Original articles

Establishment and application of thrombophilia gene detection panel based on next generation sequencing in identification of genetic background of Chinese patients with venous thromboembolism

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  • 1. State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    3. Faculty of Medical Laboratory Science, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2019-05-01

  Online published: 2019-08-25

Abstract

Objective: To develop an accurate, simple and practical method for detecting hereditary risk factors of thrombophilia, which can be used for early diagnosis and treatment guidance in Chinese thrombophilia patients. Methods: Altogether 246 patients with venous thrombosis at our hospital were enrolled. The clinical data and family history were collected. Phenotypic examinations were performed. Eighteen candidate genes related to thrombosis were selected to compose a gene panel through literature searching. Point mutation, small deletion/insertion and copy number variations of this panel were detected by next-generation sequencing and CNVplex® technique. Results: Of the 246 patients with venous thrombosis, 159 patients were identified as having gene mutations. The mutation detection rate was 64.6%. Among them, 69.2% carried a single mutation, 13.2% carried compound heterozygous mutation in one gene, and 17.6% carried mutations of at least two genes. Of the 159 patients carrying gene mutations,144 patients carried mutations of anticoagulant protein genes(SERPINC1, PROS1 and PROC), while 31 patients carried mutations of other 10 genes (F2, F5, F9, F12, PROCR, THBD, SERPIND1, PLG, ADAMTS13 and TFPI), in which some mutations (F2 R384Q and F9 R596Q) had been confirmed to be associated with venous thrombosis. Copy number detection showed that 19 patients had copy number variations, mainly in PROCR and PROS1 genes. In addition, 40 of 61 patients with acquired thrombosis risk factors (antiphospholipid syndrome, surgery or pregnancy, etc.) carried hereditary thrombosis risk factors. Of the 56 patients with normal phenotypic results, 20 of them carried pathogenic thrombotic mutations revealed by genetic analysis. Moreover, of the 72 patients who were in the acute stage of thrombosis or during anticoagulants treatment thus could not take phenotypic examination, 32 were identified as having pathogenic thrombotic mutations. Conclusions: The hemophilia gene detection panel established can screen the hereditary thrombosis risk factors more quickly, effectively and accurately. It is necessary to carry out genetic analysis in patients with acquired risk factors. According to the results of gene analysis, clinicians can provide appropriate preventive treatment to prevent the occurrence or recurrence of thrombosis, and to reduce the occurrence of post-thrombotic syndrome, and is worthy of application in clinical practice.

Cite this article

LI Lei, WU Xi, XU Guanqun, LIANG Qian, DAI Jing, WU Wenman, DING Qiulan, WANG Hongli, WANG Xuefeng . Establishment and application of thrombophilia gene detection panel based on next generation sequencing in identification of genetic background of Chinese patients with venous thromboembolism[J]. Journal of Diagnostics Concepts & Practice, 2019 , 18(04) : 394 -401 . DOI: 10.16150/j.1671-2870.2019.04.004

References

[1] 丁秋兰, 王学锋. 遗传性易栓症的表型和基因诊断流程[J]. 诊断学理论与实践, 2019, 18(2):127-132.
[2] Ding Q, Wang M, Xu G, et al. Molecular basis and thrombotic manifestations of antithrombin deficiency in 15 unrelated Chinese patients[J]. Thromb Res, 2013, 132(3):367-373.
[3] Ding Q, Shen W, Ye X, et al. Clinical and genetic features of protein C deficiency in 23 unrelated Chinese patients[J]. Blood Cells Mol Dis, 2013, 50(1):53-58.
[4] Li L, Wu X, Wu W, et al. Clinical Manifestation and Mutation Spectrum of 53 Unrelated Pedigrees with Protein S Deficiency in China[J]. Thromb Haemost, 2019, 119(3):449-460.
[5] Simioni P, Tormene D, Tognin G, et al. X-linked thrombophilia with a mutant factor IX (factor IX Padua)[J]. N Engl J Med, 2009, 361(17):1671-1675.
[6] Ichinose A, Espling ES, Takamatsu J, et al. Two types of abnormal genes for plasminogen in families with a predisposition for thrombosis[J]. Proc Natl Acad Sci U S A, 1991, 88(1):115-119.
[7] Shigekiyo T, Yoshida H, Matsumoto K, et al. HRG Tokushima: molecular and cellular characterization of histidine-rich glycoprotein (HRG) deficiency[J]. Blood, 1998, 91(1):128-133.
[8] Moatti D, Haidar B, Fumeron F, et al. A new T-287C polymorphism in the 5' regulatory region of the tissue factor pathway inhibitor gene. Association study of the T-287C and C-399T polymorphisms with coronary artery disease and plasma TFPI levels[J]. Thromb Haemost, 2000, 84(2):244-249.
[9] Hu B, Wang QY, Tang L, et al. Association of thrombomodulin c.1418C>T polymorphism and venous thromboembolism[J]. Gene, 2017, 628:56-62.
[10] Wu C, Dwivedi DJ, Pepler L, et al. Targeted gene sequencing identifies variants in the protein C and endothelial protein C receptor genes in patients with unprovoked venous thromboembolism[J]. Arterioscler Thromb Vasc Biol, 2013, 33(11):2674-2681.
[11] Villa P, Aznar J, Vaya A, et al. Hereditary homozygous heparin cofactor II deficiency and the risk of developing venous thrombosis[J]. Thromb Haemost, 1999, 82(3):1011-1014.
[12] Lee EJ, Dykas DJ, Leavitt AD, et al. Whole-exome sequencing in evaluation of patients with venous thromboembolism[J]. Blood Adv, 2017, 1(16):1224-1237.
[13] Yin T, Takeshita S, Sato Y, et al. Alarge deletion of the PROS1 gene in a deep vein thrombosis patient with protein S deficiency[J]. Thromb Haemost, 2007, 98(4):783-789.
[14] Choung HS, Kim HJ, Gwak GY, et al. Inherited protein S deficiency as a result of a large duplication mutation of the PROS1 gene detected by multiplex ligation-dependent probe amplification[J]. J Thromb Haemost, 2008, 6(8):1430-1432.
[15] Reitsma PH. Genetics in thrombophilia. An update[J]. Hamostaseologie, 2015, 35(1):47-51.
[16] Zhang Z, Li C, Wu F, et al. Genomic variations of the mevalonate pathway in porokeratosis[J]. ELife, 2015, 4:e06322.
[17] Richards S, Aziz N, Bale S, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology[J]. Genet Med, 2015, 17(5):405-424.
[18] Sivasundar S, Oommen AT, Prakash O, et al. Molecular defect of 'Prothrombin Amrita': substitution of arginine by glutamine (Arg553 to Gln) near the Na(+) binding loop of prothrombin[J]. Blood Cells Mol Dis, 2013, 50(3):182-183.
[19] Djordjevic V, Kovac M, Miljic P, et al. A novel prothrombin mutation in two families with prominent thrombophi-lia--the first cases of antithrombin resistance in a Caucasian population[J]. J Thromb Haemost, 2013, 11(10):1936-1939.
[20] Baglin T, Gray E, Greaves M, et al. Clinical guidelines for testing for heritable thrombophilia[J]. Br J Haematol, 2010, 149(2):209-220.
[21] Connors JM. Thrombophilia Testing and Venous Thrombosis[J]. N Engl J Med, 2017, 377(12):1177-1187.
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