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Benz EJ. Introduction to the Thalassemia Syndromes: Molecular Medicine's Index Case. Hematol Oncol Clin North Am 2023; 37:245-259. [PMID: 36907601 DOI: 10.1016/j.hoc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Thalassemia is a heterogeneous group of inherited anemias having in common defective biosynthesis of one or more of the globin chain subunits of human hemoglobin. Their origins lie in inherited mutations that impair the expression of the affected globin genes. Their pathophysiology arises from the consequent insufficiency of hemoglobin production and the imbalance in the production of globin chains resulting in the accumulation of insoluble unpaired chains. These precipitate and damage or destroy developing erythroblasts and erythrocytes producing ineffective erythropoiesis and hemolytic anemia. Treatment of severe cases requires lifelong transfusion support with iron chelation therapy.
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Affiliation(s)
- Edward J Benz
- Dana Farber Cancer Institute, Dana Farber/Harvard Cancer Center, Harvard Medical School, Room D 1644a, Dana Building, 450 Brookline Avenue, Boston, MA 02215, USA.
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2
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Wajcman H, de Brevern AG, Riou J, Latouche C, Marden MC, Pissard S. Short in-Frame Insertions/Deletions in the Coding Sequence of the α-Globin Gene. Consequences of the 3D Structure and Resulting Phenotypes: Hb Choisy as an Example. Hemoglobin 2019; 42:287-293. [PMID: 30700179 DOI: 10.1080/03630269.2018.1556683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A small group of hemoglobin (Hb) variants result from 'in-frame' deletion/insertion (del/ins). We describe a new variant of this group (Hb Choisy), found on the α1 gene, which is the exact counterpart of a previously published deletional variant, Hb J-Biskra [codons 51-58 (or codons 52-59) (-24 bp) (-TCTGCCCAGGTTAAGGGCCACGGC); HBA1: c.157_180del (or HBA2)]. In Hb J-Biskra, the sequence Ser-Ala-Gln-Val-Lys-Gly-His-Gly located from positions α52(E1) to α59(E8) is deleted, while in Hb Choisy the same sequence (Ser-Ala-Gln-Val-Lys-Gly-His-Gly) is inserted at position α52(E1). The variant carrying the insertion appears to be less damaging than the one with the deletion. A possible explanation could be that the additional sequence is located in the C to E interhelical region, and is less disturbing to the general structure of the globin chain. This insertion/deletion (ins/del) is likely favored by the repetition, at an interval of 16 nucleotides, of an eight nucleotide sequence. Comparison of variants of this group, found in the HbVar database, shows that structural modifications resulting from insertions are frequently less damaging than that caused by deletions.
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Affiliation(s)
- Henri Wajcman
- a Institut National de la Sante et de la Recherche Médicale (INSERM) U 955 eq 2 , Institut Mondor de Recherche Biomoléculaire (IMRB) , Créteil , France
| | - Alexandre G de Brevern
- b Biologie Integree du Globule Rouge Unité Mixte de Recherche (UMR)-S1134, INSERM , Université Paris Diderot, Sorbonne, Paris Cite, Université de la Réunion, Université des Antilles , Paris , France.,c Institut National de la Transfusion Sanguine (INTS) , Paris , France.,e Laboratoire d'Excellence GR-Ex , Créteil , France
| | - Jean Riou
- d Assistance Publique-Hôpitaux de Paris (APHP), Département de Génétique , Hôpital Henri Mondor , Créteil , France
| | - Celine Latouche
- d Assistance Publique-Hôpitaux de Paris (APHP), Département de Génétique , Hôpital Henri Mondor , Créteil , France
