title: Familial thrombotic risk based on the genetic background of Protein C Deficiency in a Portuguese Study.
abstract: BACKGROUND
  Inherited protein C (PC) deficiency is a well-known risk factor for venous thrombosis (VT). Plasma PC levels are reliable in moderate to severe deficiencies; however, in mildly deficient individuals, the levels may overlap with those considered normal. Genetic studies of PROC, which encodes PC, could help identify carriers; genome-wide association studies (GWAS) have shown that approximately 50% of phenotypic variation in PC deficiency is caused by the cumulative effects of mutations in several other loci, namely in the PROCR.
  
  
  METHODS
  With the main objective of determining the genotype/phenotype correlation in 59 Portuguese individuals from 26 unrelated families with history of thrombosis and repeatedly low/borderline PC plasma levels, we conducted a molecular study by direct sequencing of PROC; PROC promoter haplotypes and PROCR c.4600A>G polymorphism (rs867186), which are known to influence plasma PC concentrations, were also screened.
  
  
  RESULTS
  Twelve different PROC mutations were identified, one of them not previously reported, p.Cys105Arg. The mutation types and locations as well as haplotype combinations correlated with the phenotypic severity. The most frequent mutation, p.Arg199X, correlated with the CGTC haplotype and was identified in nine families containing patients with higher numbers of VT episodes. This mutation in homozygous individuals for the CGTC haplotype is a significant risk factor for VT in Portuguese.
  
  
  CONCLUSIONS
  These genetic family studies allowed the identification of the unknown carriers and individuals at a higher thrombotic risk within each family, thus permitting the evaluation of the need for prophylactic measures, particularly in at-risk situations.
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Fidalgo
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Martinho
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Ramon
authors.initials: R
authors.lastname: Salvado
authors.affiliation: Department of Life Sciences, University of Coimbra, Coimbra, Portugal.
authors.forename: Licínio
authors.initials: L
authors.lastname: Manco
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Oliveira
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Catarina S
authors.initials: CS
authors.lastname: Pinto
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Elsa
authors.initials: E
authors.lastname: Gonçalves
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Dalila
authors.initials: D
authors.lastname: Marques
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Sevivas
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Natália
authors.initials: N
authors.lastname: Martins
authors.affiliation: Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal.
authors.forename: Maria Letícia
authors.initials: ML
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution; D015703:Antigens, CD / Q000235:genetics; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D002648:Child; D002675:Child, Preschool; D019295:Computational Biology / Q000379:methods; D000074283:Endothelial Protein C Receptor; D005260:Female; D005787:Gene Frequency; D056726:Genetic Association Studies; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006239:Haplotypes; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D020641:Polymorphism, Single Nucleotide; D011174:Portugal; D011401:Promoter Regions, Genetic; D011486:Protein C / Q000235:genetics*; D020151:Protein C Deficiency / Q000150:complications* / Q000175:diagnosis / Q000235:genetics*; D011956:Receptors, Cell Surface / Q000235:genetics; D012306:Risk; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
chemical_list: D015703:Antigens, CD; D000074283:Endothelial Protein C Receptor; C478370:PROCR protein, human; D011486:Protein C; D011956:Receptors, Cell Surface
keywords: genotype; hereditary protein C deficiency; phenotype; risk factor; venous thrombosis