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Al-Allawi N, Atroshi SD, Sadullah RK, Eissa AA, Kriegshäuser G, Al-Zebari S, Qadir S, Khalil D, Oberkanins C. A Population-Oriented Genetic Scoring System to Predict Phenotype: A Pathway to Personalized Medicine in Iraqis With β-Thalassemia. Hemoglobin 2024:1-7. [PMID: 38390736 DOI: 10.1080/03630269.2024.2319733] [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: 11/20/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
To assess the roles of genetic modifiers in Iraqi β-thalassemia patients, and determine whether a genotype-based scoring system could be used to predict phenotype, a total of 224 Iraqi patients with molecularly characterized homozygous or compound heterozygous β-thalassemia were further investigated for α-thalassemia deletions as well as five polymorphisms namely: rs7482144 C > T at HBG2, rs1427407 G > T and rs10189857 A > G at BCL11A, and rs28384513 A > C and rs9399137 T > C at HMIP. The enrolled patients had a median age of 14 years, with 96 males and 128 females. They included 144 thalassemia major, and 80 thalassemia intermedia patients. Multivariate logistic regression analysis revealed that a model including sex and four of these genetic modifiers, namely: β+ alleles, HBG2 rs7482144, α-thalassemia deletions, and BCL11A rs1427407 could significantly predict phenotype (major versus intermedia) with an overall accuracy of 83.9%. Furthermore, a log odds genetic score based on these significant predictors had a highly significant area under curve of 0.917 (95% CI 0.882-0.953). This study underscores the notion that genetic scoring systems should be tailored to populations in question, since genetic modifiers (and/or their relative weight) vary between populations. The population-oriented genetic scoring system created by the current study to predict β-thalassemia phenotype among Iraqis may pave the way to personalized medicine in this patient's group.
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Affiliation(s)
- Nasir Al-Allawi
- Department of Pathology, College of Medicine, University of Duhok, Iraq
| | - Sulav D Atroshi
- Department of Pathology, College of Medicine, University of Duhok, Iraq
| | - Regir K Sadullah
- Medical Laboratory Technology Department, College of Health and Medical Technology, Duhok Polytechnic University, Shekhan, Iraq
| | | | | | - Shaima Al-Zebari
- Research Center, College of Science, University of Duhok, Duhok, Iraq
| | - Shatha Qadir
- Department of Hematology, Azadi Teaching Hospital, Duhok, Iraq
| | - Dilan Khalil
- Research Center, College of Science, University of Duhok, Duhok, Iraq
| | - Christian Oberkanins
- Department of Research and Development, ViennaLab Diagnostics GmbH, Vienna, Austria
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Khan AM, Al-Sulaiti AM, Younes S, Yassin M, Zayed H. The spectrum of beta-thalassemia mutations in the 22 Arab countries: a systematic review. Expert Rev Hematol 2020; 14:109-122. [PMID: 33317346 DOI: 10.1080/17474086.2021.1860003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the mutational spectrum in the HBB gene in Arab patients with β-thal. METHODS Authors searched five databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar) from the time of inception until March 2020. RESULTS The authors search strategy yielded 3,229 citations, of which 48 eligible studies captured. 105 mutations were captured, of these, 99 were shared between Arabs and other ethnic groups, six mutations were unique to Arabs (c.92 + 2 T > G, c.-240 G > A, c.150delC, c.420dupT, deletion of 192 bp spanning exon 1, intron 1, and the first two bases of exon 2 of HBB gene, and deletion of 9.6 kb, including exon 1 and intron 2 of HBB gene). The most common HBB gene mutations among Arabs were c.93-21 G > A, c.118 C > T, c.92 + 1 G > A, c.92 + 6 T > C, c.92 + 5 G > C, c.315 + 1 G > A, and c.27dupG. Consanguinity is high among Arab patients with β-thal. Migration into Arab countries led to allelic heterogeneity among Arab patients with β-thal. CONCLUSION Our findings present a platform for further genetic epidemiological studies for Arab patients with β-thal.
