Combined deficiency of coagulation factor V (FV) and factor VIII (FVIII) (F5F8D) is an inherited bleeding disorder characterized by a reduction in plasma concentrations of FV and FVIII. F5F8D is genetically linked to mutations in either LMAN1 or MCFD2. Here, we investigated the molecular basis of F5F8D in a Japanese patient, and identified a novel missense mutation (p.Trp67Ser, c.200G>C) in the LMAN1, but no mutation in the MCFD2. The amount of LMAN1 in Epstein-Barr virus-immortalized lymphoblasts from the patient was found to be almost the same as that in cells from a normal individual. Interestingly, an anti-MCFD2 antibody did not co-immunoprecipitate the mutant LMAN1 with MCFD2 in lymphoblasts from the patient, suggesting the affinity of MCFD2 for the mutant LMAN1 is weak or abolished by the binding of the anti-MCFD2 antibody. In addition, a Myc/63His-tagged recombinant form of wild-type LMAN1 could bind to D-mannose, but that of the mutant could not. The p.Trp67Ser mutation was located in the carbohydrate recognition domain (CRD), which is thought to participate in the selective binding of LMAN1 to the D-mannose of glycoproteins as well as the EF-motif of MCFD2. Taken together, it was suggested that the p.Trp67Ser mutation might affect the molecular chaperone function of LMAN1, impairing affinity for D-mannose as well as for MCFD2, which may be responsible for F5F8D in the patient. This is the first report of F5F8D caused by a qualitative defect of LMAN1 due to a missense mutation in LMAN1. Am. J. Hematol. 84:738-742, 2009. V V C 2009 WileyLiss, Inc.
IntroductionCoagulation factor V (FV) and factor VIII (FVIII) are both essential in the blood coagulation cascade, as cofactors for the proteases factor X and factor IX, respectively. Combined deficiency of FV and FVIII (F5F8D) is an autosomal recessive bleeding disorder first described by Oeri et al. in 1954 [1], and a distinct clinical entity from chance co-inheritance of hemophilia A (FVIII deficiency) and parahemophilia (FV deficiency). F5F8D is extremely rare (1:2,000,000) in the general population [2], and characterized by a mild-to-moderate bleeding tendency manifested after surgical trauma, abortion, and delivery. Menorrhagia is also common, but hematuria and gastrointestinal bleeding are infrequent, and hemarthrosis is rare [3]. Generally, patients with F5F8D show plasma levels of FV and FVIII in the range of 5-30% of normal [4].Positional cloning has identified two genes, LMAN1 (lectin, mannose-binding, 1; also known as ERGIC-53) and MCFD2 (multiple coagulation factor deficiency gene 2), associated with F5F8D [4,5] LMAN1 is a Type-1 transmembrane protein that cycles between the endoplasmic reticulum (ER) and the ER-Golgi intermediate compartment (ERGIC) [6,7]. It contains a mannose-specific carbohydrate recognition domain (CRD) on the ER luminal side, and ER exit and retrieval motifs on the cytoplasmic side [8]. MCFD2 has an EF-hand domain that interacts with LMAN1 in a Ca 21 -dependent manner [5]. The LMAN1-MCFD2 protein complex functions as a cargo ...