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Agarwal AM, Rets AV. Advances in Hemoglobinopathies and Thalassemia Evaluation. Clin Lab Med 2024; 44:441-453. [PMID: 39089750 DOI: 10.1016/j.cll.2024.04.006] [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: 08/04/2024]
Abstract
Hemoglobin (Hb) disorders are among the most prevalent inherited diseases. Despite a limited number of involved genes, these conditions represent a broad clinical and prognostic spectrum. The menu of laboratory tests is extensive. From widely available modalities, for example, complete blood count to rather sophisticated molecular technologies, the investigation of Hb disorders recapitulates an increasing complexity of laboratory workup in other medical fields. This review highlights a current state of biochemical and molecular investigation of Hb disorders and offers a glimpse on technologies that are yet to be fully embraced in clinical practice.
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Affiliation(s)
- Archana M Agarwal
- Department of Pathology, University of Utah Health and ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
| | - Anton V Rets
- Department of Pathology, University of Utah Health and ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108, USA
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2
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Wagner M, Stoffel-Wagner B, Zur B. Influence of Hemoglobin Strasbourg, a Rare High Oxygen Affinity Hemoglobin Variant, on Different Methods of HbA1c Measurement. Hemoglobin 2024:1-3. [PMID: 39103306 DOI: 10.1080/03630269.2024.2360450] [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: 10/11/2023] [Accepted: 05/22/2024] [Indexed: 08/07/2024]
Abstract
Hemoglobin Strasbourg is a rare high oxygen affinity hemoglobin variant which leads to secondary erythrocytosis. This variant is caused by a HBB gene mutation c.71T > A resulting in an amino acid exchange on position 23 of the β globin chain (p.Val23Asp.). The influence of Hb Strasbourg on HbA1c measurement has not been studied to date. For patients with hemoglobin variants it is important to know whether possible interferences exist with the measurement of HbA1c. We therefore investigated the influence of Hb Strasbourg on HbA1c measurement with two different HPLC (high-performance liquid chromatography) systems and one turbidimetric immunoassay in two non-diabetic brothers who are heterozygous carriers of Hb Strasbourg. The examined tests are all used in routine diagnostics. In the case of Hb Strasbourg, the HbA1c measured by HPLC showed lower results than those obtained by the immunoassay. We conclude that HbA1c is underestimated when measured with these methods as glycated Hb Strasbourg is most likely not co-eluting with HbA1c in HPLC.
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Affiliation(s)
- Marcus Wagner
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
- Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgit Stoffel-Wagner
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
- Rheinland Klinikum Neuss, Neuss, Germany
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3
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Gravholt EAE, Petersen J, Mørk M, Glenthøj A. A Novel β-Globin Variant, Hb Odder [ HBB: C.316C > G; CD105 (Leu > Val)]. Hemoglobin 2024:1-4. [PMID: 38961566 DOI: 10.1080/03630269.2024.2355125] [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: 01/01/2024] [Accepted: 04/05/2024] [Indexed: 07/05/2024]
Abstract
We report the discovery of a novel β-globin gene variant, Hb Odder, characterized by a single nucleotide substitution; HBB:c.316C > G; CD105 (Leu > Val). This variant emerged incidentally during routine HbA1c measurements for diabetes monitoring. The patient exhibited no clinical or biochemical evidence of anemia or hemolysis. Our data on this variant suggest that Hb Odder is benign, regrettably limitations in our data make formal evaluations of stability and oxygen affinity impossible; additionally this emphasizes the importance of considering hemoglobin variants in the differential diagnosis of abnormal Hb A1c levels and suggest that laboratories should use alternative methods for the correct measurement of Hb A1c when hemoglobin variants interfere with diabetes monitoring. Notably, three other mutations have been described at codon 105 of the β globin chains and correspond to three Hb variants with different characteristics: Hb South Milwaukee, Hb Bellevue IV and Hb St. George.
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Affiliation(s)
- Esther Agnethe Ejskjær Gravholt
- Danish Red Blood Cell Center, Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Petersen
- Danish Red Blood Cell Center, Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas Glenthøj
- Danish Red Blood Cell Center, Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bellad A, Rangiah K, Sathe G, Dey G, Appadorai PK, Lokanatha H, Murthy PR, Gowdra A, Pandey A. Identification of a rare [ Gγ( Aγδβ) 0] -thalassemia using tandem mass spectrometry. Proteomics 2024; 24:e2300495. [PMID: 38212249 PMCID: PMC7616216 DOI: 10.1002/pmic.202300495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
Thalassemias are a group of inherited monogenic disorders characterized by defects in the synthesis of one or more of the globin chain subunits of the hemoglobin tetramer. Delta-beta (δβ-) thalassemia has large deletions in the β globin gene cluster involving δ- and β-globin genes, leading to absent or reduced synthesis of both δ- and β-globin chains. Here, we used direct globin-chain analysis using tandem mass spectrometry for the diagnosis of δβ-thalassemia. Two cases from unrelated families were recruited for the study based on clinical and hematological evaluation. Peptides obtained after trypsin digestion of proteins extracted from red blood cell pellets from two affected individuals and their parents were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Mass spectrometric analysis revealed a severe reduction in δ, β, and Aγ globin proteins with increased Gγ globin protein in the affected individuals. The diagnosis of Gγ(Aγδβ)0 -thalassemia in the homozygous state in the affected individuals and in the heterozygous state in the parents was made from our results. The diagnosis was confirmed at the genetic level using multiplex ligation-dependent probe amplification (MLPA). Our findings demonstrate the utility of direct globin protein quantitation using LC-MS/MS to quantify individual globin proteins reflecting changes in globin production. This approach can be utilized for accurate and timely diagnosis of hemoglobinopathies, including rare variants, where existing diagnostic methods provide inconclusive results.
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Affiliation(s)
- Anikha Bellad
- Manipal Academy of Higher Education, Manipal, Karnataka, India
- Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India
| | - Kannan Rangiah
- Manipal Academy of Higher Education, Manipal, Karnataka, India
- Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India
| | - Gajanan Sathe
- Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India
| | - Gourav Dey
- Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India
| | | | - Hemalatha Lokanatha
- Department of Pathology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Pradeep Rudra Murthy
- Department of Pathology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Aruna Gowdra
- Department of Biochemistry, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Akhilesh Pandey
- Manipal Academy of Higher Education, Manipal, Karnataka, India
- Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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5
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Allard P, Tagliaferri L, Weru V, Cario H, Lobitz S, Grosse R, Bleeke M, Oevermann L, Hakimeh D, Jarisch A, Kopp-Schneider A, Kulozik AE, Kunz JB. The German sickle cell disease registry reveals a surprising risk of acute splenic sequestration and an increased transfusion requirement in patients with compound heterozygous sickle cell disease HbS/β-thalassaemia and no or low HbA expression. Eur J Haematol 2024. [PMID: 38946051 DOI: 10.1111/ejh.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Patients with sickle cell disease (SCD) in Germany exhibit a substantial genetic diversity in the β-globin genotype. Data collected by the national German SCD registry reflect this diversity and allowed us to analyze the phenotypes associated with different SCD genotypes. Our study focused on 90 patients with HbS/β-thalassaemia (HbS/β-thal) and compared these to patients with HbSS and HbSC. Patients with HbS/β-thal were classified into three groups: HbS/β0-thal (no HbA), HbS/β+-thal (HbA < 14%), and HbS/β++-thal (HbA≥14%). In comparison to HbSS, patients with HbS/β++-thal had higher Hb-levels, lower hemolytic activity and rarely required red blood cell transfusions. HbS/β0-thal and HbS/β+-thal closely resembled each other and are jointly referred to as HbS/β0/+-thal. Compared to HbSS, patients with HbS/β0/+-thal experienced a similar frequency of vasoocclusive crises and degree of hemolysis. However, the frequency of red blood cell transfusions (0.6 vs. 0.39/year, p = .0049) and splenic sequestration crises (42.4 vs. 15.5% of patients, p = 3.799e-05) was higher in HbS/β0/+-thal than in HbSS, but close to zero in HbS/β++-thal. In conclusion, the level of HbA expression determines the phenotype of HbS/β+-thal. HbS/β-thal expressing no or little HbA is hematologically similar to HbSS, but causes a previously unknown high risk of splenic sequestration.
