High prevalence of low serum vitamin B12 in a multi-ethnic Israeli population

This study ascertained serum vitamin B12 levels among patients with Gaucher disease and among healthy Israelis. Serum B12 and metabolites' levels were studied in consecutive adult patients with Gaucher disease not treated with enzyme plus Ashkenazi Jewish neighbour-controls, together with healthy blood-donor volunteers of various ethnicities. Each group showed a high incidence of low serum B12 concentrations, with a 22.3% incidence among Ashkenazi Jews and 40% among patients with Gaucher disease. These findings raise questions on the individual and community levels of serum B12. We recommend evaluation of B12 levels among geographically contingent peoples.

Fanconi anaemia group A (FANCA) mutations in Israeli non-Ashkenazi Jewish patients

Fanconi anaemia (FA) is a genetically heterogeneous disease with at least eight complementation groups (A-H). In the present study, we investigated the molecular basis of the disease in 13 unrelated Israeli Jewish (non-Ashkenazi) patients with FA. All 43 exons of the Fanconi anaemia A (FANCA) gene were amplified from genomic DNA and screened for mutations by single-strand conformation polymorphism and DNA sequencing. We identified four ethnic-specific mutations: (1) 2172-2173insG (exon 24), the first 'Moroccan mutation': (2) 4275delT (exon 43), the second 'Moroccan mutation'; (3) 890-893del (exon 10), the 'Tunisian mutation'; and (4) 2574C > G (S858R), the 'Indian mutation'. The tetranucleotide CCTG motif, previously identified as a mutation hotspot in FANCA and other human genes, was found in the vicinity of 2172-2173insG and 890-893del. According to our study, the four mutations account for the majority (88%) of the FANCA alleles in the Israeli Jewish (non-Ashkenazi) FA population. A screening of 300 Moroccan Jews identified three carriers of the first 'Moroccan mutation', but we did not find any carrier of the second 'Moroccan mutation' among 140 Moroccan Jews, nor any carrier of the 'Tunisian mutation' among 50 Tunisian Jews. Two 'Indian mutation' carriers were identified among 53 Indian Jews. All carriers within each ethnic group had the same haplotype, suggesting a common founder for each mutation.

Genetic differentiation of Yemeni people according to rhesus and Gm polymorphisms

For introducing Yemeni population in synthesis of genetic relationships of human populations, analysis of rhesus and Gm polymorphisms have been carried out for a population sample of 210 Yemenites. Rhesus haplotype frequencies were compared to those estimated in an original sample of 171 Tunisians and to available data for other populations. Gm haplotype frequencies were introduced in a wide synthesis of genetic relationships for 67 populations from Africa, Europe, the Near East and India. The genetic profile of Yemeni people would be close to that of a highly diversified ancestral population. The first inhabitants of North Africa, the Berbers and Yemenites have very likely a common origin and were not subject to important genetic drift after their geographic differentiation. While, the divergence between Yemenites and their neighbours of sub-Saharan Africa would have occurred with a founder effect and a long isolation. An important parallelism is observed for the Gm system between genetic and linguistic differentiations.

Two new Ggamma chain variants: Hb F-clamart [gamma17(A14)Lys-->Asn] and Hb F-Ouled Rabah [gamma19(B1)Asn-->Lys]

Two new fetal hemoglobin variants affecting the Ggamma chain are reported. Hb F-Clamart was found during investigation of a French newborn who presented with a mild microcytemia. The second variant was found during neonatal screening for hemoglobinopathies of 30,000 babies from a population-at-risk living in the Paris region. It was named Hb F-Ouled Rabah because its structural modification and ethnic distribution is similar to that of Hb D-Ouled Rabah [beta19(B1)Asn-->Lys]. Hb F-Ouled Rabah is clinically silent and occurs at a frequency of ca. 0.1% in newborns originating from Maghreb. Structural characterization of both variants was done by protein chemistry methods, including amino acids analysis and mass spectrometry.

