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Riskin A, Bravdo Y, Habib C, Maor I, Mousa J, Shahbarat S, Shahak E, Shalata A. The Genetics of Glucose-6-Phosphate-Dehydrogenase (G6PD) and Uridine Diphosphate Glucuronosyl Transferase 1A1 (UGT1A1) Promoter Gene Polymorphism in Relation to Quantitative Biochemical G6PD Activity Measurement and Neonatal Hyperbilirubinemia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1172. [PMID: 37508669 PMCID: PMC10378156 DOI: 10.3390/children10071172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency and polymorphism in uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1) were associated with significant neonatal hyperbilirubinemia (NHB) and increased risk for kernicterus. However, quantitative screening tests for G6PD enzyme activity proved unsatisfactory in estimating the risk for significant NHB, especially in heterozygous females that could present phenotype overlap between normal homozygotes, heterozygotes, and deficient homozygotes, resulting in a continuum of intermediate G6PD activity. OBJECTIVE To examine the association of genotype and phenotype in newborns with decreased G6PD activity and its relation to NHB. STUDY DESIGN Quantitative G6PD enzyme activities were measured on umbilical cord blood samples. After accepting parental consent, samples were analyzed for G6PD mutations and UGT1A1 gene polymorphisms (number of TA repeats in the UGT1A1 promoter). The associations to quantitative G6PD activity and bilirubin levels were assessed. RESULTS 28 females and 27 males were studied. The Mediterranean mutation (NM_001360016.2(G6PD): c.563C>T (p.Ser188Phe)) was responsible for most cases of G6PD deficiency (20 hemizygous males, 3 homozygous and 16 heterozygous females). The association between this mutation, decreased G6PD activity and higher bilirubin levels was confirmed. Heterozygosity to 6/7 TA repeats in the UGT1A1 promoter was associated with increased NHB, especially in female newborns with G6PD deficiency. However, it seems that the interaction between G6PD deficiency, UGT1A1 promoter polymorphism, and NHB is more complex, possibly involving other genetic interactions, not yet described. Despite genotyping females with G6PD deficiency, the overlap between the upper range of borderline and the lower range of normal G6PD activity could not be resolved. CONCLUSIONS The results of this study highlight the possibility for future implementation of molecular genetic screening to identify infants at risk for significant NHB, especially UGT1A1 polymorphism in heterozygous females with borderline G6PD deficiency. However, further studies are needed before such screening could be applicable to daily practice.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Yulia Bravdo
- Department of Pediatrics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Clair Habib
- Department of Pediatrics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Irit Maor
- Biochemistry Laboratory, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Julnar Mousa
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Sizett Shahbarat
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Elena Shahak
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
| | - Adel Shalata
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 32000, Israel
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Lee HY, Ithnin A, Azma RZ, Othman A, Salvador A, Cheah FC. Glucose-6-Phosphate Dehydrogenase Deficiency and Neonatal Hyperbilirubinemia: Insights on Pathophysiology, Diagnosis, and Gene Variants in Disease Heterogeneity. Front Pediatr 2022; 10:875877. [PMID: 35685917 PMCID: PMC9170901 DOI: 10.3389/fped.2022.875877] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/02/2022] [Indexed: 01/04/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a prevalent condition worldwide and is caused by loss-of-function mutations in the G6PD gene. Individuals with deficiency are more susceptible to oxidative stress which leads to the classical, acute hemolytic anemia (favism). However, G6PD deficiency in newborn infants presents with an increased risk of hyperbilirubinemia, that may rapidly escalate to result in bilirubin induced neurologic dysfunction (BIND). Often with no overt signs of hemolysis, G6PD deficiency in the neonatal period appears to be different in the pathophysiology from favism. This review discusses and compares the mechanistic pathways involved in these two clinical presentations of this enzyme disorder. In contrast to the membrane disruption of red blood cells and Heinz bodies formation in favism, G6PD deficiency causing jaundice is perhaps attributed to the disruption of oxidant-antioxidant balance, impaired recycling of peroxiredoxin 2, thus affecting bilirubin clearance. Screening for G6PD deficiency and close monitoring of affected infants are important aspects in neonatal care to prevent kernicterus, a permanent and devastating neurological damage. WHO recommends screening for G6PD activity of all infants in countries with high prevalence of this deficiency. The traditional fluorescent spot test as a screening tool, although low in cost, misses a significant proportion of cases with moderate deficiency or the partially deficient, heterozygote females. Some newer and emerging laboratory tests and diagnostic methods will be discussed while developments in genomics and proteomics contribute to increasing studies that spatially profile genetic mutations within the protein structure that could predict their functional and structural effects. In this review, several known variants of G6PD are highlighted based on the location of the mutation and amino acid replacement. These could provide insights on why some variants may cause a higher degree of phenotypic severity compared to others. Further studies are needed to elucidate the predisposition of some variants toward certain clinical manifestations, particularly neonatal hyperbilirubinemia, and how some variants increase in severity when co-inherited with other blood- or bilirubin-related genetic disorders.
