TY - JOUR T1 - ACTN1 mutations lead to a benign form of platelet macrocytosis not always associated with thrombocytopenia. JF - Br J Haematol Y1 - 2018 A1 - Faleschini, Michela A1 - Melazzini, Federica A1 - Marconi, Caterina A1 - Giangregorio, Tania A1 - Pippucci, Tommaso A1 - Cigalini, Elena A1 - Pecci, Alessandro A1 - Bottega, Roberta A1 - Ramenghi, Ugo A1 - Siitonen, Timo A1 - Seri, Marco A1 - Pastore, Annalisa A1 - Savoia, Anna A1 - Noris, Patrizia AB -

The inherited thrombocytopenias (IT) are a heterogeneous group of diseases resulting from mutations in more than 30 different genes. Among them, ACTN1-related thrombocytopenia (ACTN1-RT; Online Mendelian Inheritance in Man: 615193) is one of the most recently identified forms. It has been described as a mild autosomal dominant macrothrombocytopenia caused by mutations in ACTN1, a gene encoding for one of the two non-muscle isoforms of α-actinin. We recently identified seven new unrelated families with ACTN1-RT caused by different mutations. Two of them are novel missense variants (p.Trp128Cys and p.Pro233Leu), whose pathogenic role has been confirmed by in vitro studies. Together with the 10 families we have previously described, our cohort of ACTN1-RT now consists of 49 individuals carrying ACTN1 mutations. This is the largest case series ever collected and enabled a critical evaluation of the clinical aspects of the disease. We concluded that ACTN1-RT is the fourth most frequent form of IT worldwide and it is characterized by platelet macrocytosis in all affected subjects and mild thrombocytopenia in less than 80% of cases. The risk of bleeding, either spontaneous or upon haemostatic challenge, is negligible and there are no other associated defects, either congenital or acquired. Therefore, ACTN1-RT is a benign form of IT, whose diagnosis provides affected individuals and their families with a good prognosis.

VL - 183 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30351444?dopt=Abstract ER - TY - JOUR T1 - A new form of inherited thrombocytopenia due to monoallelic loss of function mutation in the thrombopoietin gene. JF - Br J Haematol Y1 - 2018 A1 - Noris, Patrizia A1 - Marconi, Caterina A1 - De Rocco, Daniela A1 - Melazzini, Federica A1 - Pippucci, Tommaso A1 - Loffredo, Giuseppe A1 - Giangregorio, Tania A1 - Pecci, Alessandro A1 - Seri, Marco A1 - Savoia, Anna VL - 181 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28466964?dopt=Abstract ER - TY - JOUR T1 - Mutations of RUNX1 in families with inherited thrombocytopenia. JF - Am J Hematol Y1 - 2017 A1 - De Rocco, Daniela A1 - Melazzini, Federica A1 - Marconi, Caterina A1 - Pecci, Alessandro A1 - Bottega, Roberta A1 - Gnan, Chiara A1 - Palombo, Flavia A1 - Giordano, Paola A1 - Coccioli, Maria Susanna A1 - Glembotsky, Ana C A1 - Heller, Paula G A1 - Seri, Marco A1 - Savoia, Anna A1 - Noris, Patrizia KW - Adult KW - Blood Platelets KW - Cell Size KW - Child KW - Child, Preschool KW - Core Binding Factor Alpha 2 Subunit KW - Female KW - Frameshift Mutation KW - Genes, Dominant KW - Heterozygote KW - Humans KW - Introns KW - Leukemia, Myeloid, Acute KW - Male KW - Middle Aged KW - Mutation, Missense KW - Protein Domains KW - RNA Splice Sites KW - Sequence Deletion KW - Thrombocythemia, Essential KW - Thrombopoietin KW - Transcriptional Activation KW - Young Adult VL - 92 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28240786?dopt=Abstract ER - TY - JOUR T1 - Clinical and pathogenetic features of ETV6 related thrombocytopenia with predisposition to acute lymphoblastic leukemia. JF - Haematologica Y1 - 2016 A1 - Melazzini, Federica A1 - Palombo, Flavia A1 - Balduini, Alessandra A1 - De Rocco, Daniela A1 - Marconi, Caterina A1 - Noris, Patrizia A1 - Gnan, Chiara A1 - Pippucci, Tommaso A1 - Bozzi, Valeria A1 - Faleschini, Michela A1 - Barozzi, Serena A1 - Doubek, Michael A1 - Di Buduo, Christian A A1 - Stano Kozubik, Katerina A1 - Radova, Lenka A1 - Loffredo, Giuseppe A1 - Pospisilova, Sarka A1 - Alfano, Caterina A1 - Seri, Marco A1 - Balduini, Carlo L A1 - Pecci, Alessandro A1 - Savoia, Anna AB -

