Thromb Haemost 2012; 108(04): 693-700
DOI: 10.1160/TH12-03-0177
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Polymorphisms in antithrombin and in tissue factor pathway inhibitor genes are associated with recurrent pregnancy loss

Elvira M. Guerra-Shinohara
1   Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, S P, Brasil
,
Juliano Felix Bertinato
1   Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, S P, Brasil
,
Carolina Tosin Bueno
1   Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, S P, Brasil
,
Kelma Cordeiro da Silva
1   Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, S P, Brasil
,
Mário Henrique Burlacchini de Carvalho
2   Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, S P, Brasil
,
Rossana Pulcineli Vieira Francisco
2   Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, S P, Brasil
,
Marcelo Zugaib
2   Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, S P, Brasil
,
Alvaro Cerda
1   Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, S P, Brasil
,
Vânia Maris Morelli
3   Disciplina de Hematologia e Hemoterapia, Departamento de Oncologia Clínica e Experimental, Universidade Federal de São Paulo, S P, Brasil
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Publikationsverlauf

Received: 21. März 2012

Accepted after major revision: 28. Juli 2012

Publikationsdatum:
29. November 2017 (online)

Summary

Recurrent pregnancy loss (RPL) is a multifactorial condition. The effect of antithrombin (SERPINC1), protein C (PROC), thrombomodulin (THBD) and tissue factor pathway inhibitor (TFPI) single nucleotide polymorphisms (SNPs) on the risk of RPL is thus far unknown. Our objective was to determine the association of SNPs in the above mentioned genes with RPL. We included 117 non-pregnant women with three or more consecutive losses prior to 20 weeks of pregnancy without a previous history of carrying a fetus to viability, and 264 healthy fertile non-pregnant women who had at least two term deliveries and no known pregnancy losses. The PROC (rs1799809 and rs1799808), SERPINC1 (rs2227589), THBD (rs1042579) and TFPI (rs10931292, rs8176592 and rs10153820) SNPs were analysed by Real Time PCR. Genotype frequencies for PROC 2418A>G, PROC 2405C>T, THBD 1418C>T, TFPI (T-33C and TFPI C-399T) SNPs were similar in cases and controls. The carriers of SERPINC1 786A allele (GA + AA genotypes) had an increased risk for RPL (odds ratio [OR]: 1.77, 95% confidence interval [CI]: 1.05 – 3.00, p= 0.034) while women carrying the TFPI –287C allele (TC + CC genotypes) had a protection effect on having RPL (OR: 0.46, 95% CI: 0.26 – 0.83, p= 0.009). The TCC haplotype for TFPI T-33C/ TFPI T-287C/ TFPI C-399T SNPs was less frequent in cases (5.7%) than in controls (11.6%) (OR: 0.45, 95% CI: 0.23 – 0.90, p= 0.025). In conclusion, our data indicate that SERPINC1 786G>A variant increases the risk for RPL, while TFPI T-287C variant is protective; however, further studies are required to confirm our findings.