| | - Michael C Marden
- a Institut National de la Sante et de la Recherche Médicale (INSERM) U 955 eq 2 , Institut Mondor de Recherche Biomoléculaire (IMRB) , Créteil , France.,e Laboratoire d'Excellence GR-Ex , Créteil , France
| | - Serge Pissard
- a Institut National de la Sante et de la Recherche Médicale (INSERM) U 955 eq 2 , Institut Mondor de Recherche Biomoléculaire (IMRB) , Créteil , France.,d Assistance Publique-Hôpitaux de Paris (APHP), Département de Génétique , Hôpital Henri Mondor , Créteil , France.,e Laboratoire d'Excellence GR-Ex , Créteil , France
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Farashi S, Vakili S, Garous NF, Ashki M, Forouzesh Pour F, Zeinali F, Rad F, Imanian H, Azarkeivan A, Najmabadi H. Identification of Mutations Causing Aberrant Termination and Deficient Splice Donor Site on theHBA1Gene. Hemoglobin 2015; 40:38-43. [DOI: 10.3109/03630269.2015.1088456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de la Fuente-Gonzalo F, Nieto JM, Ricard P, Anguita J, Martínez R, Cervera A, Villegas A, González FA, Ropero P. Hb Cervantes, Hb Marañón, Hb La Mancha and Hb Goya: Description of 4 new haemoglobinopathies. Clin Biochem 2015; 48:662-7. [DOI: 10.1016/j.clinbiochem.2015.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/29/2022]
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Abstract
Alpha (α)-thalassemia represents a group of recessively inherited hemoglobin disorders marked by deficient or absent synthesis of 1 to all 4 of the α-globin genes. Inactivation of 3 α-globin genes--either by deletional or nondeletional mutations--results in hemoglobin H (Hb H) disease. Patients with Hb H disease produce hemoglobin composed of all beta chains and have moderate to severe hemolytic anemia, a variable degree of ineffective erythropoiesis, and splenomegaly. Transfusion requirements vary depending on the mutation and clinical severity. Treatment for deletional Hb H disease is primarily preventative and transfusions are uncommon. Patients with nondeletional Hb H disease (e.g., Hb H Constant Spring) typically have more severe anemia, and approximately one-third require regular transfusions. These patients often require comprehensive, multidisciplinary care. This chapter focuses on screening, diagnosis, and treatment approaches for patients with Hb H disease.
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Affiliation(s)
- Elliott Vichinsky
- Children's Hospital & Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA.
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Paglietti ME, Sollaino MC, Loi D, Barella S, Desogus MF, Galanello R. First Detection of Hb Taybe [α38(C3) or α39(C4) Thr→0 (α1)] in An Italian Child. Hemoglobin 2012; 36:299-304. [DOI: 10.3109/03630269.2012.659780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Traeger-Synodinos J, Douna V, Papassotiriou I, Stamoulakatou A, Ladis V, Siahanidou T, Fylaktou I, Kanavakis E. Variable and Often Severe Phenotypic Expression in Patients with the α-Thalassemic Variant Hb Agrinio [α29(B10)Leu→Pro (α2)]. Hemoglobin 2010; 34:430-8. [DOI: 10.3109/03630269.2010.509224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dutly F, Fehr J, Goede JS, Morf M, Troxler H, Frischknecht H. A New Highly Unstable α Chain Variant Causing α+‐Thalassemia: Hb Zurich Albisrieden [α59(E8)Gly→Arg (α2)]. Hemoglobin 2009; 28:347-51. [PMID: 15658192 DOI: 10.1081/hem-200037714] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A new alpha-globin mutation causing persistent mild hypochromic microcytosis and erythrocytosis is described. Hb Zurich Albisrieden [alpha59(E8)Gly-->Arg (alpha2)] is not detected at the protein level and leads to alpha(+)-thalassemia (thal).