ETV6-related thrombocytopenia (ETV6-RT) is an autosomal dominant thrombocytopenia that has been recently identified in a few families and has been suspected to predispose to hematological malignancies. To gain further information on this disorder, we searched for ETV6 mutations in the 130 families with inherited thrombocytopenia of unknown origin from our cohort of 274 consecutive pedigrees with familial thrombocytopenia. We identified 20 ETV6-RT patients from 7 pedigrees. They have 5 different ETV6 variants, including three novel mutations affecting the highly conserved E26 transformation-specific domain. The relative frequency of ETV6-RT resulted 2.6% in the whole case series and 4.6% among the families with known forms of inherited thrombocytopenia. The degree of thrombocytopenia and bleeding tendency of ETV6-RT patients were mild, but 4 subjects developed B-cell acute lymphoblastic leukemia during childhood, resulting in a significantly increased incidence compared to the general population. Clinical and laboratory findings did not identify any peculiar defects that can be used to suspect this disorder by routine diagnostic workup. However, at variance with most inherited thrombocytopenias, platelet size was not enlarged. In vitro studies revealed that patients megakaryocytes have defective maturation and impaired proplatelet formation. Moreover, ETV6-RT platelets have reduced ability to spread on fibrinogen. Since also the dominant thrombocytopenias due to mutations in RUNX1 and ANKRD26 are characterized by normal platelet size and predispose to hematological malignancies, we suggest that mutation screening of ETV6, RUNX1 and ANKRD26 should be performed in all the subjects with autosomal dominant thrombocytopenia and normal platelet size.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/27365488?dopt=Abstract ER - TY - JOUR T1 - Platelet diameters in inherited thrombocytopenias: analysis of 376 patients with all known disorders. JF - Blood Y1 - 2014 A1 - Noris, Patrizia A1 - Biino, Ginevra A1 - Pecci, Alessandro A1 - Civaschi, Elisa A1 - Savoia, Anna A1 - Seri, Marco A1 - Melazzini, Federica A1 - Loffredo, Giuseppe A1 - Russo, Giovanna A1 - Bozzi, Valeria A1 - Notarangelo, Lucia Dora A1 - Gresele, Paolo A1 - Heller, Paula G A1 - Pujol-Moix, Núria A1 - Kunishima, Shinji A1 - Cattaneo, Marco A1 - Bussel, James A1 - De Candia, Erica A1 - Cagioni, Claudia A1 - Ramenghi, Ugo A1 - Barozzi, Serena A1 - Fabris, Fabrizio A1 - Balduini, Carlo L KW - Adolescent KW - Adult KW - Blood Platelets KW - Case-Control Studies KW - Cell Size KW - Child KW - Child, Preschool KW - Diagnosis, Differential KW - Female KW - Hearing Loss, Sensorineural KW - Humans KW - Infant KW - Male KW - Middle Aged KW - Molecular Motor Proteins KW - Mutation KW - Myosin Heavy Chains KW - Purpura, Thrombocytopenic, Idiopathic KW - Thrombocytopenia KW - Young Adult AB -