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Affiliation(s)
- Aisha Moeen Khan
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
| | - Asma Mohammed Al-Sulaiti
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
| | - Salma Younes
- Translational Research Institute, Women's Wellness and Research Center, Hamad Medical Corporation , Qatar
| | - Mohamed Yassin
- Department of Hematology and BMT, National Center for Cancer Care and Research, Hamad Medical Corporation , Doha, Qatar
| | - Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University , Doha, Qatar
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Amin SS, Jalal SD, Ali KM, Mohammed AI, Rasool LK, Osman TJ. Beta-Thalassemia Intermedia: A Single Thalassemia Center Experience from Northeastern Iraq. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2807120. [PMID: 32190657 PMCID: PMC7066418 DOI: 10.1155/2020/2807120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the molecular characterization and disease-associated complications of beta-thalassemia intermedia (β-TI) patients in Sulaymaniyah province, northeastern Iraq. METHODS A total of 159 β-TI) patients in Sulaymaniyah province, northeastern Iraq. β-TI) patients in Sulaymaniyah province, northeastern Iraq. RESULTS Nineteen different β-globin gene mutations arranged in 37 various genotypes were determined. The most frequent were IVS-II-I (G>A) (47.2%), followed by IVS-I-6 (T>C) (23.3%) and IVS-I-110 (G>A) (5%). Among disease-related morbidities documented, bone disease amounted to 53% (facial deformity and osteoporosis), followed by endocrinopathies 17.6% (growth retardation and subclinical hypothyroidism), cholelithiasis 13.8%, pulmonary hypertension 11.3%, and abnormal liver function test 7.5%, whereas venous thrombosis, extramedullary hemopoiesis, and leg ulcer were less frequently observed. Age ≥ 35 and female sex were risk factors for cholelithiasis, while age was an independent risk for hypothyroidism and female sex was associated with increased risk for osteoporosis. Mean serum ferritin of ≥1000 μg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. β +-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.β-TI) patients in Sulaymaniyah province, northeastern Iraq. μg/L was associated with an increased risk of osteoporosis, whereas chelation therapy was protective for a multitude of other complications. Transfusion, on the other hand, increased the risk of osteoporosis, yet it was protective for cholelithiasis and hypothyroidism. Moreover, splenectomy was protective for cholelithiasis, although it was an independent risk for hypothyroidism. Finally, hydroxyurea was associated with an increased risk of osteoporosis, while it was protective for cholelithiasis. Discussion and Conclusion. β +-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.Discussion and Conclusion. β +-thalassemia mutation had contributed to 41.25 of families with a less severe β-thalassemia phenotype in the northeastern part of Iraq, justifying the need to investigate the contribution of genetic modifiers in ameliorating disease severity. In addition, the substantial number of β-TI patients developed disease-related morbidities, which necessitates the need for more appropriate clinical management with earlier intervention.β-TI) patients in Sulaymaniyah province, northeastern Iraq. β-TI) patients in Sulaymaniyah province, northeastern Iraq.
