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Zhang W, Li X, Yu U, Huang X, Wang H, Lu Y, Liu S, Zhang J. Genome-wide methylation and gene-expression analyses in thalassemia. Aging (Albany NY) 2024; 16:11591-11605. [PMID: 39133159 DOI: 10.18632/aging.206037] [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: 12/05/2023] [Accepted: 07/11/2024] [Indexed: 08/13/2024]
Abstract
Thalassemia is the most common autosomal genetic disorder in humans. The pathogenesis of thalassemia is principally due to the deletion or mutation of globin genes that then leads to disorders in globin-chain synthesis, and its predominant clinical manifestations include chronic forms of hemolytic anemia. However, research on the epigenetics and underlying pathogenesis of thalassemia is in its nascency and not yet been systematically realized. In this study, we compared the results of RNA-seq and the whole-genome bisulfite sequencing (WGBS) on 22 peripheral blood samples from 14 thalassemic patients and eight healthy individuals revealed a genome-wide methylation landscape of differentially methylated regions (DMRs). And functional-enrichment analysis revealed the enriched biological pathways with respect to the differentially expressed genes (DEGs) and differentially methylated genes (DMGs) to include hematopoietic lineage, glucose metabolism, and ribosome. To further analyze the interaction between the transcriptome and methylome, we implemented a comprehensive analysis of overlaps between DEGs and DMGs, and observed that biological processes significantly enriched the immune-related genes (i.e., our hypermethylated and down-regulated gene group). Hypermethylated and hypomethylated regions of thalassemia-related genes exhibited different distribution patterns. We thus, further identified and validated thalassemia-associated DMGs and DEGs by multi-omics integrative analyses of DNA methylation and transcriptomics data, and provided a comprehensive genomic map of thalassemia that will facilitate the exploration of the epigenetics mechanisms and pathogenesis underlying thalassemia.
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Affiliation(s)
- Wei Zhang
- School of Medicine, Southern University of Science and Technology, Shenzhen 518055, Guangdong, China
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, Guangdong, China
| | - Xiaokang Li
- Center for Reproductive Medicine, University of Hongkong-Shenzhen Hospital, Shenzhen 518053, Guangdong, China
| | - Uet Yu
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong, China
| | - Xin Huang
- School of Medicine, Southern University of Science and Technology, Shenzhen 518055, Guangdong, China
| | - Hongmei Wang
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong, China
| | - Yi Lu
- School of Medicine, Southern University of Science and Technology, Shenzhen 518055, Guangdong, China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen 518038, Guangdong, China
| | - Jian Zhang
- School of Medicine, Southern University of Science and Technology, Shenzhen 518055, Guangdong, China
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2
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Tan JY, Yeo YH, Chan KH, Shaaban HS, Guron G. Causes of Death and Mortality Trends in Individuals with Thalassemia in the United States, 1999-2020. J Blood Med 2024; 15:331-339. [PMID: 39132283 PMCID: PMC11315644 DOI: 10.2147/jbm.s470177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/23/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose Our study aims to describe the mortality trends and disparities among individuals with thalassemia in the United States (US). Patients and Methods We used CDC WONDER database to calculate the age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and used the Joinpoint Regression Program to measure the average annual percent change (AAPC). Subgroup evaluations were performed by sex, age, race, census region, and urbanization level. Results From 1999 to 2020, there were 2797 deaths relatd to thalassemia in the US. The AAMR of thalassemia-related death showed a decreasing trend from 0.50 (95% CI, 0.41-0.58) in 1999 to 0.48 (95% CI, 0.41-0.55) in 2020 with the AAPC of -1.42 (95% CI, -2.42, -0.42). Asians have the highest AAMR (1.34 [95% CI, 1.20-1.47]), followed by non-Hispanic Blacks (0.65 [95% CI, 0.59-0.71]), non-Hispanic Whites (0.32 [95% CI, 0.30-0.33]), and Hispanics (0.11 [95% CI, 0.08-0.14]). Cardiovascular disease remains the leading cause of death among individuals with thalassemia. The urban population has a higher AAMR than the rural population (0.43 [95% CI, 0.41-0.45] vs 0.29 [95% CI, 0.26-0.32]). Conclusion Our study calls for targeted interventions to address the racial and geographic disparities existed among individuals of thalassemia in the US.
