The common prothrombin gene cleavage site mutation 20210G>A is associated with elevated prothrombin levels and thrombosis. The pathomechanism of the 20210G>A mutation was explained by increased mRNA formation and/or more efficient translation. Human studies also showed an influence of the intronic 19911A>G polymorphism on prothrombin activity. We established HepG2 cell lines stably transfected with prothrombin mini-genes containing the last 2 prothrombin exons, the last intron, 3 untranslated region (UTR), and flanking sequence. The highest mRNA expression and protein activity resulted from the mutant haplotype 19911A-20210A. Haplotypes with wild-type cleavage site (19911A-20210G, 19911G-20210G) also differed significantly as a consequence of the intronic 19911 mutation; the 19911G-20210G haplotype showed lower expression than the 19911A-20210G haplotype, whereas previous clinical studies have reported elevated prothrombin activity with the 19911G-20210G haplotype. The cleavage site pattern was homogeneous with 20210A, which may cause a favorable intracellular processing, and heterogeneous with 20210G. In an independent assay for splicing efficiency, 19911G showed about 30% higher efficiency than 19911A. We conclude that the intronic 19911A>G single nucleotide polymorphism is itself functional and changes splicing efficiency by altering a known functional pentamer motif. Further studies are needed to define the value of additional prothrombin 19911 genotyping for thrombophilia screening, especially in cases heterozygous for 20210G>A.
IntroductionA noncoding mutation in the 3Ј untranslated region (UTR) of the prothrombin gene (20210GϾA) has been associated with thrombophilia. 1 Several studies have since confirmed the association of this common mutation with arterial 2 or venous 1,3-7 thrombosis. The 20210GϾA mutation confers a 3-to 7-fold increased risk for venous thrombosis. 8,9 The determination of the prothrombin 20210GϾA genotype is recommended as a high-priority test in the investigation of genetic thrombophilia. 10 The activity of prothrombin may be partially regulated at a posttranslational level 11 and is controlled by a strong genetic background. 12 Linkage analysis demonstrated a cosegregation of the mutant allele with elevated prothrombin activity and suggested that this mutation in the 3Ј UTR is in itself functional instead of in linkage disequilibrium with another polymorphism. 13 Recent reviews have emphasized the role of the mRNA UTR in the pathomechanisms of some human diseases. 14,15 Gehring et al demonstrated increased prothrombin mRNA end formation efficiency as a cause of elevated prothrombin protein levels in carriers of the 20210GϾA mutation. 16 In this study, a -globin gene vector supplemented with the UTR of the prothrombin gene was used to investigate the polyadenylation reaction. A different study provided no evidence in vivo for altered prothrombin mRNA stability by the 20210A mutation. 17 In contrast, the in vitro study by Carter et al 18 found an effect of the 20210A genotype on bo...