Fibrinogen Alpha-Chain (FGA) Gene, Full Gene Analysis
Confirming a diagnosis of fibrinogen alpha-chain (FGA) gene-related familial visceral amyloidosis
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
The systemic amyloidoses are a number of disorders of varying etiology characterized by extracellular protein deposition. The most common form is an acquired amyloidosis secondary to multiple myeloma or monoclonal gammopathy of unknown significance (MGUS) in which the amyloid is composed of immunoglobulin light chains. In addition to light chain amyloidosis, there are a number of acquired amyloidoses caused by the misfolding and precipitation of a wide variety of proteins. There are also hereditary forms of amyloidosis.
The hereditary amyloidoses comprise a group of autosomal dominant, late-onset diseases that show variable penetrance. A number of genes have been associated with hereditary forms of amyloidosis including those that encode transthyretin, apolipoprotein AI, apolipoprotein AII, gelsolin, cystatin C, lysozyme and fibrinogen alpha chain (FGA). Apolipoprotein AI, apolipoprotein AII, lysozyme, and fibrinogen amyloidosis present as non-neuropathic systemic amyloidosis, with renal dysfunction being the most prevalent manifestation.
FGA-related familial visceral amyloidosis commonly presents with renal failure, which can often be fulminant, and is characterized by hypertension, proteinuria, and azotemia. Liver and spleen involvement may be seen in advanced cases. Neuropathy is not a feature of FGA-related familial visceral amyloidosis
Due to the clinical overlap between the acquired and hereditary forms, it is imperative to determine the specific type of amyloidosis in order to provide an accurate prognosis and consider appropriate therapeutic interventions. Tissue-based, laser capture tandem mass spectrometry might serve as a useful test preceding gene sequencing to better characterize the etiology of the amyloidosis, particularly in cases that are not clear clinically.
It is important to note that there are rare disorders of hemostasis that are also associated with mutations in the FGA gene. Patients with afibrinogenemia, hypofibrinogenemia, and dysfibrinogenemia have all been reported to have mutations in FGA. Most dysfibrinogenemias are autosomal dominant disorders; afibrinogenemia and hypofibrinogenemia are more often autosomal recessive disorders. In general, truncating mutations in FGA result in afibrinogenemia and missense mutations are a common cause of dysfibrinogenemia.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
An interpretive report will be provided.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
A small percentage of individuals who have a diagnosis of fibrinogen alpha-chain (FGA)-related familial visceral amyloidosis may have a mutation that is not identified by this method (eg, large genomic deletions, promoter mutations). The absence of a mutation, therefore, does not eliminate the possibility of positive carrier status or the diagnosis of FGA-related familial visceral amyloidosis. For carrier testing, it is important to first document the presence of a FGA mutation in an affected family member.
In some cases, DNA alterations of undetermined significance may be identified.
Rare polymorphisms exist that could lead to false-negative or false-positive results. If results obtained do not match the clinical findings, additional testing should be considered.
A previous bone marrow transplant from an allogenic donor will interfere with testing. Call Mayo Medical Laboratories for instructions for testing patients who have received a bone marrow transplant.
Test results should be interpreted in the context of clinical findings, family history, and other laboratory data. Errors in our interpretation of results may occur if information given is inaccurate or incomplete.
Mutations in other genes, such as those encoding transthyretin, lysozyme, apolipoprotein AII, gelsolin, and others, have been shown to cause other forms of familial amyloidosis. Abnormalities in these genes are not detected by this assay.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Benson MD: The hereditary amyloidoses. Best Pract Res Clin Rhematol 2003;17:909-927
2. Benson MD: Ostertag revisited: The inherited systemic amyloidoses without neuropathy. Amyloid 2005;12(2):75-87
3. Asselta R, Duga S, Tenchini ML: The molecular basis of quantitative fibrinogen disorders. Thromb Haemost 2006 Oct;4(10):2115-2129
4. Shiller SM, Dogan A, Highsmith WE: Laboratory methods for the diagnosis of hereditary amyloidoses. In Amyloidosis-Mechanisms and Prospects for Therapy. Edited by S Sarantseva. InTech 2011, pp 101-120