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Shamoon R, Yassin A, Charkaneh A. Detection of a Rare Mutation in the Initiation Codon of the β-Globin Gene ( HBB:C.2T > C; P.Met1Thr). Hemoglobin 2023; 47:118-121. [PMID: 37503544 DOI: 10.1080/03630269.2023.2240708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
β-thalassemia is one of the most common inherited autosomal disorders in the northern Iraqi Kurdistan region. This study reports a rare mutation in the initiation codon of the β-globin gene (HBB: c.2T > C; p.Met1Thr) in an 11-year-old male with severe transfusion-dependent β-thalassemia. Molecular testing to uncover the mutations of the β-globin gene in the proband and his parents was performed by amplification and reverse hybridization. Sanger sequencing was conducted for further identification. A severe β-globin gene mutation in codon 8/9 [+G] was initially identified in the proband and his mother's DNA samples. However, the detection of only one β-globin gene mutation was not enough to elucidate the patient's severe phenotype. Thus, a rare mutation in the initiation codon was identified later in the proband and his father by Sanger sequencing. In thalassemias, the presence of a rare mutation should be suspected when the patient's genotype does not correlate with the phenotype.
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Affiliation(s)
- Rawand Shamoon
- Department of Pathology, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Hematology, Nanakali Hospital of Blood Diseases and Cancer, Erbil, Iraq
- Department of Hematology, Thalassemia Care Center, Erbil, Iraq
- Department of Laboratory Medical Sciences, College of Health Sciences, Catholic University in Erbil, Erbil, Iraq
- Genetics Unit, Laboratory Division, PAR Private Hospital, Erbil, Iraq
| | - Ahmed Yassin
- Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Clinical Hematology, Nanakali Hospital of Blood Diseases and Cancer, Erbil, Iraq
| | - Amir Charkaneh
- Genetics Unit, Laboratory Division, PAR Private Hospital, Erbil, Iraq
- Department of Biology, University of Guilan, Rasht, Iran
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Identification of novel mutations in β-thalassemia patients in Maysan Governorate, Iraq. Mol Biol Rep 2023; 50:3053-3062. [PMID: 36683082 DOI: 10.1007/s11033-023-08271-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/10/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND In homozygous β-thalassemia, the primary genetic modifiers affecting the clinical severity of β-thalassemia are genetic variants and the ability to reduce globin chain imbalance, thus resulting in a milder form of thalassemia. However, there are few reports on the molecular genetics of β-thalassemia in Iraq. METHODS We performed PCR and DNA sequencing on 40 Iraqi patients who were clinically suspected of having β-thalassemia. RESULTS The first genetic sequencing study was conducted in Maysan Governate, Iraq, using patients from various locations to identify novel mutations. There were five novel mutations: 294.T>C 12% (city center and Almajar district), 205. C>T 25% (city center, Alsalam, and Almashrah districts), 289.G>A 38% (Almaymuna and Gleat Salih districts), 49.T>C 32% (city center), and 624.C>A 32% (city center). These mutations were identified among β-thalassemia patients by two regions of HBB gene 696 bp and 861 bp. CONCLUSIONS The discovery of new genetic variants helps predict the severity of β-thalassemia disease. There are relatively few studies in molecular genetics of β-thalassemia in Iraq, and the new mutations reported here will provide valuable data for the prevention and control of β-thalassemia in Maysan Governate, Iraq. The results can lead to new genetic sequencing investigations for other Iraqi regions.
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Smart LR, Ambrose EE, Balyorugulu G, Songoro P, Shabani I, Komba P, Charles M, Howard TA, McElhinney KE, O'Hara SM, Odame J, Nakafeero M, Adams J, Stuber SE, Lane A, Latham TS, Makubi AN, Ware RE. Stroke Prevention with Hydroxyurea Enabled through Research and Education: A Phase 2 Primary Stroke Prevention Trial in Sub-Saharan Africa. Acta Haematol 2022; 146:95-105. [PMID: 35977532 PMCID: PMC10100573 DOI: 10.1159/000526322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Stroke is a severe complication of sickle cell anemia (SCA), with devastating sequelae. Transcranial Doppler (TCD) ultrasonography predicts stroke risk, but implementing TCD screening with suitable treatment for primary stroke prevention in low-resource environments remains challenging. SPHERE (NCT03948867) is a prospective phase 2 open-label hydroxyurea trial for SCA in Tanzania. METHODS After formal training and certification, local personnel screened children 2-16 years old; those with conditional (170-199 cm/s) or abnormal (≥200 cm/s) time-averaged mean velocities (TAMVs) received hydroxyurea at 20 mg/kg/day with dose escalation to maximum tolerated dose (MTD). The primary study endpoint is change in TAMV after 12 months of hydroxyurea; secondary endpoints include SCA-related clinical events, splenic volume and function, renal function, infections, hydroxyurea pharmacokinetics, and genetic modifiers. RESULTS Between April 2019 and April 2020, 202 children (average 6.8 ± 3.5 years, 53% female) enrolled and underwent TCD screening; 196 were deemed eligible by DNA testing. Most had numerous previous hospitalizations and transfusions, with low baseline hemoglobin (7.7 ± 1.1 g/dL) and %HbF (9.3 ± 5.4%). Palpable splenomegaly was present at enrollment in 49 (25%); average sonographic splenic volume was 103 mL (range 8-1,045 mL). TCD screening identified 22% conditional and 2% abnormal velocities, with hydroxyurea treatment initiated in 96% (45/47) eligible children. CONCLUSION SPHERE has built local capacity with high-quality research infrastructure and TCD screening for SCA in Tanzania. Fully enrolled participants have a high prevalence of elevated baseline TCD velocities and splenomegaly. SPHERE will prospectively determine the benefits of hydroxyurea at MTD for primary stroke prevention, anticipating expanded access to hydroxyurea treatment across Tanzania.
