The common VTE-protective G haplotype of F5 increases factor V-short, TFPI function, and risk of bleeding.
Matthew C Sims; Magdalena Gierula; Jonathan C Stephens; Alex Tokolyi; Luca Stefanucci; Elodie Persyn; Luanluan Sun; Janine H Collins; Emma E Davenport; Emanuele Di Angelantonio; Kate Downes; Michael Inouye; Dirk S Paul; Will Thomas; Alexander Tolios; Willem H Ouwehand; Nicholas S Gleadall; James T B Crawley; Adam S Butterworth; Mattia Frontini; Josefin Ahnström
Abstract
The G haplotype is a group of co-inherited single nucleotide variants in the F5 gene that reduce venous thromboembolism (VTE) risk. Although 7% of the population is homozygous for the G haplotype (F5-G/G), the underlying mechanism of VTE protection is poorly understood. Using RNA sequencing data from 4651 blood donors in the INTERVAL study, we detected a rare excision event at the factor V (FV)-short splice sites in 5% of F5-G/Gs carriers as compared with 2.16% of homozygotes for the F5 reference sequence (F5-ref; P = .003). Highly elevated (∼10-fold) FV-short, a FV isoform that lacks most of the B-domain, has been linked with increased tissue factor inhibitor α (TFPIα) levels in rare hemorrhagic diathesis, including East Texas bleeding disorder. To ascertain whether the enhanced FV-short splicing seen in F5-G/G INTERVAL participants translated to increased plasma FV-short levels, we analyzed plasma samples from 7 F5-G/G and 13 F5-ref individuals in a recall-by-genotype study. A ∼2.2-fold higher amount of FV-short was found in a plasma pool from F5-G/G participants when compared with the pool of F5-refs (P = .029), but there was no difference in the total FV levels. Although no significant difference in TFPI levels were found, F5-G/Gs showed a ∼1.4-fold TFPI-dependent increase in lag time to thrombin generation than F5-refs (P = .0085). Finally, in an analysis of 117 699 UK Biobank participants, we discovered that, although being protective against VTE, the G haplotype also confers an increase in bleeding episodes (P = .011). Our study provides evidence that the effect of the common G haplotype is mediated by the FV-short/TFPI pathway.
| Journal | BLOOD ADVANCES |
| ISSN | 2473-9537 |
| Published | 14 Jan 2025 |
| Volume | 9 |
| Issue | 1 |
| Pages | 132-142 |
| DOI | 10.1182/bloodadvances.2024014020 |
| Type | Journal Article |
| Sponsorship |