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Affiliation(s)
- Jia Yi Tan
- Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics, Corewell Health, Royal Oak, MI, USA
| | - Kok Hoe Chan
- Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - Hamid S Shaaban
- Division of Hematology/Oncology, Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA
| | - Gunwant Guron
- Division of Hematology/Oncology, Department of Internal Medicine, New York Medical College at Saint Michael’s Medical Center, Newark, NJ, USA
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3
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Li Z, Yao X, Zhang J, Yang J, Ni J, Wang Y. Exploring the bone marrow micro environment in thalassemia patients: potential therapeutic alternatives. Front Immunol 2024; 15:1403458. [PMID: 39161767 PMCID: PMC11330836 DOI: 10.3389/fimmu.2024.1403458] [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: 03/19/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
Genetic mutations in the β-globin gene lead to a decrease or removal of the β-globin chain, causing the build-up of unstable alpha-hemoglobin. This condition is referred to as beta-thalassemia (BT). The present treatment strategies primarily target the correction of defective erythropoiesis, with a particular emphasis on gene therapy and hematopoietic stem cell transplantation. However, the presence of inefficient erythropoiesis in BT bone marrow (BM) is likely to disturb the previously functioning BM microenvironment. This includes accumulation of various macromolecules, damage to hematopoietic function, destruction of bone cell production and damage to osteoblast(OBs), and so on. In addition, the changes of BT BM microenvironment may have a certain correlation with the occurrence of hematological malignancies. Correction of the microenvironment can be achieved through treatments such as iron chelation, antioxidants, hypoglycemia, and biologics. Hence, This review describes damage in the BT BM microenvironment and some potential remedies.
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Affiliation(s)
- Zengzheng Li
- Department of Hematology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Hematologic Disease, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
- Yunnan Provincial Clinical Medical Center for Blood Diseases and Thrombosis Prevention and Treatment, Kunming, Yunnan, China
| | - Xiangmei Yao
- Department of Hematology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Hematologic Disease, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
- Yunnan Provincial Clinical Medical Center for Blood Diseases and Thrombosis Prevention and Treatment, Kunming, Yunnan, China
| | - Jie Zhang
- Department of Medical Genetics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jinghui Yang
- Department of Pediatrics, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Junxue Ni
- Hospital Office, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Yajie Wang
- Department of Hematology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Yunnan Province Clinical Research Center for Hematologic Disease, The First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
- Yunnan Provincial Clinical Medical Center for Blood Diseases and Thrombosis Prevention and Treatment, Kunming, Yunnan, China
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Musallam KM, Sheth S, Cappellini MD, Forni GL, Maggio A, Taher AT. Anemia and iron overload as prognostic markers of outcomes in β-thalassemia. Expert Rev Hematol 2024:1-12. [PMID: 39037857 DOI: 10.1080/17474086.2024.2383420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Ineffective erythropoiesis and subsequent anemia as well as primary and secondary (transfusional) iron overload are key drivers for morbidity and mortality outcomes in patients with β-thalassemia. AREAS COVERED In this review, we highlight evidence from observational studies evaluating the association between measures of anemia and iron overload versus outcomes in both non-transfusion-dependent and transfusion-dependent forms of β-thalassemia. EXPERT OPINION Several prognostic thresholds have been identified with implications for patient management. These have also formed the basis for the design of novel therapy clinical trials by informing eligibility and target endpoints. Still, several data gaps persist in view of the challenge of assessing prospective long-term outcomes in a chronic disease. Pooling insights on the prognostic value of different measures of disease mechanism will be key to design future scoring systems that can help optimize patient management.
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Affiliation(s)
- Khaled M Musallam
- Center for Research on Rare Blood Disorders (CR-RBD), Burjeel Medical City, Abu Dhabi, United Arab Emirates
- Division of Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Sujit Sheth
- Division of Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community, University of Milan, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, Milan, Italy
| | | | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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El-Beshlawy A, Dewedar H, Hindawi S, Alkindi S, Tantawy AA, Yassin MA, Taher AT. Management of transfusion-dependent β-thalassemia (TDT): Expert insights and practical overview from the Middle East. Blood Rev 2024; 63:101138. [PMID: 37867006 DOI: 10.1016/j.blre.2023.101138] [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: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
β-Thalassemia is one of the most common monogenetic diseases worldwide, with a particularly high prevalence in the Middle East region. As such, we have developed long-standing experience with disease management and devising solutions to address challenges attributed to resource limitations. The region has also participated in the majority of clinical trials and development programs of iron chelators and more novel ineffective erythropoiesis-targeted therapy. In this review, we provide a practical overview of management for patients with transfusion-dependent β-thalassemia, primarily driven by such experiences, with the aim of transferring knowledge to colleagues in other regions facing similar challenges.
