IntroductionFactor X (FX) is a vitamin K-dependent plasma protein required for the intrinsic and extrinsic pathways of blood coagula- and has structural homology with the genes encoding the other vitamin K-dependent clotting factors (7). The functional domains of the protein are represented by different exons: exon I codes for the signal sequence, exon H for the propeptide, and the y-carboxyglutamic acid-rich domain, exon III for the short aromatic acid-rich stack, exons IV and V for the epidermal growth factor-like domains, exon VI for the activation peptide, and exons VII and VIII for the catalytic domain (7).Congenital FX deficiency is inherited as an autosomal recessive trait (8). Considerable phenotypic heterogeneity exists among FX variants (9-1 1). The molecular basis of congenital FX deficiency has been completely elucidated in only three families so far. Two of these are homozygous for defects in exon 11 (12) and exon VIII (13), respectively. One compound heterozygote has been reported (14). Here we report another homozygous FX deficiency (FXs.,. Donna b) in which a point mutation in exon I leads to a severe bleeding disorder in the affected proposita.
MethodsPatient data. The proposita is a 16-yr-old female from Santo Domingo, Dominican Republic, who came to medical attention because ofheavy menstrual bleeding at menarche. This was associated with significant blood loss, requiring transfusion, and on occasion, treatment with prothrombin complex concentrates. Blood samples were obtained from the proposita and her parents after informed consent. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were performed using standard methods. FX antigen levels were determined by immunoassay using a FX-specific sandwich ELISA. Four different monoclonal antibodies were used as capture antibodies (gift of Dr. William Church, University of Vermont, and Dr. D. M. Monroe, University ofNorth Carolina). One ofthese has been extensively characterized and recognizes an epitope in the heavy chain (15); the other three also recognize epitopes in the heavy chain. Plates are coated first with 1. Abbreviations used in this paper: aPTT, activated partial thromboplastin time; FX, Factor X; PT, prothrombin; TBE, Tris-borate-EDTA buffer.Factor X Deficiency and Signal Sequence Defect 1685 J. Clin. Invest.