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Affiliation(s)
- Shaema Salih Amin
- Sulaymaniyah Directorate of Health, Hewa Oncology Hospital, Sulaymaniyah, Iraq
| | - Sana Dlawar Jalal
- Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | - Kosar Muhammed Ali
- Department of Medicine, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | - Ali Ibrahim Mohammed
- Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | | | - Tara Jamel Osman
- Thalassemia and Congenital Blood Disorders Center, Sulaymaniyah 46001, Iraq
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Faraon R, Daraghmah M, Samarah F, Srour MA. Molecular characterization of β-thalassemia intermedia in the West Bank, Palestine. BMC HEMATOLOGY 2019; 19:4. [PMID: 30820323 PMCID: PMC6380065 DOI: 10.1186/s12878-019-0135-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/07/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to investigate the molecular basis of β-Thalassemia intermedia (TI) in the West Bank region and its management practices. METHODS This was a case series multi-center study and included 51 cases of TI. DNA sequencing was used to analyze β-globin gene mutations. Common α-globin gene mutations were screened by Gap-PCR (-α3.7, -α4.2, --MED, αααanti3.7) or DNA sequencing (α2-IVS II 5 nt del). XmnI -158 C > T polymorphisms of Gγ-globin gene was determined by RFLP-PCR. RESULTS Seven β-globin gene mutations were observed, namely IVS-I -6 C > T, IVS-I-110 G > A, IVS-II-1 G > A, IVS-I-1 G > A, Codon 37 Trp > Stop, beta - 101 and IVS-II-848 C > A. Ten genotypes were observed. Homozygosity for IVS-I-6 accounted for the majority of TI cases with a frequency of 74.5%. The second common β-globin gene genotype was homozygote IVS-I-110 G > A (5.8%) and homozygote IVS-II-1 G > A (5.8%). The remaining seven genotypes were each detected in about 2% of patients. α-Thalassemia mutations were seen in five patients (9.8%), and included (-α3.7, αααanti3.7 and α2-IVSII-5 nt del). XmnI polymorphism was observed in four patients (7.8%), three homozygotes and one heterozygote. CONCLUSIONS Homozygosity for the mild β-globin gene IVS-I-6 allele was the major contributing factor for the TI phenotype among the study subjects. The role of XmnI SNP and α-thalassemia mutations in ameliorating the TI phenotype was observed in few patients for each factor. The beta - 101 C > T mutation was diagnosed in one patient in homozygote state for the first time in Palestine.
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Affiliation(s)
- Rashail Faraon
- Department of Medical Laboratory Sciences, Al-Quds University, East Jerusalem, Palestine
| | - Mahmoud Daraghmah
- Palestine Thalassemia Patients’ Friends Society, Al-Bireh, Palestine
| | - Fekri Samarah
- Department of Medical Laboratory Sciences, Arab-American University, Jenin, Palestine
| | - Mahmoud A. Srour
- Department of Medical Laboratory Sciences, Al-Quds University, East Jerusalem, Palestine
- Department of Biology & Biochemistry, Birzeit University, P.O. Box 14, Birzeit, Palestine
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Miri-Moghaddam E, Bahrami S, Naderi M, Bazi A, Karimipoor M. Molecular Characterization of β-Thalassemia Intermedia in Southeast Iran. Hemoglobin 2017; 40:173-8. [PMID: 27117567 DOI: 10.3109/03630269.2016.1167735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Inheritance of mild mutations within the β-globin gene and coinheritance of α-thalassemia (α-thal) are known as two important genetic modifiers in β-thalassemia (β-thal) intermedia (β-TI). We aimed to evaluate the spectrum of β- and α-thal mutations in β-TI patients in Southeast Iran. Common β- and α-globin gene mutations were detected by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and multiplex gap-PCR, respectively. There were 26 male (57.8%) and 19 female (42.2%) patients. HBB: c.92 + 5T > C [IVS-I-5 (G > C)] and HBB: c.-138C + 1G > A [IVS-II-I (G > A)] represented the prevalent alleles with respective frequencies of 60.0 and 10.0%. Other β-globin mutations included HBB: c.-138C > T [-88 (C > T)], HBB: c.27_28insG [frameshift codons (FSC) 8/9 (+G)], HBB: c.46delT [codon 15 (-T)], HBB: c.93-22_95del (IVS-I, 25 del), and the 619 bp deletion (NG_000007.3: g.71609_72227del619). The predominant genotypic combinations were β(0)/β(0) (68.9%), β(0)/β(+ )(8.9%) and β(+)/β(+ )(2.2%). Coinheritance of α-thal was observed in 33.0% of the patients, with the -α(3.7) (rightward) (NG_000006.1: g.34164_37967del3804) as the most common deletion (86.0%). One patient was diagnosed with the -α(4.2) (leftward) (AF221717) and one with the - -(MED) (g.24664_41064del16401) deletions, while no patients carried the -(α)(20.5) (g.15164_37864del22701), α(-5 nt) (HBA2: c.95 + 2_95_6delTGAGG) or codon 19 (-G) (HBA2: c.56delG) mutations. The alleviating molecular mechanism was not explainable by β(+ )or concurrent α-thal in more than half of our β-TI patients. This encourages conducting more studies to identify other contributing factors, especially Hb F-inducing genetic modifiers.