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Affiliation(s)
- Amal El-Beshlawy
- Department of Pediatric Hematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Dewedar
- Thalassemia Center, Latifa Hospital, Dubai, United Arab Emirates
| | - Salwa Hindawi
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salam Alkindi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Azza A Tantawy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A Yassin
- Department of Hematology and Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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6
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Hodroj MH, Taher A. Thalassemia and malignancies: Updates from the literature. Ann N Y Acad Sci 2023; 1529:14-20. [PMID: 37676814 DOI: 10.1111/nyas.15061] [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] [Indexed: 09/09/2023]
Abstract
Thalassemia management has undergone significant development with the advancement in iron chelation therapy, which has led to a prolonged life expectancy. This has been accompanied by the emergence of several new morbidities and chronic diseases, including cancer. Over the years, multiple cases of solid and hematologic malignancies in thalassemia patients have been reported in the literature, with no clear mechanism for the development of cancer in these patients despite a number of potential mechanisms. However, the results of many studies have been contradictory regarding the risk of development of malignancies in thalassemia. The present review aims to discuss the available data on cancer and thalassemia in the literature, with the latest updates regarding possible malignancy development mechanisms, risks, and the most commonly reported types.
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Affiliation(s)
- Mohammad Hassan Hodroj
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Fragodimitri C, Schiza V, Giakoumis A, Drakaki K, Salichou A, Karampatsos F, Yousef J, Karageorga M, Berdoukas V, Aessopos A. Successful chelation in beta-thalassemia major in the 21st century. Medicine (Baltimore) 2023; 102:e35455. [PMID: 37832083 PMCID: PMC10578721 DOI: 10.1097/md.0000000000035455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
This century has seen a revolution the management of beta-thalassemia major. Over a 12-year period to 2016, we aimed to analyze the benefits of such advances. In 209 patients, independent of the chelation regimen, ferritin, cardiac T2* and liver iron concentration changes were evaluated. We defined chelation success (ChS) as no iron load in the heart and acceptable levels in the liver. Over 3 early magnetic resonance imagings, the same parameters were assessed in 2 subgroups, the only 2 that had sufficient patients continuing on 1 regimen and for a significant period of time, 1 on deferrioxamine (low iron load patients n = 41, Group A) and 1 on deferoxamine-deferiprone (iron overloaded n = 60, Group B). Finally, 28 deaths and causes were compared to those of an earlier period. The 209 patients significantly optimized those indices, while the number of patients with chelation success, increased from 6% to 51% (P < .0001). In group A, ChS after about 8 years increased from 21 to 46% (P = .006), while in Group B, from 0% to 60% (P < .001) after about 7 years. Deaths over the 2 periods showed significant reduction. Combined clearance of cardiac and liver iron (ChS) is feasible and should become the new target for all patients. This requires, serial magnetic resonance imagings and often prolonged intensified chelation for patients.
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Affiliation(s)
| | - Vasiliki Schiza
- Thalassemia Unit, “Aghia Sofia” Children’s Hospital, Athens, Greece
| | | | - Kalliopi Drakaki
- Thalassemia Unit, “Aghia Sofia” Children’s Hospital, Athens, Greece
| | | | | | | | | | | | - Athanasios Aessopos
- 1 Academic Department of Internal Medicine, “Laiko” General Hospital, Athens, Greece
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8
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Bou-Fakhredin R, Motta I, Cappellini MD, Taher AT. Clinical Complications and Their Management. Hematol Oncol Clin North Am 2023; 37:365-378. [PMID: 36907609 DOI: 10.1016/j.hoc.2022.12.007] [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
The diversity of disease-related complications among patients with β-thalassemia is complicated by the wide spectrum of genotypes and clinical risk factors. The authors herein present the different complications seen in patients with β-thalassemia, the pathophysiology underlying these complications and their management.