From the desert: transcultural aspects of cancer nursing care in Israel

Quality of life perceptions, the meaning of cancer perception, and the meaning of illness are culture bound. Culture includes learned and shared ways of interpreting the world and interacting in society, and thereby provides all individuals with ideas about what is good or bad, desirable or undesirable, valued or devalued in life. Israel is an immigration country, and its citizens came from all over the world. It is also a meeting zone between Middle Eastern traditional culture and Western modern medicine. Cancer patients and a substantial proportion of doctors, nurses, and other health care professionals are from different ethnic backgrounds. In hospitals, clinics, and other places where health professionals live, work, or relax, there is a network of cultural factors that plays an important role in the well-being of patients. Cultural effects can considerably complicate the assessment of how an individual is likely to react to various aspects of the hospital environment, medical condition, treatment, staff, fellow patients, and so on. Ideal management includes the foresight to forestall problems that may arise and to create favorable psychosomatic effects that help patients to respond positively to treatment. To illustrate the cultural component in nursing care, four cancer patients from totally different cultural backgrounds are described: a bedouin, an Israeli-born Jew whose parents immigrated from Tunisia, and two immigrant patients, one from the United States and the other from Ethiopia. All four patients were treated by chemotherapy, radiation, or both in an oncology day-care unit at the Soroka Medical Center in Beer-Sheva. Also, a special education program for immigrant nurses is presented, as well as a new immigrant nurse from the former Soviet Union.

A novel allele in the promoter region of the human serotonin transporter gene

The human serotonin transporter (hSERT) gene is a promising candidate for mediating the genetic susceptibility for various psychiatric conditions such as mood and obsessive-compulsive disorders. Two polymorphic sites in this gene attracted much interest: a VNTR of 17-bp repeats in intron two, and an insertion/deletion in the 5'-flanking promoter region (5-HTT gene-linked polymorphic region-5-HTTLPR) creating a short (S) and a long (L) allele. The 5-HTTLPR polymorphism is situated in a GC-rich region composed of 20-23 bp repeating units. The S and L alleles have 14 and 16 repeat-elements respectively. Positive associations of the 5-HTTLPR polymorphism with mood disorders, anxiety-related personality traits, autism and late-onset Alzheimer's disease have been published, although some non replications were also reported. Here we report a novel allele (termed LJ) in the 5-HTTLPR site. This allele is longer than the L allele by 43 bp, has 18 repeat units and contains two copies of the insertion/deletion sequence arranged in tandem. The LJ allele was found in individuals of Libyan and Tunisian Jewish origin but not in Moroccan or Ashkenazi Jews.

A high-resolution genetic map of the familial Mediterranean fever candidate region allows identification of haplotype-sharing among ethnic groups

Familial Mediterranean fever (FMF) is a recessive disorder of inflammation caused by mutations in a gene (designated MEFV) on chromosome 16p13.3. We have recently constructed a 1-Mb cosmid contig that includes the FMF critical region. Here we show genotype data for 12 markers from our physical map, including 5 newly identified microsatellites, in FMF families. Intrafamilial recombinations placed MEFV in the approximately 285 kb between D16S468/D16S3070 and D16S3376. We observed significant linkage disequilibrium in the North African Jewish population, and historical recombinants in the founder haplotype placed MEFV between D16S3082 and D16S3373 (approximately 200 kb). In smaller panels of Iraqi Jewish, Arab, and Armenian families, there were significant allelic associations only for D16S3370 and D16S2617 among the Armenians. A sizable minority of Iraqi Jewish and Armenian carrier chromosomes appeared to be derived from the North African Jewish ancestral haplotype. We observed a unique FMF haplotype common to Iraqi Jews, Arabs, and Armenians and two other haplotypes restricted to either the Iraqi Jewish or the Armenian population. These data support the view that a few major mutations account for a large percentage of the cases of FMF and suggest that some of these mutations arose before the affected Middle Eastern populations diverged from one another.

The risk of developing Creutzfeldt-Jakob disease in subjects with the PRNP gene codon 200 point mutation

We determined the penetrance of the PRNP 200Lys mutation in the large cluster of Creutzfeldt-Jakob disease (CJD) cases among Jews of Libyan-Tunisian origin living in Israel, utilizing data from 52 carriers with definite or probable CJD and 34 unaffected mutation carriers. A life table analysis was carried out with development of CJD as the end point. The probability of developing CJD rose with age, fitting a second-order regression curve (R = 0.97, p < 0.001). The cumulative penetrance reached 50% at the age of 60 and 80% at 80 years. Including seven elderly possible CJD patients in the analysis made the penetrance approach 100% by age eighty. The penetrance of the mutation is high, and although age is a predominant influencing factor, other factors, such as gender, may also play a role.

