mfold was applied to predict secondary DNA structure.Results: With a designed DMD capture panel, 22 samples achieved 2.25 gigabases and 1.28 million reads on average. Average depth was 308× and 99.98% bases were covered at least 1×. The deletion breakpoints in intron 44 were scattered and no breakpoints clustered in any region less than 500 bp. A total of 72.7% of breakpoints located in distal 100 kb of intron 44 and more repetitive elements were found in this region. Microhomologies of 0–1 bp were found in 36.4% (8/22) of patients, which corresponded with non-homologous end-joining. Microhomologies of 2–20 bp were found in 59.1% (13/22) of patients, which corresponded with microhomology-mediated end-joining. Moreover, a 7 bp insertion was found in one patient, which might be evidence of aberrant replication origin firing. Palindromic sequences, polypyrimidine sequences, and small hairpin loops were found near several breakpoint junctions. No evidence of large hairpin loop formation in deletion root sequences was observed.Conclusion: This study was the first to explore possible mechanisms underlying exon deletions starting from intron 44 of the DMD gene based on long-read sequencing. Diverse mechanisms might be associated with deletions in the DMD gene.

scholarly journals Effects of mitoTALENs-Directed Double-Strand Breaks on Plant Mitochondrial Genomes

Genes ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 153
Author(s):  
Shin-ichi Arimura
Keyword(s):  
Double Strand Breaks ◽  
Mitochondrial Genomes ◽  
Transcription Activator ◽  
End Joining ◽  
Strand Breaks ◽  
Large Deletions ◽  
Naturally Occurring ◽  
Copy Numbers ◽  
Nuclear Genomes ◽  
Non Homologous End Joining

Mitochondrial genomes in flowering plants differ from those in animals and yeasts in several ways, including having large and variable sizes, circular, linear and branched structures, long repeat sequences that participate in homologous recombinations, and variable genes orders, even within a species. Understanding these differences has been hampered by a lack of genetic methods for transforming plant mitochondrial genomes. We recently succeeded in disrupting targeted genes in mitochondrial genomes by mitochondria-targeted transcription activator-like effector nucleases (mitoTALENs) in rice, rapeseed, and Arabidopsis. Double-strand breaks created by mitoTALENs were repaired not by non-homologous end-joining (NHEJ) but by homologous recombination (HR) between repeats near and far from the target sites, resulting in new genomic structures with large deletions and different configurations. On the other hand, in mammals, TALENs-induced DSBs cause small insertions or deletions in nuclear genomes and degradation of mitochondrial genomes. These results suggest that the mitochondrial and nuclear genomes of plants and mammals have distinct mechanisms for responding to naturally occurring DSBs. The different responses appear to be well suited to differences in size and copy numbers of each genome.

scholarly journals oca2 targeting using CRISPR/Cas9 in the Malawi cichlid Astatotilapia calliptera

2022 ◽  
Author(s):  
Bethan Clark ◽  
Joel Elkin ◽  
Aleksandra Marconi ◽  
George F Turner ◽  
Alan M Smith ◽  
...  
Keyword(s):  
Lake Malawi ◽  
Large Deletion ◽  
Colour Pattern ◽  
Coding Region ◽  
Genetic Loci ◽  
End Joining ◽  
Knock Out ◽  
Homology Directed Repair ◽  
Non Homologous End Joining

Identifying genetic loci underlying trait variation provides insights into the mechanisms of diversification, but demonstrating causality and characterising the role of genetic loci requires testing candidate gene function, often in non-model species. Here we establish CRISPR/Cas9 editing in Astatotilapia calliptera, a generalist cichlid of the remarkably diverse Lake Malawi radiation. By targeting the gene oca2 required for melanin synthesis in other vertebrate species, we show efficient editing and germline transmission. Gene edits include indels in the coding region, likely a result of non-homologous end joining, and a large deletion in the 3′ UTR due to homology-directed repair. We find that oca2 knock-out A. calliptera lack melanin, which may be useful for developmental imaging in embryos and studying colour pattern formation in adults. As A. calliptera resembles the presumed generalist ancestor of the Lake Malawi cichlids radiation, establishing genome editing in this species will facilitate investigating speciation, adaptation and trait diversification in this textbook radiation.