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Affiliation(s)
- Fabrizio Dutly
- Institute for Medical and Molecular Diagnostics Ltd, Zürich, Switzerland
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Dimisianos G, Traeger-Synodinos J, Vrettou C, Papassotiriou I, Kanavakis E. A Rare 33 bp In‐Frame Deletion (α63–74 or α64–74 or α65–75) in the α1‐Globin Gene Causing α+‐Thalassemia: A Second Observation. Hemoglobin 2009; 28:137-43. [PMID: 15182056 DOI: 10.1081/hem-120035914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The most frequent defects resulting in alpha-thalassemia (thal) include large deletions that remove one or both of the duplicated alpha-globin genes on chromosome 16. Less commonly, alpha-thal mutations involve single nucleotide substitutions or micro-deletions, leading either directly to decreased alpha-globin chain synthesis by the affected allele, or indirectly through production of hyperunstable variant alpha-globin chains. Here we describe the characterization of a 33 bp in-frame deletion within the alpha1-globin gene, in a woman with hematological findings consistent with an alpha-thal trait. The amino acids predicted to be missing as a result of the 33 bp deletion are at the end of the E helix and the EF corner of the alpha-globin protein chain, and are not normally involved in the heme contact, although it is presumed that alpha-globin chain folding and hemoglobin (Hb) formation will be disrupted. The observation of inclusion and Heinz bodies indicates the synthesis of some abnormal Hb (or globin chains). An identical mutation has been previously observed in a single case, a Canadian individual of Greek descent, indicating that it is a rare mutation, and probably of the same origin. Possible mechanisms underlying the mutation at the DNA level are discussed.
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Affiliation(s)
- Gerasimos Dimisianos
- Medical Genetics, Athens University, Aghia Sophia Children's Hospital, Athens, Greece
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Douna V, Papassotiriou I, Stamoulakatou A, Metaxotou-Mavrommati A, Kanavakis E, Traeger-Synodinos J. Association of Mild and Severely Unstable α Chain Variants: The First Observation of a Compound Heterozygote with Hb Setif [α94(G1)Asp→Tyr (α2)] and Hb Agrinio [α29(B10)Leu→Pro (α2)] in a Greek Family. Hemoglobin 2009; 32:592-5. [DOI: 10.1080/03630260802507964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Douna V, Papassotiriou I, Garoufi A, Georgouli E, Ladis V, Stamoulakatou A, Metaxotou-Mavrommati A, Kanavakis E, Traeger-Synodinos J. A Rare Thalassemic Syndrome Caused by Interaction of Hb Adana [α59(E8)Gly→Asp] with an α+-Thalassemia Deletion: Clinical Aspects in Two Cases. Hemoglobin 2009; 32:361-9. [DOI: 10.1080/03630260802173890] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Wajcman H, Traeger-Synodinos J, Papassotiriou I, Giordano PC, Harteveld CL, Baudin-Creuza V, Old J. Unstable and Thalassemic α Chain Hemoglobin Variants: A Cause of Hb H Disease and Thalassemia Intermedia. Hemoglobin 2009; 32:327-49. [DOI: 10.1080/03630260802173833] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Douna V, Papassotiriou I, Metaxotou-Mavrommati A, Stamoulakatou A, Liapi D, Kampourakis D, Tsilimigaki A, Kanavakis E, Traeger-Synodinos J. Further Identification of The Hyperunstable α-Globin Chain Variant Hb Heraklion [codons 36/37 (–CCC); Pro→0 (α1)] in Greek Cases With Co-Inherited α+-Thalassemia Mutations. Hemoglobin 2009; 32:379-85. [DOI: 10.1080/03630260802174021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Viprakasit V, Tanphaichitr VS, Veerakul G, Chinchang W, Petrarat S, Pung-Amritt P, Higgs DR. Co-inheritance of Hb Pak Num Po, a novel alpha1 gene mutation, and alpha0 thalassemia associated with transfusion-dependent Hb H disease. Am J Hematol 2004; 75:157-63. [PMID: 14978697 DOI: 10.1002/ajh.10479] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Hb H disease is generally associated with moderate to severe anemia but rarely requires regular blood transfusion. We recently studied two apparently unrelated patients with transfusion-dependent Hb H disease. Hemoglobin studies demonstrated Hb H and Hb Bart's without other detectable abnormal globin species. Extensive molecular analyses of the alpha globin genes and their regulatory sequence (HS-40) revealed that both patients are compound heterozygotes for alpha0 thalassemia (--(SEA)) and a novel point mutation, a thymidine insertion after codon 131 of the alpha1 gene. The resulting frameshift gives rise to a highly unstable alpha globin chain, which we refer to as "Hb Pak Num Po," containing an additional 34 amino acids. This unusual alpha1 globin variant clearly causes alpha thalassemia, but the unexpectedly severe phenotype suggests that this mutation may have additional effects on red cell physiology. A PCR-based (ARMS) assay was developed for rapid detection of this novel mutation, and this might be useful to study the prevalence of this novel mutation which poses potentially significant clinical consequences in populations of Southeast Asia. Detecting carriers of this mutation using the molecular diagnostic procedures described will provide the means to screen and prevent a potentially severe form of alpha thalassemia in Thailand.
