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Xia Z, Wang X, Ye H, Gao C, Zhou X, Chen J, Ge Y, Li J, Zhou Y, Guo Q. Evaluation of strategies for identification of infants with pathogenic glucose-6-phosphate dehydrogenase variants in China. Front Genet 2022; 13:844381. [PMID: 36212124 PMCID: PMC9538342 DOI: 10.3389/fgene.2022.844381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency, which is caused by pathogenic variants of G6PD that result in decreased G6PD activity, is an X-linked inherited inborn error of metabolism that occurs worldwide. Individuals with G6PD deficiency and heterozygous females with normal G6PD activity (i.e., all individuals with pathogenic G6PD variants) are at risk of developing hemolytic anemia under increased oxidative challenge. However, this risk can be minimized by timely diagnosis. Currently, two assays are used to diagnose G6PD deficiency in China: evaluation of enzymatic activity and targeted genotyping. In terms of identification of all individuals with pathogenic G6PD variants, the performance and cost of different diagnostic strategies (isolated or combined evaluation of G6PD activity and G6PD genotyping) can vary, and these factors should be comprehensively evaluated. In this study, we examined 555 infants (437 males and 118 females) who were positive for the newborn screening of G6PD deficiency. We first evaluated the diagnostic performances of enzymatic testing and targeted genotyping. Both assays attained 100% specificities and positive predictive values for both male and female infants. In contrast, the sensitivities and negative predictive values (NPVs) of the diagnostic tests were different for male and female infants. For male infants, the sensitivities were 99.8 and 98.3%, and the NPVs were 94.1% and 69.6%, for enzymatic testing and targeted genotyping, respectively. For female infants, the sensitivities were 62.5% and 97.9%, and the NPVs were 37.9% and 91.7%, for enzymatic testing and targeted genotyping, respectively. We also evaluated the cost of the five different diagnostic strategies. The combination of G6PD activity testing of all infants, followed by genotyping of female infants with normal G6PD activity, attained high diagnostic sensitivity (99.8%) at a low cost (8.60 USD per diagnosed case). In the future, simultaneous examination of G6PD activity and whole-exon or whole-gene G6PD sequencing could become a standard clinical practice. Our data provide references for clinical practice on the standardization of current and future interventions for G6PD deficiency in China.
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Affiliation(s)
- Zhongmin Xia
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xudong Wang
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Huiming Ye
- Department of Clinical Laboratory, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Chunliu Gao
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xiaoman Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jing Chen
- Department of Child Health, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yunsheng Ge
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Juan Li
- Department of Clinical Laboratory, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
- *Correspondence: Yulin Zhou, ; Qiwei Guo,
| | - Qiwei Guo
- United Diagnostic and Research Center for Clinical Genetics, Women and Children’s Hospital, School of Medicine and School of Public Health, Xiamen University, Xiamen, Fujian, China
- *Correspondence: Yulin Zhou, ; Qiwei Guo,
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Mondal A, Mukherjee S, Dar W, Upadhyay P, Ranganathan A, Pati S, Singh S. G6PD deficiency: imbalance of functional dichotomy contributing to the severity of COVID-19. Future Microbiol 2022; 17:1161-1170. [PMID: 35880537 PMCID: PMC9332910 DOI: 10.2217/fmb-2021-0299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Human COVID-19 has affected more than 491 million people worldwide. It has caused over 6.1 million deaths and has especially perpetrated a high number of casualties among the elderly and those with comorbid illnesses. COVID-19 triggers a pro-oxidant response, leading to the production of reactive oxygen species (ROS) as a common innate defense mechanism. However, ROS are regulated by a key enzyme called G6PD via the production of reduced nicotinamide adenine dinucleotide phosphate (NADPH), which controls the generation and removal of ROS in a tissue-specific manner. Therefore, a deficiency of G6PD can lead to the dysregulation of ROS, which causes a severe inflammatory response in COVID-19 patients. This report highlights the G6PD dichotomy in the regulation of ROS and inflammatory responses, as well as its deficiency in severity among COVID-19 patients.
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Affiliation(s)
- Abir Mondal
- Department of Life Sciences, Neurobiology & Disease Modelling Laboratory, Host-Pathogen Interactions & Disease Modelling Group, School of Natural Sciences, Shiv Nadar University, Greater Noida, 201314, India
| | - Soumyadeep Mukherjee
- Department of Life Sciences, Neurobiology & Disease Modelling Laboratory, Host-Pathogen Interactions & Disease Modelling Group, School of Natural Sciences, Shiv Nadar University, Greater Noida, 201314, India
| | - Waseem Dar
- Department of Life Sciences, Neurobiology & Disease Modelling Laboratory, Host-Pathogen Interactions & Disease Modelling Group, School of Natural Sciences, Shiv Nadar University, Greater Noida, 201314, India
| | - Prince Upadhyay
- Department of Life Sciences, Neurobiology & Disease Modelling Laboratory, Host-Pathogen Interactions & Disease Modelling Group, School of Natural Sciences, Shiv Nadar University, Greater Noida, 201314, India
| | - Anand Ranganathan
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
| | - Soumya Pati
- Department of Life Sciences, Neurobiology & Disease Modelling Laboratory, Host-Pathogen Interactions & Disease Modelling Group, School of Natural Sciences, Shiv Nadar University, Greater Noida, 201314, India
| | - Shailja Singh
- Special Centre for Molecular Medicine, Jawaharlal Nehru University, New Delhi, India
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Fimognari FL, Bambara V, Scarpino P, Cuccurullo O, Ricchio R, Iorio C, Rizzo M. Methemoglobinemia and acute hemolysis induced by high intravenous doses of vitamin C in a COVID-19 patient with unrecognized glucose-6- phosphate-dehydrogenase deficiency. GERIATRIC CARE 2022. [DOI: 10.4081/gc.2022.10286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In glucose-6-phosphate-dehydrogenase deficiency (favism), exposure to oxidant agents can trigger hemolytic crises. The intravenous administration of very high doses of vitamin C was proposed as a treatment for severe coronavirus disease 2019 (COVID-19) pneumonia. Unlike low vitamin C doses, very high doses (>6 gr daily) can promote H2O2 formation, oxidation of hemoglobin to methemoglobin and, eventually, hemolytic anemia in patients with favism. We here describe the case of a 77-year old man hospitalized for severe COVID-19 pneumonia and treated with a mean daily dose of 9.5 gr of intravenous vitamin C during the first 6 days. He developed methemoglobinemia and hemolytic anemia, which improved after interruption of vitamin C treatment. Previously unrecognized glucose- 6-phophate-dehydrogenase deficiency was diagnosed. This first case of vitamin Cinduced hemolytic anemia in a COVID-19 patient indicates the need of a screening for glucose-6-phosphate-dehydrogenase deficiency before treatment with very high vitamin C doses or for long period.