Διερεύνηση παραγόντων που συμβάλλουν στη γονιδιωματική σταθερότητα με τεχνικές λειτουργικής μικροσκοπίας ζωντανών κυττάρων

2019 ◽  
Author(s):  
Ανδρέας Παναγόπουλος
Keyword(s):  
Homologous Recombination ◽  
Single Strand ◽  
End Joining ◽  
Single Strand Annealing ◽  
Non Homologous End Joining ◽  
Strand Annealing ◽  
Break Induced Replication ◽  
Uv C

Η γονιδιωματική σταθερότητα διατηρείται μέσω του συντονισμού μεταξύ των μηχανισμών του φυσιολογικού κυτταρικού κύκλου και των μηχανισμών απόκρισης σε βλάβη στο γενετικό υλικό. Οι παράγοντες που διαδραματίζουν κομβικό ρόλο στη διασύνδεση των συγκεκριμένων μηχανισμών καθίστανται ιδιαίτερα σημαντικοί. Χαρακτηριστικά παραδείγματα αποτελούν τα Cdt1 και Cdc6 που συμβάλλουν στην αδειοδότηση της αντιγραφής του γενετικού υλικού. Μάλιστα, οι εν λόγω παράγοντες διαδραματίζουν κομβικό ρόλο στον καρκίνο όπου η υπερέκφρασή τους οδηγεί σε γονιδιωματική αστάθεια και επικράτηση κυττάρων με ογκογονικές ιδιότητες. Επιπρόσθετα, η σημαντικότητα τους υποδεικνύεται και από το γεγονός πως ένα ευρύ φάσμα μηχανισμών είναι υπεύθυνο για τη ρύθμισή τους τόσο κατά το φυσιολογικό κυτταρικό κύκλο όσο και μετά από βλάβη στο γενετικό υλικό.Η περιοδική πρωτεόλυση πρωτεϊνών είναι ιδιαίτερα σημαντική για τη διατήρηση της κυτταρικής φυσιολογίας. Η διαδικασία της πρωτεόλυσης πραγματοποιείται μέσω της πρόσδεσης αλυσίδων ουβικουϊτίνης στις πρωτεΐνες-υποστρώματα, οι οποίες στη συνέχεια καθίστανται στόχοι αποικοδόμησης από το πρωτεάσωμα. Η λιγάση της ουβικουϊτίνης CRL4Cdt2 αποτελεί ένα σύμπλοκο υπεύθυνο για την ουβικουϊτινιλίωση μεγάλου αριθμού μορίων που συμβάλλουν στην πρόοδο του κυτταρικού κύκλου. Η ρύθμιση μέσω αυτού του συμπλόκου πραγματοποιείται μέσω της πρόσδεσης του υποστρώματος στο PCNA που βρίσκεται στο DNA. Το CRL4Cdt2 είναι ενεργό κατά τη διάρκεια της S φάσης και μετά από βλάβη στο γενετικό υλικό. Παρά το γεγονός πως η εν λόγω λιγάση της ουβικουϊτίνης αποτελεί έναν κεντρικό ρυθμιστή της γονιδιωματικής σταθερότητας εντούτοις ο μοριακός μηχανισμός αναγνώρισης υποστρώματος δεν είχε διαλευκανθεί πλήρως. Το μέχρι πρόσφατα επικρατές μοντέλο όριζε πως το CRL4Cdt2 στρατολογείται στη χρωματίνη αφού πρώτα έχει σχηματιστεί το σύμπλοκο PCNA-υπόστρωμα. Ερευνητικά δεδομένα από διάφορες ομάδες υποδείκνυαν ένα διαφορετικό μηχανισμό σε σχέση με το συγκεκριμένο μοντέλο. Στην παρούσα διατριβή, με τη χρήση μεταλλαγμάτων του υποδοχέα υποστρώματος της λιγάσης, Cdt2 και ακτινοβολίας UV-C καταφέραμε να διαπιστώσουμε πως η συσσώρευση στην περιοχή της βλάβης πραγματοποιείται μέσω του καρβοξυ-τελικού τμήματος της πρωτεΐνης και συγκεκριμένα μέσω μοτίβου PIP-box που εδράζεται στο καρβόξυ-τελικό άκρο. Τα συγκεκριμένα δεδομένα οδήγησαν στην περιγραφή ενός νέου μοντέλου για το μηχανισμό αναγνώρισης υποστρώματος όπου η λιγάση και το υπόστρωμα συσσωρεύονται ανεξάρτητα στο PCNA. Στη συνέχεια ακολουθεί η αναγνώριση και η ουβικουϊτινιλίωση του υποστρώματος το οποίο στοχεύεται για πρωτεόλυση.