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Fotzi I, Pegoraro F, Chiocca E, Casini T, Mogni M, Veltroni M, Favre C. Case Report: Clinical and Hematological Characteristics of ε γδβ Thalassemia in an Italian Patient. Front Pediatr 2022; 10:839775. [PMID: 35372167 PMCID: PMC8969019 DOI: 10.3389/fped.2022.839775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION εγδβ thalassemia is a rare form of β-thalassemia mostly described in children originating from Northern Europe. Only anecdotic cases from the Mediterranean area are reported. The diagnosis is challenging, considering the rarity of the disease and its heterogeneous clinical presentation. Most patients have neonatal microcytic anemia, sometimes requiring in utero and/or neonatal transfusions, and typically improving with age. CASE DESCRIPTION We report on an Italian newborn presenting with severe neonatal anemia that required red blood cell transfusion. After the first months of life, hemoglobin levels improved with residual very low mean corpuscular volume. β and α thalassemia, IRIDA syndrome, and sideroblastic anemia were excluded. Finally, a diagnosis of εγδβ thalassemia was made after microarray analysis of single nucleotide polymorphisms revealed a 26 kb single copy loss of chromosome 11p15.4, including the HBD, HBBP1, HBG1, and HBB genes. CONCLUSIONS Despite its rarity, the diagnosis of εγδβ thalassemia should be considered in newborns with severe neonatal anemia requiring in utero and/or neonatal transfusions, but also in older infants with microcytic anemia, after excluding more prevalent red blood cell disorders.
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Affiliation(s)
- Ilaria Fotzi
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Francesco Pegoraro
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy.,Department of Health Science, University of Florence, Florence, Italy
| | - Elena Chiocca
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Tommaso Casini
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Massimo Mogni
- Human Genetics Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Marinella Veltroni
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Claudio Favre
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
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De Simone G, Quattrocchi A, Mancini B, di Masi A, Nervi C, Ascenzi P. Thalassemias: From gene to therapy. Mol Aspects Med 2021; 84:101028. [PMID: 34649720 DOI: 10.1016/j.mam.2021.101028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/19/2021] [Indexed: 12/26/2022]
Abstract
Thalassemias (α, β, γ, δ, δβ, and εγδβ) are the most common genetic disorders worldwide and constitute a heterogeneous group of hereditary diseases characterized by the deficient synthesis of one or more hemoglobin (Hb) chain(s). This leads to the accumulation of unstable non-thalassemic Hb chains, which precipitate and cause intramedullary destruction of erythroid precursors and premature lysis of red blood cells (RBC) in the peripheral blood. Non-thalassemic Hbs display high oxygen affinity and no cooperativity. Thalassemias result from many different genetic and molecular defects leading to either severe or clinically silent hematologic phenotypes. Thalassemias α and β are particularly diffused in the regions spanning from the Mediterranean basin through the Middle East, Indian subcontinent, Burma, Southeast Asia, Melanesia, and the Pacific Islands, whereas δβ-thalassemia is prevalent in some Mediterranean regions including Italy, Greece, and Turkey. Although in the world thalassemia and malaria areas overlap apparently, the RBC protection against malaria parasites is openly debated. Here, we provide an overview of the historical, geographic, genetic, structural, and molecular pathophysiological aspects of thalassemias. Moreover, attention has been paid to molecular and epigenetic pathways regulating globin gene expression and globin switching. Challenges of conventional standard treatments, including RBC transfusions and iron chelation therapy, splenectomy and hematopoietic stem cell transplantation from normal donors are reported. Finally, the progress made by rapidly evolving fields of gene therapy and gene editing strategies, already in pre-clinical and clinical evaluation, and future challenges as novel curative treatments for thalassemia are discussed.
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Affiliation(s)
- Giovanna De Simone
- Dipartimento di Scienze, Università Roma Tre, Viale Guglielmo Marconi 446, 00146, Roma, Italy
| | - Alberto Quattrocchi
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Facoltà di Farmacia e Medicina, "Sapienza" Università di Roma, Corso della Repubblica, 79, 04100, Latina, Italy
| | - Benedetta Mancini
- Dipartimento di Scienze, Università Roma Tre, Viale Guglielmo Marconi 446, 00146, Roma, Italy
| | - Alessandra di Masi
- Dipartimento di Scienze, Università Roma Tre, Viale Guglielmo Marconi 446, 00146, Roma, Italy
| | - Clara Nervi
- Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, Facoltà di Farmacia e Medicina, "Sapienza" Università di Roma, Corso della Repubblica, 79, 04100, Latina, Italy.
| | - Paolo Ascenzi
- Dipartimento di Scienze, Università Roma Tre, Viale Guglielmo Marconi 446, 00146, Roma, Italy; Accademia Nazionale dei Lincei, Via della Lungara 10, 00165, Roma, Italy.