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Affiliation(s)
- Pierre Allard
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Laura Tagliaferri
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| | - Vivienn Weru
- Abteilung Biostatistik, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Holger Cario
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Ulm, Germany
| | - Stephan Lobitz
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Gemeinschaftsklinikum Mittelrhein, Kemperhof, Pädiatrische Hämatologie und Onkologie, Koblenz, Germany
| | - Regine Grosse
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| | - Matthias Bleeke
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Universitätsklinikum Hamburg-Eppendorf, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Klinik und Poliklinik für Pädiatrische Hämatologie und Onkologie, Hamburg, Germany
| | - Lena Oevermann
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m.S. Onkologie/Hämatologie/KMT, Berlin, Germany
| | - Dani Hakimeh
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m.S. Onkologie/Hämatologie/KMT, Berlin, Germany
| | - Andrea Jarisch
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Klinikum der Johann-Wolfgang-Goethe Universität, Zentrum für Kinder- und Jugendmedizin, Schwerpunkt Stammzelltransplantation und Immunologie, Frankfurt am Main, Germany
| | | | - Andreas E Kulozik
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| | - Joachim B Kunz
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
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Prasad K, Devaraju N, George A, Ravi NS, Paul J, Mahalingam G, Rajendiran V, Panigrahi L, Venkatesan V, Lakhotiya K, Periyasami Y, Pai AA, Nakamura Y, Kurita R, Balasubramanian P, Thangavel S, Velayudhan SR, Newby GA, Marepally S, Srivastava A, Mohankumar KM. Precise correction of a spectrum of β-thalassemia mutations in coding and non-coding regions by base editors. MOLECULAR THERAPY. NUCLEIC ACIDS 2024; 35:102205. [PMID: 38817682 PMCID: PMC11137594 DOI: 10.1016/j.omtn.2024.102205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/26/2024] [Indexed: 06/01/2024]
Abstract
β-thalassemia/HbE results from mutations in the β-globin locus that impede the production of functional adult hemoglobin. Base editors (BEs) could facilitate the correction of the point mutations with minimal or no indel creation, but its efficiency and bystander editing for the correction of β-thalassemia mutations in coding and non-coding regions remains unexplored. Here, we screened BE variants in HUDEP-2 cells for their ability to correct a spectrum of β-thalassemia mutations that were integrated into the genome as fragments of HBB. The identified targets were introduced into their endogenous genomic location using BEs and Cas9/homology-directed repair (HDR) to create cellular models with β-thalassemia/HbE. These β-thalassemia/HbE models were then used to assess the efficiency of correction in the native locus and functional β-globin restoration. Most bystander edits produced near target sites did not interfere with adult hemoglobin expression and are not predicted to be pathogenic. Further, the effectiveness of BE was validated for the correction of the pathogenic HbE variant in severe β0/βE-thalassaemia patient cells. Overall, our study establishes a novel platform to screen and select optimal BE tools for therapeutic genome editing by demonstrating the precise, efficient, and scarless correction of pathogenic point mutations spanning multiple regions of HBB including the promoter, intron, and exons.
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Affiliation(s)
- Kirti Prasad
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Karnataka 576104, India
| | - Nivedhitha Devaraju
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Karnataka 576104, India
| | - Anila George
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695 011, India
| | - Nithin Sam Ravi
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695 011, India
| | - Joshua Paul
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Karnataka 576104, India
| | - Gokulnath Mahalingam
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
| | - Vignesh Rajendiran
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695 011, India
| | - Lokesh Panigrahi
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Karnataka 576104, India
| | - Vigneshwaran Venkatesan
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Karnataka 576104, India
| | - Kartik Lakhotiya
- Molecular Cardiology Research Institute, Tufts Medical Center, 800 Washington Street, Boston MA 02111, USA
| | - Yogapriya Periyasami
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
| | - Aswin Anand Pai
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695 011, India
- Department of Haematology, Christian Medical College & Hospital, Vellore 632 004, India
| | - Yukio Nakamura
- Cell Engineering Division, RIKEN BioResource Center, 3-1-1 Koyadai, Tsukuba, Ibaraki 3050074, Japan
| | - Ryo Kurita
- Research and Development Department, Central Blood Institute Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Poonkuzhali Balasubramanian
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695 011, India
- Department of Haematology, Christian Medical College & Hospital, Vellore 632 004, India
| | - Saravanabhavan Thangavel
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
| | - Shaji R. Velayudhan
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Department of Haematology, Christian Medical College & Hospital, Vellore 632 004, India
| | - Gregory A. Newby
- Departments of Genetic Medicine and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Srujan Marepally
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
| | - Alok Srivastava
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Department of Haematology, Christian Medical College & Hospital, Vellore 632 004, India
| | - Kumarasamypet M. Mohankumar
- Centre for Stem Cell Research (a Unit of inStem, Bengaluru), Christian Medical College Campus, Bagayam, Vellore, Tamil Nadu 632002, India
- Manipal Academy of Higher Education, Karnataka 576104, India
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Srichairatanakool S, Chai-Adisaksopha C, Tantiworawit A, Phusua A, Charoenkwan P. Uncommon Combination of Hemoglobin Jax and Hemoglobin Constant Spring Leading to Microcytic Anemia. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943560. [PMID: 38725231 PMCID: PMC11092283 DOI: 10.12659/ajcr.943560] [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: 12/20/2023] [Revised: 03/24/2024] [Accepted: 03/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Thalassemia and hemoglobin (Hb) variants are the most common hereditary red blood cell disorders worldwide. Alpha-thalassemia and alpha-globin variants are caused by mutations of the alpha-globin genes (HBA2 and HBA1), resulting in impaired alpha-globin production and structurally abnormal globin, respectively. Clinical severity of alpha-thalassemia correlates with the number of affected alpha-globin genes, yielding a spectrum of clinical manifestations from mild to severe anemia. Routine diagnosis involves Hb analysis and PCR-based methods, yet identifying rare variants necessitates comprehensive clinical and hematologic laboratory data. The knowledge of phenotype and genotype correlation is useful for genetic counseling and treatment planning. CASE REPORT A 59-year-old Thai woman presented with chronic anemia. Her baseline Hb level ranged between 8.0 and 9.0 g/dL, with no history of transfusion. Physical examination showed mild pallor, without enlarged liver and spleen. Laboratory investigations showed microcytic, hypochromic anemia and abnormal Hb peak by Hb analysis (retention time 4.58 min by HPLC method). Common alpha-globin gene deletions, including the Southeast-Asian/Thai 3.7 kb and 4.2 kb deletions were tested using gap-PCR, with none of these deletions detected. Direct DNA sequencing revealed a compound heterozygosity of Hb Jax (HBA2: c.44G>C) and Hb Constant Spring (HBA2: c.427T>C). CONCLUSIONS Compound heterozygosity of Hb Jax and Hb Constant Spring results in microcytic anemia. Hb Jax can be identified by Hb analysis, and diagnosis can be confirmed by direct DNA sequencing method. Coinheritance of Hb Jax and alpha-globin variants should be considered in cases with microcytic anemia and a specific Hb peak seen in Hb chromatogram.
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Affiliation(s)
- Sirichai Srichairatanakool
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Tantiworawit
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arunee Phusua
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimlak Charoenkwan
- Thalassemia and Hematology Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Dakshinamoorthy Putchen D, Nambiar A, Ashok Menon A, Jayaram A, Ramaprasad S. Electrospray triple quadrupole mass spectrometry guides pathologists to suggest appropriate molecular testing in the identification of rare hemoglobin variants. J Mass Spectrom Adv Clin Lab 2024; 32:18-23. [PMID: 38371348 PMCID: PMC10874710 DOI: 10.1016/j.jmsacl.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Background The presumptive diagnosis of hemoglobinopathies relies on routine tests such as Complete Blood Count (CBC), peripheral blood smear, Liquid Chromatography (LC), and Capillary Electrophoresis (CE), along with clinical findings. Pathologists suggest molecular sequencing of HBA and HBB genes to correlate blood picture with clinical findings in order to identify unknown rare haemoglobin (Hb) variants or variants that coelute with Hb. This paper presents a low-resolution mass spectrometry (MS)-based method for presumptive identification of variants that eluted in zone 12 of CE, followed by molecular sequencing of the HBB gene for a definitive diagnosis of hemoglobinopathies. Methods Eight patient samples with a variant peak in zone 12 of CE (Sebia) were analyzed using MS. The mass-to-charge ratio (m/z) observed was deconvoluted to determine the mass of Hb variants. The β variants were subsequently confirmed through molecular sequencing. Results Based on the intact mass of the variants, there were two samples of the α variant (α + 58 Da and α + 44 Da), and six samples of the β variant. Out of these six β variant samples, three were the β + 58 Da variant, and three were the β + 30 Da variant. By correlating the intact mass information with the CE pattern and considering the ethnicity of the patients, it was presumed that the α variants were HbJ Meerut (α + 58 Da, x-axis 102) and HbJ Paris-I (α + 44 Da, x-axis 80). Molecular analysis confirmed the identity of β variants as Hb Rambam/HbJ Cambridge, HbJ Bangkok (+58 Da), and Hb Hofu (+30 Da). Conclusion The mass information of Hb variants obtained using Electrospray triple quadrupole MS assists pathologists in recommending the appropriate molecular sequencing for identifying unknown variants.
