Abstract
Laboratory testing for Factor V Leiden and Prothrombin G20210A genetic variants permits defining the increased relative risk for venous thromboembolism in selected patients. Laboratory DNA testing for these variants may be undertaken by a variety of methods, including fluorescence-based quantitative real-time PCR (qPCR). This is a rapid, simple, robust, and reliable method to identify genotypes of interest. This chapter describes the method that employs PCR amplification of the patient DNA region of interest and genotyping by allele-specific discrimination technology on a quantitative real-time PCR (qPCR) instrument.
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References
Zhang S, Taylor AK, Huang X, Luo B, Spector EB, Fang P, Richards CS (2018) Venous thromboembolism laboratory testing (factor V Leiden and factor II c.*97G>A), 2018 update: a technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med 20(12):1489–1498. https://doi.org/10.1038/s41436-018-0322-z
Zöller B, Svensson PJ, Dahlbäck B, Lind-Hallden C, Hallden C, Elf J (2020) Genetic risk factors for venous thromboembolism. Expert Rev Hematol 13(9):971–981. https://doi.org/10.1080/17474086.2020.1804354
Foy P, Moll S (2009) Thrombophilia: 2009 update. Curr Treat Options Cardiovasc Med 11(2):114–128. https://doi.org/10.1007/s11936-009-0012-x
Kujovich JL (1993) Prothrombin thrombophilia. In: Adam MP, Mirzaa GM, Pagon RA et al (eds) GeneReviews(®). University of Washington, Seattle copyright © 1993–2022, University of Washington. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved, Seattle
De Stefano V, Martinelli I, Mannucci PM, Paciaroni K, Chiusolo P, Casorelli I, Rossi E, Leone G (1999) The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation. N Engl J Med 341(11):801–806
De Stefano V, Rossi E (2013) Testing for inherited thrombophilia and consequences for antithrombotic prophylaxis in patients with venous thromboembolism and their relatives. Thromb Haemost 110(10):697–705
Bertina RM (1997) Factor V Leiden and other coagulation factor mutations affecting thrombotic risk. Clin Chem 43(9):1678–1683
Bertina RM, Koeleman BP, Koster T, Rosendaal FR, Dirven RJ, de Ronde H, van der Velden PA, Reitsma PH (1994) Mutation in blood coagulation factor V associated with resistance to activated protein C. Nature 369(6475):64–67
Sun X, Evatt B, Griffin JH (1994) Blood coagulation factor Va abnormality associated with resistance to activated protein C in venous thrombophilia. Blood 83(11):3120–3125
Voorberg J, Roelse J, Koopman R, Buller H, Berends F, ten Cate JW, Mertens K, van Mourik JA (1994) Association of idiopathic venous thromboembolism with single point-mutation at Arg506 of factor V. Lancet 343(8912):1535–1536
Zoller B, Dahlback B (1994) Linkage between inherited resistance to activated protein C and factor V gene mutation in venous thrombosis. Lancet 343(8912):1536–1538
Zoller B, Svensson PJ, He X, Dahlback B (1994) Identification of the same factor V gene mutation in 47 out of 50 thrombosis-prone families with inherited resistance to activated protein C. J Clin Invest 94(6):2521–2524
Ruben EA, Rau MJ, Fitzpatrick JAJ, Di Cera E (2021) Cryo-EM structures of human coagulation factors V and Va. Blood 137(22):3137–3144. https://doi.org/10.1182/blood.2021010684
Kalafatis M, Bertina RM, Rand MD, Mann KG (1995) Characterization of the molecular defect in factor VR506Q. J Biol Chem 270(8):4053–4057