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The Possible Role of Glucose-6-Phosphate Dehydrogenase in the SARS-CoV-2 Infection. Cells 2022; 11:cells11131982. [PMID: 35805067 PMCID: PMC9265820 DOI: 10.3390/cells11131982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/18/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) is the second rate-limiting enzyme of the pentose phosphate pathway. This enzyme is present in the cytoplasm of all mammalian cells, and its activity is essential for an adequate functioning of the antioxidant system and for the response of innate immunity. It is responsible for the production of nicotinamide adenine dinucleotide phosphate (NADPH), the first redox equivalent, in the pentose phosphate pathway. Viral infections such as SARS-CoV-2 may induce the Warburg effect with an increase in anaerobic glycolysis and production of lactate. This condition ensures the success of viral replication and production of the virion. Therefore, the activity of G6PD may be increased in COVID-19 patients raising the level of the NADPH, which is needed for the enzymatic and non-enzymatic antioxidant systems that counteract the oxidative stress caused by the cytokine storm. G6PD deficiency affects approximately 350–400 million people worldwide; therefore, it is one of the most prevalent diseases related to enzymatic deficiency worldwide. In G6PD-deficient patients exposed to SARS-CoV-2, the amount of NADPH is reduced, increasing the susceptibility for viral infection. There is loss of the redox homeostasis in them, resulting in severe pneumonia and fatal outcomes.
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Pal S, Myburgh J, Bansil P, Hann A, Robertson L, Gerth-Guyette E, Ambler G, Bizilj G, Kahn M, Zobrist S, Manis MR, Styke NA, Allan V, Ansbro R, Akingbade T, Bryan A, Murphy SC, Kublin JG, Layton M, Domingo GJ. Reference and point-of-care testing for G6PD deficiency: Blood disorder interference, contrived specimens, and fingerstick equivalence and precision. PLoS One 2021; 16:e0257560. [PMID: 34543346 PMCID: PMC8452025 DOI: 10.1371/journal.pone.0257560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
Certain clinical indications and treatments such as the use of rasburicase in cancer therapy and 8-aminoquinolines for Plasmodium vivax malaria treatment would benefit from a point-of-care test for glucose-6-phosphate dehydrogenase (G6PD) deficiency. Three studies were conducted to evaluate the performance of one such test: the STANDARD™ G6PD Test (SD BIOSENSOR, South Korea). First, biological interference on the test performance was evaluated in specimens with common blood disorders, including high white blood cell (WBC) counts. Second, the test precision on fingerstick specimens was evaluated against five individuals of each, deficient, intermediate, and normal G6PD activity status. Third, clinical performance of the test was evaluated at three point-of-care settings in the United States. The test performed equivalently to the reference assay in specimens with common blood disorders. High WBC count blood samples resulted in overestimation of G6PD activity in both the reference assay and the STANDARD G6PD Test. The STANDARD G6PD Test showed good precision on multiple fingerstick specimens from the same individual. The same G6PD threshold values (U/g Hb) were applied for a semiquantitative interpretation for fingerstick- and venous-derived results. The sensitivity/specificity values (95% confidence intervals) for the test for G6PD deficiency were 100 (92.3–100.0)/97 (95.2–98.2) and 100 (95.7–100.0)/97.4 (95.7–98.5) for venous and capillary specimens, respectively. The same values for females with intermediate (> 30% to ≤ 70%) G6PD activity were 94.1 (71.3–99.9)/88.2 (83.9–91.7) and 82.4 (56.6–96.2)/87.6(83.3–91.2) for venous and capillary specimens, respectively. The STANDARD G6PD Test enables point-of-care testing for G6PD deficiency.
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Affiliation(s)
- Sampa Pal
- PATH, Seattle, Washington, United States of America
| | - Jane Myburgh
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - Pooja Bansil
- PATH, Seattle, Washington, United States of America
| | - Amanda Hann
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | - Lynn Robertson
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
| | | | - Gwen Ambler
- PATH, Seattle, Washington, United States of America
| | - Greg Bizilj
- PATH, Seattle, Washington, United States of America
| | - Maria Kahn
- PATH, Seattle, Washington, United States of America
| | | | - Michelle R. Manis
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Nickolas A. Styke
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Vajra Allan
- PATH, Seattle, Washington, United States of America
| | | | - Tobi Akingbade
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Andrew Bryan
- Departments of Laboratory Medicine and Microbiology, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Sean C. Murphy
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America
- Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - James G. Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Mark Layton
- Special Haematology Laboratory, Hammersmith Hospital, London, United Kingdom
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