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Affiliation(s)
| | - Athira Nambiar
- R&D, Neuberg Anand Academy of Laboratory Medicine Pvt Ltd, Bengaluru, India
| | - Aswathy Ashok Menon
- Department of Molecular Pathology, Neuberg Anand Reference Laboratory, A Unit of Neuberg Diagnostics Pvt Ltd, Bengaluru, India
| | - Ananthvikas Jayaram
- Department of Molecular Pathology, Neuberg Anand Reference Laboratory, A Unit of Neuberg Diagnostics Pvt Ltd, Bengaluru, India
| | - Sujay Ramaprasad
- R&D, Neuberg Anand Academy of Laboratory Medicine Pvt Ltd, Bengaluru, India
- Department of Molecular Pathology, Neuberg Anand Reference Laboratory, A Unit of Neuberg Diagnostics Pvt Ltd, Bengaluru, India
- Technical Director, India
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9
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Ozalp O, Anlas O. Detection of 13 Novel Variants and Investigation of Mutation Distribution by Next Generation Sequencing in Hemoglobinopathies: A Single Center Experience. Indian J Hematol Blood Transfus 2024; 40:268-280. [PMID: 38708170 PMCID: PMC11065806 DOI: 10.1007/s12288-023-01694-7] [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: 11/23/2022] [Accepted: 08/21/2023] [Indexed: 05/07/2024] Open
Abstract
Hemoglobinopathies are the most common monogenic disorders in the world. Traditional diagnostic algorithms generated by conventional methods for thalassemia can be labor-intensive and time-consuming due to the complexities of the genes involved and the variability in disease-causing mutations. With the advantages of next-generation sequencing (NGS) technology, molecular analysis of highly complex diseases such as hemoglobinopathies has become easier. Next-generation sequencing is a highly sensitive and effective method due to its capacity to sequence many gene regions simultaneously while allowing good read depths. In this study, single nucleotide changes, small deletions and copy number variations in HBA1, HBA2 and HBB in 914 patients with suspected hemoglobinopathy were analysed with NGS. At least one HBA1, HBA2, HBB or HBD variant was detected in 483 (52.8%) patients. Ten novel variants were detected in HBA1 and HBA2, three in HBB, and one in HBD. From these variants, c.*76T > A, c.301-24 G > A, c.301-24G > C c.-41C > G, c.-37-40C > G, c.-9G > C, c. 95 + 9C > T, c.95 + 26C > A, c.95 + 38C > T and c.*18C > G variants were located in α-globin genes, c.-25T > C, c.*103T > C and c92 + 39A > G variants were located in β-globin genes, and c.-43C > A was located in HBD. This is the first comprehensive study using NGS for the molecular diagnosis of hemoglobinopathies in Turkey. Accurate molecular diagnosis is of critical importance in hemoglobinopathies which are a public health problem due to their increased prevalence, high burden to society, and lack of curative treatment. Currently, NGS appears to be an advanced option over conventional methods to detect all variants occurring by molecular mechanisms and simultaneously analyse many genomic sequences.
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Affiliation(s)
- Ozge Ozalp
- Department of Medical Genetics, Adana City Training and Research Hospital, University of Health Sciences, 4522. Street, 01230 Adana, Turkey
| | - Ozlem Anlas
- Department of Medical Genetics, Adana City Training and Research Hospital, University of Health Sciences, 4522. Street, 01230 Adana, Turkey
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Alavi S, Mohammadimoghaddam S, Najmabadi H, Maghsoudlou S. The First Iranian Case of Unstable Hemoglobin Santa Ana. Hemoglobin 2024; 48:125-128. [PMID: 38500334 DOI: 10.1080/03630269.2024.2330554] [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: 02/07/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
In this report, we describe a 6-year-old girl with a medical history of pallor, mild icterus, anemia, blood transfusion and abnormal hemoglobin variant analysis on capillary electrophoresis. She was referred for further analysis. DNA sequencing of the proband revealed a de novo mutation in Codon 88 (CTG > CCG) of the β-globin gene (HBB: c.266T > C) in a heterozygous state compatible with hemoglobin Santa Ana, an unstable hemoglobin. This is the first case of Hb Santa Ana from Iran associated with moderate to severe anemia who underwent splenectomy with clinical improvement.
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Affiliation(s)
- Samin Alavi
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soha Mohammadimoghaddam
- Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Najmabadi
- Department of Genetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Maghsoudlou
- Department of Computer Science and Software Engineering, Concordia University, Montreal, QC, Canada
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11
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Waye JS, Hanna M, Nakamura L, Walker L, Eng B, Nfonsam LE. Splice Acceptor Mutation [ HBB:c.93-2A > T] in a Patient with Hb S/β 0-Thalassemia. Hemoglobin 2024; 48:116-117. [PMID: 38360540 DOI: 10.1080/03630269.2024.2314075] [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: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
We report a case of Hb S/β0-thalassemia (Hb S/β0-thal) in a patient who is a compound heterozygote for the Hb Sickle mutation (HBB:c.20A > T) and a mutation of the canonical splice acceptor sequence of IVS1 (AG > TG, HBB:c.93-2A > T). This is the fifth mutation involving the AG splice acceptor site of IVS1, all of which prevent normal splicing and cause β0-thal.
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Affiliation(s)
- John S Waye
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Meredith Hanna
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Lisa Nakamura
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Lynda Walker
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Barry Eng
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Landry E Nfonsam
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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12
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Vousvouki M, Delaki EE, Boutou E, Yfanti E, Mantzou G, Karipidou C, Vyzantiadis A, Efstathiou A, Dimopoulou M, Vlachaki E, Theodoridou S. A New α1-Globin Variant, Hb Ormylia [ HBA1:c.63C > G; p.His21Gln]. Report of Eleven Cases in Northern Greece. Hemoglobin 2024; 48:133-137. [PMID: 38632978 DOI: 10.1080/03630269.2024.2339517] [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: 10/13/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
The first identification of a novel α1-Globin variant, Hb Ormylia in 11 Greeks originating from a small village, Ormylia, Chalkidiki, Greece is reported. The new genetic variant leads to the production of a hemoglobin variant that can be identified and quantified by High-Performance Liquid Chromatography. Capillary and classic electrophoresis were not informative. Direct DNA sequencing revealed a new mutation C > G mutation at codon 21 of α1 gene (His > Gln). The new variant has been named Hb Ormylia and this is the first description of this genetic variant of α1 gene in the literature.
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Affiliation(s)
- Maria Vousvouki
- Hemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Evangelia-Eleni Delaki
- Thalassaemia National Center of Greece, Laikon General Hospital of Athens, Athens, Greece
| | - Effrosyni Boutou
- Thalassaemia National Center of Greece, Laikon General Hospital of Athens, Athens, Greece
| | - Eleni Yfanti
- Thalassaemia National Center of Greece, Laikon General Hospital of Athens, Athens, Greece
| | - Genovefa Mantzou
- Hemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christina Karipidou
- Hemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Vyzantiadis
- Hemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Athina Efstathiou
- Hemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Dimopoulou
- Thalassaemia National Center of Greece, Laikon General Hospital of Athens, Athens, Greece
| | - Efthymia Vlachaki
- Adult Thalassemia Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
| | - Stamatia Theodoridou
- Hemoglobinopathy Prevention Unit, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece
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13
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Khamphikham P, Tepakhan W, Tongjai S, Jan-Ngam V, Laonan A, Thimsin W, Boontha S, Santiyos S, Pornprasert S. Identification of a novel and rare α 0 -thalassemia 27.0 kb deletion with 9 bp insertion (Lamphun deletion; -- LAMPHUN ) in a Thai family. Int J Lab Hematol 2024; 46:176-179. [PMID: 37723543 DOI: 10.1111/ijlh.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Pinyaphat Khamphikham
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Hematology and Health Technology Research Center, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wanicha Tepakhan
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Siripong Tongjai
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Varit Jan-Ngam
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Master of Science Program in Medical Technology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Apichaya Laonan
- Bachelor of Science Program in Medical Technology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Woraya Thimsin
- Bachelor of Science Program in Medical Technology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Siriraj Boontha
- Bachelor of Science Program in Medical Technology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Sakorn Pornprasert
- Division of Clinical Microscopy, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Hematology and Health Technology Research Center, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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14
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Komninaka V, Flevari P, Ntelaki EE, Yfanti E, Androutsakos T, Ntanasis-Stathopoulos I, Terpos E. High-Oxygen-Affinity Hemoglobins-Case Series and Review of the Literature. J Clin Med 2024; 13:458. [PMID: 38256595 PMCID: PMC10815990 DOI: 10.3390/jcm13020458] [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: 12/02/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Modifications of the hemoglobin (Hb) structure in regions involving the regulation of oxygen transport may lead to an increased oxygen affinity for the hemoglobin molecule and impaired oxygen delivery to the tissues. Herein, we present six patients with high-oxygen-affinity Hb variants, either in heterozygous form or in compound heterozygosity (such as heterozygosity for Hb Hiroshima, Köln, Crete, and compound heterozygosity Hb Crete with β or δβ thalassemia), in order to demonstrate the need for prompt and accurate diagnosis and enrich the limited literature due to the rarity of such cases. Hb Crete, Hb Hiroshima, and Hb Köln have distinct pathophysiologies and may result in different clinical phenotypes. In conclusion, high-oxygen-affinity hemoglobins are rare and inherited within a dominant autosomal manner, have various clinical presentations, and should always be suspected in patients with erythrocytosis. Their management (as phlebotomy or low-dose aspirin) should be based on an individualized assessment of the risk of complications, the medical history, concomitant symptoms, and quality of life.
