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Tomiyama M, Takayama S, Konno H, Murakoshi T, Koga M, Nakamura M, Yamashiro Y, Matsubayashi T. ( G γ A γ δ β ) 0 $({}^{\rm G}{\gamma}{}^{\rm A}{\gamma}\delta\beta)^0$ -Thalassemia: Report of two cases in a family. Pediatr Blood Cancer 2023; 70:e30666. [PMID: 37712671 DOI: 10.1002/pbc.30666] [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: 06/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Case 1 presented with severe anemia and received an intrauterine blood cell transfusion at 33 weeks of gestation. The anemia spontaneously improved in early infancy. Case 2, the father of Case 1, had an uneventful birth with no evidence of anemia, though microcytic anemia was observed during childhood. The genetic analysis of the β-globin gene cluster identified a novel heterozygous deletion of DNA extending from the Gγ-globin gene downstream to the β-globin gene, confirming a diagnosis of (G γA γδβ)0 -thalassemia. In cases where thalassemia is suspected based on blood tests, a genetic diagnosis should be performed for the sake of the offspring.
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Affiliation(s)
- Mana Tomiyama
- Department of Pediatrics, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Saki Takayama
- Department of Pediatrics, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Hiroko Konno
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Hakuhokai Central Hospital, Hyogo, Japan
| | - Momoko Nakamura
- Division of Clinical Laboratory Science, Faculty of Health Sciences, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Yasuhiro Yamashiro
- Division of Clinical Laboratory Science, Faculty of Health Sciences, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Capasso S, Cardiero G, Musollino G, Prezioso R, Testa R, Dembech S, Piluso G, Nigro V, Digilio FA, Lacerra G. Functional analysis of three new alpha-thalassemia deletions involving MCS-R2 reveals the presence of an additional enhancer element in the 5' boundary region. PLoS Genet 2023; 19:e1010727. [PMID: 37216374 DOI: 10.1371/journal.pgen.1010727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
We report three novel deletions involving the Multispecies Conserved Sequences (MCS) R2, also known as the Major Regulative Element (MRE), in patients showing the α-thalassemia phenotype. The three new rearrangements showed peculiar positions of the breakpoints. 1) The (αα)ES is a telomeric 110 kb deletion ending inside the MCS-R3 element. 2) The (αα)FG, 984 bp-long, ends 51 bp upstream to MCS-R2; both are associated with a severe α-thalassemia phenotype. 3) The (αα)CT, 5058 bp-long starts at position +93 of MCS-R2 and is the only one associated to a mild α-thalassemia phenotype. To understand the specific role of different segments of the MCS-R2 element and of its boundary regions we carried out transcriptional and expression analysis. Transcriptional analysis of patients' reticulocytes showed that (αα)ES was unable to produce α2-globin mRNA, while a high level of expression of the α2-globin genes (56%) was detected in (αα)CT deletion, characterized by the presence of the first 93 bp of MCS-R2. Expression analysis of constructs containing breakpoints and boundary regions of the deletions (αα)CT and (αα)FG, showed comparable activity both for MCS-R2 and the boundary region (-682/-8). Considering that the (αα)CT deletion, almost entirely removing MCS-R2, has a less severe phenotype than the (αα)FG α0thalassemia deletion, removing both MCS-R2 almost entirely and an upstream 679 bp, we infer for the first time that an enhancer element must exist in this region that helps to increase the expression of the α-globin genes. The genotype-phenotype relationship of other previously published MCS-R2 deletions strengthened our hypothesis.
