Letter to the Editor
Founder Mutation C.3344C>t(p.Pro1115Leu) in the EIF2KA4 Gene in Iberian Romani Patients With Pulmonary Veno-Occlusive Disease: A Warning for our Daily Practice
Hallazgo de la mutación fundadora C.3344C>t(p.Pro1115Leu) en el gen EIF2KA4 en pacientes ibéricos de etnia gitana con enfermedad veno-oclusiva pulmonar: una llamada de atención a nuestra práctica diaria
a Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
b Red de investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
c Servicio de Cardiología, Hospital Central de Asturias, Oviedo, Asturias, Spain
d Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario Doce de Octubre, Red de investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
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The incidence of this entity is unknown, partly due to underdiagnosis and mistaken classification as idiopathic pulmonary arterial hypertension (IPAH).</p><p id="par0010" class="elsevierStylePara elsevierViewall">PVOD is distinguished by a marked reduction in carbon monoxide diffusing capacity (DLCO) and a typical radiological pattern. It occurs more often in men, and has a more aggressive course than IPAH.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Multiple causes, including genetic alterations, have been associated with its development. Recently, homozygous or compound heterozygous mutation of the <span class="elsevierStyleItalic">EIF2AK4</span> gene was described as the cause of PVOD. This mutation appears to occur in 25% of sporadic cases and 100% of familial cases, showing an autosomal recessive inheritance pattern and high penetrance.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our group has described a homozygous founder mutation C.3344C>T(p. Pro1115Leu) in <span class="elsevierStyleItalic">EIF2AK4</span> in 18 patients from 10 highly consanguineous Romani families with several affected members (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">All patients developed the disease as young adults (mean: 27.43±7.3 years), and most progressed rapidly to a fatal outcome (death or double-lung transplantation) in the first year after diagnosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although the clinical characteristics of the patients varied on diagnosis, they all had a common trait: severely reduced DLCO.</p><p id="par0030" class="elsevierStylePara elsevierViewall">It is interesting to note that the study of family members revealed a high incidence of death among relatives with no genetic studies but with a history suggestive of PVOD. Moreover, we found an alarming number of family members (59.7%) who were heterozygous carriers of the mutation, generating a risk of new homozygous cases in future generations (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the current time, the Romani population in Spain, a community characterized by a high level of consanguinity, is estimated to be around 750<span class="elsevierStyleHsp" style=""></span>000 individuals distributed around the whole country.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> Since this <span class="elsevierStyleItalic">EIF2AK4</span> mutation appears to be typical of the Romani race, and in view of the severity of the disease, we are facing a potentially serious public health problem among this population, which could be partially prevented by early genetic diagnosis and appropriate genetic counseling aimed at reducing the number of new cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Therefore, we believe that maintaining a high level of suspicion is essential for Spanish physicians: and that PVOD must be ruled out and a genetic study for <span class="elsevierStyleItalic">EIF2AK4</span> should be performed (as lung biopsy is contraindicated) in those Romani patients presenting with dyspnea and a family history of PAH or severely diminished DLCO. If <span class="elsevierStyleItalic">EIF2KA4</span> homozygous mutations are found, the patient must be rapidly referred to a hospital with an available lung transplantation program being the initiation of pulmonary vasodilators contraindicated due to the high risk of triggering severe pulmonary edema. Moreover, family members of carriers of this mutation must be screened and given appropriate genetic counseling, in order to avoid new cases in future generations and to prevent the propagation of this devastating disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cardiovascular Research Network (RIC) of the Instituto de Salud Carlos III, the Spanish Pulmonary Hypertension Association, Actelion and the Fundación Air Liquide.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Navas P, Rodriguez Reguero JJ, Escribano Subías P. Hallazgo de la mutación fundadora C.3344C>t(p.Pro1115Leu) en el gen <span class="elsevierStyleItalic">EIF2KA4</span> en pacientes ibéricos de etnia gitana con enfermedad veno-oclusiva pulmonar: una llamada de atención a nuestra práctica diaria. Arch Bronconeumol. 2016;52:444–445.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PVOD: pulmonary veno-occlusive disease.