Abnormalities of platelet size are one of the distinguishing features of inherited thrombocytopenias (ITs), and evaluation of blood films is recommended as an essential step for differential diagnosis of these disorders. Nevertheless, what we presently know about this subject is derived mainly from anecdotal evidence. To improve knowledge in this field, we evaluated platelet size on blood films obtained from 376 patients with all 19 forms of IT identified so far and found that these conditions differ not only in mean platelet diameter, but also in platelet diameter distribution width and the percentage of platelets with increased or reduced diameters. On the basis of these findings, we propose a new classification of ITs according to platelet size. It distinguishes forms with giant platelets, with large platelets, with normal or slightly increased platelet size, and with normal or slightly decreased platelet size. We also measured platelet diameters in 87 patients with immune thrombocytopenia and identified cutoff values for mean platelet diameter and the percentage of platelets with increased or reduced size that have good diagnostic accuracy in differentiating ITs with giant platelets and with normal or slightly decreased platelet size from immune thrombocytopenia and all other forms of IT.

VL - 124 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24990887?dopt=Abstract ER - TY - JOUR T1 - Clinical and laboratory features of 103 patients from 42 Italian families with inherited thrombocytopenia derived from the monoallelic Ala156Val mutation of GPIbα (Bolzano mutation). JF - Haematologica Y1 - 2012 A1 - Noris, Patrizia A1 - Perrotta, Silverio A1 - Bottega, Roberta A1 - Pecci, Alessandro A1 - Melazzini, Federica A1 - Civaschi, Elisa A1 - Russo, Sabina A1 - Magrin, Silvana A1 - Loffredo, Giuseppe A1 - Di Salvo, Veronica A1 - Russo, Giovanna A1 - Casale, Maddalena A1 - De Rocco, Daniela A1 - Grignani, Claudio A1 - Cattaneo, Marco A1 - Baronci, Carlo A1 - Dragani, Alfredo A1 - Albano, Veronica A1 - Jankovic, Momcilo A1 - Scianguetta, Saverio A1 - Savoia, Anna A1 - Balduini, Carlo L KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Bernard-Soulier Syndrome KW - Child KW - Child, Preschool KW - Family Health KW - Female KW - Heterozygote KW - Humans KW - Infant KW - Italy KW - Male KW - Membrane Glycoproteins KW - Middle Aged KW - Mutation, Missense KW - Platelet Aggregation KW - Platelet Count KW - Platelet Glycoprotein GPIb-IX Complex KW - Polymorphism, Genetic KW - Thrombocytopenia KW - Thrombopoietin KW - Tubulin KW - Young Adult AB -

BACKGROUND: Bernard-Soulier syndrome is a very rare form of inherited thrombocytopenia that derives from mutations in GPIbα, GPIbβ, or GPIX and is typically inherited as a recessive disease. However, some years ago it was shown that the monoallelic c.515C>T transition in the GPIBA gene (Bolzano mutation) was responsible for macrothrombocytopenia in a few Italian patients.

DESIGN AND METHODS: Over the past 10 years, we have searched for the Bolzano mutation in all subjects referred to our institutions because of an autosomal, dominant form of thrombocytopenia of unknown origin.

RESULTS: We identified 42 new Italian families (103 cases) with a thrombocytopenia induced by monoallelic Bolzano mutation. Analyses of the geographic origin of affected pedigrees and haplotypes indicated that this mutation originated in southern Italy. Although the clinical expression was variable, patients with this mutation typically had a mild form of Bernard-Soulier syndrome with mild thrombocytopenia and bleeding tendency. The most indicative laboratory findings were enlarged platelets and reduced GPIb/IX/V platelet expression; in vitro platelet aggregation was normal in nearly all of the cases.

CONCLUSIONS: Our study indicates that monoallelic Bolzano mutation is the most frequent cause of inherited thrombocytopenia in Italy, affecting 20% of patients recruited at our institutions during the last 10 years. Because many people from southern Italy have emigrated during the last century, this mutation may have spread to other countries.