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Affiliation(s)
- Veroniki Komninaka
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece; (V.K.); (P.F.); (E.-E.N.); (E.Y.)
| | - Pagona Flevari
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece; (V.K.); (P.F.); (E.-E.N.); (E.Y.)
| | - Evangelia-Eleni Ntelaki
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece; (V.K.); (P.F.); (E.-E.N.); (E.Y.)
| | - Eleni Yfanti
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, 11527 Athens, Greece; (V.K.); (P.F.); (E.-E.N.); (E.Y.)
| | - Theodoros Androutsakos
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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15
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Mamata M, Padma G, Pragna Laxmi T, Saroja K, Ashwin D, Suman J. Identification of a Novel Variant c.163delG in HBB Gene Resulting in a Beta Null Phenotype in a Proband with Thalassemia Intermedia. Hemoglobin 2024; 48:1-3. [PMID: 38258429 DOI: 10.1080/03630269.2023.2279609] [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: 08/01/2023] [Accepted: 10/31/2023] [Indexed: 01/24/2024]
Abstract
A 21-year-old patient presented with a previous medical history of pallor, mild icterus, increased fatigue, low hemoglobin, and abnormal hemoglobin variant analysis with more than 70 transfusions. He was referred for genetic analysis to identify the pathogenic variations in the β-globin gene. Sanger's sequencing of the proband and his family revealed the presence of a novel frame shift variant HBB:c.163delG in a compound heterozygous state with hemoglobin E (HbE) (HBB:c.79G > A) variant. The father and the sibling of the patient were found to be normal for the HBB gene. Mother was found to be heterozygous for HbE (HBB:c.79G > A) variant. In silico analysis by Mutalyzer predicted that c.163delG variant generated a premature stop codon after seven codons, leading to a truncated protein. FoldX protein stability analysis showed a positive ΔΔG value of 45.27 kcal/mol suggesting a decrease in protein stability. HBB:c.79G > A is a known variant coding for HbE variant, which results in the reduced synthesis of β-globin chain and shows mild thalassemia. Combined effect of HBB:c.163delG and HBB:c.79G > A variants in the proband might have led to the reduced synthesis of β-globin chains resulting in a thalassemia intermedia type of clinical manifestation.
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Affiliation(s)
- M Mamata
- Kamala Hospital and Research Centre for Thalassemia and Sickle Cell Patients, Hyderabad, India
| | - G Padma
- Kamala Hospital and Research Centre for Thalassemia and Sickle Cell Patients, Hyderabad, India
| | - T Pragna Laxmi
- Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - K Saroja
- Kamala Hospital and Research Centre for Thalassemia and Sickle Cell Patients, Hyderabad, India
| | - Dalal Ashwin
- Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Jain Suman
- Kamala Hospital and Research Centre for Thalassemia and Sickle Cell Patients, Hyderabad, India
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16
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Shojaei Z, Abiri M, Zafarghandi Motlagh F, Amini M, Dabbagh Bagheri S, Asnavandi S, Asadi S, Bagherian H, Zeinali S. First report of a patient with homozygous hemoglobin Ernz: Evidence to support a non-pathogenic variant. Blood Cells Mol Dis 2024; 104:102797. [PMID: 37826942 DOI: 10.1016/j.bcmd.2023.102797] [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: 03/30/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
Hemoglobin Ernz (Hb Ernz) is a missense variant in β-globin caused by a Threonine to Asparagine substitution at the 123rd amino acid position and HBB c.371C > A in gene level. Hb Ernz has been classified as Uncertain Significance (VUS) by ACMG due to limited reports and the absence of any homozygote genotypes. In our study, we found eight cases of Hb Ernz by DNA sequencing of the β-globin gene during >20 years of Thalassemia Screening in individuals with borderline hematological parameters who were possible carriers of thalassemia or their spouses. We also report the first homozygote variant of Hb Ernz. Our findings suggest that the changes in hematological parameters observed in individuals with Hb Ernz are likely due to α-globin gene mutations rather than Hb Ernz itself. These findings support the reclassification of Hb Ernz as a benign variant in variant classification.
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Affiliation(s)
- Zohreh Shojaei
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Maryam Abiri
- Department of Medical Genetics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Zafarghandi Motlagh
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Masoume Amini
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Samira Dabbagh Bagheri
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Sadaf Asnavandi
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Sedighe Asadi
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Hamideh Bagherian
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran
| | - Sirous Zeinali
- Dr. Zeinali's Medical Genetics Laboratory, Kawsar Human Genetics Research Center, 41 IRNA St., Vali Asr St., Tehran 1595645513, Iran..
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17
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Waye JS, Hanna M, Hohenadel BA, Nakamura L, Walker L, Eng B, Nfonsam LE. β 0-Thalassemia Caused by a Novel Nonsense Mutation [ HBB:c.199A > T]. Hemoglobin 2024; 48:69-70. [PMID: 38425097 DOI: 10.1080/03630269.2024.2322518] [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: 10/16/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
We report two hemoglobinopathy cases involving a novel β-thalassemia (β-thal) nonsense mutation, HBB:c.199A > T. One patient had Hb S/β-thal, and a second unrelated patient had Hb D-Punjab/β-thal. The HBB:c.199A > T mutation introduces a premature termination codon at amino acid codon 66 (AAA→TAA) in exon 2, resulting in typical high Hb A2 β0-thal.
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Affiliation(s)
- John S Waye
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Hanna
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Betty-Ann Hohenadel
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lisa Nakamura
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lynda Walker
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Barry Eng
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Landry E Nfonsam
- Molecular Genetics Laboratory, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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18
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Bae J, Ahn WK, Jang J, Jang H, Kang H, Rim JH, Hahn SM, Han JW, Lyu CJ, Lim JB. The First Korean Hemoglobinopathy With Unique Hemoglobin Electrophoresis Results Diagnosed as Hemoglobin Boras. Ann Lab Med 2024; 44:97-99. [PMID: 37665291 PMCID: PMC10485859 DOI: 10.3343/alm.2024.44.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/26/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Jeongyun Bae
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Kee Ahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jaehyeok Jang
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hanmil Jang
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyein Kang
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - John Hoon Rim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jong-Baeck Lim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
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Manita D, Ogino S, Marivoet S, Ogura M. Detectability of and interference by major and minor hemoglobin variants using a new-generation ion-exchange HPLC system with two switchable analysis modes. Pract Lab Med 2024; 38:e00346. [PMID: 38099267 PMCID: PMC10716769 DOI: 10.1016/j.plabm.2023.e00346] [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: 11/05/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives High-performance liquid chromatography (HPLC) is commonly used to measure hemoglobin A1c (HbA1c) levels and detect hemoglobin variants (Hb-Vars). HLC-723GR01 (GR01) is a new-generation automated ion-exchange HPLC system with two switchable analysis modes, namely short (30 s/test) and long modes (50 s/test). We evaluated the general performance of both analysis modes of GR01 for quantifying HbA1c and detecting Hb-Vars. Design and methods We evaluated the instrument's precision based on CLSI protocol EP-05-A3. A comparison of the two analysis modes of GR01 against the standard mode of HLC-723G11 was performed on 100 whole blood samples. The GR01 long mode was compared with affinity HPLC (AF-HPLC) for detecting common Hb-Vars (HbE, HbD, HbS, and HbC, >20 samples). To examine the detection capability for minor Hb-Vars, we analyzed 26 Hb-Vars using multiple analyzers, including both analysis modes of GR01. Results Both modes of GR01 had within-laboratory coefficients of variation of ≤1.0 % from four samples with HbA1c concentrations of 32-86 mmol/mol. Good correlation was observed between GR01 and HLC-723G11. The results for HbA1c detection in the presence of the major variants revealed a strong correlation between the long mode of GR01 and AF-HPLC (r = 0.986-0.998), and the difference biases ranged 0.1-1.9 mmol/mol. In the long mode, only one variant had a difference bias exceeding 14 % [10 % (%NGSP)]. Conclusion The two analysis modes of GR01 were fast and had high accuracy and reproducibility, indicating their utility for routine clinical use in measuring HbA1c samples with Hb-Vars.
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Affiliation(s)
| | | | | | - Masatsune Ogura
- Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Japan
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center, Japan
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20
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Zeng S, Lei S, Qu C, Wang Y, Teng S, Huang P. CRISPR/Cas-based gene editing in therapeutic strategies for beta-thalassemia. Hum Genet 2023; 142:1677-1703. [PMID: 37878144 DOI: 10.1007/s00439-023-02610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
Beta-thalassemia (β-thalassemia) is an autosomal recessive disorder caused by point mutations, insertions, and deletions in the HBB gene cluster, resulting in the underproduction of β-globin chains. The most severe type may demonstrate complications including massive hepatosplenomegaly, bone deformities, and severe growth retardation in children. Treatments for β-thalassemia include blood transfusion, splenectomy, and allogeneic hematopoietic stem cell transplantation (HSCT). However, long-term blood transfusions require regular iron removal therapy. For allogeneic HSCT, human lymphocyte antigen (HLA)-matched donors are rarely available, and acute graft-versus-host disease (GVHD) may occur after the transplantation. Thus, these conventional treatments are facing significant challenges. In recent years, with the advent and advancement of CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 (CRISPR-associated protein 9) gene editing technology, precise genome editing has achieved encouraging successes in basic and clinical studies for treating various genetic disorders, including β-thalassemia. Target gene-edited autogeneic HSCT helps patients avoid graft rejection and GVHD, making it a promising curative therapy for transfusion-dependent β-thalassemia (TDT). In this review, we introduce the development and mechanisms of CRISPR/Cas9. Recent advances on feasible strategies of CRISPR/Cas9 targeting three globin genes (HBB, HBG, and HBA) and targeting cell selections for β-thalassemia therapy are highlighted. Current CRISPR-based clinical trials in the treatment of β-thalassemia are summarized, which are focused on γ-globin reactivation and fetal hemoglobin reproduction in hematopoietic stem cells. Lastly, the applications of other promising CRISPR-based technologies, such as base editing and prime editing, in treating β-thalassemia and the limitations of the CRISPR/Cas system in therapeutic applications are discussed.
