5 years ago

Molecular and clinical profile of von Willebrand disease in Spain (PCM-EVW-ES): Comprehensive genetic analysis by next-generation sequencing of 480 patients.

Bermejo, Arribalzaga, Balda, García-Frade, Altisent, Pérez-Montes, Pérez-Rodríguez, Cid, Herrero, Vilariño, Fisac, Rodríguez-Huerta, Batlle, Parra, García-Candel, Sarmiento, Palomo, Cornudella, Aguinaco, de Rueda, Rodríguez-Trillo, López-Fernández, Cabrera, Lourés, Moret, Soto, Mingot-Castellano, Nieto, Iñigo, Alonso, Aguilar, Rodríguez-González, Vidal, Campos, Iruín, Corrales, Mateo, Ferreiro, Berrueco, Martínez, Paloma, Jimimenez-Yuste, Bonanad, Borràs, César, Arija, Cuesta, Vidal, Marco
Molecular diagnosis of patients with von Willebrand disease is pending in most populations due to the complexity and high cost of conventional molecular analyses. The need for molecular and clinical characterization of von Willebrand disease in Spain prompted the creation of a multicenter project (PCM-EVW-ES) that resulted in the largest prospective cohort study of patients with all types of von Willebrand disease. Molecular analysis of relevant regions of the VWF, including intronic and promoter regions, was achieved in the 556 individuals recruited by development of a simple, innovative, relatively low-cost protocol based on microfluidic technology and next-generation sequencing. A total of 704 variants (237 different) were identified along VWF, and 155 had not been previously recorded in the international mutation database. The potential pathogenic effect of these variants was assessed by in silico analysis. Furthermore, 4 short tandem repeats were analyzed to evaluate the ancestral origin of recurrent mutations. The outcome of genetic analysis allowed reclassification of 110 patients, identification of 37 asymptomatic carriers (important for genetic counseling) and re-inclusion of 43 patients previously excluded by phenotyping results. In total, 480 patients were definitively diagnosed. Candidate mutations were identified in all patients except 13 type 1 von Willebrand disease, yielding a high genotype-phenotype correlation. Our data reinforce the capital importance and usefulness of genetics in von Willebrand disease diagnostics. Progressive implementation of molecular study as the first-line test for routine diagnosis of this condition will lead to increasingly more personalized and effective care for this patient population.

Publisher URL: http://doi.org/10.3324/haematol.2017.168765

DOI: 10.3324/haematol.2017.168765

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