Further mapping of the properdin deficiency gene in a Tunisian Jewish family--evidence for genetic homogeneity

The properdin deficiency gene has been localized to Xp21.1-Xcen; however, it is not clear whether the mutation responsible for the disease co-maps exactly with the structural properdin gene. Based on a recent study on a total of six families, the gene was found linked to DXS255 (theta = 0.00). As only a few families have been studied, it is not known whether the same gene is responsible for the disease in all families. In order to better localize the disease gene in Israel, we studied a Tunisian Jewish family with properdin deficiency for linkage with various X-markers. A maximum lod score of 1.93 at theta = 0.00 was calculated with the DXS7 probe while there was one recombination with DXS255. This study helps to better localize the properdin deficiency gene to Xp11.3-p21.1 proximal to DXS255 locus and confirms that there is no indication of genetic heterogeneity. Whether the properdin structural gene (PFC) and properdin deficiency locus are one and the same await demonstration of mutations in the structural gene in patients with properdin deficiency.

Mutations of the tyrosinase gene in patients with oculocutaneous albinism from various ethnic groups in Israel

We have analyzed the tyrosinase (TYR) gene in 38 unrelated patients with oculocutaneous albinism (OCA), derived from several different ethnic groups of the diverse population of Israel. We detected TYR gene mutations in 23 of the 34 patients with apparent type I (i.e., tyrosinase-deficient) OCA and in none of the patients with other clinical forms of albinism. Among Moroccan Jews with type IA (i.e., tyrosinase-negative) OCA, we detected a highly predominant mutant allele containing a missense substitution, Gly47Asp (G47D). This mutation occurs on the same haplotype as in patients from the Canary Islands and Puerto Rico, suggesting that the G47D mutation in these ethnically distinct populations may stem from a common origin.

Hemoglobin variants in North Africa

The populations of Morocco, Algeria, and Tunisia are composed of different ethnic groups including Arabs, Berbers, Sub-Saharan Africans, Europeans, and Turks. Between 1981 and 1991, we studied more than 3,000 individuals from these North African countries. One-hundred and eighty-one carried one (or more) unusual hemoglobin variant(s) other than Hb S and Hb C which are the most frequent variants in these countries. Each of these 181 individuals was heterozygous for at least one of the 49 abnormal alpha or beta alleles identified by electrophoretic and/or structural studies, and some homozygotes were detected. A few mutants are common in North Africa: Hb O-Arab, Hb D-Punjab and Hb G-Philadelphia. Other mutants encountered in European or African populations are found in relatively few North African families. The observed polymorphisms in the populations of North Africa probably result largely from their complex ethnic origins.

Hereditary properdin deficiency in three families of Tunisian Jews

Hereditary properdin deficiency is a rare genetic disorder of the complement system. Three propositi and six additional family members with properdin deficiency have been found following analysis of the hemolytic activity of the classical (CH50) and the alternative (AP50) complement pathways in the sera of 101 survivors of meningococcal infections and 59 survivors of severe pneumococcal and Haemophilus influenza infections. All the properdin-deficient individuals had undetectable levels of properdin by radial immunodiffusion and by Western blotting. They belonged to three non-related families of Tunisian Jews who came from different parts of Tunisia. Two patients had a meningococcal infection at 15 and 16 years of age, respectively, and one had Haemophilus influenza meningitis at 1.5 years of age. In contrast to the fulminant and fatal course of meningococcal infection which was previously described in some properdin-deficient patients, our patients had a relatively mild disease. Properdin deficiency may not be as rare as previously thought. Analysis of AP50, in addition to CH50, in sera of patients who had meningococcal infection, will probably disclose many more cases of hereditary properdin deficiency. In addition, our findings indicate that, as in other complement abnormalities, hereditary properdin deficiency may also be associated with the ethnic origin of the patient.

A missense mutation, S349P, completely inactivates phenylalanine hydroxylase in north African Jews with phenylketonuria

The majority of hyperphenylalaninemias (HPAs) result from mutations at the gene for phenylalanine hydroxylase (PAH). The broad phenotypic variability of these conditions, ranging from phenylketonuria (PKU) to mild benign HPA, is underlain by a wide spectrum of mutations giving rise to various genotypic combinations. Mutant PAH alleles, labeled by specific polymorphic haplotypes and mutations, are becoming useful markers in human population genetics. We report here a mutant PAH allele found in Jews from Morocco and Tunisia, marked by haplotype 4 and a missense mutation, TCASer-->CCAPro, at codon 349 in exon 10 of the gene. In vitro expression of the mutation showed normal levels of mRNA with virtually no enzymatic activity or protein immunoreactivity, pointing to a highly unstable protein. A homozygote for this mutation showed the most severe ("classical") type of PKU, while compound heterozygotes showed two other types of HPA--"atypical" PKU and "high benign" HPA--illustrating the interplay between different mutations that gives rise to various HPAs.