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Affiliation(s)
- Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Irene Motta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; UOC General Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; UOC General Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ali T Taher
- Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Origa R, Gianesin B, Longo F, Di Maggio R, Cassinerio E, Gamberini MR, Pinto VM, Quarta A, Casale M, La Nasa G, Caocci G, Piroddi A, Piolatto A, Di Mauro A, Romano C, Gigante A, Barella S, Maggio A, Graziadei G, Perrotta S, Forni GL. Incidence of cancer and related deaths in hemoglobinopathies: A follow-up of 4631 patients between 1970 and 2021. Cancer 2023; 129:107-117. [PMID: 36321594 PMCID: PMC10092274 DOI: 10.1002/cncr.34509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The correlation between thalassemia and malignancies other than hepatocellular carcinoma (HCC) and the possible relationship between other hemoglobinopathies and tumor risk have been poorly evaluated. METHODS Eight Italian specialized centers evaluated the incidence of malignant neoplasms in hemoglobinopathies as well as their sites and features. The study cohort included 4631 patients followed between 1970 and 2021 (transfusion-dependent β-thalassemia, 55.6%; non-transfusion-dependent thalassemia, 17.7%; sickle cell disease, 17.6%; hemoglobin H disease, 8.3%). RESULTS A total of 197 diagnoses of cancer were reported (incidence rate, 442 cases per 100,000 person-years). The liver was the most frequent site of tumors in both sexes, with a higher incidence (190 cases per 100,000 person-years) in comparison with the general population found in all types of hemoglobinopathies (except hemoglobin H disease). In recent years, tumors have become the second cause of death in patients with transfusion-dependent thalassemia. A lower risk of breast and prostate cancer was observed in the whole group of patients with hemoglobinopathies. The first cancer diagnoses dated back to the 1980s, and the incidence rate sharply increased after the 2000s. However, although the incidence rate of cancers of all sites but the liver continued to show an increasing trend, the incidence of HCC showed stability. CONCLUSIONS These findings provide novel insights into the relationship between cancer and hemoglobinopathies and suggest that the overall risk is not increased in these patients. HCC has been confirmed as the most frequent tumor, but advances in chelation and the drugs that have led to the eradication of hepatitis C may explain the recent steadiness in the number of diagnoses that is reported here.
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Affiliation(s)
- Raffaella Origa
- Università di Cagliari, SSD Talassemia, Ospedale Microcitemico 'A. Cao,' ASL8 Cagliari, Cagliari, Italy
| | | | - Filomena Longo
- Centro Microcitemie-Pediatria Azienda Ospedaliero Universitaria San Luigi Gonzaga, Turin, Italy
| | - Rosario Di Maggio
- Unità Operativa Complessa Ematologia per le Malattie Rare del Sangue e degli Organi Ematopoietici, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-V. Cervello, Palermo, Italy
| | - Elena Cassinerio
- Attività Diurne Malattie Rare Internistiche-Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Rita Gamberini
- Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Valeria Maria Pinto
- Struttura Semplice Dipartimentale Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - Antonella Quarta
- Unità Operativa Semplice Centro Microcitemia, Unità Operativa Complessa Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale 'A. Perrino', Brindisi, Italy
| | - Maddalena Casale
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università̀ della Campania 'Luigi Vanvitelli,', Naples, Italy
| | - Giorgio La Nasa
- Università di Cagliari, Struttura Complessa Ematologia e Centro Trapianto di Midollo Osseo, Ospedale Businco, Cagliari, Italy
| | - Giovanni Caocci
- Università di Cagliari, Struttura Complessa Ematologia e Centro Trapianto di Midollo Osseo, Ospedale Businco, Cagliari, Italy
| | - Antonio Piroddi
- Centro Trapianti Cellule Staminali, Ospedale Microcitemico 'A. Cao', ASL8 Cagliari, Cagliari, Italy
| | - Andrea Piolatto
- Centro Microcitemie-Pediatria Azienda Ospedaliero Universitaria San Luigi Gonzaga, Turin, Italy
| | - Alessandra Di Mauro
- Attività Diurne Malattie Rare Internistiche-Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Romano
- Unità Operativa Semplice Centro Microcitemia, Unità Operativa Complessa Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale 'A. Perrino', Brindisi, Italy
| | | | - Susanna Barella
- Struttura Semplice Dipartimentale Talassemia, Ospedale Microcitemico 'A. Cao,' ASL8 Cagliari, Cagliari, Italy
| | - Aurelio Maggio
- Unità Operativa Complessa Ematologia per le Malattie Rare del Sangue e degli Organi Ematopoietici, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-V. Cervello, Palermo, Italy
| | - Giovanna Graziadei
- Attività Diurne Malattie Rare Internistiche-Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università̀ della Campania 'Luigi Vanvitelli,', Naples, Italy