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Affiliation(s)
- Serena Capasso
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Giovanna Cardiero
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Gennaro Musollino
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Romeo Prezioso
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
| | - Rosario Testa
- A.O.U. Policlinico Rodolico-San Marco, University of Catania, Catania, Italy
| | - Sabrina Dembech
- Central analysis laboratory, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Giulio Piluso
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - F Anna Digilio
- Research Institute on Terrestrial Ecosystems (IRET-CNR), National Research Council (CNR), Naples, Italy
| | - Giuseppina Lacerra
- Institute of Genetics and Biophysics "Adriano Buzzati Traverso" (IGB-ABT), National Research Council (CNR), Naples, Italy
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Alpha-Thalassemia in Southern Italy: Characterization of Five New Deletions Removing the Alpha-Globin Gene Cluster. Int J Mol Sci 2023; 24:ijms24032577. [PMID: 36768900 PMCID: PMC9916800 DOI: 10.3390/ijms24032577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
α-thalassemia is characterized in about 80% of cases by deletions generated by the presence of duplications and interspersed repeated sequences in the α-globin gene cluster. In a project on the molecular basis of α-thalassemia in Southern Italy, we identified six families, showing an absence of the most common deletions, and normal α-globin gene sequences. Multiplex Ligation-dependent Probe Amplification (MLPA), qRT-PCR, and the sequencing of long-range PCR amplicon have been used for the identification and characterization of new deletions. MLPA analysis for the identification of α- and β-globin rearrangement revealed the presence of five new α-thalassemia deletions. The set-up of qRT-PCR allowed us to delimit the extent of the deletions ranging from about 10 kb to more than 250 kb, two of them being of the telomeric type. The long-range PCR generated a specific anomalous fragment in three deletions, and only several unspecific bands in the other two deletions. The sequencing of the anomalous amplicons revealed the breakpoints of two deletions: the --PA, 34 kb long, identified in two families, and the telomeric --AG, 274 kb long. The anomalous fragment containing the breakpoint of the deletion --FG was partially sequenced, and it was not possible to identify the breakpoints due to the presence of several repetitive Alu sequences. The analysis of the breakpoint regions of the --Sciacca and --Puglia, respectively, are about 10 and 165 kb long, and revealed the presence of repeats that most likely impaired the amplification of a specific fragment for the identification of the breakpoint. MLPA, in association with qRT-PCR and long-range PCR, is a good approach for the identification and molecular characterization of rare or new deletions. Breakpoint analysis confirms that Alu sequences play an important role in favoring unequal crossing-over. Southern Italy shows considerable genetic heterogeneity, as expected with its central position in the Mediterranean basin, favoring migratory flows.
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Fotzi I, Pegoraro F, Chiocca E, Casini T, Mogni M, Veltroni M, Favre C. Case Report: Clinical and Hematological Characteristics of ε γδβ Thalassemia in an Italian Patient. Front Pediatr 2022; 10:839775. [PMID: 35372167 PMCID: PMC8969019 DOI: 10.3389/fped.2022.839775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION εγδβ thalassemia is a rare form of β-thalassemia mostly described in children originating from Northern Europe. Only anecdotic cases from the Mediterranean area are reported. The diagnosis is challenging, considering the rarity of the disease and its heterogeneous clinical presentation. Most patients have neonatal microcytic anemia, sometimes requiring in utero and/or neonatal transfusions, and typically improving with age. CASE DESCRIPTION We report on an Italian newborn presenting with severe neonatal anemia that required red blood cell transfusion. After the first months of life, hemoglobin levels improved with residual very low mean corpuscular volume. β and α thalassemia, IRIDA syndrome, and sideroblastic anemia were excluded. Finally, a diagnosis of εγδβ thalassemia was made after microarray analysis of single nucleotide polymorphisms revealed a 26 kb single copy loss of chromosome 11p15.4, including the HBD, HBBP1, HBG1, and HBB genes. CONCLUSIONS Despite its rarity, the diagnosis of εγδβ thalassemia should be considered in newborns with severe neonatal anemia requiring in utero and/or neonatal transfusions, but also in older infants with microcytic anemia, after excluding more prevalent red blood cell disorders.