VL - 97 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21933849?dopt=Abstract ER - TY - JOUR T1 - Clinical and genetic aspects of Bernard-Soulier syndrome: searching for genotype/phenotype correlations. JF - Haematologica Y1 - 2011 A1 - Savoia, Anna A1 - Pastore, Annalisa A1 - De Rocco, Daniela A1 - Civaschi, Elisa A1 - Di Stazio, Mariateresa A1 - Bottega, Roberta A1 - Melazzini, Federica A1 - Bozzi, Valeria A1 - Pecci, Alessandro A1 - Magrin, Silvana A1 - Balduini, Carlo L A1 - Noris, Patrizia KW - Adolescent KW - Adult KW - Amino Acid Sequence KW - Bernard-Soulier Syndrome KW - Blood Platelets KW - Cell Shape KW - Child KW - Child, Preschool KW - Female KW - Genetic Association Studies KW - Genetic Markers KW - Hemorrhage KW - Homozygote KW - Humans KW - Italy KW - Male KW - Membrane Glycoproteins KW - Middle Aged KW - Molecular Sequence Data KW - Platelet Aggregation KW - Platelet Count KW - Platelet Glycoprotein GPIb-IX Complex KW - Point Mutation KW - Polymerase Chain Reaction KW - Ristocetin KW - Thrombocytopenia KW - von Willebrand Factor KW - Young Adult AB -

BACKGROUND: Bernard-Soulier syndrome is a severe bleeding disease due to a defect of GPIb/IX/V, a platelet complex that binds the von Willebrand factor. Due to the rarity of the disease, there are reports only on a few cases compromising any attempt to establish correlations between genotype and phenotype. In order to identify any associations, we describe the largest case series ever reported, which was evaluated systematically at the same center.

DESIGN AND METHODS: Thirteen patients with the disease and seven obligate carriers were enrolled. We collected clinical aspects and determined platelet features, including number and size, expression of membrane glycoproteins, and ristocetin induced platelet aggregation. Mutations were identified by direct sequencing of the GP1BA, GP1BB, and GP9 genes and their effect was shown by molecular modeling analyses.

RESULTS: Patients all had a moderate thrombocytopenia with giant platelets and a bleeding tendency whose severity varied among individuals. Consistent with expression levels of GPIbα always lower than 10% of control values, platelet aggregation was absent or severely reduced. Homozygous mutations were identified in the GP1BA, GP1BB and GP9 genes; six were novel alterations expected to destabilize the conformation of the respective protein. Except for obligate carriers of a GP9 mutation with a reduced GPIb/IX/V expression and defective aggregation, all the other carriers had no obvious anomalies.

CONCLUSIONS: Regardless of mutations identified, the patients' bleeding diathesis did not correlate with thrombocytopenia, which was always moderate, and platelet GPIbα expression, which was always severely impaired. Obligate carriers had features similar to controls though their GPIb/IX/V expression showed discrepancies. Aware of the limitations of our cohort, we cannot define any correlations. However, further investigations should be encouraged to better understand the causes of this rare and underestimated disease.

VL - 96 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21173099?dopt=Abstract ER - TY - JOUR T1 - Mutations in ANKRD26 are responsible for a frequent form of inherited thrombocytopenia: analysis of 78 patients from 21 families. JF - Blood Y1 - 2011 A1 - Noris, Patrizia A1 - Perrotta, Silverio A1 - Seri, Marco A1 - Pecci, Alessandro A1 - Gnan, Chiara A1 - Loffredo, Giuseppe A1 - Pujol-Moix, Núria A1 - Zecca, Marco A1 - Scognamiglio, Francesca A1 - De Rocco, Daniela A1 - Punzo, Francesca A1 - Melazzini, Federica A1 - Scianguetta, Saverio A1 - Casale, Maddalena A1 - Marconi, Caterina A1 - Pippucci, Tommaso A1 - Amendola, Giovanni A1 - Notarangelo, Lucia D A1 - Klersy, Catherine A1 - Civaschi, Elisa A1 - Balduini, Carlo L A1 - Savoia, Anna KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Ankyrin Repeat KW - Child KW - Cohort Studies KW - Family KW - Female KW - Gene Frequency KW - Humans KW - Inheritance Patterns KW - Male KW - Middle Aged KW - Mutation KW - Pedigree KW - Thrombocytopenia KW - Transcription Factors KW - Young Adult AB -