| | - Gian Luca Forni
- Struttura Semplice Dipartimentale Centro della Microcitemia, delle Anemie Congenite e dei Disordini del Metabolismo del Ferro, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
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10
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Zha G, Xiao X, Tian Y, Zhu H, Chen P, Zhang Q, Yu C, Li H, Wang Y, Cao C. An efficient isoelectric focusing of microcolumn array chip for screening of adult Beta-Thalassemia. Clin Chim Acta 2023; 538:124-130. [PMID: 36400321 DOI: 10.1016/j.cca.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
Traditional capillary isoelectric focusing (cIEF), liquid chromatography (LC) and capillary zone electrophoresis (CZE) still suffered from low resolution for hemoglobinopathy screening. Herein, a 30-mm pH 5.2-7.8 microcolumn IEF (mIEF) array chip was developed for hemoglobinopathy screening. As a proof of concept, adult beta-thalassemia was chosen as a model disease. In the method, blood samples were hemolyzed via hemolysin solution and loaded into the microcolumn. The experiments showed that (i) the species of Hb A, F, A2 and variants were clearly separated in the chip, and the resolution was greatly higher than the ones of LC/CZE/cIEF; (ii) up to 24 samples could be simultaneously analyzed in 12-min run; (iii) the intraday and interday RSDs were respectively 3.32-4.91 % and 4.07-5.33 %. The assays of mIEF to total 634 samples were compared with the ones of LC (n = 327) and PCR (n = 307). The cutoff of 3.5 % HbA2 led to the sensitivity of 100 % and specificity of 89.1 % for the mIEF-based screening; and there was 96.7 % coincidence between the methods of mIEF and PCR if refer Hb A2 and F. The method had the merits of facility, efficiency, specificity and sensitivity in contrast to the currently-used methods, implying its potential to screening of beta-thalassemia and hemoglobinopathies.
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Affiliation(s)
- Genhan Zha
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Xuan Xiao
- NHC Key Laboratory of Thalassemia Medicine, Key Laboratory of Thalassemia Medicine, Chinese Academy of Medical Sciences, Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning 530021, P. R. China
| | - Youli Tian
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Hengying Zhu
- NHC Key Laboratory of Thalassemia Medicine, Key Laboratory of Thalassemia Medicine, Chinese Academy of Medical Sciences, Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning 530021, P. R. China
| | - Ping Chen
- NHC Key Laboratory of Thalassemia Medicine, Key Laboratory of Thalassemia Medicine, Chinese Academy of Medical Sciences, Guangxi Key Laboratory of Thalassemia Research, Guangxi Medical University, Nanning 530021, P. R. China.
| | - Qiang Zhang
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China.
| | - Changjie Yu
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Honggen Li
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Yuxing Wang
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - Chengxi Cao
- School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China; School of Life Science and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
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The Outcomes of Patients with Haemoglobin Disorders in Cyprus: A Joined Report of the Thalassaemia International Federation and the Nicosia and Paphos Thalassaemia Centres (State Health Services Organisation). THALASSEMIA REPORTS 2022. [DOI: 10.3390/thalassrep12040019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Haemoglobinopathies, including thalassaemias and sickle-cell syndromes, are demanding, lifelong conditions that pose a significant burden to patients, families, and healthcare systems. Despite the therapeutic advances and the resulting improvements in prognosis accomplished in past decades, these patients still face important challenges, including suboptimal access to quality care in areas with developing economies, changing epidemiology due to massive migration flows, an evolving clinical spectrum due to ageing in well-treated patients, and limited access to novel high-cost therapies. We herein describe the organization of healthcare services for haemoglobinopathies in Cyprus—with particular focus on beta-thalassaemia, the most prevalent condition in this region—along with selected patient outcomes. This report aims at underscoring the fact that nationally funded and well-coordinated prevention and care programmes for chronic and complex conditions, such as haemoglobinopathies, with active involvement from patient organizations lead to effective disease control and excellent outcomes in survival, quality of life, social adaptation, and public health savings, and allow timely and effective responses to emerging crises, such as the COVID-19 pandemic. The Cyprus paradigm could therefore serve as a blueprint for the organization or adaptation of haemoglobinopathy programs in other countries since these disorders are still widely occurring.