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Ferreira RD, Mota NO, Pedroso GA, Kimura EM, Geraldo APM, Santos MNN, Costa FF, Sonati MF. First report of εγδβ 0 -thalassemia in a Brazilian family. Int J Lab Hematol 2018; 40:e96-e98. [PMID: 29851275 DOI: 10.1111/ijlh.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R D Ferreira
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - N O Mota
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - G A Pedroso
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - E M Kimura
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - A P M Geraldo
- Integrated Center for Pediatric Hematology/Oncology Research (CIPOI), School of Medical Sciences, State University of Campinas- UNICAMP, Campinas, SP, Brazil
| | - M N N Santos
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - F F Costa
- Hematology and Hemotherapy Center, UNICAMP, Campinas, SP, Brazil
| | - M F Sonati
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
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Hui ASY, Au PKC, Ting YH, Kan ASY, Cheng YKY, Leung AWK, Chan KYK, Li CK, Tang MHY, Leung TY. First Report of a Novel Deletion Due toεγδβ-Thalassemia in a Chinese Family. Hemoglobin 2017; 41:175-179. [PMID: 28950778 DOI: 10.1080/03630269.2017.1366918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Annie S. Y. Hui
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic of China
| | - Patrick K. C. Au
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People’s Republic of China
| | - Yuen-Ha Ting
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic of China
| | - Anita S. Y. Kan
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People’s Republic of China
| | - Yvonne K. Y. Cheng
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic of China
| | - Alex W. K. Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Kelvin Y. K. Chan
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People’s Republic of China
| | - Chi-Kong Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Mary H. Y. Tang
- Department of Obstetrics & Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, People’s Republic of China
| | - Tak-Yeung Leung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, People’s Republic of China
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Luo HY, Chui DHK. Diverse hematological phenotypes of β-thalassemia carriers. Ann N Y Acad Sci 2016; 1368:49-55. [PMID: 27123947 DOI: 10.1111/nyas.13056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 01/19/2023]
Abstract
Most β-thalassemia carriers have mild anemia, low mean corpuscular volume and mean corpuscular hemoglobin, and elevated hemoglobin α2 (HbA2 ). However, there is considerable variability resulting from coinheritance with α- and/or δ-globin gene mutations, dominant inheritance of β-thalassemia mutations, highly unstable variant globin chains, large deletions removing part or all of the β-globin gene cluster, loss of heterozygosity of the β-globin gene cluster during development, or concomitant erythroid enzyme or membrane protein abnormalities. Recognition of the specific abnormality and correct diagnosis can allay anxiety and unnecessary investigation, help formulate treatment programs, and deliver appropriate genetic and family counseling.
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Affiliation(s)
- Hong-Yuan Luo
- Departments of Medicine, Pathology, and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - David H K Chui
- Departments of Medicine, Pathology, and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
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Abstract
The β-thalassemias are characterized by a quantitative deficiency of β-globin chains underlaid by a striking heterogeneity of molecular defects. Although most of the molecular lesions involve the structural β gene directly, some down-regulate the gene through distal cis effects, and rare trans-acting mutations have also been identified. Most β-thalassemias are inherited in a Mendelian recessive fashion but there is a subgroup of β-thalassemia alleles that behave as dominant negatives. Unraveling the molecular basis of β-thalassemia has provided a paradigm for understanding of much of human genetics.
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Affiliation(s)
- Swee Lay Thein
- Department of Haematological Medicine, King's College London School of Medicine/King's College Hospital NHS Foundation Trust, London SE5 9NU, United Kingdom.
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Von Kanel T, Röthlisberger B, Schanz U, Dutly F, Huber AR, Saller E. A Swiss (εγδβ)⁰-thalassemia patient with a novel 3-Mb deletion associated with mild mental impairment. Am J Hematol 2013; 88:158-9. [PMID: 23255297 DOI: 10.1002/ajh.23364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 10/30/2012] [Accepted: 11/07/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas Von Kanel
- Centre of Laboratory Medicine; Kantonsspital Aarau; Tellstrasse; Aarau; Switzerland
| | - Benno Röthlisberger
- Centre of Laboratory Medicine; Kantonsspital Aarau; Tellstrasse; Aarau; Switzerland
| | - Urs Schanz
- Division of Hematology; University Hospital Zürich; Raemistrasse Zürich; Switzerland
| | - Fabrizio Dutly
- Institut für medizinische & molekulare Diagnostik AG; Rautistrasse Zürich; Switzerland
| | - Andreas R. Huber
- Centre of Laboratory Medicine; Kantonsspital Aarau; Tellstrasse; Aarau; Switzerland
| | - Elisabeth Saller
- Institut für medizinische & molekulare Diagnostik AG; Rautistrasse Zürich; Switzerland
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Shalev H, Landau D, Pissard S, Krasnov T, Kapelushnik J, Gilad O, Broides A, Dgany O, Tamary H. A novel epsilon gamma delta beta thalassemia presenting with pregnancy complications and severe neonatal anemia. Eur J Haematol 2013. [DOI: 10.1111/ejh.12047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hanna Shalev
- Pediatric Division; Soroka University Medical Center; Beer Sheva; Israel
| | - Daniela Landau
- Pediatric Division; Soroka University Medical Center; Beer Sheva; Israel
| | - Serge Pissard
- Laboratory of Biochemistry and Genetics, Henri Mondor and UPEC; Creteil; France
| | - Tanya Krasnov
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv; Israel
| | - Joseph Kapelushnik
- Pediatric Division; Soroka University Medical Center; Beer Sheva; Israel
| | - Oded Gilad
- Department of Pediatrics B; Schneider Children's Medical Center of Israel, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv; Israel
| | - Arnon Broides
- Pediatric Division; Soroka University Medical Center; Beer Sheva; Israel
| | - Orly Dgany
- Laboratory of Biochemistry and Genetics, Henri Mondor and UPEC; Creteil; France
| | - Hannah Tamary
- Department of Hematology-Oncology; Schneider Children's Medical Center of Israel; Petach Tikva and Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv; Israel
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