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Affiliation(s)
- Heng Yang Lee
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Azlin Ithnin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Raja Zahratul Azma
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
| | - Ainoon Othman
- Department of Medical Science II, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Armindo Salvador
- CNC-Centre for Neuroscience Cell Biology, University of Coimbra, Coimbra, Portugal.,Coimbra Chemistry Centre-Institute of Molecular Sciences (CQC-IMS), University of Coimbra, Coimbra, Portugal.,Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
| | - Fook Choe Cheah
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia
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Sirdah M, Reading NS, Vankayalapati H, Prchal JT. A computational study of structural differences of binding of NADP + and G6P substrates to G6PD Mediterranean c.563T, G6PD A- c.202A/c.376G, G6PD Cairo c.404C and G6PD Gaza c.536A mutations. Blood Cells Mol Dis 2021; 89:102572. [PMID: 33957359 DOI: 10.1016/j.bcmd.2021.102572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked inherited enzymopathic disorder that may lead to transfusion-requiring acute hemolytic anemia (AHA) triggered by fava beans ingestion, infection or some drugs. The gene encoding for G6PD carries a large number of genetic variants that have varying pathogenicity. We reported on three G6PD variants in the Gaza Strip Palestinian population with differing clinical impacts and frequencies: G6PD Mediterraneanc.563T, African G6PD A-c.202A/c.376G, and G6PD Cairoc.404C. We also identified a novel G6PD missense (Ser179Asn) mutation c.536G > A "G6PD Gaza". In this work we explore the effect of these four genetic variants on the structural and substrate (NADP+ and G6P) binding characteristics of the G6PD enzyme using the Monte Carlo (MC) flexible docking and molecular dynamics (MD) simulation approaches. We report that G6PD A-c.202A/c.376G, G6PD Mediterraneanc.563T, G6PD Cairoc.404C and G6PD Gazac.536A mutations cause significant structural changes in G6PD enzyme to induce conformational instability leading to the loss of binding of one or both substrates and are causative of G6PD deficiency.
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Affiliation(s)
- Mahmoud Sirdah
- Biology Department, Al Azhar University-Gaza, Palestine; Division of Hematology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
| | - N Scott Reading
- Division of Hematology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America; Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, United States of America; Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Hariprasad Vankayalapati
- Department of Medicinal Chemistry, Huntsman Cancer Institute and College of Pharmacy, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Josef T Prchal
- Division of Hematology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
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Genotype-Phenotype Correlation of G6PD Mutations among Central Thai Children with G6PD Deficiency. Anemia 2021; 2021:6680925. [PMID: 33628497 PMCID: PMC7886513 DOI: 10.1155/2021/6680925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common X-linked inherited erythroenzymopathy in Thailand. The clinical and hematological manifestations of G6PD deficiency are variable. Objective This study aimed to characterize the genotype-phenotype correlation of G6PD mutations in Thai pediatric patients who were followed-up in Phramongkutklao Hospital, a tertiary center in central Thailand. Material and Method. A total of 102 children including 73 males (71.6%) and 29 females (28.4%) were included in our study. Mutation analysis was performed by direct DNA sequencing of all coding exons of the G6PD gene. Ninety-one patients (89.2%) were presented with neonatal hyperbilirubinemia and 11 patients (10.8%) were presented with acute hemolytic anemia beyond the neonatal period. Results Molecular analysis of the G6PD gene in 102 G6PD-deficient Thai children identified 12 different mutations. G6PD Viangchan (871G > A) and G6PD Canton (1376G > T) were the first (46.2%) and the second (15.4%) most common identified mutations among both male and female G6PD-deficient individuals, respectively. All affected males were hemizygous for G6PD mutations and had an average G6PD level of 16.7 ± 11.5 (3–76) IU/ml.RBC. Majority of female patients (27 in 29, 93.1%) were heterozygous for G6PD mutations and had an average G6PD level of 133.6 ± 43.4 (9–195) IU/ml.RBC. Two female patients (6.9%) were either homozygous or compound heterozygous for the mutations and had G6PD level in the affected male range (35 and 10 IU/ml.RBC). Only 1 in 27 heterozygous females (3.7%) had G6PD level in the affected male range (9 IU/ml.RBC) which is possibly explained by nonrandom X-chromosome inactivation. The correlation of genotypes, G6PD levels, and clinical phenotypes was not demonstrated in our study in which all of the included G6PD-deficient patients were presented with neonatal hyperbilirubinemia and acute hemolytic anemia, since the genotype-phenotype correlation is normally demonstrated in chronic nonspherocytic hemolytic anemia (CNSHA) G6PD-deficient individuals. Conclusion This study characterizes the molecular heterogeneity of G6PD variants causing G6PD deficiency in Thai children. Our study demonstrated the efficiency of direct DNA sequencing which can identify 12 missense mutations in Thai children.