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12
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Ding J, Huang Z, Jiang X, Li Q, Cao Y, Guo Y. The prevalence and genetic disorders spectrum of thalassemia among breast cancer patients in Jiangxi province, China. Front Genet 2022; 13:1001369. [PMID: 36330446 PMCID: PMC9623098 DOI: 10.3389/fgene.2022.1001369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/04/2022] [Indexed: 09/09/2023] Open
Abstract
Background: Thalassemia is a common inherited hematological disease with genetic disorders characterized by imbalanced synthesis of the globin chains. Due to the improvement of treatment methods, patients with thalassemia can survive for a long time. Therefore, it is not uncommon for patients with thalassemia suffering from malignant tumors. However, there are quite few reports on thalassemia patients complicated with breast cancer. Herein, we try to investigate the prevalence and genetic disorders spectrum of thalassemia in patients with breast cancer. Methods: Blood routing tests and serum ferritin analysis were conducted in 1887 breast cancer patients treated in the department of radiation oncology during 1 April 2020 and 30 March 2022. The suspected thalassemia carriers with small mean corpuscular volume (MCV), mean corpuscular hemoglobin content (MCH) or mean corpuscular hemoglobin concentration (MCHC) but the concentration of serum ferritin within normal limits were further investigated by polymerase chain reaction (PCR) and flow through hybridization gene chip to detect common mutations of α-globin and β-globin genes using Thalassemia Geno Array Diagnostic Kit. The prevalence and genetic mutation spectrum of thalassemia among breast cancer patients were analyzed. Results: Four hundred and eighty-nine suspected thalassemia carriers were detected by complete blood cell counts and serum ferritin analysis among 1887 breast cancer patients. One hundred and seven cases (5.7%) were identified as carriers of thalassemia, of which 55 cases (51.4%) were α-thalassemia, 50 cases (46.7%) were β-thalassemia, and 2 cases (1.9%) were co-inheritance of α-thalassemia and β-thalassemia simultaneously. In α-thalassemia, the most prevalent genotype is -SEA/αα; as for β-thalassemia, βIVS-II-654/β is the most common genotype. The degree of anemia is more severe in β-thalassemia than in α-thalassemia. Conclusion: This is the first comprehensive molecular epidemiological investigation on thalassemia among breast cancer patients. Our data indicated that thalassemia was not uncommon in breast cancer patients. The physicians should have the knowledge to avoid misdiagnosis as iron deficiency anemia.
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Affiliation(s)
- Jingxian Ding
- Department of Radiation Oncology, The Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang, China
| | - Zhaohui Huang
- Department of Radiation Oncology, The Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang, China
| | - Xiaoliu Jiang
- Department of Radiation Oncology, The Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang, China
| | - Qingge Li
- Department of Radiation Oncology, The Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang, China
| | - Yali Cao
- Department of Breast Surgery, The Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang, China
| | - Yonghong Guo
- Department of Radiation Oncology, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
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13
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Lee YC, Yen CT, Lee YL, Chen RJ. Thalassemia Intermedia: Chelator or Not? Int J Mol Sci 2022; 23:ijms231710189. [PMID: 36077584 PMCID: PMC9456380 DOI: 10.3390/ijms231710189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Thalassemia is the most common genetic disorder worldwide. Thalassemia intermedia (TI) is non-transfusion-dependent thalassemia (NTDT), which includes β-TI hemoglobin, E/β-thalassemia and hemoglobin H (HbH) disease. Due to the availability of iron chelation therapy, the life expectancy of thalassemia major (TM) patients is now close to that of TI patients. Iron overload is noted in TI due to the increasing iron absorption from the intestine. Questions are raised regarding the relationship between iron chelation therapy and decreased patient morbidity/mortality, as well as the starting threshold for chelation therapy. Searching all the available articles up to 12 August 2022, iron-chelation-related TI was reviewed. In addition to splenectomized patients, osteoporosis was the most common morbidity among TI cases. Most study designs related to ferritin level and morbidities were cross-sectional and most were from the same Italian study groups. Intervention studies of iron chelation therapy included a subgroup of TI that required regular transfusion. Liver iron concentration (LIC) ≥ 5 mg/g/dw measured by MRI and ferritin level > 300 ng/mL were suggested as indicators to start iron chelation therapy, and iron chelation therapy was suggested to be stopped at a ferritin level ≤ 300 ng/mL. No studies showed improved overall survival rates by iron chelation therapy. TI morbidities and mortalities cannot be explained by iron overload alone. Hypoxemia and hemolysis may play a role. Head-to-head studies comparing different treatment methods, including hydroxyurea, fetal hemoglobin-inducing agents, hypertransfusion as well as iron chelation therapy are needed for TI, hopefully separating β-TI and HbH disease. In addition, the target hemoglobin level should be determined for β-TI and HbH disease.
