The contact system, or intrinsic coagulation system, have for a long time been an undervalued part of the thrombosis and hemostasis field. Not by me. I love FXI & FXII Not just now, since FXI is suddenly the “new kid on the block” as the new target for antithrombotic treatment through ASOs, but already since I started my PhD in 2007/2008. As any of my colleagues from back then will confirm, I couldn’t shut up about FXI and FXII as I thought that my topic was the only relevant topic in the world. Although common amongst young researcher, I do apologize for this now that I have 20/20 hindsight.
Still, it is only natural that some of the work I continues to be focused on those little bit weird coagulation proteins. Are they relevant to hemostasis? Are they relevant in pathological thrombus formation? What is their role in other biological systems? Questions that the field is only slowly getting answers to. Our latest contribution to this is the analyses of genetic variations in the genes that code for these protein, and estimate if the levels of activation and antigen are in fact -in part- genetically determinant.
This analysis was performed in the RATIO study, from which we primarily focused on the control group. That control group is relatively small for a genetic analyses, but given that we have a relative young group the hope is that the noise is not too bad to pick up some signals. Additionally, given the previous work in the RATIO study, I think this is the only dataset that has a comprehensive phenotyping of the intrinsic coagulation proteins as it includes measures of protein activity, antigen and activation.
The results, which we published in the JTH, are threefold: we were able to confirm previously reported associations between known genetic variations and phenotype. Se were also able to identify two new loci (i.e. KLKB1 rs4253243 for prekallikrein and KNG1rs5029980 for HMWK levels). Third, we did not find evidence of strong associations between variation in the studied genes and the risk of ischemic stroke or myocardial infarction. Small effects can however not be ruled, as the sample size of this study is not enough to yield very precise estimates.
The work was spearheaded by JLR, with tons of help by HdH, and in collaboration with the thrombosis group at the LUMC.