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Robinson KM, Yang W, Haidar CE, Hankins JS, Jay DW, Kornegay N, Rubnitz JE, Broeckel U, Cheng C, Pui CH, Jeha S, Relling MV. Concordance between glucose-6-phosphate dehydrogenase (G6PD) genotype and phenotype and rasburicase use in patients with hematologic malignancies. THE PHARMACOGENOMICS JOURNAL 2018; 19:305-314. [PMID: 30206300 PMCID: PMC6414283 DOI: 10.1038/s41397-018-0043-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 06/21/2018] [Accepted: 08/10/2018] [Indexed: 02/02/2023]
Abstract
Phenotypic rather than genotypic tests remain the gold standard for diagnosing glucose-6-phosphate dehydrogenase (G6PD) deficiency. However, with increasing use of genomic arrays and whole exome or genome sequencing, G6PD genetic data are increasingly available. We examined the utility of G6PD genetic data in patients with hematologic malignancies and the association of G6PD genotype and phenotype with rasburicase-induced methemoglobinemia. We analyzed G6PD activity for 990 patients. Genotype data were available from the Affymetrix DMET array (n=379), whole exome sequencing (n=374), and/or the Illumina exome array (n=634) for 645 patients. Medical records of 341 patients with methemoglobin measures were assessed for the administration of rasburicase. We observed 5 non-synonymous SNPs, 4 of which were known to be associated with deficient G6PD activity (WHO Class I-III). Genotyping 367 males resulted in a positive predictive value of 81.8% (47.8–96.8%), and two males with a Class I-III allele having normal activity both received a red blood cell transfusion prior to the activity assay. However, genotyping males had only 39.1% (20.5–61.2%) sensitivity. Two of the 12 heterozygous females had deficient G6PD activity. Rasburicase-induced methemoglobinemia occurred in 6 patients, 5 of whom had at least one Class I-III allele, despite 2 of these having normal G6PD activity. We conclude that although an apparent nondeficient genotype does not necessarily imply a normal phenotype, a deficient genotype result indicates a deficient phenotype in those without transfusions, and may be a useful adjuct to phenotype to prevent adverse drug reactions.
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Affiliation(s)
- Katherine M Robinson
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wenjian Yang
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Cyrine E Haidar
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Dennis W Jay
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nancy Kornegay
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeffrey E Rubnitz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ulrich Broeckel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sima Jeha
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
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6
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Sirdah MM, Shubair ME, Al-Kahlout MS, Al-Tayeb JM, Prchal JT, Reading NS. Possible association of 3′ UTR +357 A>G, IVS11-nt 93 T>C, c.1311 C>T polymorphism with G6PD deficiency. Hematology 2017; 22:370-374. [DOI: 10.1080/10245332.2016.1276117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Mahmoud M. Sirdah
- Biology Department, Al Azhar University-Gaza, Gaza, Palestine
- Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Mohammad E. Shubair
- Department of Medical Laboratory Sciences, Islamic University-Gaza, Gaza, Palestine
| | | | - Jamal M. Al-Tayeb
- Palestinian Ministry of Health, Al Nasser Pediatric Hospital, Palestine
| | - Josef T. Prchal
- Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
- Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA
| | - N. Scott Reading
- Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
- Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA
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7
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Baird JK, Valecha N, Duparc S, White NJ, Price RN. Diagnosis and Treatment of Plasmodium vivax Malaria. Am J Trop Med Hyg 2016; 95:35-51. [PMID: 27708191 PMCID: PMC5198890 DOI: 10.4269/ajtmh.16-0171] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/19/2016] [Indexed: 11/07/2022] Open
Abstract
The diagnosis and treatment of Plasmodium vivax malaria differs from that of Plasmodium falciparum malaria in fundamentally important ways. This article reviews the guiding principles, practices, and evidence underpinning the diagnosis and treatment of P. vivax malaria.
