Expanded repertoire of RASGRP2 variants responsible for platelet dysfunction and severe bleeding
File(s)BRIDGE RASGRP2_revised and submitted.pdf (258.05 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
Heritable platelet function disorders (PFDs) are genetically heterogeneous and poorly characterised. Pathogenic variants in RASGRP2, which encodes calcium and diacylglycerol-regulated guanine exchange factor I (CalDAG-GEFI), have been reported previously in three pedigrees with bleeding and reduced platelet aggregation responses. To better define the phenotype associated with pathogenic RASGRP2 variants, we compared high-throughput sequencing and phenotype data from 2,042 cases in pedigrees with unexplained bleeding or platelet disorders to data from 5,422 controls. Eleven cases harboured 11 different, previously unreported RASGRP2 variants that were biallelic and likely pathogenic. The variants included five high-impact variants predicted to prevent CalDAG-GEFI expression and six missense variants affecting the CalDAG-GEFI CDC25 domain, which mediates Rap1 activation during platelet inside-out αIIbβ3 signalling. Cases with biallelic RASGRP2 variants had abnormal mucocutaneous, surgical and dental bleeding from childhood, requiring at least one blood or platelet transfusion in 78% of cases. Platelets displayed reduced aggregation in response to ADP and epinephrine, but variable aggregation defects with other agonists. There were no other consistent clinical or laboratory features. These data enable definition of human CalDAG-GEFI deficiency as a non-syndromic, recessive PFD associated with a moderate or severe bleeding phenotype and complex defects in platelet aggregation.
Date Issued
2017-08-24
Date Acceptance
2017-06-11
Citation
Blood, 2017, 130 (8), pp.1026-1030
ISSN
1528-0020
Publisher
American Society of Hematology
Start Page
1026
End Page
1030
Journal / Book Title
Blood
Volume
130
Issue
8
Copyright Statement
© 2017 by The American Society of Hematology
Sponsor
Medical Research Council (MRC)
Grant Number
MR/J011711/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Hematology
GENETIC-VARIANTS
WORLDWIDE SURVEY
CALDAG-GEFI
DISORDERS
DIAGNOSIS
THROMBOCYTOPENIA
ACTIVATION
MUTATIONS
DEFECTS
ISTH
Publication Status
Published