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Blood, 1 January 2007, Vol. 109, No. 1, pp. 145-154.
Prepublished online as a Blood First Edition Paper on August 10, 2006; DOI 10.1182/blood-2006-05-021105.


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Submitted May 5, 2006
Accepted July 18, 2006

The mutational spectrum of type 1 von Willebrand disease: results from a Canadian cohort study

Paula D. James, Colleen Notley, Carol Hegadorn, Jayne Leggo, Angie Tuttle, Shawn Tinlin, Christine Brown, Chandler Andrews, Andrea Labelle, Yvette Chirinian, Lee O'Brien, Maha Othman, Georges Rivard, Dilys Rapson, Christine Hough, and David Lillicrap*

Dept of Medicine & Dept of Pathology & Molecular Medicine, Queen's University, Kingston, Canada
Dept of Pathology & Molecular Medicine, Queen's University, Kingston, Canada
Hopital Sainte-Justine

* Corresponding author; email: lillicrap{at}cliff.path.queensu.ca.

In order to evaluate the changes within the VWF gene that might contribute to the pathogenesis of Type 1 VWD, a large multicenter Canadian study was undertaken. We present data from the sequence analysis of the VWF gene in 123 Type 1 VWD index cases and their families. We have identified putative mutations within the VWF gene in 63% (n=78) of index cases leaving 37% (n=45) with no identified changes. These changes comprise 50 different putative mutations; 31 (62%) missense mutations, 8 (16%) changes involving the VWF transcriptional regulatory region, 5 (10%) small deletions/insertions, 5 (10%) splicing consensus sequence mutations, and 1 nonsense mutation. Twenty-one of the index cases had more than one putative VWF mutation identified. We were somewhat more likely to identify putative mutations in cases with lower VWF levels, and the contribution of other factors, such as ABO blood group seems more important in milder cases. Taken as a whole, our data supports a complex spectrum of molecular pathology resulting in Type 1 VWD. In more severe cases, genetic changes are common within the VWF gene and are highly penetrant. In milder cases, the genetic determinants are more complex and involve factors outside of the VWF gene.


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