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Journal ArticleDOI

Hemofilia: diagnóstico molecular y alternativas de tratamiento

01 Jul 2007-Colombia Medica (Universidad del Valle)-Vol. 38, Iss: 3, pp 308-315

AbstractLa hemofilia es una enfermedad recesiva ligada al cromosoma X que generalmente padecen los hombres. El diagnostico genetico preimplantacion (DGP), el diagnostico prenatal y el diagnostico molecular de las mutaciones que causan hemofilia, se realizan en investigaciones aisladas con el fin de hacer prevencion primaria, asesorar a las portadoras y a sus familias, lo que ha permitido traer al mundo ninos libres de esta enfermedad y tambien mejorar la calidad de vida de los afectados. Los esperanzadores procedimientos en terapia genica (TG) han mostrado gran efectividad, se pretende con ella la produccion normal de la proteina que esta ausente o alterada en los afectados, pero en el momento los ensayos que se llevan a cabo en seres humanos estan detenidos. Aqui se muestran otras terapias alternas que aunque estan en fase de investigacion, permitirian obtener una produccion de proteina a largo termino y que se han desarrollado gracias al entendimiento de la naturaleza molecular de los factores de la coagulacion.

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Journal Article
TL;DR: A Colombian family that apparently suffered the two diseases according to clinical diagnosis and the lack of a genetic study to verify and contrast the diagnosis made by health institutions can lead to a wrong classification of von Willebrand disease as a type of mild Hemophilia.
Abstract: El Factor von Willebrand circula en el plasma formando un complejo con el Factor VIII de coagulacion por enlaces no covalentes. Esta interaccion evita la degradacion enzimatica del Factor VIII y asegura su transporte al lugar de formacion del coagulo de fibrina. Debido a su estrecha relacion, la disminucion de la actividad de un factor puede afectar la actividad del otro, lo que genera un diagnostico clinico equivocado en cuanto a que enfermedad se padece, si Hemofilia A o Enfermedad de von Willebrand. Este estudio reporta el caso de una familia colombiana que segun diagnostico clinico de su fenotipo, padecia las dos enfermedades. Sin embargo, dicha familia carecia de un estudio genetico que permitiera verificar y contrastar el diagnostico que hacen las entidades de salud. Por tal razon, se realizo un diagnostico genetico por pruebas moleculares que detectan mutaciones, como las inversiones en los intrones 1 y 22 por PCR de fragmentos largos y la secuenciacion del gen del Factor VIII, esta ultima no aplicada y publicada en Colombia hasta el momento. Se encontraron dos mutaciones sinonimas en los exones 14 y 26 que no alteran la secuencia de aminoacidos en la proteina; por tanto, se descarta la presencia de Hemofilia A en la familia. Se plantea la posibilidad de un caso de Enfermedad de von Willebrand unicamente. El estudio demuestra la necesidad que hay en el pais de ampliar las pruebas clinicas y de incluir el diagnostico genetico en casos de ambiguedad en el diagnostico de estas coagulopatias. Palabras clave: Hemofilia A, Factor VIII, Enfermedad de von Willebrand. MOLECULAR ANALYSIS OF HEMOPHILIA A IN A COLOMBIAN FAMILY WITH DIAGNOSIS OF HEMOPHILIA A AND VON WILLEBRAND DISEASE ABSTRACT Von Willebrand Factor circulates in plasma in a protein complex together with coagulation Factor VIII, joined by noncovalent bonds. This interaction prevents enzymatic degradation of Factor VIII and ensures its transport to the place of the fibrin clot formation. Because of their close relationship, decrease activity of one factor may affect the other one. The late generates a clinical diagnosis not very accurate for Hemophilia A or von Willebrand disease. We report here a Colombian family that apparently suffered the two diseases according to clinical diagnosis. However, the lack of a genetic study to verify and contrast the diagnosis made by health institutions, which is based on phenotype, only, can lead to a wrong classification of von Willebrand disease as a type of mild Hemophilia. The aim of this study was to confirm the clinical diagnosis in this family by molecular analysis. To achieve this, we identify the presence of Factor VIII gene inversions in introns 22 and 1 by LD - PCR and a general scan of the gene for frame shift mutations or stop codons through three family generations. Two synonymous mutations were found in exons 14 and 26, so no changes were observed in the aminoacid sequences, fact that disregards the presence of Hemophilia A. This family could be a case of von Willebrand disease only. The use of molecular techniques to confirm the clinical diagnosis for bleeding disorders will improve adequate treatment and patient prognosis in Colombia. Key words: Hemophilia A, Factor VIII, von Willebrand disease.

2 citations


Cites background from "Hemofilia: diagnóstico molecular y ..."

  • ...Frecuencia de los alelos de referencia y alterno en poblaciones reportadas en NCBI para la variación rs1800292....