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Affiliation(s)
- Vip Viprakasit
- Department of Pediatrics and Siriraj-Thalassemia Research Program, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Lacerra G, Testa R, De Angioletti M, Schilirò G, Carestia C. Hb Bronte or alpha93(FG5)Val-->Gly: a new unstable variant of the alpha2-globin gene, associated with a mild alpha(+)-thalassemia phenotype. Hemoglobin 2003; 27:149-59. [PMID: 12908799 DOI: 10.1081/hem-120023378] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report a new unstable variant identified in three carriers of a family from East Sicily; it was named Hb Bronte after the place from which the family originated. DNA sequencing from nucleotides -181 to +894 (alpha1) and to +884 (alpha2) revealed a GTG-->GGG substitution at codon 93 of the alpha2-globin gene. The MCV and MCH values were at the lower end of the normal range in the carriers. On cation exchange high performance liquid chromatography (HPLC), the Hb A2 level was apparently increased to around 6%, and a small abnormal peak (0.3-0.4%) was detected after Hb A2. Two abnormal bands were detected by cellulose acetate electrophoresis: a major band (about 3-4%) migrated between Hb A and Hb F; a minor band (<1%) migrated between Hb A2 and carbonic anhydrase. Normal values of Hb A2 were detected by DEAE microchromatography. On reversed phase HPLC the variant chain was not detected, and most likely it was eluted with the alpha chain peak. The isopropanol stability test was very slightly positive in the carriers. Hemolytic symptoms were absent with the exception of indirect bilirubin, which was at high borderline in 2/3 carriers. In biosynthesis in vitro, the specific activity of the alpha chains was much higher than that of the beta-globin chains, and the alpha/beta biosynthetic ratio in the mother and proband was of the beta-thalassemia (thal) type (2.24 and 2.54, respectively). Time course experiments showed that the increase of the 3H-specific activity of the peak containing normal and variant alpha chains was not linear and was much higher than that of beta chains; moreover, the alpha/beta biosynthetic ratio varied during the 2 hours incubation.
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Affiliation(s)
- Giuseppina Lacerra
- Istituto di Genetica e Biofisica "Adriano Buzzati Traverso," CNR, Napoli, Italia
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McBride KL, Snow K, Kubik KS, Fairbanks VF, Hoyer JD, Fairweather RB, Chaffee S, Edwards WH. Hb Dartmouth [alpha66(E15)Leu-->Pro (alpha2) (CTG-->CCG)]: a novel alpha2-globin gene mutation associated with severe neonatal anemia when inherited in trans with Southeast Asian alpha-thalassemia-1. Hemoglobin 2001; 25:375-82. [PMID: 11791870 DOI: 10.1081/hem-100107874] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report a novel mutation at alpha66(E15)Leu-->Pro (alpha2) (CTG-->CCG), that we have named Hb Dartmouth for the medical center at which the patients were cared for, in monozygotic twins who also inherited the Southeast Asian alpha-thalassemia-1 deletion. The mother, of Khmer ancestry, is heterozygous for alpha-thalassemia-1. The father, who is of Scottish-Irish ancestry, is a silent carrier of the codon 66 mutation. The twins had severe neonatal anemia requiring transfusion.
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Affiliation(s)
- K L McBride
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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