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Affiliation(s)
- Ebrahim Miri-Moghaddam
- a Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences , Zahedan , Iran.,b Department of Genetics , Faculty of Medicine, Zahedan University of Medical Sciences , Zahedan , Iran
| | - Sara Bahrami
- c Department of Biology , Payame Noor University , Zahedan , Iran
| | - Majid Naderi
- d Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences , Zahedan , Iran.,e Department of Pediatric Hematology & Oncology , Faculty of Medicine, Zahedan University of Medical Sciences , Zahedan , Iran
| | - Ali Bazi
- f Faculty of Allied Medical Sciences , Zabol University of Medical Sciences , Zabol , Iran
| | - Morteza Karimipoor
- g Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran , Tehran , Iran
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Mahdieh N, Rabbani B. Beta thalassemia in 31,734 cases with HBB gene mutations: Pathogenic and structural analysis of the common mutations; Iran as the crossroads of the Middle East. Blood Rev 2016; 30:493-508. [DOI: 10.1016/j.blre.2016.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 06/13/2016] [Accepted: 07/08/2016] [Indexed: 12/16/2022]
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Prevalence and Risk Factors for Complications in Patients with Nontransfusion Dependent Alpha- and Beta-Thalassemia. Anemia 2015; 2015:793025. [PMID: 26664743 PMCID: PMC4667021 DOI: 10.1155/2015/793025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 11/05/2015] [Indexed: 01/27/2023] Open
Abstract
Background. Nontransfusion dependent thalassemia (NTDT) is a milder form of thalassemia that does not require regular transfusion. It is associated with many complications, which differ from that found in transfusion-dependent thalassemia (TDT). Currently available information is mostly derived from beta-NTDT; consequently, more data is needed to describe complications found in the alpha-NTDT form of this disease. Methods. We retrospectively reviewed the medical records of NTDT patients from January 2012 to December 2013. Complications related to thalassemia were reviewed and compared. Results. One hundred patients included 60 females with a median age of 38 years. The majority (54 patients) had alpha-thalassemia. Overall, 83 patients had one or more complications. The three most common complications were cholelithiasis (35%), abnormal liver function (29%), and extramedullary hematopoiesis (EMH) (25%). EMH, cardiomyopathy, cholelithiasis, and pulmonary hypertension were more commonly seen in beta-thalassemia. Osteoporosis was the only complication that was more common in alpha-thalassemia. The risk factors significantly related to EMH were beta-thalassemia type and hemoglobin < 8 g/dL. The risk factors related to osteoporosis were female gender and age > 40 years. Iron overload (ferritin > 800 ng/mL) was the only risk factor for abnormal liver function. Conclusion. The prevalence of alpha-NTDT complications was lower and different from beta-thalassemia.
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Shamoon RP, Al-Allawi NAS, Cappellini MD, Di Pierro E, Brancaleoni V, Granata F. Molecular Basis of β-Thalassemia Intermedia in Erbil Province of Iraqi Kurdistan. Hemoglobin 2015; 39:178-83. [PMID: 25902180 DOI: 10.3109/03630269.2015.1032415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
β-Thalassemia intermedia (β-TI) is a clinical term describing a range of clinical phenotypes that are intermediate in severity between the carrier state and β-thalassemia major (β-TM). To characterize the molecular basis of β-TI in Erbil Province, Northern Iraq, 83 unrelated patients were investigated. Detection of β-globin gene mutations was carried out by reverse hybridization assay and direct gene sequencing. All patients were screened for the XmnI polymorphism by direct sequencing of HBG2 ((G)γ promoter gene). Detection of α-globin gene deletions and triplication was carried out using the reverse hybridization assay. Four main molecular patterns were identified in association with the β-TI phenotype, namely: β(+)/β(+) (38.5%), β(+)/β(0) (21.6%), β(0)/β(0) (31.3%), and β(0)/wild type (8.4%). IVS-I-6 (T > C) was the most frequently encountered mutation (55 alleles, 34.6%), followed by IVS-II-1 (G > A) and codon 8 (-AA); furthermore, we report for the first time from Iraq two β(+) mutations, -87 (C > G) and 5' untranslated region (5'UTR) +22 (G > A). The XmnI polymorphism was detected in 47.0% of patients, mainly in association with the β(0)/β(0) genotype. The α-globin gene deletions were encountered in four cases, including one case with (- -(FIL)) double gene deletion, a report that is the first from our country. The α-globin gene triplication was detected in five of the seven heterozygous β-thalassemia (β-thal) patients. Similar to other Mediterranean countries, inheritance of mild β-globin mutations was the main molecular pattern underlying β-TI in our patients followed by the ameliorating effect of the XmnI polymorphism.
