Camilleri, R., Cohen, H., Mackie, I.J., Skully, M., Starke, R.D., Crawley, J.T.B., Lane, D.A. and Machin, S.J. 2008. Prevalence of the ADAMTS-13 missense mutation R1060W in late onset adult thrombotic thrombocytopenic purpura. Journal of Thrombosis and Haemostasis. 6 (2), pp. 331-338. https://doi.org/10.1111/j.1538-7836.2008.02846.x
| Title | Prevalence of the ADAMTS-13 missense mutation R1060W in late onset adult thrombotic thrombocytopenic purpura |
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| Authors | Camilleri, R., Cohen, H., Mackie, I.J., Skully, M., Starke, R.D., Crawley, J.T.B., Lane, D.A. and Machin, S.J. |
| Abstract | Background: Thrombotic thrombocytopenic purpura (TTP) is most commonly associated with deficiency or inhibition of von Willebrand factor-cleaving protease (ADAMTS-13) activity. ADAMTS-13 mutations and polymorphisms have been reported in childhood congenital TTP, but their significance in adult onset TTP remains unclear. Objectives: We sought to identify common ADAMTS-13 mutations in adults with late onset TTP and to investigate whether they may predispose acute clinical episodes of the disorder in adulthood. Patients/Methods/Results: We detected a missense mutation (C3178T) in exon 24 of ADAMTS-13 in 6/53 (11.3%) adult onset TTP patients, but no normal controls (n = 100). Three of the patients had pregnancy-associated TTP; three had chronic relapsing acute idiopathic TTP. C3178T encodes an arginine to tryptophan (R1060W) substitution in the TSP1-7 domain of ADAMTS-13. In vitro expression of mutant and wild-type ADAMTS-13 demonstrated that R1060W caused severe intracellular retention of ADAMTS-13 (<5% secretion) without affecting its metalloprotease activity. One homozygous and five heterozygous patients were identified. No other causative mutations were discovered, yet all six patients had ADAMTS-13 activity levels <5% at presentation (normal: 66–126%). Antibodies/inhibitors to ADAMTS-13 were detected in three/five heterozygous patients, and all six patients had subnormal antigen levels. Six asymptomatic first-degree relatives, including those of two probands with antibodies, were also heterozygous for C3178T; all but one had subnormal ADAMTS-13 activity. Conclusion: The high prevalence of R1060W ADAMTS-13 in adult onset TTP, together with its absence in childhood congenital TTP cases reported elsewhere, suggests it may be a factor in the development of late onset TTP. |
| Journal | Journal of Thrombosis and Haemostasis |
| Journal citation | 6 (2), pp. 331-338 |
| ISSN | 1538-7933 |
| Year | Feb 2008 |
| Publisher | Wiley |
| Digital Object Identifier (DOI) | https://doi.org/10.1111/j.1538-7836.2008.02846.x |
| Publication dates | |
| Published | Feb 2008 |