Until recently, thrombocytopenia 2 (THC2) was considered an exceedingly rare form of autosomal dominant thrombocytopenia and only 2 families were known. However, we recently identified mutations in the 5'-untranslated region of the ANKRD26 gene in 9 THC2 families. Here we report on 12 additional pedigrees with ANKRD26 mutations, 6 of which are new. Because THC2 affected 21 of the 210 families in our database, it has to be considered one of the less rare forms of inherited thrombocytopenia. Analysis of all 21 families with ANKRD26 mutations identified to date revealed that thrombocytopenia and bleeding tendency were usually mild. Nearly all patients had no platelet macrocytosis, and this characteristic distinguishes THC2 from most other forms of inherited thrombocytopenia. In the majority of cases, platelets were deficient in glycoprotein Ia and α-granules, whereas in vitro platelet aggregation was normal. Bone marrow examination and serum thrombopoietin levels suggested that thrombocytopenia was derived from dysmegakaryopoiesis. Unexplained high values of hemoglobin and leukocytes were observed in a few cases. An unexpected finding that warrants further investigation was a high incidence of acute leukemia. Given the scarcity of distinctive characteristics, the ANKRD26-related thrombocytopenia has to be taken into consideration in the differential diagnosis of isolated thrombocytopenias.

VL - 117 IS - 24 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21467542?dopt=Abstract ER - TY - JOUR T1 - Eltrombopag for the treatment of the inherited thrombocytopenia deriving from MYH9 mutations. JF - Blood Y1 - 2010 A1 - Pecci, Alessandro A1 - Gresele, Paolo A1 - Klersy, Catherine A1 - Savoia, Anna A1 - Noris, Patrizia A1 - Fierro, Tiziana A1 - Bozzi, Valeria A1 - Mezzasoma, Anna Maria A1 - Melazzini, Federica A1 - Balduini, Carlo L KW - Administration, Oral KW - Adolescent KW - Adult KW - Benzoates KW - Dose-Response Relationship, Drug KW - Female KW - Genetic Predisposition to Disease KW - Humans KW - Hydrazines KW - Male KW - Molecular Motor Proteins KW - Mutation KW - Myosin Heavy Chains KW - Platelet Aggregation KW - Platelet Count KW - Pyrazoles KW - Receptors, Thrombopoietin KW - Survival Rate KW - Thrombocytopenia KW - Treatment Outcome KW - Young Adult AB -

Platelet transfusion is currently the primary medical treatment for reducing thrombocytopenia in patients with inherited thrombocytopenias. To evaluate whether stimulating megakaryopoiesis could increase platelet count in these conditions, we treated patients with a severe thrombocytopenia induced by MYH9 mutations (MYH9-related disease) with a nonpeptide thrombopoietin receptor agonist, eltrombopag. Twelve adult patients with MYH9-RD and platelet counts of less than 50 × 10(9)/L received 50 mg of eltrombopag orally per day for 3 weeks. Patients who achieved a platelet count higher than 150 × 10(9)/L stopped therapy, those with 100 to 150 platelets × 10(9)/L continued treatment at the same eltrombopag dose for 3 additional weeks, while those with less than 100 platelets × 10(9)/L increased the eltrombopag dose to 75 mg for 3 weeks. Major responses (platelet count of at least 100 × 10(9)/L or 3 times the baseline value) were obtained in 8 patients, minor responses (platelet counts at least twice the baseline value) in 3. One patient did not respond. Bleeding tendency disappeared in 8 of 10 patients with bleeding symptoms at baseline. Mild adverse events were reported in 2 patients. The availability of thrombopoietin mimetics opened new prospects in the treatment of inherited thrombocytopenias. This study is registered at www.clinicaltrials.gov as NCT01133860 (European Union Drug Regulating Authorities Clinical Trials number 2008-001903-42).

VL - 116 IS - 26 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20844233?dopt=Abstract ER -