Type 3 von Willebrand disease (VWD3) is a rare and severe bleeding disorder characterized by often undetectable von Willebrand factor (VWF) plasma levels, a recessive inheritance pattern, and heterogeneous genotype. The objective of this study was to identify the VWF defects in 265 European and Iranian patients with VWD3 enrolled in 3WINTERS-IPS (Type 3 Von Willebrand International Registries Inhibitor Prospective Study). All analyses were performed in centralized laboratories. The VWF genotype was studied in 231 patients with available DNA (121 [115 families] from Europe [EU], and 110 [91 families] from Iran [IR]). Among 206 unrelated patients, 134 were homozygous (EU/IR 5 57/77) and 50 were compound heterozygous (EU/IR 5 43/7) for VWF variants. In 22 patients, no or only one variant was found. A total of 154 different VWF variants (EU/IR 5 101/58 [5 shared]) were identified among the 379 affected alleles (EU/IR 5 210/169), of which 48 (EU/IR 5 18/30) were novel. The variants p.Arg1659*, p.Arg1853*, p.Arg2535*, p.Cys275Ser, and delEx1_Ex5 were found in both European and Iranian VWD3 patients. Sixty variants were identified only in a single allele (EU/IR 5 50/10), whereas 18 were recurrent ($3 patients) within 144 affected alleles. Nine large deletions and one large insertion were found. Although most variants predicted null alleles, 21% of patients carried at least 1 missense variant. VWD3 genotype was more heterogeneous in the European population than in the Iranian population, with nearly twice as many different variants. A higher number of novel variants were found in the Iranian VWD3 patients.
Bibliographical noteFunding Information:
The authors thank the Members and current Chair of the SubCommittee on VWF of the Scientific Standardization Committee of the International Society on Thrombosis and Haemostasis who promoted the endorsement of the 3WINTERS-IPS project among the scientific activities of this Sub-Committee. The authors also thank Javier Battle, Erik Berntorp, Cosimo Ettorre, Charles R.M. Hay, Massimo Morfini, Maria Gabriella Mazzucconi, Johannes Oldenburg, Rafael Parra Lòpez, and Omidreza Zekavat for patients’ enrollment and collection of clinical data. The 3WINTERS-IPS project received unconditional research grants from several pharmaceutical companies, and the authors therefore acknowledge the representatives of Baxter-Shire-Takeda, Grifols, CSL Behring, LFB, and Octapharma. The authors thank Paolo De Simoni, Luca Maravigna, and Elisabetta Musazzi of the CRO Sintesi Research for the study coordination and L.F. Ghilardini for the illustration work.
This work was partially supported by the Hungarian National Research Development and Innovation Office (NFKI) grant OTKA-K19_131945 (I.B.). This work was also partially supported by the Italian Ministry of Health-Bando Ricerca Corrente (F.P.).
This work was partially supported by the Hungarian National Research Development and Innovation Office (NFKI) grant OTKA-K19_131945 (I.B.). This work was also partially supported by the Italian Ministry of Health–Bando Ricerca Corrente (F.P.).
© 2021 by The American Society of Hematology