Associação da mutação G1691A (fator V de Leiden) no gene do fator V da coagulação, da mutação G20210A no gene da protrombina e das mutações C677T e G1793A no gene da metilenotetrahidrofolato redutase com a doença arterial coronariana

Pós-graduação em Biociências e Biotecnologia Aplicadas à Farmácia - FCFAR

Heterogeneous ethnic distribution of the factor V leiden mutation

Inherited resistance to activated protein C caused by the factor V Leiden (FVL) mutation is the most common genetic cause of venous thrombosis yet described, being found in 20-60% of patients with venous thrombophilia. A relationship between the FVL mutation and an increased predisposition to arterial thrombosis in young women was recently reported. We assessed the prevalence of the FVL mutation in 440 individuals (880 chromosomes) belonging to four different ethnic groups: Caucasians, African Blacks, Asians and Amerindians. PCR amplification followed by MnlI digestion was employed to define the genotype. The FVL mutation was found in a heterozygous state in four out of 152 Whites (2.6%), one out of 151 Amerindians (0.6%), and was absent among 97 African Blacks and 40 Asians. Our results confirm that FVL has a heterogeneous distribution in different human populations, a fact that may contribute to geographic and ethnic differences in the prevalence of thrombotic diseases. In addition, these data may be helpful in decisions regarding the usefulness of screening for the FVL mutation in subjects at risk for thrombosis.

Increased risk of venous thrombosis by AB alleles of the ABO blood group and Factor V Leiden in a Brazilian population

Most cases of a predisposition to venous thrombosis are caused by resistance to activated protein C, associated in 95% of cases with the Factor V Leiden allele (FVL or R506Q). Several recent studies report a further increased risk of thrombosis by an association between the AB alleles of the ABO blood group and Factor V Leiden. The present study investigated this association with deep vein thrombosis (DVT) in individuals treated at the Hemocentro de Pernambuco in northeastern Brazil. A case-control comparison showed a significant risk of thrombosis in the presence of Factor V Leiden (OR = 10.1), which was approximately doubled when the AB alleles of the ABO blood group were present as well (OR = 22.3). These results confirm that the increased risk of deep vein thrombosis in the combined presence of AB alleles and Factor V Leiden is also applicable to the Brazilian population suggesting that ABO blood group typing should be routinely added to FVL in studies involving thrombosis.

Willem de Sitter in Leiden - ein Kapitel in der Rezeptionsgeschichte der Relativitätstheorien

Der niederländische Astronom Willem de Sitter ist bekannt für seine inzwischen berühmte Kontroverse mit Einstein von 1916 bis 1918, worin die relativistische Kosmologie begründet wurde. In diesem Kontext wird sein Name mit dem von ihm geschaffenen kosmologischen Modell verbunden, welches er als Gegenbeispiel zu Einsteins physikalischer Intuition schuf. Obwohl diese Debatte schon in wissenschaftshistorischen Arbeiten analysiert wurde, hat de Sitters Rolle in der Rezeption und dem Verbreiten der allgemeinen Relativitätstheorie bislang in der Hauptrichtung der Einstein-Studien noch nicht die ihr zustehende Aufmerksamkeit erhalten. Die vorliegende Untersuchung zielt darauf ab, seine zentrale Wichtigkeit für die Forschung zur ART innerhalb der Leidener Community aufzuzeigen. Wie Eddington war de Sitter einer der wenigen Astronomen, die sowohl hinreichende Ausbildung als auch nötige Interessen vereinten, um zum einen die spezielle und zum anderen die allgemeine Relativitätstheorie zu verfolgen. Er befasste sich zunächst 1911 mit dem Relativitätsprinzip (Einsteins erstes Postulat der SRT); zwei Jahre später fand er einen Nachweis für die Konstanz der Lichtgeschwindigkeit (Einsteins zweites Postulat). De Sitters Interesse an Gravitationstheorien reicht sogar noch weiter zurück und lässt sich bis 1908 zurückverfolgen. Überdies verfolgte er Einsteins Versuche, einen feldtheoretischen Ansatz für die Gravitation zu konstruieren, inklusive der kontroversen Einstein-Grossmann Theorie von 1913. Diese Umstände zeigen deutlich, dass de Sitters bekannteres Werk zur ART eine Konsequenz seiner vorausgegangenen Forschungen war und kein Resultat einer plötzlichen, erst 1916 einsetzenden Beschäftigung mit Einsteins Relativitätstheorie.

Recurrent ischemic colitis in a patient with leiden factor V mutation and systemic lupus erythematous with antiphospholipid syndrome

Ischemic colitis results from insufficient blood supply to the large intestine and is often associated with hypercoagulable states. The condition comprises a wide range presenting with mild to fulminant forms. Diagnosis remains difficult because these patients may present with non-specific abdominal symptoms. We report a 51- year-old female patient with known Leiden factor V mutation as well as systemic lupus erythematous along with antiphospholipid syndrome suffering from recurrent ischemic colitis. At admission, the patient complained about abdominal pain, diarrhea and rectal bleeding lasting for 24 hours. Laboratory tests showed an increased C-reactive protein (29.5 mg/dl), while the performed abdominal CT-scan revealed only a dilatation of the descending colon along with a thickening of the bowel wall. Laparotomy was performed showing an ischemic colon and massive peritonitis. Histological examination proved the suspected ischemic colitis. Consecutively, an anti-coagulation therapy with coumarin and aspirin 100 was initiated. Up to the time point of a follow up examination no further ischemic events had occurred. This case illustrates well the non-specific clinical presentation of ischemic colitis. A high index of suspicion, recognition of risk factors and a history of non-specific abdominal symptoms should alert the clinicians to the possibility of ischemic disease. Early diagnosis and initiation of anticoagulation therapy or surgical intervention in case of peritonitis are the major goals of therapy.

Simultaneous subacute coronary drug-eluting stent thrombosis in two different vessels of a patient with factor V Leiden mutation

We review the case of a 46-year-old man who underwent elective percutaneous coronary intervention and stenting of the left anterior descending artery and right coronary artery with two sirolimus- and paclitaxel-eluting stents. Four days after angioplasty, he was readmitted with cardiogenic shock due to acute anterior and inferior myocardial infarction. Coronary angiography revealed subacute thrombosis of both stents, and balloon dilation was performed successfully thereafter. The follow-up investigations revealed that the patient was a carrier of factor V Leiden. We hereby discuss the importance of factor V Leiden as the most common cause of hypercoagulable state and its probable role in acute and subacute coronary stent thrombosis in drug-eluting stents.