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Affiliation(s)
- Luke R. Smart
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emmanuela E. Ambrose
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Idd Shabani
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Thad A. Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathryn E. McElhinney
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara M. O'Hara
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jodie Odame
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Maria Nakafeero
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Janet Adams
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan E. Stuber
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam Lane
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Teresa S. Latham
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Abel N. Makubi
- Catholic University of Health & Allied Sciences, Mwanza, Tanzania
- Bugando Medical Centre, Mwanza, Tanzania
| | - Russell E. Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Macharia AW, Mochamah G, Makale J, Howard T, Mturi N, Olupot-Olupot P, Färnert A, Ware RE, Williams TN. Case Report: β-thalassemia major on the East African coast. Wellcome Open Res 2022; 7:188. [PMID: 37811313 PMCID: PMC10551670 DOI: 10.12688/wellcomeopenres.17907.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 10/10/2023] Open
Abstract
Background: β-thalassemia is rare in sub-Saharan Africa and to our knowledge there has been no case of homozygous β-thalassemia major reported from this region. In a recent cohort study, we identified four β-thalassemia mutations among 83 heterozygous carriers in Kilifi, Kenya. One of the mutations identified was a rare β-globin gene initiation codon mutation (ATG➝ACG) (rs33941849). Here we present a patient with β-thalassemia major resulting from this mutation, only the second homozygous patient to have been reported. Methods: The female patient presented to Kilifi County Hospital aged two years with a one week left sided abdominal swelling. Clinical, hematological and genetic information were collected at admission and follow-up. Results: Admission bloods revealed marked anemia, with a hemoglobin (Hb) value of 6.6 g/dL and a low mean corpuscular volume of 64 fL. High performance liquid chromatography (HPLC) revealed the absence of HbA0 and elevated levels of HbF, suggesting a diagnosis of β-thalassemia major. Sequencing revealed that the child was homozygous for the rs33941849 initiation codon mutation. Conclusions: We hope that this study will create awareness regarding the presence of β-thalassemia as a potential public health problem in the East Africa region and will prompt the development of local guidelines regarding the diagnosis and management of this condition.
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Affiliation(s)
- Alexander W. Macharia
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - George Mochamah
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - Johnstone Makale
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - Thad Howard
- Division of Hematology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Neema Mturi
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Mbale, Uganda
- Busitema University Faculty of Health Sciences, Mbale, Uganda
| | | | - Russell E. Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Thomas N. Williams
- Epidemiology and Demography Department, KEMRI/Wellcome Trust Kilifi, Kilifi, 254, Kenya
- Institute for Global Health Innovation, Imperial College, London, UK
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Macharia AW, Mochamah G, Uyoga S, Ndila CM, Nyutu G, Tendwa M, Nyatichi E, Makale J, Ware RE, Williams TN. β-Thalassemia pathogenic variants in a cohort of children from the East African coast. Mol Genet Genomic Med 2020; 8:e1294. [PMID: 32394645 PMCID: PMC7336762 DOI: 10.1002/mgg3.1294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND β-Thalassemia is rare in sub-Saharan Africa. Previous studies have suggested that it is limited to specific parts of West Africa. Based on hemoglobin A2 (HbA2 ) concentrations measured by HPLC, we recently speculated that β-thalassemia might also be present on the East African coast of Kenya. Here, we follow this up using molecular methods. METHODS We used raised hemoglobin A2 (HbA2 ) values (> 4.0% of total Hb) to target all HbAA members of a cohort study in Kilifi, Kenya, for HBB sequencing for β-thalassemia (n = 99) together with a sample of HbAA subjects with lower HbA2 levels. Because HbA2 values are artifactually raised in subjects carrying sickle hemoglobin (HbS) we sequenced all participants with an HPLC pattern showing HbS without HbA (n = 116) and a sample with a pattern showing both HbA and HbS. RESULTS Overall, we identified 83 carriers of four separate β-thalassemia pathogenic variants: three β0 -thalassemia [CD22 (GAA→TAA), initiation codon (ATG→ACG), and IVS1-3' end del 25bp] and one β+ -thalassemia pathogenic variants (IVS-I-110 (G→A)). We estimated the minimum allele frequency of all variants combined within the study population at 0.3%. CONCLUSIONS β-Thalassemia is present in Kilifi, Kenya, an observation that has implications for the diagnosis and clinical care of children from the East Africa region.
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Affiliation(s)
| | | | - Sophie Uyoga
- KEMRI-Wellcome Trust Research ProgrammeKilifiKenya
| | | | - Gideon Nyutu
- KEMRI-Wellcome Trust Research ProgrammeKilifiKenya
| | | | | | | | - Russell E. Ware
- Cincinnati Children’s Hospital Medical CenterCincinnatiOHUSA
| | - Thomas N. Williams
- KEMRI-Wellcome Trust Research ProgrammeKilifiKenya
- Department of MedicineImperial CollegeSt Mary’s HospitalLondonUK
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