A mutation in the prion protein gene in Creutzfeldt-Jakob disease in Jewish patients of Libyan, Greek, and Tunisian origin

A modified host protein encoded by the gene specifying the scrapie amyloid precursor is critically involved in the pathogenesis of transmissible spongiform encephalopathies such as Creutzfeldt-Jakob disease (CJD), Gerstmann-Straussler-Scheinker's syndrome, and Kuru. A mutation in the open reading frame of this gene was recently described in a cluster of patients with CJD in Slovakia. This mutation at codon 200 changes glutamic acid coded by GAG to lysine coded by AAG. We examined the prevalence of this mutation in the cluster of patients with CJD among Sephardic Jews of Libyan descent in Israel. A polymerase chain reaction was used to amplify the open reading frame of the prion protein gene from DNA extracted from frozen brain tissue of five Israeli residents (four of Libyan and one of Greek origin) and two familial cases in Jews born in Greece and Tunisia who later emigrated to France. The existence of the codon 200 mutation was detected by digestion of the open reading frame fragments with the BsmA1 restriction enzyme. All patients had the same codon 200 mutation. These findings implicate this mutation in the high prevalence of CJD among Libyan and Sephardic Jews from other Mediterranean countries.

[Determination of the frequency of the A2m (2) allele of immunoglobin A in the Tunisian population by RFLP analysis]

The human IgA2 subclass has two allotypes A2m(1) and A2m (2). Using the RFLP technique, we determined the A2m(2) frequency in a sample of 29 tunisian individuals. In accordance with Lefranc and all. [6], the presence of a polymorphic EcoRI site of the A2m(2) allele was confirmed in our RFLP study whereas no BamHI nor HindIII polymorphisms were shown. Among the 29 cases studies, 11 were heterozygous A2m2-1, 17 homozygous A2m1-1 and 1 homozygous A2m2-2. The A2m2 allele frequency in the Tunisian population (0,22) is intermediate between the European frequency and the African one.

[Epidemiologic study of anti-HCV antibodies in Tunisian blood donors]

A study carried out on 2,006 Tunisian blood donors permitted us to evaluate the prevalence of hepatitis C virus antibodies (anti-HCV) which was 1.09%; frequency of indirect markers of NANBH were as follows: ALAT greater than 2 N (1.24%), anti-HBc (30.35%), 55.5% of HCV (+) donors had anti-HBc (+), 12.5% had rises ALAT and only 33.3% both markers.

Peptic ulcer in migrants. Seven case-reports from Italy

Migrant workers in Central Europe are reported to suffer from an increased prevalence of both duodenal and gastric ulcer as compared to native population. No information is available, however, as far as Italy is concerned. The Authors have thought of interest to report on 7 cases of peptic ulcer disease occurring in migrant workers in Italy. Patients were young adult males from African or Mediterranean developing Countries. In 5 cases the symptoms of their peptic ulcers began after their arrival in Italy. The etiopathogenesis of peptic ulcer was likely to include an interaction among emotional stress, low income, shift and manual work, cigarette smoking and nonsteroidal antiinflammatory drugs self-administration. This last factor has not been reported in literature. The hypothesis that migrant workers in Italy are a peptic ulcer-prone population needs further confirmation for its clinical and social implications.

Deletion, insertion, and restriction site polymorphism of the T-cell receptor gamma variable locus in French, Lebanese, Tunisian, and black African populations

The human T-cell receptor gamma region spans 160 kb of genomic DNA and is densely populated by coding sequences. Restriction fragment length polymorphisms have been previously documented for the constant region genes, the joining segments, and the variable genes belonging to subgroups I and IV. Here we further define the polymorphism of the V gamma I subgroup genes. based on complete mapping of the Eco RI and Taq I allelic restriction fragments. We describe seven haplotypes; five result from polymorphic restriction sites, the sixth corresponds to a deletion of about 10 kb encompassing V4 and V5, and the seventh results from an insertion of an additional gene, V3P, between V3 and V4. As a consequence of the deletion or insertion polymorphism, the number of V gamma I subgroup genes vary from seven in haplotype TRGVI*3 to ten in haplotype TRGVI*4, whereas the most common haplotype, TRGVI*1, has nine V genes, five of them being functional. Frequencies of the different TRGVI haplotypes in French, Lebanese, Tunisian, and Black African populations are given.