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Affiliation(s)
- Yen-Chien Lee
- Department of Medical Oncology, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan 70043, Taiwan
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
- Correspondence: (Y.-C.L.); (R.-J.C.)
| | - Chi-Tai Yen
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan 70043, Taiwan
| | - Yen-Ling Lee
- Department of Medical Oncology, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan 70043, Taiwan
| | - Rong-Jane Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Correspondence: (Y.-C.L.); (R.-J.C.)
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14
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Elfaituri MK, Ghozy S, Ebied A, Morra ME, Hassan OG, Alhusseiny A, Abbas AS, Sherif NA, Fernandes JL, Huy NT. Amlodipine as adjuvant therapy to current chelating agents for reducing iron overload in thalassaemia major: a systematic review, meta-analysis and simulation of future studies. Vox Sang 2021; 116:887-897. [PMID: 33634883 DOI: 10.1111/vox.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Iron overload in thalassaemia is a crucial prognostic factor and a major cause of death due to heart failure or arrhythmia. Therefore, previous research has recommended amlodipine as an auxiliary treatment to current chelating agents for reducing iron overload in thalassaemia patients. MATERIALS AND METHODS A systematic review and meta-analysis of the results of three randomized clinical trials evaluating the use of amlodipine in thalassaemia patients through 12 databases were carried out. RESULTS Our final cohort included 130 patients. Insignificant difference in decreasing liver iron concentrations was found between amlodipine and control groups {weighted mean difference = -0·2, [95% confidence interval = (-0·55-0·15), P = 0·26]}. As regards serum ferritin, our analysis also showed no significant difference in serum ferritin between amlodipine and control groups {weighted mean difference [95% confidence interval = -0·16 (-0·51-0·19), P = 0·36]}. Similarly, there was insignificant difference in cardiac T2* between amlodipine and control groups {weighted mean difference [95% confidence interval = 0·34 (-0·01-0·69), P = 0·06]}. CONCLUSIONS Despite the growing evidence supporting the role of amlodipine in reducing iron overload in thalassaemia patients, our meta-analysis did not find that evidence collectively significant. The results of our simulation suggest that when more data are available, a meta-analysis with more randomized clinical trials could provide more conclusive insights.