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Affiliation(s)
- Rawand P Shamoon
- Department of Pathology, College of Medicine, Hawler Medical University , Erbil , Iraq
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Al-Allawi NAS, Puehringer H, Raheem RA, Oberkanins C. Genetic Modifiers in β-Thalassemia Intermedia: A Study on 102 Iraqi Arab Patients. Genet Test Mol Biomarkers 2015; 19:242-7. [PMID: 25751242 DOI: 10.1089/gtmb.2014.0310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To determine the molecular basis of β-thalassemia intermedia (TI) and the contribution of the three hemoglobin F (HbF) quantitative trait loci (QTLs) on chromosomes 11, 2, and 6 to the milder phenotype, a total of 102 Iraqi Arab patients with TI were studied. The β and α genotypes as well as HBG2 g. 158 C>T (rs7482144), BCL11A (rs1427407 and rs10189857), and HBS1L-MYB (rs28384513 and rs9399137) by multiplex polymerase chain reaction and reverse hybridization were studied. A total of 21 different β-thalassemia mutations arranged in 35 different genotypes were identified. The genotypes encompassed β(+)/β(+) mutations in 33 cases, β(+)/β(0) in 17 cases, β(0)/β(0) in 47 cases, β(0)/wild type in 3 and β(0)/Hb E in 2 cases. The most common was IVS-II-1 (G>A)/IVS-II-1 (G>A), followed by IVS-I-6 (T>C)/IVS-I-6 (T>C) and IVS-I-110 (G>A)/IVS-I-110 (G>A), in 31.4%, 17.6%, and 6.9%, respectively. Alpha-thalassemia mutations were found in 15.2% of those homozygous for the β-mutations, while α gene triplication was identified in all three heterozygotes. Of the five QTLs tested, only rs7482144 and rs10189857 were significantly associated with β(0)/β(0) when compared to β(+)/β(+), with odds ratios of 6.4 (95% confidence interval [CI] 2.9-14.0) and 3.2 (95% CI 1.2-8.6), respectively. In conclusion, this study has demonstrated that among Iraqi patients with thal intermedia, the main contributors to the milder phenotype were β(+) alleles, XmnI polymorphism, and BCL11A (rs10189857), while other QTLs on chromosomes 2 and 6, as well as alpha-thalassemia, were not significantly relevant.
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Affiliation(s)
- Nasir A S Al-Allawi
- 1 Faculty of Medical Sciences, Scientific Research Center, University of Duhok , Duhok, Iraq
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Ali N, Ayyub M, Khan SA, Ahmed S, Abbas K, Malik HS, Tashfeen S. Frequency of Gγ-globin promoter −158 (C>T) XmnI polymorphism in patients with homozygous/compound heterozygous beta thalassaemia. Hematol Oncol Stem Cell Ther 2015; 8:10-5. [DOI: 10.1016/j.hemonc.2014.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/20/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022] Open
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β -thalassemia intermedia in Northern Iraq: a single center experience. BIOMED RESEARCH INTERNATIONAL 2014; 2014:262853. [PMID: 24719849 PMCID: PMC3955643 DOI: 10.1155/2014/262853] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 12/20/2022]
Abstract
To investigate the molecular basis of β-thalassemia intermedia in Northern Iraq and evaluate its management practices, a total of 74 patients from 51 families were enrolled. The patients were clinically and hematologically reevaluated, and had their β-thalassemia mutations characterized, as well as the number of α-globin genes and Xmn I Gγ −158 (C>T) polymorphism studied. Out of 14 β-thalassemia mutations identified, the four most common were IVS-I-6 (T>C) [33.3%], IVS-II-I (G>A) [21.1%], codon 82/83(−G) [10.1%], and codon 8 (−AA) [8.1%]. The most common contributing factors to the less severe phenotype of thalassemia intermedia were found to be the inheritance of mild β-thalassemia alleles and the Xmn I polymorphism, while concomitant α-thalassemia had a limited role. Several complications were documented including: pulmonary hypertension in 20.4%, diabetes mellitus in 1.4%, hypothyroidism in 2.9%, and heart failure in 2.7%, while no documented cases of venous thrombosis were found. Compared to their counterparts in several Mediterranean countries, it appears that our patients were much less frequently transfused and had a lower proportion of patients who were splenectomized, on iron chelation, or hydroxycarbamide therapy. Such practices require further scrutiny to ensure that a better level of care is provided and that growth retardation, skeletal changes, and other complications are prevented or reduced.