Camire RM, Kalafatis M, Cushman M, Tracy RP, Mann KG, Tracy PB (1995) The mechanism of inactivation of human platelet factor Va from normal and activated protein C-resistant individuals. J Biol Chem 270(35):20794–20800
Shen L, Dahlback B (1994) Factor V and protein S as synergistic cofactors to activated protein C in degradation of factor VIIIa. J Biol Chem 269(29):18735–18738
Dahlback B (1999) Activated protein C resistance and thrombosis: molecular mechanisms of hypercoagulable state due to FVR506Q mutation. Semin Thromb Hemost 25(3):273–289
Dahlback B (2008) Advances in understanding pathogenic mechanisms of thrombophilic disorders. Blood 112(1):19–27
Favaloro EJ, Mohammed S, Vong R, Chapman K, Swanepoel P, Kershaw G, Cai N, Just S, Connelly L, Brighton T, Pasalic L (2021) A multi-laboratory assessment of congenital thrombophilia assays performed on the ACL TOP 50 family for harmonisation of thrombophilia testing in a large laboratory network. Clin Chem Lab Med 59(10):1709–1718. https://doi.org/10.1515/cclm-2021-0499
Favaloro EJ, Mirochnik O, McDonald D (1999) Functional activated protein C resistance assays: correlation with factor V DNA analysis is better with RVVT-than APTT-based assays. Br J Biomed Sci 56(1):23–33
Svensson PJ, Zoller B, Dahlback B (1997) Evaluation of original and modified APC-resistance tests in unselected outpatients with clinically suspected thrombosis and in healthy controls. Thromb Haemost 77(2):332–335
Williamson D, Brown K, Luddington R, Baglin C, Baglin T (1998) Factor V Cambridge: a new mutation (Arg306-->Thr) associated with resistance to activated protein C. Blood 91(4):1140–1144
Chan WP, Lee CK, Kwong YL, Lam CK, Liang R (1998) A novel mutation of Arg306 of factor V gene in Hong Kong Chinese. Blood 91(4):1135–1139
Norstrøm E, Thorelli E, Dahlbäck B (2002) Functional characterization of recombinant FV Hong Kong and FV Cambridge. Blood 100(2):524–530. https://doi.org/10.1182/blood-2002-02-0343
Rees DC, Cox M, Clegg JB (1995) World distribution of factor V Leiden. Lancet 346(8983):1133–1134
Segers K, Dahlback B, Nicolaes GA (2007) Coagulation factor V and thrombophilia: background and mechanisms. Thromb Haemost 98(3):530–542
Gregg JP, Yamane AJ, Grody WW (1997) Prevalence of the factor V-Leiden mutation in four distinct American ethnic populations. Am J Med Genet 73(3):334–336
Ridker PM, Miletich JP, Hennekens CH, Buring JE (1997) Ethnic distribution of factor V Leiden in 4047 men and women. Implications for venous thromboembolism screening. JAMA 277(16):1305–1307
Pajič T (2010) Factor V Leiden and FII 20210 testing in thromboembolic disorders. Clin Chem Lab Med 48(Suppl 1):S79–S87. https://doi.org/10.1515/cclm.2010.372
Koster T, Rosendaal FR, de Ronde H, Briet E, Vandenbroucke JP, Bertina RM (1993) Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden thrombophilia study. Lancet 342(8886–8887):1503–1506
Svensson PJ, Dahlback B (1994) Resistance to activated protein C as a basis for venous thrombosis. N Engl J Med 330(8):517–522
Alfirevic ZSA-M, Nikolac N, Sobocan N, Alfirevic I, Stefanovic M et al (2010) Frequency of factor II G20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphism in patients with venous thromboembolism: Croatian case-control study. Biochem Med 20(2):229–235
Bedencic M, Bozic M, Peternel P, Stegnar M (2008) Major and potential prothrombotic genotypes in patients with venous thrombosis and in healthy subjects from Slovenia. Pathophysiol Haemost Thromb 36(2):58–63
