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Expanded repertoire of RASGRP2 variants responsible for platelet dysfunction and severe bleeding.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Westbury, Sarah K 
Canault, Matthias 
Greene, Daniel 
Bermejo, Emilse 
Hanlon, Katharine 

Abstract

Heritable platelet function disorders (PFDs) are genetically heterogeneous and poorly characterized. Pathogenic variants in RASGRP2, which encodes calcium and diacylglycerol-regulated guanine exchange factor I (CalDAG-GEFI), have been reported previously in 3 pedigrees with bleeding and reduced platelet aggregation responses. To better define the phenotype associated with pathogenic RASGRP2 variants, we compared high-throughput sequencing and phenotype data from 2042 cases in pedigrees with unexplained bleeding or platelet disorders to data from 5422 controls. Eleven cases harbored 11 different, previously unreported RASGRP2 variants that were biallelic and likely pathogenic. The variants included 5 high-impact variants predicted to prevent CalDAG-GEFI expression and 6 missense variants affecting the CalDAG-GEFI CDC25 domain, which mediates Rap1 activation during platelet inside-out αIIbβ3 signaling. Cases with biallelic RASGRP2 variants had abnormal mucocutaneous, surgical, and dental bleeding from childhood, requiring ≥1 blood or platelet transfusion in 78% of cases. Platelets displayed reduced aggregation in response to adenosine 5'-diphosphate and epinephrine, but variable aggregation defects with other agonists. There were no other consistent clinical or laboratory features. These data enable definition of human CalDAG-GEFI deficiency as a nonsyndromic, recessive PFD associated with a moderate or severe bleeding phenotype and complex defects in platelet aggregation.

Description

Keywords

Alleles, Base Sequence, Blood Platelets, Female, Guanine Nucleotide Exchange Factors, Hemorrhage, Humans, Male, Mutation, Pedigree

Journal Title

Blood

Conference Name

Journal ISSN

0006-4971
1528-0020

Volume Title

130

Publisher

American Society of Hematology