Haj Amelia K, Paul David S, Jurgens Sean J, Eswaran Harish, Weng Lu-Chen, Ryu Justine, Rodriguez Espada Alfonso, Chaudhry Sharjeel, Feingold Louis M, Burke Kristen, Koyama Satoshi, Wang Xin, Francis Joyce, Choi Seung Hoan, Mackman Nigel, Bergmeier Wolfgang, Burgin Alex, Rämö Joel T, Ellinor Patrick T, Grover Steven P, Bendapudi Pavan K
Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
Nat Commun. 2025 Sep 1;16(1):8176. doi: 10.1038/s41467-025-62789-5.
Coagulation factor XII has been identified as a potential drug target that could prevent thrombosis without increasing the risk of bleeding. However, human data to support the development of factor XII-directed therapeutics are lacking. To assess the role of factor XII in venous thromboembolism, we examine genetic variation in the coding region of the F12 locus across 703,745 participants in the UK Biobank and NIH All of Us biorepositories. We find that heterozygous carriers of nonsense, frameshift, and essential splice site variants in F12 are protected against venous thromboembolism without an increased risk of bleeding or infection. We also show that F12 variant carriers generally experience a quantitative (type I) defect in circulating factor XII levels, though a subset of participants was also identified with possible qualitative (type II) deficiency. In vitro plasma-based thrombin generation is reduced at factor XII concentrations reflective of those seen in F12 variant carriers. We also show that F12 heterozygous mice are protected against venous thromboembolism and display an intermediate phenotype between wild-type and F12-null animals. We conclude that heterozygous loss of F12 represents a haploinsufficient state characterized by protection against venous thromboembolism and that therapeutically inhibiting factor XII is likely to be safe and effective.
凝血因子XII已被确定为一个潜在的药物靶点,它可以预防血栓形成而不增加出血风险。然而,缺乏支持开发针对因子XII的治疗方法的人体数据。为了评估因子XII在静脉血栓栓塞中的作用,我们在英国生物银行和美国国立卫生研究院“我们所有人”生物样本库的703745名参与者中检测了F12基因座编码区的基因变异。我们发现,F12中无义、移码和必需剪接位点变异的杂合携带者可预防静脉血栓栓塞,且不会增加出血或感染风险。我们还表明,F12变异携带者通常在循环因子XII水平上存在定量(I型)缺陷,不过也有一部分参与者被确定可能存在定性(II型)缺乏。在反映F12变异携带者体内水平的因子XII浓度下,基于体外血浆的凝血酶生成减少。我们还表明,F12杂合小鼠可预防静脉血栓栓塞,并表现出介于野生型和F12基因敲除动物之间的中间表型。我们得出结论,F12的杂合缺失代表一种单倍体不足状态,其特征是可预防静脉血栓栓塞,并且治疗性抑制因子XII可能是安全有效的。