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Affiliation(s)
- Shujun Zeng
- The Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, People's Republic of China
| | - Shuangyin Lei
- The Second Norman Bethune Clinical College of Jilin University, Changchun, Jilin, People's Republic of China
| | - Chao Qu
- The First Norman Bethune Clinical College of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yue Wang
- The Second Norman Bethune Clinical College of Jilin University, Changchun, Jilin, People's Republic of China
| | - Shuzhi Teng
- The Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, People's Republic of China.
| | - Ping Huang
- The Key Laboratory of Pathobiology, Ministry of Education, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, People's Republic of China.
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21
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Qin D, Wang J, Yao C, Bao X, Liang J, Du L. Hb Q-Thailand heterozygosity unlinked with the (-α 4.2/) α +-thalassemia deletion allele identified by long-read SMRT sequencing: hematological and molecular analyses. Hematology 2023; 28:2184118. [PMID: 36867091 DOI: 10.1080/16078454.2023.2184118] [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: 03/04/2023] Open
Abstract
OBJECTIVE In the present study, two unrelated cases of Hb Q-Thailand heterozygosity unlinked with the (-α4.2/) α+-thalassemia deletion allele were identified by long-read single molecule real-time (SMRT) sequencing in southern China. The aim of this study was to report the hematological and molecular features as well as diagnostic aspects of the rare manifestation. METHODS Hematological parameters and hemoglobin analysis results were recorded. A suspension array system for routine thalassemia genetic analysis and long-read SMRT sequencing were applied in parallel for thalassemia genotyping. Traditional methods, including Sanger sequencing, multiplex gap-polymerase chain reaction (gap-PCR) and multiplex ligation-dependent probe amplification (MLPA), were used together to confirm the thalassemia variants. RESULTS Long-read SMRT sequencing was used to diagnose two Hb Q-Thailand heterozygous patients for whom the hemoglobin variant was unlinked to the (-α4.2/) allele for the first time. The hitherto undescribed genotypes were verified by traditional methods. Hematological parameters were compared with those of Hb Q-Thailand heterozygosity linked with the (-α4.2/) deletion allele in our study. For the positive control samples, long-read SMRT sequencing revealed a linkage relationship between the Hb Q-Thailand allele and the (-α4.2/) deletion allele. CONCLUSIONS Identification of the two patients confirms that the linkage relationship between the Hb Q-Thailand allele and the (-α4.2/) deletion allele is a common possibility but not a certainty. Remarkably, as it is superior to traditional methods, SMRT technology may eventually serve as a more comprehensive and precise method that holds promising prospects in clinical practice, especially for rare variants.
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Affiliation(s)
- Danqing Qin
- Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Thalassemia Diagnosis Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Jicheng Wang
- Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Thalassemia Diagnosis Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Cuize Yao
- Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Thalassemia Diagnosis Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Xiuqin Bao
- Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Thalassemia Diagnosis Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Jie Liang
- Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China.,Thalassemia Diagnosis Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Li Du
- Medical Genetics Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, People's Republic of China
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22
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Wildenberg NP, Rossi C, Kulozik AE, Kunz JB. Hb Santa Juana ( β 108(G10) Asn > Ser): a low oxygen affinity hemoglobin variant in a family of Bosnian background. Hematology 2023; 28:2184120. [PMID: 36867085 DOI: 10.1080/16078454.2023.2184120] [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: 03/04/2023] Open
Abstract
We present a family that carries the β-hemoglobin variant Hb Santa Juana (HBB:c.326A>G, β 108(G10) Asn>Ser), also known as Hb Serres, in three generations. All affected family members had an anomal hemoglobin fraction as detected by HPLC but normal blood count without evidence of anemia or hemolysis. Oxygen affinity (p50 (O2) = 31.9-40.4 mmHg) was decreased in all probands, compared to 24.9-28.1 mmHg in unaffected individuals. Clinical symptoms likely related to the hemoglobin variant were cyanosis during anaesthesia, while other complaints such as shortness of breath or dizziness were less clearly linked with the hemoglobin variant.
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Affiliation(s)
- N P Wildenberg
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - C Rossi
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - A E Kulozik
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - J B Kunz
- Department of Pediatric Oncology, Hematology, and Immunology, University of Heidelberg, Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
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23
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Hsu LA, Wu S, Teng MS, Ko YL. Causal links of α-thalassemia indices and cardiometabolic traits and diabetes: MR study. Life Sci Alliance 2023; 6:e202302204. [PMID: 37788909 PMCID: PMC10547910 DOI: 10.26508/lsa.202302204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
Our study aimed to investigate if genetic variants around 16p13.3's HBA1 locus, associated with erythrocyte indices and HbA1c levels, predict α-thalassemia-related erythrocyte indices, cardiometabolic traits, and diabetes risk in Taiwanese individuals. We analyzed Taiwan Biobank data, including whole-genome sequencing from 1,493 participants and genotyping arrays from 129,542 individuals. First, we performed regional association analysis using whole-genome sequencing data to identify genetic variants significantly associated with erythrocyte indices, confirming their linkage disequilibrium with the α0 thalassemia --SEA deletion mutation, a common cause of α-thalassemia in Southeast Asian populations. Deletion mutation sequencing further validated these variants' association with α-thalassemia. Subsequently, we analyzed genotyping array data, revealing associations between specific genetic variants and cardiometabolic traits, including lipid profiles, HbA1c levels, bilirubin levels, and diabetes risk. Using Mendelian randomization, we established causal relationships between α-thalassemia-related erythrocyte indices and cardiometabolic traits, elucidating their role in diabetes susceptibility. Our findings highlight genetic variants around the α-globin genes as surrogate markers for common α-thalassemia mutations in Taiwan, emphasizing the causal links between α-thalassemia-related erythrocyte indices, cardiometabolic traits, and heightened diabetes risk.
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Affiliation(s)
- Lung-An Hsu
- The First Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Semon Wu
- Department of Life Science, Chinese Culture University, Taipei, Taiwan
| | - Ming-Sheng Teng
- https://ror.org/00q017g63 Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yu-Lin Ko
- https://ror.org/00q017g63 Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- https://ror.org/00q017g63 The Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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24
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Bazazzadegan N, Abedini SS, Azarkeivan A, Banihashemi S, Nikzat N, Najmabadi H, Neishabury M. The Spectrum of HBB Mutations among 2315 Beta Thalassemia Patients of a Reference Clinic in Tehran-Iran. Hemoglobin 2023; 47:147-151. [PMID: 37548174 DOI: 10.1080/03630269.2023.2242787] [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: 08/24/2022] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
Beta Thalassemia is the most prevalent and well-studied single gene disorder in Iran. Here, we investigated the spectrum of HBB gene mutations, identified among 2315 patients, referred to a reference thalassemia clinic in Tehran, on the basis of suspicion to thalassemia major or intermedia. The patients were homozygous or compound heterozygous for HBB mutations, and were referred from various Iranian provinces, during 15 years (2001- 2016). The HBB mutations were classified based on their frequency, and the result was compared to a meta-analysis of 14,293 beta thalassemia cases in the Iranian population, within the same time period. The mutation spectrum in this study contained 43 HBB mutations, compared to the 90, presented by the meta-analysis. Similar to the meta-analysis, IVSII-1 (G > A) and IVSI-5 (G > C) were the most common mutations in this study. These two comprised 62.40% of the total HBB mutant alleles in the studied population, comparable to 51.92% of that in the meta-analysis. IVSII-1 (G > A) and IVSI-5 (G > C), followed by 17 other mutations that had frequencies ranging from 0.15% to 5.44%, were among the 20 common HBB mutations in Iran and neighboring countries, according to the meta-analysis. This study provided further evidence to support the spectrum of the most common HBB mutations in the Iranian population.