Οι διπλές θραύσεις στο γενετικό υλικό είναι μία από τις πιο επιζήμιες βλάβες και μπορούν να προκληθούν από ενδογενείς διεργασίες ή εξωγενείς παράγοντες. Αν δεν επιδιορθωθούν ή επιδιορθωθούν με λανθασμένο τρόπο μπορεί να προκαλέσουν γονιδιωματική αστάθεια. Οι κύριοι επιδιορθωτικοί μηχανισμοί που έχουν αναπτυχθεί προκειμένου να αντιμετωπιστούν οι εν λόγω βλάβες είναι η Μη-Ομόλογη Σύνδεση των Άκρων (Non-Homologous End Joining, NHEJ) που λειτουργεί καθ' όλη τη διάρκεια του κυτταρικού κύκλου και είναι επιρρεπής σε λάθη και ο Ομόλογος Ανασυνδυασμός (Homologous Recombination, HR) που λειτουργεί μόνο κατά τις S και G2 φάσεις του κυτταρικού κύκλου και επιδιορθώνει τις διπλές θραύσεις με υψηλή πιστότητα. Όταν οι συγκεκριμένοι μηχανισμοί παρουσιάζουν αδυναμία επιδιόρθωσης των βλαβών στο γενετικό υλικό τότε η επιδιόρθωση επαφίεται στους εναλλακτικούς επιδιορθωτικούς μηχανισμούς που περιλαμβάνουν την Εναλλακτική Σύνδεση των Άκρων (Alternative Non-Homologous End Joining, A-NHEJ) με κύριο υπομονοπάτι τη Σύνδεση των Άκρων ρυθμιζόμενη από Μικρο-ομολογία (Microhomology Mediated End Joining, MMEJ), τη Σύνδεση Μονού Κλώνου (Single Strand Annealing, SSA) και την Επιδιόρθωση Αντιγραφής Επαγόμενης από Θραύση (Break Induced Replication, BIR). Τα συγκεκριμένα επιδιορθωτικά μονοπάτια αν και βελτιώνουν τις πιθανότητες ενός κυττάρου για επιβίωση μετά από βλάβη εντούτοις παρουσιάζονται ιδιαίτερα επιρρεπή σε λάθη. Προηγούμενα ερευνητικά δεδομένα του εργαστηρίου υπέδειξαν την ταχύτατη συσσώρευση του Cdt1 στην περιοχή της εντοπισμένης βλάβης από UV-A παλμικό laser. Στην παρούσα διατριβή πραγματοποιήθηκε εκτεταμένη μελέτη της πιθανής εμπλοκής του Cdt1 στην επιδιόρθωση των διπλών θραύσεων. Τα ερευνητικά δεδομένα από πειράματα με κυτταρικά συστήματα αναφοράς φθορισμού υποδεικνύουν πως ο συγκεκριμένος παράγοντας συμμετέχει στα βασικά μονοπάτια επιδιόρθωσης NHEJ, HR καθώς και στα εναλλακτικά μονοπάτια SSA και BIR. Πειράματα που πραγματοποιήθηκαν με ετοποσίδιο, neocarzinostatin και ακτίνες Χ προκειμένου να διαλευκανθεί το ακριβές σημείο εμπλοκής του Cdt1 στα μονοπάτια επιδιόρθωσης των διπλών θραύσεων δεν οδήγησαν σε κάποιο ξεκάθαρο συμπέρασμα.Στην παρούσα διατριβή διαπιστώθηκε για πρώτη φορά πως ο αδειοδοτικός παράγοντας Cdc6 διαδραματίζει σημαντικό ρόλο στην επιδιόρθωση των διπλών θραύσεων στο γενετικό υλικό. Συγκεκριμένα με τη χρήση UV-A παλμικού laser διαπιστώθηκε πως το Cdc6 συσσωρεύεται ταχύτατα στην περιοχή της εντοπισμένης βλάβης. Πειράματα με ετοποσίδιο και neocarzinostatin καθώς και με κυτταρικά συστήματα αναφοράς φθορισμού υπέδειξαν πως το Cdc6 εμπλέκεται στο μονοπάτι NHEJ και συγκεκριμένα στα αρχικά στάδια κατά τη συσσώρευση των παραγόντων 53BP1 και RIF1 στα σημεία της βλάβης. Στον αντίποδα η συσσώρευση στα σημεία βλάβης των παραγόντων του μονοπατιού HR, pRPA και Rad51 δεν επηρεάζεται από το Cdc6. Τα συγκεκριμένα πειράματα υπέδειξαν επίσης πως το Cdc6 εμπλέκεται στην ενεργοποίηση της κινάσης ATM χωρίς ωστόσο να επηρεάζει τη φωσφορυλίωση της ιστόνης H2AX. Τέλος, στην παρούσα διατριβή διαπιστώθηκε πως η απουσία του Cdc6 οδηγεί σε ευαισθητοποίηση των καρκινικών κυττάρων σε επώαση με γενοτοξικούς παράγοντες, γεγονός που υποδεικνύει πως η εμπλοκή του Cdc6 στα μονοπάτια απόκρισης στη βλάβη είναι σημαντική για την επιβίωση των κυττάρων. Παράλληλα, υποδεικνύει πως η αποσιώπηση του Cdc6 μπορεί να χρησιμοποιηθεί σε θεραπευτικές προσεγγίσεις για την καταπολέμηση του καρκίνου.

