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Prepublished online as a Blood First Edition Paper on February 6, 2003; DOI 10.1182/blood-2002-11-3329.

Submitted November 4, 2002
Accepted January 29, 2003
Characterization of molecular defects of Fitzgerald trait and another novel high molecular weight kininogen-deficient patient: insights into structural requirements for kininogen expression
Yelena Krijanovski, Valerie Proulle, Fakhri Mahdi, Marie Dreyfus, Werner Mueller-Esterl, and Alvin H Schmaier*
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Departement d'Hematologie, Hopital Bicetre, Paris, France
Department of Biochemistry II, University of Frankfurt, Frankfurt, Germany
* Corresponding author; email: aschmaie{at}umich.edu.
A 6-year-old male with vertebral-basilar artery thrombosis was recognized to have high molecular weight kininogen (HK) deficiency. The propositus had no HK procoagulant activity and antigen (< 1 %). Using monoclonal antibodies (Mabs)to domain 3 of kininogen, the propositus, family members and Fitzgerald plasma have detectable low molecular weight kininogen. Mabs to domains 5 and 6 of HK do not detect HK antigen in the plasma of the propositus. The propositus has a single base pair deletion in cDNA position 1492 of exon 10 affecting amino acid 480 of the mature protein and resulting in a frameshift and a premature stop codon at position 1597 (amino acid 532). Unexpectedly, Mabs to the heavy chain and domain 5 of HK detect a 92 kDa form of HK in Fitzgerald plasma, the first HK deficient plasma. The 92 kDa Fitzgerald HK has amino acid residues through 502, corresponding to domains 1 through 5, but lacks epitopes of domain 6 (positions 543 to 595). Fitzgerald DNA has a normal exon 10, but a 17 basepair mutation in intron 9. These combined results indicate that mutations in the kininogen gene may differentially affect biosynthesis, processing, and/or secretion of HK.

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