 
  • References

  • 1 Blumenfeld Z, Brenner B. Thrombophilia-associated pregnancy wastage. Fertil Steril 1999; 72: 765-774.
  • 2 Battinelli EM, Bauer KA. Thrombophilias in pregnancy. Hematol Oncol Clin North Am 2011; 25: 323-333.
  • 3 Crawley JT, Lane DA. The haemostatic role of tissue factor pathway inhibitor. Arterioscler Thromb Vasc Biol 2008; 28: 233-242.
  • 4 Dahlbäck B. Advances in understanding pathogenic mechanisms of thrombophilic disorders. Blood 2008; 112: 19-27.
  • 5 Segers O, van Oerle R, ten Cate H. et al. Thrombin generation as an intermediate phenotype for venous thrombosis. Thromb Haemost 2010; 103: 114-122.
  • 6 IBGE.. Available at: http://www.ibge.gov.br/home/estatistica/populacao/censo2010/ Accessed May 9, 2012..
  • 7 Andrade FL, Annichino-Bizzacchi JM, Saad ST. et al. Prothrombin mutant, factor V Leiden, and thermolabile variant of methylenetetrahydrofolate reductase among patients with sickle cell disease in Brazil. Am J Hematol 1998; 59: 46-50.
  • 8 Poort SR, Rosendaal FR, Reitsma PH. et al. A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis. Blood 1996; 88: 3698-3703.
  • 9 Schaid DJ, Rowland CM, Tines DE. et al. Score tests for association between traits and haplotypes when linkage phase is ambiguous. Am J Hum Genet 2002; 70: 425-434.
  • 10 Pomp ER, Doggen CJ, Vos HL. et al. Polymorphisms in the protein C gene as risk factor for venous thrombosis. Thromb Haemost 2009; 101: 62-67.
  • 11 Heit JA, Petterson TM, Owen WG. et al. Thrombomodulin gene polymorphisms or haplotypes as potential risk factors for venous thromboembolism: a population-based case-control study. J Thromb Haemost 2005; 3: 710-717.
  • 12 Ameziane N, Seguin C, Borgel D. et al. The -33T-->C polymorphism in intron 7 of the TFPI gene influences the risk of venous thromboembolism, independently of the factor V Leiden and prothrombin mutations. Thromb Haemost 2002; 88: 195-199.
  • 13 Lincz LF, Adams MJ, Scorgie FE. et al. Polymorphisms of the tissue factor pathway inhibitor gene are associated with venous thromboembolism in the antiphosp-holipid syndrome and carriers of factor V Leiden. Blood Coagul Fibrinolysis 2007; 18: 559-564.
  • 14 Opstad TB, Pettersen AA, Weiss T. et al. Gender differences of polymorphisms in the TF and TFPI genes, as related to phenotypes in patients with coronary heart disease and type-2 diabetes. Thromb J 2010; 8: 7.
  • 15 Altmäe S, Salumets A, Bjuresten K. et al. Tissue factor and tissue factor pathway inhibitors TFPI and TFPI2 in human secretory endometrium--possible link to female infertility. Reprod Sci 2011; 18: 666-678.
  • 16 Moatti D, Seknadji P, Galand C. et al. Polymorphisms of the tissue factor pathway inhibitor (TFPI) gene in patients with acute coronary syndromes and in healthy subjects - Impact of the V264M substitution on plasma levels of TFPI. Arterioscler Thromb Vasc Biol 1999; 19: 862-869.
  • 17 Moatti D, Haidar B, Fumeron F. et al. A new T-287C polymorphism in the 5' regulatory region of the tissue factor pathway inhibitor gene. Association study of the T-287C and C-399T polymorphisms with coronary artery disease and plasma TFPI levels. Thromb Haemost 2000; 84: 244-249.
  • 18 Opstad TB, Eilertsen AL, Høibraaten E. et al. Tissue factor pathway inhibitor polymorphisms in women with and without a history of venous thrombosis and the effects of postmenopausal hormone therapy. Blood Coagul Fibrinolysis 2010; 21: 516-521.
  • 19 Bezemer ID, Bare LA, Doggen CJ. et al. Gene variants associated with deep vein thrombosis. J Am Med Assoc 2008; 299: 1306-1314.
  • 20 Gadelha T, André C, Jucá AA. et al. Prothrombin 20210A and oral contraceptive use as risk factors for cerebral venous thrombosis. Cerebrovasc Dis 2005; 19: 49-52.
  • 21 Pereira AC, Lourenço DM, Maffei FH. et al. A transcobalamin gene polymorphism and the risk of venous thrombosis. The BRATROS (Brazilian Thrombosis Study). Thromb Res 2007; 119: 183-188.
  • 22 Pena SD, Bastos-Rodrigues L, Pimenta JR. et al. DNA tests probe the genomic ancestry of Brazilians. Braz J Med Biol Res 2009; 42: 870-876.
  • 23 Parra FC, Amado RC, Lambertucci JR. et al. Color and genomic ancestry in Brazilians. Proc Natl Acad Sci USA 2003; 100: 177-182.
  • 24 Pena SD, Di Pietro G, Fuchshuber-Moraes M. et al. The genomic ancestr y of individuals from different geographical regions of Brazil is more uniform than expected. PLoS One 2011; 6: e17063.