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Affiliation(s)
- Ilaria Fotzi
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Francesco Pegoraro
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy.,Department of Health Science, University of Florence, Florence, Italy
| | - Elena Chiocca
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Tommaso Casini
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Massimo Mogni
- Human Genetics Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Marinella Veltroni
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
| | - Claudio Favre
- Department of Pediatric Hematology/Oncology and Hematopoietic Stem Cell Transplantation (HSCT), Meyer Children's University Hospital, Florence, Italy
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Svetec Miklenić M, Svetec IK. Palindromes in DNA-A Risk for Genome Stability and Implications in Cancer. Int J Mol Sci 2021; 22:2840. [PMID: 33799581 PMCID: PMC7999016 DOI: 10.3390/ijms22062840] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
A palindrome in DNA consists of two closely spaced or adjacent inverted repeats. Certain palindromes have important biological functions as parts of various cis-acting elements and protein binding sites. However, many palindromes are known as fragile sites in the genome, sites prone to chromosome breakage which can lead to various genetic rearrangements or even cell death. The ability of certain palindromes to initiate genetic recombination lies in their ability to form secondary structures in DNA which can cause replication stalling and double-strand breaks. Given their recombinogenic nature, it is not surprising that palindromes in the human genome are involved in genetic rearrangements in cancer cells as well as other known recurrent translocations and deletions associated with certain syndromes in humans. Here, we bring an overview of current understanding and knowledge on molecular mechanisms of palindrome recombinogenicity and discuss possible implications of DNA palindromes in carcinogenesis. Furthermore, we overview the data on known palindromic sequences in the human genome and efforts to estimate their number and distribution, as well as underlying mechanisms of genetic rearrangements specific palindromic sequences cause.
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Affiliation(s)
| | - Ivan Krešimir Svetec
- Faculty of Food Technology and Biotechnology, University of Zagreb, Pierottijeva 6, 10000 Zagreb, Croatia;
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Repnikova E, Roberts J, Mc Dermott S, Farooqi MS, Iqbal NT, Silvey M, Nolen J, Taboada E, Li W. Clinical and molecular characterization of novel deletions causing epsilon gamma delta beta thalassemia: Report of two cases. Pathol Res Pract 2019; 215:152578. [PMID: 31451289 DOI: 10.1016/j.prp.2019.152578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022]
Abstract
Epsilon gamma delta beta (εγδβ)0 - thalassemia is a very rare disorder that results from large deletions in the β-globin gene cluster which abolish all regional globin chain gene expression from that allele. Since it is an exceedingly rare cause of neonatal anemia and is not detected by routine newborn screening, it is usually not suspected clinically and commonly undiagnosed or misdiagnosed. In this study, we describe two patients diagnosed in our hospital with (εγδβ)0-thalassemia based on the results obtained from DNA microarray analysis of their peripheral blood. The first patient of mixed European descent presented as a neonate with microcytic hemolytic anemia, hyperbilirubinemia, hypoglycemia and hypothermia, and was found to have a 2.2 Mb loss that included the entire β-globin gene cluster and the locus control region (LCR). The second patient, also of mixed European descent, presented in the neonatal period with anemia, thrombocytopenia and cutaneous extramedullary hematopoiesis, and was found to have a 59 kb loss that included the β-globin LCR, HBE1, HBG1, and HBG2 genes. Both cases highlight the importance of recognizing the clinical features of (εγδβ)0-thalassemia and implementing appropriate testing to clarify the diagnosis and manage the condition.
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Affiliation(s)
- Elena Repnikova
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jennifer Roberts
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
| | - Sarah Mc Dermott
- Hematology/ Oncology and Bone Marrow Transplant Division, Children's Mercy Hospital, Kansas City, MO, United States
| | - Midhat S Farooqi
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
| | - Nazia Tabassum Iqbal
- Hematology/ Oncology and Bone Marrow Transplant Division, Children's Mercy Hospital, Kansas City, MO, United States
| | - Michael Silvey
- Hematology/ Oncology and Bone Marrow Transplant Division, Children's Mercy Hospital, Kansas City, MO, United States
| | - Jdl Nolen
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
| | - Eugenio Taboada
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
| | - Weijie Li
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States.
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Ferreira RD, Mota NO, Pedroso GA, Kimura EM, Geraldo APM, Santos MNN, Costa FF, Sonati MF. First report of εγδβ 0 -thalassemia in a Brazilian family. Int J Lab Hematol 2018; 40:e96-e98. [PMID: 29851275 DOI: 10.1111/ijlh.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R D Ferreira
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - N O Mota
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - G A Pedroso
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - E M Kimura
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - A P M Geraldo
- Integrated Center for Pediatric Hematology/Oncology Research (CIPOI), School of Medical Sciences, State University of Campinas- UNICAMP, Campinas, SP, Brazil
| | - M N N Santos
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - F F Costa
- Hematology and Hemotherapy Center, UNICAMP, Campinas, SP, Brazil
| | - M F Sonati
- Department of Clinical Pathology, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
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