scholarly journals Necessities in the Processing of DNA Double Strand Breaks and Their Effects on Genomic Instability and Cancer

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1671 ◽  
Author(s):  
George Iliakis ◽  
Emil Mladenov ◽  
Veronika Mladenova
Keyword(s):  
High Speed ◽  
Double Strand Breaks ◽  
Dna Double Strand Breaks ◽  
End Joining ◽  
Strand Breaks ◽  
Large Deletions ◽  
Single Strand Annealing ◽  
Modes Of Processing ◽  
Non Homologous End Joining ◽  
Strand Annealing

Double strand breaks (DSBs) are induced in the DNA following exposure of cells to ionizing radiation (IR) and are highly consequential for genome integrity, requiring highly specialized modes of processing. Erroneous processing of DSBs is a cause of cell death or its transformation to a cancer cell. Four mechanistically distinct pathways have evolved in cells of higher eukaryotes to process DSBs, providing thus multiple options for the damaged cells. The homologous recombination repair (HRR) dependent subway of gene conversion (GC) removes IR-induced DSBs from the genome in an error-free manner. Classical non-homologous end joining (c-NHEJ) removes DSBs with very high speed but is unable to restore the sequence at the generated junction and can catalyze the formation of translocations. Alternative end-joining (alt-EJ) operates on similar principles as c-NHEJ but is slower and more error-prone regarding both sequence preservation and translocation formation. Finally, single strand annealing (SSA) is associated with large deletions and may also form translocations. Thus, the four pathways available for the processing of DSBs are not alternative options producing equivalent outcomes. We discuss the rationale for the evolution of pathways with such divergent properties and fidelities and outline the logic and necessities that govern their engagement. We reason that cells are not free to choose one specific pathway for the processing of a DSB but rather that they engage a pathway by applying the logic of highest fidelity selection, adapted to necessities imposed by the character of the DSB being processed. We introduce DSB clusters as a particularly consequential form of chromatin breakage and review findings suggesting that this form of damage underpins the increased efficacy of high linear energy transfer (LET) radiation modalities. The concepts developed have implications for the protection of humans from radon-induced cancer, as well as the treatment of cancer with radiations of high LET.

scholarly journals Harnessing DSB repair to promote efficient homology-dependent and -independent prime editing

2021 ◽  
Author(s):  
Martin Peterka ◽  
Nina Akrap ◽  
Songyuan Li ◽  
Sandra Wimberger ◽  
Pei-Pei Hsieh ◽  
...  
Keyword(s):  
Mammalian Cells ◽  
Strand Break ◽  
End Joining ◽  
Dsb Repair ◽  
Guide Rna ◽  
Large Deletions ◽  
Dna Double Strand Break ◽  
Repair Mechanisms ◽  
Non Homologous End Joining ◽  
Genomic Insertions