  • 25 Giolo SR, Soler JM, Greenway SC. et al. Brazilian urban population genetic structure reveals a high degree of admixture. Eur J Hum Genet 2012; 20: 111-116.
  • 26 Sabadell J, Casellas M, Alijotas-Reig J. et al. Inherited antithrombin deficiency and pregnancy: maternal and fetal outcomes. Eur J Obstet Gynecol Reprod Biol 2010; 149: 47-51.
  • 27 Antón AI, Teruel R, Corral J. et al. Functional consequences of the prothrombotic SERPINC1 rs2227589 polymorphism on antithrombin levels. Haematologica 2009; 94: 589-592.
  • 28 Dahm A, Van Hylckama Vlieg A, Bendz B. et al. Low levels of tissue factor pathway inhibitor (TFPI) increase the risk of venous thrombosis. Blood 2003; 101: 4387-4392.
  • 29 Amini-Nekoo A, Futers TS, Moia M. et al. Analysis of the tissue factor pathway inhibitor gene and antigen levels in relation to venous thrombosis. Br J Haematol 2001; 113: 537-543.
  • 30 Amini Nekoo A, Iles D. Analysis of a T-287C polymorphism in the tissue factor pathway inhibitor gene and identification of a repressor element in the promoter. Thromb Res 2008; 121: 813-819.
  • 31 Zakai NA, Lutsey PL, Folsom AR. et al. Total tissue factor pathway inhibitor and venous thrombosis. The Longitudinal Investigation of Thromboembolism Etiology. Thromb Haemost 2010; 104: 207-212.
  • 32 Hoke M, Kyrle PA, Minar E. et al. Tissue factor pathway inhibitor and the risk of recurrent venous thromboembolism. Thromb Haemost 2005; 94: 787-790.
  • 33 Huang ZF, Higuchi D, Lasky N. et al. Tissue factor pathway inhibitor gene disruption produces intrauterine lethality in mice. Blood 1997; 90: 944-951.
  • 34 Miyata T, Sakata T, Kumeda K. et al. C-399T polymorphism in the promoter region of human tissue factor pathway inhibitor (TFPI) gene does not change the plasma TFPI antigen level and does not cause venous thrombosis. Thromb Haemost 1998; 80: 345-346.
  • 35 Skretting G, Stavik B, Landvik NE. et al. Functional characterization of polymorphisms in the human TFPI gene. Biochem Biophys Res Commun 2010; 397: 106-111.
  • 36 Sandset PM, Hellgren M, Uvebrandt M. et al. Extrinsic coagulation pathway inhibitor and heparin cofactor II during normal and hypertensive pregnancy. Thromb Res 1989; 55: 665-670.
  • 37 Rosenkranz A, Hiden M, Leschnik B. et al. Calibrated automated thrombin generation in normal uncomplicated pregnancy. Thromb Haemost 2008; 99: 331-337.
  • 38 Ittel A, Bretelle F, Gris JC. et al. Increased risk of gestational vascular complications in women with low free tissue factor pathway inhibitor plasma levels out of pregnancy. Thromb Haemost 2011; 105: 66-71.
  • 39 Walker MC, Garner PR, Keely EJ. et al. Changes in activated protein C resistance during normal pregnancy. Am J Obstet Gynecol 1997; 177: 162-169.
  • 40 Hackeng TM, Seré KM, Tans G. et al. Protein S stimulates inhibition of the tissue factor pathway by tissue factor pathway inhibitor. Proc Natl Acad Sci USA 2006; 103: 3106-3111.
  • 41 de Visser MC, van Hylckama Vlieg A, Tans G. et al. Determinants of the APTT-and ETP-based APC sensitivity tests. J Thromb Haemost 2005; 3: 1488-1494.
  • 42 Nesheim ME, Canfield WM, Kisiel W. et al. Studies of the capacity of factor Xa to protect factor Va from inactivation by activated protein C. J Biol Chem 1982; 257: 1443-1447.
  • 43 Rosing J, Hoekema L, Nicolaes GA. et al. Effects of protein S and factor Xa on peptide bond cleavages during inactivation of factor Va and factor VaR506Q by activated protein C. J Biol Chem 1995; 270: 27852-27858.
  • 44 de Visser MC, Rosendaal FR, Bertina RM. A reduced sensitivity for activated protein C in the absence of factor V Leiden increases the risk of venous thrombosis. Blood 1999; 93: 1271-1276.
  • 45 Rodeghiero F, Tosetto A. Activated protein C resistance and factor V Leiden mutation are independent risk factors for venous thromboembolism. Ann Intern Med 1999; 130: 643-650.
  • 46 Gardiner C, Cohen H, Austin SK. et al. Pregnancy loss, tissue factor pathway inhibitor deficiency and resistance to activated protein C. J Thromb Haemost 2006; 4: 2724-2726.
  • 47 Aharon A, Lanir N, Drugan A. et al. Placental TFPI is decreased in gestational vascular complications and can be restored by maternal enoxaparin treatment. J Thromb Haemost 2005; 3: 2355-2357.