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Affiliation(s)
- J Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Neena Valecha
- National Institute for Malaria Research, New Delhi, India
| | | | - Nicholas J White
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ric N Price
- Division of Global and Tropical Health, Menzies School of Health Research-Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Abstract
G6PD is a housekeeping gene expressed in all cells. Glucose-6-phosphate dehydrogenase (G6PD) is part of the pentose phosphate pathway, and its main physiologic role is to provide NADPH. G6PD deficiency, one of the commonest inherited enzyme abnormalities in humans, arises through one of many possible mutations, most of which reduce the stability of the enzyme and its level as red cells age. G6PD-deficient persons are mostly asymptomatic, but they can develop severe jaundice during the neonatal period and acute hemolytic anemia when they ingest fava beans or when they are exposed to certain infections or drugs. G6PD deficiency is a global health issue.
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Affiliation(s)
- Lucio Luzzatto
- Scientific Direction, Istituto Toscano Tumori, Viale Pieraccini 6, Florence 50139, Italy; University of Florence, Florence, Italy.
| | - Caterina Nannelli
- Core Research Laboratory-Istituto Toscano Tumori, Azienda Universitaria-Ospedaliera Careggi, Viale Pieraccini 6, Florence 50139, Italy
| | - Rosario Notaro
- Core Research Laboratory-Istituto Toscano Tumori, Azienda Universitaria-Ospedaliera Careggi, Viale Pieraccini 6, Florence 50139, Italy
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9
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Gómez-Manzo S, Marcial-Quino J, Vanoye-Carlo A, Serrano-Posada H, Ortega-Cuellar D, González-Valdez A, Castillo-Rodríguez RA, Hernández-Ochoa B, Sierra-Palacios E, Rodríguez-Bustamante E, Arreguin-Espinosa R. Glucose-6-Phosphate Dehydrogenase: Update and Analysis of New Mutations around the World. Int J Mol Sci 2016; 17:ijms17122069. [PMID: 27941691 PMCID: PMC5187869 DOI: 10.3390/ijms17122069] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 01/27/2023] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) is a key regulatory enzyme in the pentose phosphate pathway which produces nicotinamide adenine dinucleotide phosphate (NADPH) to maintain an adequate reducing environment in the cells and is especially important in red blood cells (RBC). Given its central role in the regulation of redox state, it is understandable that mutations in the gene encoding G6PD can cause deficiency of the protein activity leading to clinical manifestations such as neonatal jaundice and acute hemolytic anemia. Recently, an extensive review has been published about variants in the g6pd gene; recognizing 186 mutations. In this work, we review the state of the art in G6PD deficiency, describing 217 mutations in the g6pd gene; we also compile information about 31 new mutations, 16 that were not recognized and 15 more that have recently been reported. In order to get a better picture of the effects of new described mutations in g6pd gene, we locate the point mutations in the solved three-dimensional structure of the human G6PD protein. We found that class I mutations have the most deleterious effects on the structure and stability of the protein.
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Affiliation(s)
- Saúl Gómez-Manzo
- Laboratorio de Bioquímica Genética, Instituto Nacional de Pediatría, Secretaría de Salud 04530, Mexico.
| | - Jaime Marcial-Quino
- Consejo Nacional de Ciencia y Tecnología (CONACYT), Instituto Nacional de Pediatría, Secretaría de Salud 04530, Mexico.
| | - America Vanoye-Carlo
- Laboratorio de Neurociencias, Instituto Nacional de Pediatría, Secretaría de Salud 04530, Mexico.
| | - Hugo Serrano-Posada
- Consejo Nacional de Ciencia y Tecnología (CONACYT), Laboratorio de Bioingeniería, Universidad de Colima, Colima 28400, Mexico.
| | - Daniel Ortega-Cuellar
- Laboratorio de Nutrición Experimental, Instituto Nacional de Pediatría, Secretaría de Salud 04530, Mexico.
| | - Abigail González-Valdez
- Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico.
| | | | - Beatriz Hernández-Ochoa
- Laboratorio de Inmunoquímica, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico.
| | - Edgar Sierra-Palacios
- Colegio de Ciencias y Humanidades, Plantel Casa Libertad, Universidad Autónoma de la Ciudad de México, Mexico City 09620, Mexico.
| | - Eduardo Rodríguez-Bustamante
- Departamento de Química de Biomacromoléculas, Instituto de Química, Universidad Nacional Autónoma de México, Circuito Exterior s/n, Ciudad Universitaria, Mexico City 04510, Mexico.
| | - Roberto Arreguin-Espinosa
- Departamento de Química de Biomacromoléculas, Instituto de Química, Universidad Nacional Autónoma de México, Circuito Exterior s/n, Ciudad Universitaria, Mexico City 04510, Mexico.