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  • ...Frecuencia de los alelos de referencia y alterno en poblaciones reportadas en NCBI para la variación rs1050705....

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  • ...Con ayuda del programa CLC Main Workbench 7 se alinearon las secuencias de cada individuo con la secuencia consenso proporcionada por NCBI (24)....

    [...]

  • ...De acuerdo con los resultados arrojados por SIFT y PROVEAN, así como en el reporte de NCBI la variación no afecta la proteína, pues es de tipo sinónima y en consecuencia se mantiene el aminoácido serina (NP_000123....

    [...]

  • ...Los alineamientos realizados con el programa CLC Main workbench 7 demostraron la presencia de solo dos variaciones en algunos miembros de la familia, rs1800292 y rs1050705, ya reportadas en bases de datos como NCBI, Kaviar y HAMSTeRS....

    [...]


Journal ArticleDOI
29 Sep 2020
TL;DR: Hemophilia B or Christmas disease was first differentiated from hemophilia A in 1947 and is linked to the X chromosome; women are carriers, but it manifests clinically in men, although cases of symptomatic women carriers have been described.
Abstract: La hemofilia B o enfermedad de Christmas se diferencio por primera vez de la hemofilia A en 1947. Su forma clasica consiste en un trastorno hereditario de la coagulacion causado por mutaciones en el gen F9, que codifica para el factor IX de la coagulacion. Su herencia esta ligada al cromosoma X; las mujeres son portadoras, pero se manifiesta clinicamente en hombres, aunque se han descrito casos de mujeres portadoras sintomaticas. El factor IX activado es una proteina dependiente de vitamina K, sintetizada en el higado, que forma parte del complejo tenasa, cuya funcion es formar la mayor cantidad de trombina en el nuevo modelo de la coagulacion basado en celulas. De acuerdo a la actividad del factor IX, su deficiencia se puede clasificar en leve (5% a 40%), moderada (1% a 5%), o severa (<1%). Su diagnostico se realiza con la presencia de un TPT alargado que corrige con plasma normal y con la determinacion del nivel funcional del factor IX, y se confirma con el estudio molecular que demuestra la mutacion en el gen F9. Su diagnostico diferencial incluye otras patologias como la hemofilia A. El tratamiento con factor IX recombinante es el mas utilizado en la actualidad, pero se vienen desarrollando nuevas terapias con virus adeno-asociados recombinantes que prometen mejorar la calidad de vida para algunos pacientes afectados. La profilaxis juega un papel fundamental, en particular en los casos de enfermedad moderada y severa

1 citations


Journal Article
TL;DR: Based on the insufficiency in present Chinese legislation on gene therapy rules and regulations and comparing with foreign counterparts, a Chinese "Gene Therapy" regulation is suggested to formulate to provide a batter service of gene therapy for the whole population.
Abstract: This paper analyzed ethical and legal issues related to gene therapy.Based on the insufficiency in present Chinese legislation on gene therapy rules and regulations and comparing with foreign counterparts,a Chinese "Gene Therapy" regulation is suggested to formulate to provide a batter service of gene therapy for the whole population.

1 citations


Journal ArticleDOI
06 Oct 2020
TL;DR: Coagulation factors associated with the development of inhibitory antibodies were severe hemophilia and lack of knowledge of the type of factor used prior to entering the follow-up cohort.
Abstract: Background The appearance of inhibitory antibodies against antihemophilic factors is one of the most serious complications related to hemophilia. Objective The objective of this study was to identify variables and factors related to the development of inhibitory antibodies in a group of patients undergoing antihemophilic therapy in Colombia. Methods A case-control study in patients with hemophilia treated in Specialized Healthcare Provider Institutions (IPS-E) in 21 cities of Colombia of any age and with a diagnosis of inhibitory antibodies against factor VIII or IX during 2016. Four controls per case paired by age and type of hemophilia were used. Sociodemographic, clinical, and pharmacological variables were identified and analyzed. Results Seventeen patients with inhibitory antibodies and 68 controls with hemophilia were identified. The mean age was 28.3 ± 17.8 years. A total of 94.1% had hemophilia A, and 88.2% of the cases and 50.0% of the controls had severe hemophilia; 47.1% of the cases and 54.4% of the controls were receiving prophylaxis with coagulation factors. Multivariate analysis showed that having severe hemophilia (OR:17.0, 95%CI:1.32-219.60) and lack of knowledge of the coagulation factor with which the patient was treated before entering the care program in the IPS-E (OR:8.9, 95%CI:1.82-43.75) were significantly associated with a higher probability of developing inhibitory antibodies. Conclusion and relevance Coagulation factors associated with the development of inhibitory antibodies were severe hemophilia and lack of knowledge of the type of factor used prior to entering the follow-up cohort.