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Affiliation(s)
- Niloofar Bazazzadegan
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyedeh Sedigheh Abedini
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azita Azarkeivan
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
- Iranian Blood Transfusion Organization, Thalassemia Clinic, Tehran, Iran
| | - Susan Banihashemi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nooshin Nikzat
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hossein Najmabadi
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Neishabury
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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25
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Esa E, Mohamad AS, Hamzah R, Hamid FSA, Aziz NA, Sevaratnam V, Sathar J, Chen G, Yasin NM. Clinical and haematological characteristics of 38 individuals with Hb G-Makassar in Malaysia. EJHAEM 2023; 4:940-948. [PMID: 38024609 PMCID: PMC10660101 DOI: 10.1002/jha2.750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 12/01/2023]
Abstract
Haemoglobin (Hb) G-Makassar is a rare Hb variant. It presents a diagnostic challenge as it imitates sickle Hb (Hb S) in standard electrophoresis and high-performance liquid chromatography assays requiring DNA analysis to confirm diagnosis. Both have point mutations in codon 6, exon 1 in the β-globin (HBB) gene with different pathogenicities. This study describes the clinical phenotype, haematology and genotype of Hb G-Makassar. Clinical and laboratory data of 38 cases of Hb G-Makassar over 8 years were analysed. Hb G-Makassar was confirmed by a direct sequencing of HBB gene and co-inheritance of α-thalassaemia determined through multiplex gap-PCR and multiplex Amplification Refractory Mutation System polymerase chain reaction. All cases were Malays, predominantly from Terengganu (n = 20, 52.6%). There were 14 (36.8%) males and 24 (63.2%) females with median age of 25 years. Majority (n = 33, 86.8%) had features of thalassaemia trait with mean ± SD for Hb, mean cell volume (MCV) and mean cell haemoglobin (MCH) as 13.21 g/dL ± 1.69, 73.06 ± 4.48 fL and 24.71 ± 1.82 pg, respectively. None had evidence of haemolysis or thromboembolic complications. Six genotypes were identified; ßG-Makassar/ß,αα/αα (n = 19, 50.0%), ßG-Makassar/ßE,αα/αα (n = 4, 10.5%), ßG-Makassar/ßNewYork,αα/αα (n = 1, 2.6%), ßG-Makassar/ß,αα/-α (n = 11, 28.9%), ßG-Makassar/ß,αα/αAdanaα (n = 2, 5.3%) and ßG-Makassar/ß,αα/-SEA (n = 1, 2.6%). The ßG-Makassar/ß,αα/αα showed that features of thalassaemia trait with mean ± SD for Hb, MCV and MCH were 13.74 g/dL ± 2.40, 76.18 ± 6.02 fL and 25.79 ± 2.41 pg, respectively. This is the largest study reporting a significant number of Hb G-Makassar in Malaysia. Although the mutation is similar to Hb S, the phenotype is benign.
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Affiliation(s)
- Ezalia Esa
- Institute for Medical ResearchSetia AlamSelangorMalaysia
| | - Ahmad Sabry Mohamad
- Medical EngineeringUniversiti Kuala Lumpur British Malaysian InstituteGombakSelangorMalaysia
| | | | | | | | | | - Jameela Sathar
- Hematology DepartmentAmpang HospitalAmpangSelangorMalaysia
| | - Guo Chen
- Beam Therapeutics Inc.CambridgeMassachusettsUSA
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26
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Feng J, Cui D, Li C, Yang Y, Li Q, Li X, Tan S, Li Z, Meng W, Li H, Zhang Y. The comprehensive analysis of thalassemia alleles (CATSA) based on single-molecule real-time technology (SMRT) is a more powerful strategy in the diagnosis of thalassemia caused by rare variants. Clin Chim Acta 2023; 551:117619. [PMID: 38375625 DOI: 10.1016/j.cca.2023.117619] [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: 06/14/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 02/21/2024]
Abstract
Thalassemia is one of the most widely distributed monogenic disorders in the world and affects the largest number of people. It can manifest a wide spectrum of phenotypes from asymptomatic to fatal, which is associated with the degree of imbalance between α- and β-globin chains. Therefore, individuals with different genotypes could present with a similar phenotype. Genetic analysis is always needed to make a correct diagnosis. However, routine genetic analysis of thalassemia used in the Chinese population identifies only 23 common variants, resulting in many cases undiagnosed or being misdiagnosed. In this study, we applied a long-read sequencing-based approach termed comprehensive analysis of thalassemia alleles (CATSA) to 30 subjects whose hematologic screening results could not be explained by the routine genetic test results. The identification of additional variants and the correction of genotypes allowed the interpretation of the clinical phenotype in 24 subjects, which have been confirmed to be correct by independent experiments. Moreover, we identified a novel 8.4-kb deletion containing the entire HBB and HBD genes as well as part of the HBBP1 gene, expanding the genotype spectrum of β-thalassemia. CATSA showed a great advantage over other genetic tests in the diagnosis of thalassemia caused by rare variants.
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Affiliation(s)
- Jianjiang Feng
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Di Cui
- Berry Genomics Corporation, Beijing 102200, China
| | - Caipeng Li
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Yingsong Yang
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Qiuli Li
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Xiaomin Li
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Shuming Tan
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Zhiming Li
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Wanli Meng
- Berry Genomics Corporation, Beijing 102200, China
| | - Haoxian Li
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China.
| | - Yanghui Zhang
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China.
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27
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Feng J, Mao A, Lu Y, Shi H, Meng W, Liang C. Molecular characterization of a novel 83.9-kb deletion of the α-globin upstream regulatory elements by long-read sequencing. Blood Cells Mol Dis 2023; 103:102764. [PMID: 37336681 DOI: 10.1016/j.bcmd.2023.102764] [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: 12/05/2022] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Inherited deletions of upstream regulatory elements of α-globin genes give rise to α-thalassemia, which is an autosomal recessive monogenic disease. However, conventional thalassemia target diagnosis often fails to identify these rare deletions. Here we reported a family with two previous pregnancies of Hb Bart's hydrops fetalis and was seeking for prenatal diagnosis during the third pregnancy. Both parents had low level of Hemoglobin A2 indicating α-thalassemia. Conventional Gap-PCR and PCR-reverse dot blot showed the father carried -SEA deletion but did not identify any variants in the mother. Multiplex ligation-dependent probe amplification identified a deletion containing two HS-40 probes but could not determine the exact region. Finally, a long-read sequencing (LRS)-based approach directly identified that the exact deletion region was chr16: 48,642-132,584, which was located in the α-globin upstream regulatory elements and named (αα)JM after the Jiangmen city. Gap-PCR and Sanger sequencing confirmed the breakpoint. Both the mother and fetus from the third pregnancy carried heterozygous (αα)JM, and the fetus was normally delivered at gestational age of 39 weeks. This study demonstrated that LRS technology had great advantages over conventional target diagnosis methods for identifying rare thalassemia variants and assisted better carrier screening and prenatal diagnosis of thalassemia.
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Affiliation(s)
- Jianjiang Feng
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Aiping Mao
- Berry Genomics Corporation, Beijing 102200, China
| | - Ye Lu
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Haihong Shi
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China
| | - Wanli Meng
- Berry Genomics Corporation, Beijing 102200, China
| | - Chen Liang
- Center for Medical Genetics, Jiangmen Maternal & Child Health Care Hospital, Jiangmen 529000, Guangdong, China.
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28
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Novak W, Sunder-Plassmann R, Berner J, Köhrer S, Zeitlhofer P, Haas OA, Riedl J, Kager L, Sillaber C. Dominant inherited β-thalassemia intermedia in a Polish family due to a novel frameshift mutation in HBB. Pediatr Blood Cancer 2023; 70:e30511. [PMID: 37353956 DOI: 10.1002/pbc.30511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Wolfgang Novak
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | | | - Jakob Berner
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Stefan Köhrer
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Petra Zeitlhofer
- St. Anna Children's Cancer Research Institute, Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - Oskar A Haas
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
- Labdia Labordiagnostik, Vienna, Austria
| | - Julia Riedl
- Division of Hematology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Leo Kager
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Christian Sillaber
- Division of Hematology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
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29
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Shao M, Wan Y, Cao W, Yang J, Cui D, Ma M, Hu W. Case report: A novel 10.8-kb deletion identified in the β-globin gene through the long-read sequencing technology in a Chinese family with abnormal hemoglobin testing results. Front Med (Lausanne) 2023; 10:1192279. [PMID: 37521358 PMCID: PMC10374251 DOI: 10.3389/fmed.2023.1192279] [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: 03/23/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Thalassemia is a common inherited hemoglobin disorder caused by a deficiency of one or more globin subunits. Substitution variants and deletions in the HBB gene are the major causes of β-thalassemia, of which large fragment deletions are rare and difficult to be detected by conventional polymerase chain reaction (PCR)-based methods. Case report In this study, we reported a 26-year-old Han Chinese man, whose routine blood parameters were found to be abnormal. Hemoglobin testing was performed on the proband and his family members, of whom only the proband's mother had normal parameters. The comprehensive analysis of thalassemia alleles (CATSA, a long-read sequencing-based approach) was performed to identify the causative variants. We finally found a novel 10.8-kb deletion including the β-globin (HBB) gene (Chr11:5216601-5227407, GRch38/hg38) of the proband and his father and brother, which were consistent with their hemoglobin testing results. The copy number and exact breakpoints of the deletion were confirmed by multiplex ligation-dependent probe amplification (MLPA) and gap-polymerase chain reaction (Gap-PCR) as well as Sanger sequencing, respectively. Conclusion With this novel large deletion found in the HBB gene in China, we expand the genotype spectrum of β-thalassemia and show the advantages of long-read sequencing (LRS) for comprehensive and precise detection of thalassemia variants.
