{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:56:30Z","timestamp":1791510990664,"version":"4.3.4"},"reference-count":65,"publisher":"Frontiers Media SA","issue":"11","license":[{"start":{"date-parts":[[2019,5,12]],"date-time":"2019-05-12T00:00:00Z","timestamp":1557619200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2014\/00984-3"],"award-info":[{"award-number":["2014\/00984-3"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2015\/24029-3"],"award-info":[{"award-number":["2015\/24029-3"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Exp Biol Med (Maywood)"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>Although sickle cell anemia results from homozygosity for a single mutation at position 7 of the \u03b2-globin chain, the clinical aspects of this condition are very heterogeneous. Complications include leg ulcers, which have a negative impact on patients\u2019 quality of life and are related to the severity of the disease. Nevertheless, the complex pathogenesis of this complication has yet to be elucidated. To identify novel genes associated with leg ulcers in sickle cell anemia, we performed whole-exome sequencing of extreme phenotypes in a sample of Brazilian sickle cell anemia patients and validated our findings in another sample. Our discovery cohort consisted of 40 unrelated sickle cell anemia patients selected based on extreme phenotypes: 20 patients without leg ulcers, aged from 40 to 61 years, and 20 with chronic leg ulcers. DNA was extracted from peripheral blood leukocytes and used for whole-exome sequencing. After the bioinformatics analysis, eight variants were selected for validation by Sanger sequencing and TaqMan\u00ae genotyping in 293 sickle cell anemia patients (153 without leg ulcers) from two different locations in Brazil. After the validation, Fisher\u2019s exact test revealed a statistically significant difference in a stop codon variant (rs12568784 G\/T) in the FLG2 gene between the GT and GG genotypes ( P\u2009=\u20090.035). We highlight the importance of rs12568784 in leg ulcer development as this variant of the FLG2 gene results in impairment of the skin barrier, predisposing the individual to inflammation and infection. Additionally, we suggest that the remaining seven variants and the genes in which they occur could be strong candidates for leg ulcers in sickle cell anemia.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Impact statement<\/jats:title>\n                    <jats:p>To our knowledge, the present study is the first to use whole-exome sequencing based on extreme phenotypes to identify new candidate genes associated with leg ulcers in sickle cell anemia patients. There are few studies about this complication; the pathogenesis remains complex and has yet to be fully elucidated. We identified interesting associations in genes never related with this complication to our knowledge, especially the variant in the FLG2 gene. The knowledge of variants related with leg ulcer in sickle cell anemia may lead to a better comprehension of the disease\u2019s etiology, allowing prevention and early treatment options in risk genotypes while improving quality of life for these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1535370219849592","type":"journal-article","created":{"date-parts":[[2019,5,13]],"date-time":"2019-05-13T00:25:38Z","timestamp":1557707138000},"page":"932-939","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Whole-exome sequencing indicates\n                    <i>FLG<\/i>\n                    2 variant associated with leg ulcers in Brazilian sickle cell anemia patients"],"prefix":"10.3389","volume":"244","author":[{"given":"Gabriela Queila","family":"de Carvalho-Siqueira","sequence":"first","affiliation":[{"name":"Center for Molecular Biology and Genetic Engineering (CBMEG), University of 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Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirta Tomie","family":"Ito","sequence":"additional","affiliation":[{"name":"Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas, Campinas, SP 13083-875, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sueli Matilde","family":"da Silva-Costa","sequence":"additional","affiliation":[{"name":"Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas, Campinas, SP 13083-875, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"de Farias Domingos","sequence":"additional","affiliation":[{"name":"Genetics Postgraduate Program, Federal University of Pernambuco, Recife, PE 50670-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego Arruda","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"Genetics Postgraduate Program, Federal University of Pernambuco, Recife, PE 50670-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iscia","family":"Lopes-Cendes","sequence":"additional","affiliation":[{"name":"Department of Medical Genetics and Genome Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos Andr\u00e9 Cavalcanti","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Genetics Postgraduate Program, Federal University of Pernambuco, Recife, PE 50670-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aderson","family":"da Silva Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Hematology and Hemotherapy Foundation of Pernambuco, Recife, PE 52011-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f4nio Roberto","family":"Lucena-Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Genetics Postgraduate Program, 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