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Affiliation(s)
| | - Sherief Ghozy
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Amr Ebied
- Online Research Club, Nagasaki, Japan.,Egyptian National Blood Transfusion Services, Alexandria, Egypt
| | - Mostafa Ebraheem Morra
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Osama Gamal Hassan
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Alhusseiny
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alzhraa Salah Abbas
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Nourin Ali Sherif
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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15
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Elbedewy TA, Abd-Elsalam S, Mostafa SM, Abdellatif RS, Fouad A, Youssef M, Abo-Amer YEE, Elsebaey MA. Sofosbuvir/Ledipasvir for Treatment of Chronic Hepatitis C Infection in Adult Patients with β- Thalassemia Major: A Real-Life Study. Endocr Metab Immune Disord Drug Targets 2021; 22:290-296. [PMID: 33530921 DOI: 10.2174/1871530321666210202150538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 11/22/2022]
Abstract
Background&Aims:Patients with thalassemia have lifelong need for blood transfusion, makes them more risky to hepatitis C virus (HCV). Iron overload and chronic HCV are considered risk factors for patients with thalassemia to develop liver insults. The aim of the present study is to investigate the safety and efficacy of sofosbuvir/ledipasvir in treatment of chronic HCV infection in Egyptian adult patients with β- thalassemia major. METHODS Aretrospective study included 53 patients with β-thalassemia major with chronic HCV treated with sofosbuvir (400 mg) and ledipasvir (90 mg) as a single pill fixed dose combination once daily for 12 weeks. The effectiveness of treatment was assessed by sustained virologic response (SVR) at 12 weeks after the end of treatment. RESULTS SVR was achieved in 96.23% of patients. 47.17% of patients had minor side effects. There was a significant reduction in ALT, AST, and serum ferritin 12 weeks post-therapy. There was insignificant change in hemoglobin level, or blood transfusion requirement 12 weeks post-therapy. There was no change in iron chelators doses throughout the study period. CONCLUSION Sofosbuvir/ledipasvir regimen seems to be safe and highly effective in treatment of chronic HCV in patients with β-thalassemia major.
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Affiliation(s)
- Tamer A Elbedewy
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta. Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta. Egypt
| | - Sahar Mohamed Mostafa
- Hepato-gastroentrology department, National Hepatology and Tropical Medicine Research Institute,Cairo. Egypt
| | - Raghda Samir Abdellatif
- Clinical pathology department, National hepatolgy and tropical medicine research institute, Cairo. Egypt
| | - Amina Fouad
- Clinical pathology department, National hepatolgy and tropical medicine research institute, Cairo. Egypt
| | - Mona Youssef
- Department of Hepatology and Gastroenterology,Benha Teaching Hospital, Benha. Egypt
| | - Yousry Esam-Eldin Abo-Amer
- Hepatology, Gastroenterology and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, Gharbia. Egypt
| | - Mohamed A Elsebaey
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta. Egypt
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16
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Maffei L, Sorrentino F, Caprari P, Taliani G, Massimi S, Risoluti R, Materazzi S. HCV Infection in Thalassemia Syndromes and Hemoglobinopathies: New Perspectives. Front Mol Biosci 2020; 7:7. [PMID: 32118034 PMCID: PMC7025587 DOI: 10.3389/fmolb.2020.00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/10/2020] [Indexed: 01/19/2023] Open
Abstract
Hepatitis C virus (HCV) infection is one of the most serious complications of transfusion therapy in the thalassemia and sickle cell disease (SCD) population before 1990; in fact, since 1990 serological tests were made available to detect infection in blood donors. The iron chelation therapy has improved the life expectancy of these patients and, consequently, a decrease in death due to heart disease may be observed, as well as an increase in liver disease due to the iron overload and HCV infection that lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. Until few years ago, the recommended therapy for HCV treatment consisted of pegylated-interferon alpha plus ribavirin, a therapy with important side effects. This treatment has been severely limited to thalassemic and SCD patients due to the hemolytic anemia induced by ribavirin causing an increase in the number of blood transfusions. The development of highly effective Direct-acting Antiviral Agents toward different viral genotypes has led to a real HCV eradication with negative viremia and sustained viral response between 90 and 98%. At the beginning some indications of Direct-acting Antiviral Agents administration were available for those patients exhibiting advanced cirrhosis or needing liver transplantation over time for the high costs of the new drugs. Recently, all treatment regimens can be used for patients with various HCV genotypes, different stages of liver disease, and comorbidities. The HCV eradication has also led to a marked improvement in the parameters of martial accumulation, demonstrating a synergic action also between the effect of antiviral therapy and iron chelation.
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Affiliation(s)
- Laura Maffei
- Thalassemia Unit, S. Eugenio Hospital, Rome, Italy
| | | | - Patrizia Caprari
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Gloria Taliani
- Chronic Infectious Diseases Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sara Massimi
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Risoluti
- Department of Chemistry, Sapienza University of Rome, Rome, Italy
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17
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Motta I, Mancarella M, Marcon A, Vicenzi M, Cappellini MD. Management of age-associated medical complications in patients with β-thalassemia. Expert Rev Hematol 2019; 13:85-94. [DOI: 10.1080/17474086.2020.1686354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Mancarella
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Marcon
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vicenzi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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