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Blood, 27 August 2009, Vol. 114, No. 9, pp. 1947-1953.
Prepublished online as a Blood First Edition Paper on June 10, 2009; DOI 10.1182/blood-2009-04-218727.


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THROMBOSIS AND HEMOSTASIS

Fibrinogen {alpha} and {gamma} genes and factor VLeiden in children with thromboembolism: results from 2 family-based association studies

Ulrike Nowak-Göttl1, Hartmut Weiler2, Irene Hernandez2, Sabine Thedieck1, Tanja Seehafer3, Thomas Schulte1, and Monika Stoll3

1 Pediatric Hematology/Oncology, University of Muenster, Muenster, Germany; 2 Blood Research Institute, Blood Center of Wisconsin, Milwaukee; and 3 Leibniz-Institute for Arteriosclerosis Research, Genetic Epidemiology of Vascular Disorders, Muenster, Germany

Previous case-control studies showed that genetic variation in the fibrinogen {gamma} gene (FGG) increased the risk for deep vein thrombosis (VT) in adults. We investigated the association between the fibrinogen {alpha} (FGA) and FGG haplotypes, the factor VLeiden-mutation, and pediatric VT and thromboembolic stroke (TS) in 2 independent study samples. Association analysis revealed that the FGA-H1 and FGG-H2 haplotypes were significantly overtransmitted to VT patients (FGA-H1, P = .05; FGG: H2, P = .032). In contrast, the FGG-H3 haplotype was undertransmitted (P = .022). In an independent study sample, FGA-H1 (P = .008) and FGG-H2 (P = .05) were significantly associated with TS. The association of FGA and FGG haplotypes with VT was more pronounced in FVLeiden-negative families (FGA-H1, P = .001; FGG-H2, P = .001), indicating a genetic interaction between both risk factors. The risk-conferring FGG-H2 and the protective FGG-H3 haplotypes correlated with low (FGG-H2) and high (FGG-H3) levels of the {gamma}' chain variant, respectively. These results provide independent and novel evidence that FGA-H1 and FGG-H2 variants are associated with an increased risk of VT and TS in children. The observed negative correlation of genetic VT risk with the plasma levels of the fibrinogen {gamma}' variant suggests that FGG-H2 and -H3 haplotypes modify thrombosis risk by controlling the level of this FGG splice isoform.


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