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Qari MH, Wali Y, Albagshi MH, Alshahrani M, Alzahrani A, Alhijji IA, Almomen A, Aljefri A, Al Saeed HH, Abdullah S, Al Rustumani A, Mahour K, Mousa SA. Regional consensus opinion for the management of Beta thalassemia major in the Arabian Gulf area. Orphanet J Rare Dis 2013; 8:143. [PMID: 24044606 PMCID: PMC3848639 DOI: 10.1186/1750-1172-8-143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/06/2013] [Indexed: 11/24/2022] Open
Abstract
Thalassemia syndrome has diverse clinical presentations and a global spread that has far exceeded the classical Mediterranean basin where the mutations arose. The mutations that give rise to either alpha or beta thalassemia are numerous, resulting in a wide spectrum of clinical severity ranging from carrier state to life-threatening, inherited hemolytic anemia that requires regular blood transfusion. Beta thalassemia major constitutes a remarkable challenge to health care providers. The complications arising due to the anemia, transfusional iron overload, as well as other therapy-related complications add to the complexity of this condition. To produce this consensus opinion manuscript, a PubMed search was performed to gather evidence-based original articles, review articles, as well as published work reflecting the experience of physicians and scientists in the Arabian Gulf region in an effort to standardize the management protocol.
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Affiliation(s)
- Mohamad H Qari
- The Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, New York, USA.
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Verma IC, Saxena R, Kohli S. Hemoglobinopathies in India—Clinical and Laboratory Aspects. Clin Lab Med 2012; 32:249-62. [DOI: 10.1016/j.cll.2012.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Arab A, Karimipoor M, Rajabi A, Hamid M, Arjmandi S, Zeinali S. Molecular characterization of β-thalassemia intermedia: a report from Iran. Mol Biol Rep 2010; 38:4321-6. [PMID: 21120615 DOI: 10.1007/s11033-010-0557-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
Thalassemia intermedia is a clinical definition applied to patients whose clinical phenotype is milder than thalassemia major. To characterize different common mechanisms involving in pathogenesis of moderate to severe β-thalassemia intermedia, we have studied four factors in 38 Iranian patients with thalassemia intermedia: β-globin gene mutation, deletion in α-globin genes, presence of XmnI polymprphism and RFLP haplotype at β-globin gene cluster. The results showed that 84.4% of patients were associated with severe mutations in β-globin gene, mainly IVSII-1(G to A) (56.4%). The positive XmnI polymorphism was seen in 76.9% of the studied alleles which showed strong linkage to β° mutations and high level of fetal hemoglobin. Co-existence of α-globin gene deletions, β(+) mutation and the most frequent of RFLP haplotype (-/-, +/+, -/+, +/+, +/+, +/+, -/-) were seen in 7.7, 12.8 and 17.9%, respectively. In this group of our study it seems the main ameliorating factor in the patients was co-inheritance of a positive XmnI polymorphism with β° mutation especially IVSII-1, which were associated with increased production of fetal hemoglobin. However, the other probable genetic factors should be investigated to describe genotype-phenotype correlation in thalassemia intermedia patients.