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10
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Reading NS, Sirdah MM, Shubair ME, Nelson BE, Al-Kahlout MS, Al-Tayeb JM, Aboud LN, Shaban MA, Luzzatto L, Prchal JT. Favism, the commonest form of severe hemolytic anemia in Palestinian children, varies in severity with three different variants of G6PD deficiency within the same community. Blood Cells Mol Dis 2016; 60:58-64. [DOI: 10.1016/j.bcmd.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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11
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Sirdah MM, Al-Kahlout MS, Reading NS. National G6PD neonatal screening program in Gaza Strip of Palestine: rationale, challenges and recommendations. Clin Genet 2016; 90:191-8. [PMID: 27064064 DOI: 10.1111/cge.12786] [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: 03/15/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Abstract
Congenital genetic disorders affecting neonates or young children can have serious clinical consequences if undiagnosed and left untreated. Early detection and an accurate diagnosis are, therefore, of major importance for preventing negative patient outcomes. Even though the occurrence of each specific metabolic disorder may be rare, their collective impact of preventable complications may be of considerable importance to the public health. Our previous studies showed that glucose-6-phosphate dehydrogenase (G6PD) deficiency is a problem of public health importance that has been shown to be a predominant cause of acute hemolytic anemia requiring hospitalization in Palestinian young children in Gaza Strip. Intriguingly, the majority of these children had one of the three variants, Mediterranean(c.) (563T) , African G6PD A-(c.) (202A) (/c.) (376G) and heretofore unrecognized as a common G6PD-deficient variant G6PD Cairo(c.) (404C) . The high prevalence of G6PD deficiency, as well as dietary factors in the region that precipitate anemia, argues for a need to protect the Palestinian children from a treatable and manageable genetic and metabolic disorder. This work reviews and discusses rationales and challenges of G6PD screening program in Gaza Strip. We advocate adopting a national neonatal G6PD screening program in Gaza Strip to identify children at risk and promote wellness and health for Palestine.
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Affiliation(s)
- M M Sirdah
- Biology Department, Al Azhar University-Gaza, Gaza, Palestine.,Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - M S Al-Kahlout
- Al Nasser Pediatric Hospital, Palestinian Ministry of Health, Gaza, Palestine
| | - N S Reading
- Division of Hematology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Institute for Clinical and Experimental Pathology, ARUP Laboratories, Salt Lake City, UT, USA.,Department of Pathology, School of Medicine, University of Utah, Salt Lake City, UT, USA
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12
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Xu JZ, Francis RO, Lerebours Nadal LE, Shirazi M, Jobanputra V, Hod EA, Jhang JS, Stotler BA, Spitalnik SL, Nicholas SW. G6PD Deficiency in an HIV Clinic Setting in the Dominican Republic. Am J Trop Med Hyg 2015; 93:722-9. [PMID: 26240158 DOI: 10.4269/ajtmh.14-0295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/04/2015] [Indexed: 11/07/2022] Open
Abstract
Because human immunodeficiency virus (HIV)-infected patients receive prophylaxis with oxidative drugs, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency may experience hemolysis. However, G6PD deficiency has not been studied in the Dominican Republic, where many individuals have African ancestry. Our objective was to determine the prevalence of G6PD deficiency in Dominican HIV-infected patients and to attempt to develop a cost-effective algorithm for identifying such individuals. To this end, histories, chart reviews, and G6PD testing were performed for 238 consecutive HIV-infected adult clinic patients. The overall prevalence of G6PD deficiency (8.8%) was similar in males (9.3%) and females (8.5%), and higher in Haitians (18%) than Dominicans (6.4%; P = 0.01). By logistic regression, three clinical variables predicted G6PD status: maternal country of birth (P = 0.01) and a history of hemolysis (P = 0.01) or severe anemia (P = 0.03). Using these criteria, an algorithm was developed, in which a patient subset was identified that would benefit most from G6PD screening, yielding a sensitivity of 94.7% and a specificity of 97.2%, increasing the pretest probability (8.8-15.1%), and halving the number of patients needing testing. This algorithm may provide a cost-effective strategy for improving care in resource-limited settings.
