Genotype–Phenotype Correlation of Hereditary Plasminogen Deficiency: Molecular Mechanisms From 18 Patients With Cerebral Infarction

INTRODUCTION: Hereditary plasminogen (PLG) deficiency is a rare congenital fibrinolytic disorder and a rare disease. This study conducted gene sequencing and statistical analysis on patients with cerebral infarction (CI) and decreased PLG activity (PLG:A) to explore the relationship between PLG gene variants and hereditary thrombotic diseases. AIM: To analyse PLG gene variants in 18 patients with hereditary PLG deficiency and to investigate the associated clinical manifestations. METHODS: This Retrospective Study Included 18 Patients With CI and Decreased PLG:A Who Were Admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2021 to May 2025. The patients Ranged in Age from 16 to 70 years. Peripheral blood Samples Were Collected Before Treatment to Determine Relevant Coagulation Indicators Such As PLG:A, PLG antigen (PLG:Ag), protein C activity. Polymerase chain reaction (PCR) followed by direct sequencing was performed to analyse whole genome sequence of the PLG gene. Suspected variants were confirmed by reverse sequencing. RESULTS: The 18 patients' cranial magnetic resonance (MRI) revealed recent cerebral infarct lesions in all cases. PLG:A levels ranged from 19% to 67%. All patients were diagnosed with dysplasminogenemia. Genetic analysis identified four types of PLG gene variants: c.1858G > A (p.Ala620Thr), c.398A > G(p.His133Arg), c.2108G > A(p.Gly703Asp), and c.1702G > A (p.Gly568Arg). The p.Ala620Thr mutation was the most frequent, while p.His133Arg and p.Gly568Arg were newly identified variants. CONCLUSION: Patients with hereditary PLG deficiency resulting from PLG gene variants are at a significantly increased risk of CI, potentially attributable to diminished PLG catalytic activity and consequent impairment of fibrinolytic function.