Prothrombin Arg541Trp Mutation Leads to Defective PC (Protein C) Pathway Activation and Constitutes a Novel Genetic Risk Factor for Venous Thrombosis

Author:

Wu Xi1,Dai Jing1,Xu Xiaoqian2,Li Fang3,Li Lei1,Lu Yeling1,Xu Qin3,Ding Qiulan1,Wu Wenman145,Wang Xuefeng145

Affiliation:

1. From the Department of Laboratory Medicine, Ruijin Hospital (X.W., J.D., L.L., Y.L., Q.D., W.W., X.W.), Shanghai Jiao Tong University School of Medicine, Shanghai, China

2. Department of Hematology, Shanghai General Hospital affiliated to Shanghai Jiao Tong University, China (X.X.)

3. State Key Laboratory of Microbial Metabolism, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, China (F.L., Q.X.).

4. Faculty of Laboratory Medicine (W.W., X.W.), Shanghai Jiao Tong University School of Medicine, Shanghai, China

5. Collaborative Innovation Center of Hematology (W.W., X.W.), Shanghai Jiao Tong University School of Medicine, Shanghai, China

Abstract

Objective: Defective PC (protein C) pathway predisposes patients to venous thromboembolism (VTE) and is mostly, but not exclusively, attributed to hereditary PC or PS (protein S) deficiencies and activated PC resistance caused by factor V Leiden mutation. Approach and Results: In a patient with acute mesenteric venous thrombosis and positive family history of VTE associated with the impaired PC pathway function determined by thrombin generation test, we identified a novel heterozygous prothrombin mutation p.Arg541Trp. Two more patients with positive family history of VTE carrying the same mutation were identified in a cohort of another 373 unrelated patients, making an overall prevalence of 0.8%. Family investigation revealed 11 individuals in the 3 pedigrees harboring the heterozygous prothrombin p.Arg541Trp mutation, and 8 of them (72%) had experienced episodes of VTE. Functional studies indicated the mutation moderately decreased procoagulant activity of prothrombin and had mild impact on the inactivation of thrombin by its inhibitor antithrombin. However, the amino acid residue substitution significantly compromised PC activation by thrombin, both in the absence and presence of soluble thrombomodulin, and thus rendered prothrombin function procoagulant biased. Conclusions: In summary, the prothrombin p.Arg541Trp mutation constitutes a new genetic risk factor of VTE by impairing function of PC pathway and tilting thrombin’s procoagulant activity over anticoagulant function.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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