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Affiliation(s)
- Julia Z Xu
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Richard O Francis
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Leonel E Lerebours Nadal
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Maryam Shirazi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Vaidehi Jobanputra
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Jeffrey S Jhang
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Brie A Stotler
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Steven L Spitalnik
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
| | - Stephen W Nicholas
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York; Clínica de Familia La Romana, La Romana, Dominican Republic; IFAP Global Health Program, Columbia University Medical Center, New York, New York
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13
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Molou E, Schulpis KH, Thodi G, Georgiou V, Dotsikas Y, Papadopoulos K, Biti S, Loukas YL. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency in Greek newborns: the Mediterranean C563T mutation screening. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:259-63. [PMID: 24460025 DOI: 10.3109/00365513.2013.879733] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Glucose-6-Phosphate Dehydrogenase (G6PD) gene is located at the X-chromosome at Xq28 and the disease is recessively inherited predominantly in males. More than 400 variants have been proposed based on clinical and enzymatic studies. The aim of the current study was to identify C563T mutation in G6PD-deficient newborns and to correlate the enzyme residual activity with the presence of the mutation. Some 1189 full-term neonates aged 3-5 days old were tested for G6PD activity in dried blood spots from Guthrie cards using a commercial kit. DNA extraction from Guthrie cards and mutation identification among the deficient samples were performed with current techniques. A total of 92 (7.7%) newborns were G6PD-deficient. In 46 (50%), the mutation C563T was identified. The residual activity in C563T hemizygote males (n = 28) was statistically significantly lower (1.23 ± 0.93 U/g Hb) than that in non-C563T G6PD-deficient males (n = 25) (4.01 ± 1.20 U/g Hb, p < 0.0001) and in controls (13.6 ± 2.9 U/g Hb, p < 0.0001). In C563T heterozygote females, the estimated enzyme activity was lower than that determined in non-C563T females. Male C563T hemizygotes suffer from G6PD deficiency and severe neonatal jaundice. G6PD activity showed statistically significant correlation with total bilirubin blood levels.
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Affiliation(s)
- Elina Molou
- Laboratory of Prenatal and Neonatal Screening , Neoscreen Ltd , Athens
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14
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Alharbi KK, Khan IA, Abed ASA, Syed R. Insertion/Deletion polymorphisms do play any role in G6PD deficiency individuals in the Kingdom of the Saudi Arabia. Bioinformation 2013; 9:49-53. [PMID: 23390344 PMCID: PMC3563416 DOI: 10.6026/97320630009049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022] Open
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme in the pentose phosphate pathway (PPP) that plays an important role in protecting cells from oxidative damage by producing NADPH and reduced glutathione. G6PD deficiency is considered one of the most common genetic disorders present in the X chromosome and is the most common of enzymopathic red blood cell disorder. Angiotensin converting enzyme (ACE) plays an essential role in two physiological systems, one leading to the production of angiotensin II and the other to the degradation of bradykinin. Most studies focused on an insertion/deletion (I/D) polymorphism in intron 16 of the ACE gene as a marker for a functional polymorphism. The α(2B)-adrenergic receptor gene (α(2B)AR) is a three-amino acid deletion (12Glu9) polymorphism is located on chromosome 2. (Glu(9)/Glu(9)) of this polymorphism has been first time studies in G6PD individuals. We have selected 39 G6PD deficiency male individuals and PCR was carried out with the I/D polymorphisms. ACE I/D polymorphism study was carried out in G6PD individuals and showed strong association with DD genotypes and D alleles OR=39.38, p<0.0001 (95% CI=8.80-176.1) and OR=38.58, p<0.0001 (95% CI=13.21-112.6). Another gene of α(2B)AR I/D polymorphism study cannot show any association in DD genotype OR-0.6882,p=0.9388 (95% CI=0.2035-2.327) and with D allele OR-0.9614,p=0.9388 (95% CI=0.3482-2.653). Our study shows that G6PD deficiency is showing strong association in DD genotype and D allele of ACE gene and α(2B)AR gene have not shown any important role and one of the reason could be the low sample size.
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Affiliation(s)
- Khalid K Alharbi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Kingdom of Saudi Arabia
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