Meglic L, Stegnar M, Milanez T, Bozic M, Peterlin B, Peternel P, Novak-Antolic Z (2003) Factor V Leiden, prothrombin 20210G → A, methylenetetrahydrofolate reductase 677C → T and plasminogen activator inhibitor 4G/5G polymorphism in women with pregnancy-related venous thromboembolism. Eur J Obstet Gynecol Reprod Biol 111(2):157–163
Zoller B, Hillarp A, Berntorp E, Dahlback B (1997) Activated protein C resistance due to a common factor V gene mutation is a major risk factor for venous thrombosis. Annu Rev Med 48:45–58
Lippi G, Danese E, Favaloro EJ, Montagnana M, Franchini M (2015) Diagnostics in venous thromboembolism: from origin to future prospects. Semin Thromb Hemost 41(04):374–381
Griffin JH, Evatt B, Wideman C, Fernandez JA (1993) Anticoagulant protein C pathway defective in majority of thrombophilic patients. Blood 82(7):1989–1993
Poort SR, Rosendaal FR, Reitsma PH, Bertina RM (1996) 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 88(10):3698–3703
Gehring NH, Frede U, Neu-Yilik G, Hundsdoerfer P, Vetter B, Hentze MW, Kulozik AE (2001) Increased efficiency of mRNA 3′ end formation: a new genetic mechanism contributing to hereditary thrombophilia. Nat Genet 28(4):389–392
Rosendaal FR, Doggen CJ, Zivelin A, Arruda VR, Aiach M, Siscovick DS, Hillarp A, Watzke HH, Bernardi F, Cumming AM, Preston FE, Reitsma PH (1998) Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 79(4):706–708
Martinelli I, Bucciarelli P, Margaglione M, De Stefano V, Castaman G, Mannucci PM (2000) The risk of venous thromboembolism in family members with mutations in the genes of factor V or prothrombin or both. Br J Haematol 111(4):1223–1229
Emmerich J, Rosendaal FR, Cattaneo M, Margaglione M, De Stefano V, Cumming T, Arruda V, Hillarp A, Reny JL (2001) Combined effect of factor V Leiden and prothrombin 20210A on the risk of venous thromboembolism – pooled analysis of 8 case-control studies including 2310 cases and 3204 controls. Study Group for Pooled-Analysis in Venous Thromboembolism. Thromb Haemost 86(3):809–816
Seligsohn U, Lubetsky A (2001) Genetic susceptibility to venous thrombosis. N Engl J Med 344(16):1222–1231
Makris M, Preston FE, Beauchamp NJ, Cooper PC, Daly ME, Hampton KK, Bayliss P, Peake IR, Miller GJ (1997) Co-inheritance of the 20210A allele of the prothrombin gene increases the risk of thrombosis in subjects with familial thrombophilia. Thromb Haemost 78(6):1426–1429
Varga E, Kujovich J (2012) Management of inherited thrombophilia: guide for genetics professionals. Clin Genet 81(1):7–17. https://doi.org/10.1111/j.1399-0004.2011.01746.x
Leroyer C, Mercier B, Oger E, Chenu E, Abgrall JF, Ferec C, Mottier D (1998) Prevalence of 20210 A allele of the prothrombin gene in venous thromboembolism patients. Thromb Haemost 80(1):49–51
Tosetto A, Frezzato M, Rodeghiero F (1995) Family history and inherited thrombophilia. Br J Haematol 89(1):227–228
Howard TE, Marusa M, Boisza J, Young A, Sequeira J, Channell C, Guy C, Benson E, Duncan A (1998) The prothrombin gene 3′-untranslated region mutation is frequently associated with factor V Leiden in thrombophilic patients and shows ethnic-specific variation in allele frequency. Blood 91(3):1092
Brown K, Luddington R, Williamson D, Baker P, Baglin T (1997) Risk of venous thromboembolism associated with a G to A transition at position 20210 in the 3′-untranslated region of the prothrombin gene. Br J Haematol 98(4):907–909
