Molecular genetic testing in von Willebrand disease: past, present, and beyond
Bibliographic record
Abstract
The gene for von Willebrand factor (VWF) was among the earliest genomic discoveries in the mid-1980s. It became feasible to use this new knowledge to better understand the genetic mechanisms responsible for von Willebrand disease (VWD) and to utilize the information to generate molecular genetic diagnostic testing strategies. Following initial studies demonstrating large structural variants in type 3 VWD patients, investigations focused on the genetic basis of the various type 2 forms of VWD, demonstrating that the pathogenic variants were localized to regions of the gene encoding functionally distinct domains of the VWF glycoprotein. These observations have resulted in increasing use of molecular genetic diagnosis as either the primary strategy for diagnosing type 2 forms of VWD or, more often, as confirmatory tests to substantiate the results of prior phenotypic analysis. In the meantime, genetic studies of type 3 were demonstrating that a wide range of pathogenic variants located throughout the VWF coding sequence were responsible for this severe phenotype. These studies also showed that ~15% of pathogenic variants responsible for type 3 were missense substitutions and that in ~25% of families this severe phenotype, classically thought to be recessive in nature, was transmitted as a semi-dominant trait. Finally, the most prevalent form of VWD, type 1/Low VWF, has proven to be the most challenging for routine molecular genetic testing, with VWF coding sequence variants identified in only ~65% of index cases. This review explores various aspects of molecular genetic testing for VWF, commemorating the 100th anniversary of VWD and the 40th anniversary of VWF cloning.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".