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Affiliation(s)
- Mingkun Shao
- Department of OB and GYN, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Yaoyao Wan
- Department of Cardiovascular Medicine, The Second People's Hospital of Honghe Autonomous Prefecture, Yunnan, China
| | - Weipeng Cao
- Jinyu Medical Laboratory Co., Ltd., Yunnan, China
| | - Juan Yang
- Jinyu Medical Laboratory Co., Ltd., Yunnan, China
| | - Di Cui
- Berry Genomics Corporation, Beijing, China
| | - Minhui Ma
- Berry Genomics Corporation, Beijing, China
| | - Wanqin Hu
- Department of OB and GYN, The Second Affiliated Hospital of Kunming Medical University, Yunnan, China
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30
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Rua IB, Vala B, Gameiro I, Martins JR, Castelo R. A Hemoglobin Variant Causing an Unexplained Low Oxygen Saturation by Pulse Oximetry: Two Case Reports. Cureus 2023; 15:e42182. [PMID: 37602010 PMCID: PMC10439765 DOI: 10.7759/cureus.42182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Pulse oximetry is now routinely used in neonatal resuscitation and for neonatal screening for congenital heart diseases. Beyond respiratory and cardiac diseases, hemoglobin (Hb) variants must be included in the differential diagnosis of low oxygen saturation detected by pulse oximetry. We aim to describe two cases of fetal Hb variant (heterozygous γ-globin gene (HBG1) mutation in exon 2 c.202G>A (p.Val68Met)), which was identified in two unrelated newborns.
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Affiliation(s)
- Inês B Rua
- Neonatology Department, Maternidade Daniel de Matos, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Beatriz Vala
- Pediatrics Department, Centro Hospitalar de Leiria, Leiria, PRT
| | - Inês Gameiro
- Neonatology Department, Maternidade Daniel de Matos, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - João R Martins
- Neonatology Department, Maternidade Daniel de Matos, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Rui Castelo
- Neonatology Department, Maternidade Daniel de Matos, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
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31
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Fjeld B, Sudmann-Day ÅA, Grimholt RM, Larstorp ACK, Urdal P, Klingenberg O. Additional value of red blood cell parameters in predicting uncommon α-thalassemia; experience from 10 years of α-globin gene sequencing and copy number variation analysis. Int J Lab Hematol 2023; 45:250-259. [PMID: 36567661 DOI: 10.1111/ijlh.14010] [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: 07/15/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The diagnosis of rare forms of α-thalassemia requires laborious genetic analyses. Accurate sample selection for such evaluation is therefore essential. The main objectives of this study were to investigate the predictive power of red blood cell parameters to detect rare forms of α-thalassemia (substudy 1), and to explore the frequency of rare versus common forms of α-thalassemia in our sample population (substudy 2). METHODS In substudy 1, we reviewed all blood samples selected for extended α-hemoglobinopathy evaluation at our laboratory during 2011-2020 (n = 1217), which included DNA sequencing and/or copy number variation analysis. We assessed α-thalassemia positive samples at different levels of mean corpuscular hemoglobin (MCH) alone and in combination with results for red blood cell count (RBC) or red cell distribution width (RDW). In substudy 2, we examined the distribution of α-thalassemia genotypes for all samples submitted to a first-tier hemoglobinopathy evaluation at our laboratory during 2014-2020 (n = 6495). RESULTS In substudy 1, both RBC and RDW added predictive value in detecting rare forms of α-thalassemia in samples from adults and children. In adult samples with MCH ≤ 23 pg, the presence of erythrocytosis increased the detection rate from 27% to 74% as compared to non-erythrocytosis, while normal RDW increased the detection rate from 36% to 86% as compared to elevated RDW. In substudy 2, rare forms of α-thalassemia were detected in 12% of α-thalassemia positive samples. CONCLUSION Initial assessment of MCH, RBC, and RDW provided valuable predictive information about the presence of rare forms of α-thalassemia during hemoglobinopathy evaluation.
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Affiliation(s)
- Bente Fjeld
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Runa Marie Grimholt
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
| | - Anne Cecilie Kjeldsen Larstorp
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Petter Urdal
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Olav Klingenberg
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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32
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Pan L, Tian P, Chen S, Zhang R. Novel Promoter Mutation ( HBB:C.-139_-138del) Associated with β-Thalassemia Trait Detected by Next-Generation Sequencing in Southern China. Hemoglobin 2023; 47:21-24. [PMID: 36866928 DOI: 10.1080/03630269.2023.2182215] [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: 03/04/2023]
Abstract
Here we report a novel β-globin gene mutation in the promoter (HBB:c.-139_-138delAC) detected by next-generation sequencing (NGS). The proband was a 28-year-old Chinese male, living in Shenzhen City, Guangdong Province, who originates from Hunan Province. The red cell indices were almost normal, with a slightly decreased Red Cell volume Distribution Width(RDW). Capillary electrophoresis (CE) showed the Hb A (93.1%) value was below normal, while the Hb A2 (4.2%) and Hb F (2.7%) values were both beyond normal. A set of genetic tests of the α and β-globin genes were then performed to determine whether the subject carried any causative mutations. The results of NGS revealed a two-base pair deletion at position -89 to -88(HBB:c.-139_-138delAC)in the heterozygous state, which was subsequently confirmed by Sanger sequencing.
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Affiliation(s)
- Lei Pan
- Department of Medical Genetics and Prenatal Diagnosis, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, P.R. China
| | - Peirun Tian
- BGI Genomics, BGI-Shenzhen, Shenzhen, P.R. China
| | - Shiping Chen
- BGI Genomics, BGI-Shenzhen, Shenzhen, P.R. China
| | - Rui Zhang
- Department of Medical Genetics and Prenatal Diagnosis, Baoan Women's and Children's Hospital, Jinan University, Shenzhen, P.R. China
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33
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Alkilani S, Sevimoglu T. In silico analysis of substitution mutations in the β-globin gene in Turkish population of β-thalassemia. J Biomol Struct Dyn 2023; 41:14028-14035. [PMID: 36752381 DOI: 10.1080/07391102.2023.2176924] [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: 07/04/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
Beta-thalassemia is a genetic blood disorder represented by anomalies in hemoglobin's beta chain production. Most hemoglobin defects are a result of mutations of the structural β-globin gene. Many diseases, including β-thalassemia, benefit from computational studies that aid researchers in investigating the association of genotype and phenotype. In this study, the alanine substitution mutations of the β-globin protein sub-units in the Turkish population (Hb Ankara, Hb Siirt and Hb Izmir) and the effects of those mutations on the β-globin protein structure and performance are examined using molecular dynamics simulation. While Hb Ankara variant showed a non-conservative mutation, Hb Siirt and Hb Izmir showed a semi-conservative mutation. RMSF values of Hb Siirt, between residues 95 and 99, were higher than wild-type and the other mutant proteins. The residues of Hb Ankara showed lower fluctuation compared to the other structures. The mean ROG values were 1.47 nm, 1.46 nm, 1.49 nm and 1.48 and the average number of the hydrogen bonds were 92, 100, 99, and 89 for Hb Ankara, Hb Siirt and Hb Izmir, respectively. Moreover, a significant increase in overall motion in Hb Siirt was observed based on PCA analysis. Hb Siirt substitution mutation might cause an effect in β-globin proteins which could impact the protein function. This indicates a major role on beta globin subunit's stability for alanine on 27th position. However, Hb Ankara and Hb Izmir variants may act as a silent mutation, since these two mutations did not show a large change in the dynamics of the protein.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Sima Alkilani
- Department of Bioengineering, Uskudar University, Uskudar, Istanbul, Türkiye
| | - Tuba Sevimoglu
- Department of Bioengineering, University of Health Sciences, Uskudar, Istanbul, Türkiye
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34
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Cario H. Diagnostik und Therapie der alpha- und
beta-Thalassämien. TRANSFUSIONSMEDIZIN 2023. [DOI: 10.1055/a-1966-5765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ZusammenfassungDie komplexe Behandlung von Patienten mit Thalassämien stellt nicht nur
eine medizinische, sondern angesichts der in den letzten Jahren deutlich
gestiegenen Patientenzahlen auch eine gesellschaftliche Herausforderung dar, die
eine sehr enge Zusammenarbeit aller Behandler erfordert. Der vorliegende Beitrag
erläutert Ursachen und Pathogenese der alpha- und
beta-Thalassämien und bietet eine Übersicht zu Klinik und
Therapien.