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Family \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of Index Cases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of Family Members Studied \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of Healthy Heterozygous Family Members \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of Homozygous Family Members Without PVOD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1144795.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Summary of Families Studied.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">EIF2AK4</span> mutations cause pulmonary veno-occlusive disease, a recessive form of pulmonary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Eyries" 1 => "D. Montani" 2 => "B. Girerd" 3 => "C. Perret" 4 => "A. Leroy" 5 => "C. Lonjou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ng.2844" "Revista" => array:6 [ "tituloSerie" => "Nat Genet" "fecha" => "2014" "volumen" => "46" "paginaInicial" => "65" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24292273" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A founder <span class="elsevierStyleItalic">EIF2AK4</span> mutation causes an aggressive form of pulmonary arterial hypertension in Iberian Gypsies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Tenorio" 1 => "P. Navas" 2 => "E. Barrios" 3 => "L. Fernández" 4 => "J. Nevado" 5 => "C.A. Quezada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/cge.12549" "Revista" => array:6 [ "tituloSerie" => "Clin Genet" "fecha" => "2015" "volumen" => "88" "paginaInicial" => "579" "paginaFinal" => "583" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25512148" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Informe sobre la situación social y tendencias de cambio en la población gitana" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Laparra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "titulo" => "Una primera aproximación" "fecha" => "2007" "editorial" => "Ministerio de Trabajo y Asuntos Sociales" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Estrategia Nacional para la Inclusión Social de la población Gitana en España 2012-2020." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000008/v1_201607230336/S157921291630115X/v1_201607230336/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000008/v1_201607230336/S157921291630115X/v1_201607230336/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291630115X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 2 | 4 |
| 2024 October | 50 | 15 | 65 |
| 2024 September | 54 | 23 | 77 |
| 2024 August | 74 | 33 | 107 |
| 2024 July | 61 | 24 | 85 |
| 2024 June | 75 | 24 | 99 |
| 2024 May | 97 | 39 | 136 |
| 2024 April | 50 | 32 | 82 |
| 2024 March | 61 | 27 | 88 |
| 2024 February | 57 | 19 | 76 |
| 2023 June | 1 | 0 | 1 |
| 2023 March | 9 | 2 | 11 |
| 2023 February | 65 | 21 | 86 |
| 2023 January | 43 | 22 | 65 |
| 2022 December | 83 | 29 | 112 |
| 2022 November | 58 | 31 | 89 |
| 2022 October | 50 | 49 | 99 |
| 2022 September | 30 | 31 | 61 |
| 2022 August | 25 | 46 | 71 |
| 2022 July | 38 | 35 | 73 |
| 2022 June | 28 | 37 | 65 |
| 2022 May | 46 | 36 | 82 |
| 2022 April | 25 | 27 | 52 |
| 2022 March | 29 | 37 | 66 |
| 2022 February | 33 | 22 | 55 |
| 2022 January | 30 | 49 | 79 |
| 2021 December | 38 | 40 | 78 |
| 2021 November | 25 | 45 | 70 |
| 2021 October | 34 | 38 | 72 |
| 2021 September | 32 | 47 | 79 |
| 2021 August | 22 | 25 | 47 |
| 2021 July | 17 | 23 | 40 |
| 2021 June | 40 | 39 | 79 |
| 2021 May | 44 | 48 | 92 |
| 2021 April | 92 | 107 | 199 |
| 2021 March | 63 | 27 | 90 |
| 2021 February | 30 | 21 | 51 |
| 2021 January | 21 | 13 | 34 |
| 2020 December | 35 | 25 | 60 |
| 2020 November | 30 | 17 | 47 |
| 2020 October | 17 | 12 | 29 |
| 2020 September | 28 | 11 | 39 |
| 2020 August | 21 | 15 | 36 |
| 2020 July | 32 | 24 | 56 |
| 2020 June | 21 | 6 | 27 |
| 2020 May | 31 | 20 | 51 |
| 2020 April | 31 | 25 | 56 |
| 2020 March | 32 | 15 | 47 |
| 2020 February | 31 | 19 | 50 |
| 2020 January | 28 | 22 | 50 |
| 2019 December | 32 | 19 | 51 |
| 2019 November | 33 | 20 | 53 |
| 2019 October | 25 | 17 | 42 |
| 2019 September | 22 | 17 | 39 |
| 2019 August | 32 | 18 | 50 |
| 2019 July | 22 | 18 | 40 |
| 2019 June | 21 | 19 | 40 |
| 2019 May | 38 | 12 | 50 |
| 2019 April | 61 | 22 | 83 |
| 2019 March | 34 | 10 | 44 |
| 2019 February | 45 | 17 | 62 |
| 2019 January | 44 | 17 | 61 |
| 2018 December | 39 | 16 | 55 |
| 2018 November | 62 | 15 | 77 |
| 2018 October | 110 | 19 | 129 |
| 2018 September | 33 | 12 | 45 |
| 2018 May | 27 | 1 | 28 |
| 2018 April | 75 | 8 | 83 |
| 2018 March | 101 | 5 | 106 |
| 2018 February | 94 | 5 | 99 |
| 2018 January | 174 | 6 | 180 |
| 2017 December | 63 | 5 | 68 |
| 2017 November | 30 | 2 | 32 |
| 2017 October | 29 | 5 | 34 |
| 2017 September | 35 | 3 | 38 |
| 2017 August | 27 | 12 | 39 |
| 2017 July | 24 | 8 | 32 |
| 2017 June | 35 | 14 | 49 |
| 2017 May | 23 | 12 | 35 |
| 2017 April | 21 | 8 | 29 |
| 2017 March | 18 | 7 | 25 |
| 2017 February | 17 | 9 | 26 |
| 2017 January | 17 | 4 | 21 |
| 2016 December | 24 | 22 | 46 |
| 2016 November | 42 | 35 | 77 |
| 2016 October | 2 | 2 | 4 |
| 2016 September | 0 | 1 | 1 |
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