Prime editing recently emerged as a next-generation approach for precise genome editing. Here we exploit DNA double-strand break (DSB) repair to develop two novel strategies that install precise genomic insertions using an SpCas9 nuclease-based prime editor (PEn). We first demonstrate that PEn coupled to a regular prime editing guide RNA (pegRNA) efficiently promotes short genomic insertions through a homology-dependent DSB repair mechanism. While PEn editing lead to increased levels of by-products, it rescued pegRNAs that performed poorly with a nickase-based prime editor. We also present a small molecule approach that yielded increased product purity of PEn editing. Next, we developed a homology-independent PEn editing strategy by engineering a single primed insertion gRNA (springRNA) which installs genomic insertions at DSBs through the non-homologous end joining pathway (NHEJ). Lastly, we show that PEn-mediated insertions at DSBs prevent Cas9-induced large chromosomal deletions and provide evidence that continuous Cas9-mediated cutting is one of the mechanisms by which Cas9-induced large deletions arise. Altogether, this work expands the current prime editing toolbox by leveraging distinct DNA repair mechanisms including NHEJ, which represents the primary pathway of DSB repair in mammalian cells.

Performances of an Artificial Reagent for the One-stage Factor IX Assay

1975 ◽  
Vol 33 (03) ◽  
pp. 547-552 ◽  
Author(s):  
L Meunier ◽  
J. P Allain ◽  
D Frommel
Keyword(s):  
Human Plasma ◽  
Factor Ix ◽  
Severe Haemophilia ◽  
Normal Human Plasma ◽  
Haemophilia B ◽  
One Stage ◽  
Normal Human ◽  
The One

SummaryA mixture of adsorbed normal human plasma and chicken plasma was prepared as reagent for factor IX measurement using a one-stage method. The substrate was found to be specific for factor IX. Its performances tested on samples displaying factor IX activity ranging from <l%–2,500% compared favorably with those obtained when using the plasma of severe haemophilia B patients as substrate.

Management of Haemophilia in Sweden

1976 ◽  
Vol 35 (03) ◽  
pp. 510-521 ◽  
Author(s):  
Inga Marie Nilsson
Keyword(s):  
Factor Viii ◽  
Total Population ◽  
Age Groups ◽  
Factor Ix ◽  
Haemophilia A ◽  
Severe Haemophilia ◽  
Haemophilia B ◽  
Human Fraction ◽  
Mild Haemophilia

SummaryThe incidence of living haemophiliacs in Sweden (total population 8.1 millions) is about 1:15,000 males and about 1:30,000 of the entire population. The number of haemophiliacs born in Sweden in 5-year periods between 1931-1975 (June) has remained almost unchanged. The total number of haemophilia families in Sweden is 284 (77% haemophilia A, 23% haemophilia B) with altogether 557 (436 with A and 121 with B) living haemophiliacs. Of the haemophilia A patients 40 % have severe, 18 % moderate, and 42 % mild, haemophilia. The distribution of the haemophilia B patients is about the same. Inhibitors have been demonstrated in 8% of the patients with severe haemophilia A and in 10% of those with severe haemophilia B.There are 2 main Haemophilia Centres (Stockholm, Malmo) to which haemophiliacs from the whole of Sweden are admitted for diagnosis, follow-up and treatment for severe bleedings, joint defects and surgery. Minor bleedings are treated at local hospitals in cooperation with the Haemophilia Centres. The concentrates available for treatment in haemophilia A are human fraction 1-0 (AHF-Kabi), cryoprecipitate, Antihaemophilic Factor (Hyland 4) and Kryobulin (Immuno, Wien). AHF-Kabi is the most commonly used preparation. The concentrates available for treatment in haemophilia B are Preconativ (Kabi) and Prothromplex (Immuno). Sufficient amounts of concentrates are available. In Sweden 3.2 million units of factor VIII and 1.0 million units of factor IX are given per year. Treatment is free of charge.Only 5 patients receive domiciliary treatment, but since 1958 we in Sweden have practised prophylactic treatment of boys (4–18 years old) with severe haemophilia A. At about 5-10 days interval they receive AHF in amounts sufficient to raise the AHF level to 40–50%. This regimen has reduced severe haemophilia to moderate. The joint score is identical with that found in moderate haemophilia in the same age groups. For treatment of patients with haemophilia A and haemophilia B complicated by inhibitors we have used a large dose of antigen (factor VIII or factor IX) combined with cyclophosphamide. In most cases this treatment produced satisfactory haemostasis for 5 to 30 days and prevented the secondary antibody rise.

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