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Affiliation(s)
- Aida Arab
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Pasteur Street, 13164 Tehran, Iran
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Abstract
The hemoglobin disorders serve as a model for study of the genetic heterogeneity underlying the phenotype of genetic disorders. 'Thalassemia intermedia' is a clinical phenotype which displays marked genotypic variability in different populations or ethnic groups. Two common underlying mechanisms include co-inheritance of alpha globin gene deletions in homozygous thalassemia intermedia and presence of XmnI polymorphism. The newly described mechanisms including unstable hemoglobin disorders and somatic deletions in beta-globin gene are elaborated in the present review.
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Affiliation(s)
- Inusha Panigrahi
- Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh-12, India.
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Frequency of Positive XmnI Gγ polymorphism and coinheritance of common alpha thalassemia mutations do not show statistically significant difference between thalassemia major and intermedia cases with homozygous IVSII-1 mutation. Blood Cells Mol Dis 2010; 44:95-9. [DOI: 10.1016/j.bcmd.2009.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 11/23/2022]
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Hamid M, Mahjoubi F, Akbari MT, Arab A, Zeinali S, Karimipoor M. Molecular Analysis of γ-Globin Promoters, HS-111 and 3′HS1, in β-thalassemia Intermedia Patients Associated with High Levels of Hb F. Hemoglobin 2009; 33:428-38. [DOI: 10.3109/03630260903336479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Italia KY, Jijina FJ, Merchant R, Panjwani S, Nadkarni AH, Sawant PM, Nair SB, Ghosh K, Colah RB. Response to hydroxyurea in β thalassemia major and intermedia: Experience in western India. Clin Chim Acta 2009; 407:10-5. [DOI: 10.1016/j.cca.2009.06.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 06/12/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
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Akbari MT, Izadi P, Izadyar M, Kyriacou K, Kleanthous M. Molecular Basis of Thalassemia Intermedia in Iran. Hemoglobin 2009; 32:462-70. [DOI: 10.1080/03630260802341851] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Neishabury M, Azarkeivan A, Oberkanins C, Esteghamat F, Amirizadeh N, Najmabadi H. Molecular mechanisms underlying thalassemia intermedia in Iran. ACTA ACUST UNITED AC 2009; 12:549-56. [PMID: 18939939 DOI: 10.1089/gte.2008.0018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To improve the differentiation of thalassemia intermedia from other hemoglobinopathies in Iran, four known genetic mechanisms-XmnI (G)gamma polymorphism, inheritance of mild and silent beta-thalassemia alleles, delta beta deletion, and coinheritance of alpha- and beta-thalassemia-were investigated in 52 Iranian individuals suspected to have thalassemia intermedia based on clinical and hematological characteristics. Beta-globin mutations were studied using a reverse-hybridization assay and sequencing of the total beta-globin gene. The XmnI (G)gamma polymorphism, the Sicilian delta beta deletion, and four alpha-globin mutations (-a(3.7), -a(4.2), -(MED), aaa(anti-3.7)) were studied using PCR-based techniques. The inheritance of the XmnI (G)gamma polymorphism with severe beta-thalassemia alleles in the homozygous or compound heterozygous state was the predominant mechanism observed in 27 individuals (55.3%). In five cases, this status overlapped with the -a(3.7)/aa genotype. The second most frequent cause for thalassemia intermedia (14.8%) was the inheritance of mild beta-thalassemia alleles, including IVS-I-6 (T > C), -88 (C > A), and + 113 (A > G). In three subjects (4.3%) the Sicilian delta beta deletion was identified. HbS in association with beta-zero-thalassemia was found in three patients with thalassemia intermedia phenotype. In 11 cases (21.3%) no causative genetic alteration could be identified. Our results reflect the diversity underlying thalassemia intermedia, and the limitations of the applied clinical, hematological, and molecular approaches for correct diagnosis. Some of the unresolved cases will offer an opportunity to discover additional molecular mechanisms leading to thalassemia intermedia.
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Affiliation(s)
- Maryam Neishabury
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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