Segal JB, Brotman DJ, Emadi A, Necochea AJ, Samal L, Wilson LM, Crim MT, Bass EB (2009) Outcomes of genetic testing in adults with a history of venous thromboembolism. Evid Rep Technol Assess (Full Rep) 180:1–162
Emadi A, Crim MT, Brotman DJ, Necochea AJ, Samal L, Wilson LM, Bass EB, Segal JB (2010) Analytic validity of genetic tests to identify factor V Leiden and prothrombin G20210A. Am J Hematol 85(4):264–270
Simundic AM, Topic E, Stefanovic M (2003) Detection of factor V Leiden by PCR-SSCP using GMA precast Elchrom scientific gels. Clin Appl Thromb Hemost 9(3):227–231
Bianchi M, Emanuele E, Davin A, Gagliardi S, Cova E, Meli V, Trotti R, Cereda C (2010) Comparison of three methods for genotyping of prothrombotic polymorphisms. Clin Exp Med 10(4):269–272. https://doi.org/10.1007/s10238-010-0096-3
Lyondagger E, Millsondagger A, Phan T, Wittwer CT (1998) Detection and identification of base alterations within the region of factor V Leiden by fluorescent melting curves. Mol Diagn 3(4):203–209
Albagoush SA, Koya S, Chakraborty RK, Schmidt AE (2022) Factor V Leiden mutation. In: StatPearls. StatPearls Publishing Copyright © 2022. StatPearls Publishing LLC, Treasure Island
Stevens SM, Woller SC, Bauer KA, Kasthuri R, Cushman M, Streiff M, Lim W, Douketis JD (2016) Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis 41(1):154–164. https://doi.org/10.1007/s11239-015-1316-1
Cooper PC, Rezende SM (2007) An overview of methods for detection of factor V Leiden and the prothrombin G20210A mutations. Int J Lab Hematol 29(3):153–162. https://doi.org/10.1111/j.1751-553X.2007.00892.x
Bonetta L (2005) Prime time for real-time PCR. Nat Methods 2:305–312
Livak KJ, Flood SJ, Marmaro J, Giusti W, Deetz K (1995) Oligonucleotides with fluorescent dyes at opposite ends provide a quenched probe system useful for detecting PCR product and nucleic acid hybridization. PCR Methods Appl 4(6):357–362
Sevall JS (2001) Rapid allelic discrimination from real-time DNA amplification. Methods (San Diego) 25(4):452–455
Applied Biosystems (2010) Genotyping experiments. In: Applied biosystems real-time PCR Systems Reagent Guide, vol Part Number 4387787 Rev. B 07/2010. Applied Biosystems, pp 3–15
Applied Biosystems (2017) TaqMan® SNP Genotyping Assays USER GUIDE. In: TaqMan® SNP Genotyping Assays vol Publication Number MAN0009593 Revision B.0. vol Revision B.0. Applied Biosystems, Thermo Fisher Scientific, pp 1–72
Yao Y, Nellaker C, Karlsson H (2006) Evaluation of minor groove binding probe and Taqman probe PCR assays: Influence of mismatches and template complexity on quantification. Mol Cell Probes 20(5):311–316
Spector EB, Grody WW, Matteson CJ, Palomaki GE, Bellissimo DB, Wolff DJ, Bradley LA, Prior TW, Feldman G, Popovich BW, Watson MS, Richards CS (2005) Technical standards and guidelines: venous thromboembolism (Factor V Leiden and prothrombin 20210G >A testing): a disease-specific supplement to the standards and guidelines for clinical genetics laboratories. Genet Med 7(6):444–453
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Pajič, T. (2023). Testing for Factor V Leiden (FVL) and Prothrombin G20210A Genetic Variants. In: Favaloro, E.J., Gosselin, R.C. (eds) Hemostasis and Thrombosis. Methods in Molecular Biology, vol 2663. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-3175-1_14
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DOI: https://doi.org/10.1007/978-1-0716-3175-1_14
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