References
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Journal ArticleDOI
TL;DR: The mobility shift analysis of single-stranded DNAs on neutral polyacrylamide gel electrophoresis to detect DNA polymorphisms was developed and SSCPs were found to be allelic variants of true Mendelian traits, and therefore they should be useful genetic markers.
Abstract: We developed mobility shift analysis of single-stranded DNAs on neutral polyacrylamide gel electrophoresis to detect DNA polymorphisms. This method follows digestion of genomic DNA with restriction endonucleases, denaturation in alkaline solution, and electrophoresis on a neutral polyacrylamide gel. After transfer to a nylon membrane, the mobility shift due to a nucleotide substitution of a single-stranded DNA fragment could be detected by hybridization with a nick-translated DNA fragment or more clearly with RNA copies synthesized on each strand of the DNA fragment as probes. As the mobility shift caused by nucleotide substitutions might be due to a conformational change of single-stranded DNAs, we designate the features of single-stranded DNAs as single-strand conformation polymorphisms (SSCPs). Like restriction fragment length polymorphisms (RFLPs), SSCPs were found to be allelic variants of true Mendelian traits, and therefore they should be useful genetic markers. Moreover, SSCP analysis has the advantage over RFLP analysis that it can detect DNA polymorphisms and point mutations at a variety of positions in DNA fragments. Since DNA polymorphisms have been estimated to occur every few hundred nucleotides in the human genome, SSCPs may provide many genetic markers.

3,859 citations


Journal ArticleDOI
01 Nov 1984-Nature
Abstract: The complete 186,000 base-pair (bp) human factor VIII gene has been isolated and consists of 26 exons ranging in size from 69 to 3,106 bp and introns as large as 32.4 kilobases (kb). Nine kb of mRNA and protein-coding DNA has been sequenced and the mRNA termini have been mapped. The relationship between internal duplications in factor VIII and evolution of the gene is discussed.

963 citations


Journal ArticleDOI
TL;DR: Of the various types of hemophilia, the most common of these lifelong bleeding disorders are due to an inherited deficiency of factor VIII or factor IX (Table 1).
Abstract: Of the various types of hemophilia, the most common of these lifelong bleeding disorders are due to an inherited deficiency of factor VIII or factor IX (Table 1). The genes for these blood coagulat...

875 citations


Journal ArticleDOI
TL;DR: In the past, men with haemophilia were likely to die in their youth, but with advances in diagnosis, and especially with development of safe and effective treatment, affected individuals can now look forward to a normal life expectancy.
Abstract: The haemophilias are inherited disorders in which one of the coagulation factors is deficient. Although deficiencies of factor VIII (haemophilia A) and factor IX (haemophilia B) are well recognised, von Willebrand's disease is much more common. Rare defects can occur in any of the coagulation factors. In the past, men with haemophilia were likely to die in their youth. With advances in diagnosis, and especially with development of safe and effective treatment, affected individuals can now look forward to a normal life expectancy. Complications of the disorder, particularly the development of antibodies that make treatment ineffective, and of treatment, such as transfusion-transmitted infections, have taken a severe toll on these patients. The future holds the realistic possibility of gene therapy. However, we must not forget that haemophilia is a worldwide disorder that requires significant economic resources not available for the majority.

550 citations


Journal ArticleDOI
15 Sep 1995-Blood
TL;DR: The presence of factor VII inversions is not a major predisposing factor for the development of factor VIII inhibitors; however, slightly more patients with severe hemophilia A and factor VIII inversions develop inhibitors than patients without inversions.
Abstract: Twenty-two molecular diagnostic laboratories from 14 countries participated in a consortium study to estimate the impact of Factor VIII gene inversions in severe hemophilia A. A total of 2,093 patients with severe hemophilia A were studied; of those, 740 (35%) had a type 1 (distal) factor VIII inversion, and 140 (7%) showed a type 2 (proximal) inversion. In 25 cases, the molecular analysis showed additional abnormal or polymorphic patterns. Ninety-eight percent of 532 mothers of patients with inversions were carriers of the abnormal factor VIII gene; when only mothers of nonfamilial cases were studied, 9 de novo inversions in maternal germ cells were observed among 225 cases (approximately 1 de novo maternal origin of the inversion in 25 mothers of sporadic cases). When the maternal grandparental origin was examined, the inversions occurred de novo in male germ cells in 69 cases and female germ cells in 1 case. The presence of factor VIII inversions is not a major predisposing factor for the development of factor VIII inhibitors; however, slightly more patients with severe hemophilia A and factor VIII inversions develop inhibitors (130 of 642 [20%]) than patients with severe hemophilia A without inversions (131 of 821 [16%]).

303 citations