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Novel association of a PROC variant with ischemic stroke in a Chinese Han population
1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
A novel genetic variant in the protein C gene (PROC c.574_576del) is linked to an increased risk of ischemic stroke (IS) in the Chinese Han population. This variant also reduces the anticoagulant activity of protein C (PC).
Area of Science:
- Genetics
- Cardiovascular Medicine
- Biochemistry
Background:
- Protein C (PC) is a key anticoagulant enzyme, but its role in ischemic stroke (IS) susceptibility is debated.
- Genetic factors influencing PC function may impact IS risk.
Purpose of the Study:
- To investigate the association between genetic variants in the human protein C gene (PROC) and ischemic stroke (IS) susceptibility.
- To evaluate the functional impact of identified PROC variants on PC anticoagulant activity.
Main Methods:
- Sequencing of all PROC exons and untranslated regions to identify variants.
- Case-control study in Chinese Han population (788 IS patients, 1,200 controls), with replication (262 IS patients, 288 controls).
- Functional assays to assess the anticoagulant activity of protein C in variant carriers.
Main Results:
- A novel three-nucleotide deletion variant (PROC c.574_576del) was identified and significantly associated with IS (OR 2.56, P=0.001).
- The association remained significant for lacunar and cardioembolic stroke subtypes.
- Functional studies revealed significantly reduced anticoagulant activity of PC in c.574_576del carriers.
Conclusions:
- The PROC c.574_576del variant is a potential genetic determinant for increased ischemic stroke risk.
- This variant is associated with diminished protein C anticoagulant activity.
Abstract:
Protein C (PC) is a well-characterized anticoagulant enzyme. However, the association between PC and ischemic stroke (IS) remains controversial. The aim of the present study was to investigate whether any genetic variant in the human protein C gene (PROC) was associated with susceptibility to IS in the Chinese Han population. All exons and the 5'- and 3'-untranslated regions of PROC were initially sequenced to identify informative variants. Potential abnormal variants were analyzed in a population of 788 IS patients and 1,200 healthy controls. The analysis was stratified by stroke etiology, and the results were replicated in 262 IS patients and 288 healthy controls. Finally, functional studies were performed to evaluate the effects of the variant. A three-nucleotide duplication/deletion variant (c.574_576del) was identified and found to be significantly associated with IS (OR 2.56, 95 % CI 1.45-4.52, P = 0.001). Stratification by stroke etiology after adjustment for IS risk factors showed that this association persisted in the lacunar and cardioembolic subtypes (P < 0.001 and P = 0.008, respectively) but not in the atherothrombotic and undetermined subtypes (P = 0.070 and P = 0.998, respectively). The functional studies showed a significant difference in the anticoagulant activity of PC in c.574_576del carriers and non-carriers (P < 0.001). Our results suggested that the novel PROC c.574_576del variant is a possible genetic determinant of an increased risk of IS and diminished anticoagulant activity of PC.
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