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Affiliation(s)
- Holger Cario
- Klinik für Kinder- und Jugendmedizin, Zentrum für
Seltene Störungen der Hämatopoese und Immundefekte (ZSHI Ulm),
Universitätsklinikum Ulm
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35
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Kangastupa P, Åkerman K, Risku S, Väisänen M, Kuusela R, Romppanen J, Kouki A, Sneck M, Itkonen O, Niemelä O. The prevalence of hemoglobin Tacoma in Finland detected by HbA1c capillary electrophoresis. Scand J Clin Lab Invest 2023; 83:51-57. [PMID: 36633442 DOI: 10.1080/00365513.2022.2164739] [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: 01/13/2023]
Abstract
Previous studies have identified occasional cases of heterozygous Hb Tacoma in areas that have attracted Finnish immigrants, especially in Sweden and North America, but large studies of this slightly unstable beta variant in vitro have not been carried out. Here we determined the prevalence of hemoglobin variants across Finland. A total of 5059 samples from 11 different hospital districts were analyzed using HbA1c capillary electrophoresis and reviewed for atypical profiles (HbA1c, Capillarys 3 Tera, Sebia). 38 heterozygous Hb Tacoma cases were found (0.75%). The prevalence was highest in South Ostrobothnia (2.0%), located in western Finland, and second highest in the neighboring provinces (1.0-1.4%), but only two districts were devoid of variants. Heterozygous Hb Tacoma was confirmed by genetic testing (NM_000518.5(HBB):c.93G > T (p.Arg31Ser)). In addition, five other variants were found, suggestive of HbE, Hb Helsinki (two cases) and an alpha variant, as interpreted from the electropherograms. The fifth variant, belonging to the South Ostrobothnian cohort, remained unknown at the time of the initial analyses, but was later interpreted as homozygous Hb Tacoma and confirmed by hemoglobin fraction analysis (Hemoglobin(E), Capillarys 3 Tera). In a subsequent retrospective study of the electropherograms of routine HbA1c diagnostics, altogether nine homozygous Hb Tacoma cases were identified in South Ostrobothnia. While heterozygous Hb Tacoma is usually an incidental finding, it interferes with several HbA1c assays. The present study is the first demonstration of homozygous Hb Tacoma. The clinical presentations of homozygous Hb Tacoma are not known and need to be addressed in future studies.
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Affiliation(s)
- Päivikki Kangastupa
- Department of Clinical Chemistry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Kari Åkerman
- Department of Clinical Chemistry, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Sari Risku
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Matti Väisänen
- Department of Clinical Chemistry, Vaasa Central Hospital, Vaasa, Finland
| | | | | | - Annika Kouki
- City of Turku, Welfare Division, Health Care Services, Turku, Finland.,Turku University Hospital, Tykslab, Turku, Finland
| | - Mia Sneck
- Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - Outi Itkonen
- Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - Onni Niemelä
- Department of Clinical Chemistry, Seinäjoki Central Hospital, Seinäjoki, Finland.,Department of Laboratory Medicine, University of Tampere, Tampere, Finland
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36
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Yadav N, Kumar Mandal A. Interference of hemoglobin variants in HbA 1c quantification. Clin Chim Acta 2023; 539:55-65. [PMID: 36476843 DOI: 10.1016/j.cca.2022.11.031] [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: 08/12/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Fasting blood glucose and glycated hemoglobin (HbA1c) are routine biomarkers to screen and monitor diabetes mellitus. HbA1c results from glycation at the N-terminus of the β globin chain of tetrameric human hemoglobin. Fasting blood glucose level varies with the nature and amount of food intake, physical exercise, etc., and, accordingly, is a short-term measure of glucose control. In contrast, HbA1c provides an average measure of glucose control for the long-term (8-12 weeks). Unfortunately, genetic variants of hemoglobin may interfere with HbA1c quantification using ion exchange chromatography, capillary electrophoresis, immunoassay and boronate affinity chromatography. Mass spectrometry, however, measures total glycation of hemoglobin across both α and β globin chains and correlates well with the ion exchange based method. Additionally, mass spectrometry based quantification is not impacted by the presence of genetic variants of hemoglobin and thus might be a better analytical choice for diabetes mellitus.
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Affiliation(s)
- Neha Yadav
- Department of Biological Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia, West Bengal 741246, India
| | - Amit Kumar Mandal
- Department of Biological Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia, West Bengal 741246, India.
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37
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Caprari P, Profumo E, Massimi S, Buttari B, Riganò R, Regine V, Gabbianelli M, Rossi S, Risoluti R, Materazzi S, Gullifa G, Maffei L, Sorrentino F. Hemorheological profiles and chronic inflammation markers in transfusion-dependent and non-transfusion- dependent thalassemia. Front Mol Biosci 2023; 9:1108896. [PMID: 36699704 PMCID: PMC9868635 DOI: 10.3389/fmolb.2022.1108896] [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: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
The rheological properties of blood play an important role in regulating blood flow in micro and macro circulation. In thalassemia syndromes red blood cells exhibit altered hemodynamic properties that facilitate microcirculatory diseases: increased aggregation and reduced deformability, as well as a marked increase in adherence to the vascular endothelial cells. A personalized approach to treating thalassemia patients (transfusions, iron chelation, and splenectomy), has increased patients' life expectancy, however they generally present many complications and several studies have demonstrated the presence of high incidence of thromboembolic events. In this study the hemorheological profiles of thalassemia patients have been characterized to point out new indices of vascular impairment in thalassemia. Plasma viscosity, blood viscosities at low and high shear rates (η1 and η200, respectively), erythrocyte aggregation index (η1/η200), and the erythrocyte viscoelastic profile (elastic modulus G', and viscous modulus G") have been studied in transfusion-dependent and non-transfusion-dependent thalassemia patients. Moreover, the levels of inflammation biomarkers in thalassemia have been evaluated to investigate a relationship between the biomarkers, the disease severity and the rheological parameters. The biomarkers studied are the main components of the immune and endothelial systems or are related to vascular inflammation: cytokines (IL-2, IL-6, IL-10, IL-17A, TNF-alpha), chemokines (IL-8, MIP-1alpha), adipocytokines (leptin and adiponectin), growth factors (VEGF, angiopoietin-1), adhesion molecules (ICAM-1, VCAM-1, E-selectin, L-selectin), and a monocyte/macrophage activation marker (CD163). This study shows that transfusion-dependent thalassemia patients, both major and intermedia, have blood viscosities comparable to those of healthy subjects. Non-transfusion-dependent thalassemia intermedia patients show high blood viscosities at low shear rates (η1), corresponding to the flow conditions of the microcirculation, an increase in erythrocyte aggregation, and high values of the elastic G' and viscous G" modules that reflect a reduced erythrocyte deformability and an increase in blood viscosity. Levels of cytokines, chemokines and adhesion molecules are different in transfusion- and non-transfusion dependent patients and positive correlations between η1 or η1/η200 and the cytokines IL-6 and IL-10 have been observed. The evaluation of the hemorheological profiles in thalassemia can provide new indicators of vascular impairment and disease severity in thalassemia in order to prevent the onset of thromboembolic events.
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Affiliation(s)
- Patrizia Caprari
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy,*Correspondence: Patrizia Caprari,
| | - Elisabetta Profumo
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Sara Massimi
- National Centre for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Brigitta Buttari
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Rachele Riganò
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Vincenza Regine
- Department of Infectious Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Gabbianelli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Risoluti
- Department of Chemistry, Sapienza University of Rome, Rome, Italy
| | | | | | - Laura Maffei
- Thalassemia Unit, S. Eugenio Hospital, Rome, Italy
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38
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Luo RY, Wong C, Xia JQ, Glader BE, Shi RZ, Zehnder JL. Neutral-Coating Capillary Electrophoresis Coupled with High-Resolution Mass Spectrometry for Top-Down Identification of Hemoglobin Variants. Clin Chem 2023; 69:56-67. [PMID: 36308334 DOI: 10.1093/clinchem/hvac171] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Identification of hemoglobin (Hb) variants is of significant value in the clinical diagnosis of hemoglobinopathy. However, conventional methods for identification of Hb variants in clinical laboratories can be inadequate due to the lack of structural characterization. We describe the use of neutral-coating capillary electrophoresis coupled with high-resolution mass spectrometry (CE-HR-MS) to achieve high-performance top-down identification of Hb variants. METHODS An Orbitrap Q-Exactive Plus mass spectrometer was coupled with an ECE-001 capillary electrophoresis (CE) unit through an EMASS-II ion source. A PS1 neutral-coating capillary was used for CE. Samples of red blood cells were lysed in water and diluted in 10 mM ammonium formate buffer for analysis. Deconvolution of raw mass spectrometry data was carried out to merge multiple charge states and isotopic peaks of an analyte to obtain its monoisotopic mass. RESULTS The neutral-coating CE could baseline separate individual Hb subunits dissociated from intact Hb forms, and the HR-MS could achieve both intact-protein analysis and top-down analysis of analytes. A number of patient samples that contain Hb subunit variants were analyzed, and the variants were successfully identified using the CE-HR-MS method. CONCLUSIONS The CE-HR-MS method has been demonstrated as a useful tool for top-down identification of Hb variants. With the ability to characterize the primary structures of Hb subunits, the CE-HR-MS method has significant advantages to complement or partially replace the conventional methods for the identification of Hb variants.
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Affiliation(s)
- Ruben Yiqi Luo
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - Carolyn Wong
- Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | | | - Bertil E Glader
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Run-Zhang Shi
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
| | - James L Zehnder
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA.,Clinical Laboratories, Stanford Health Care, Palo Alto, CA, USA
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39
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Gorfinkel L, Wachter F, Luo HY, Hansbury E, Williams DA, Agarwal A, Chui DHK, Cantor AB. Transient neonatal hemolytic anemia due to the novel gamma globin gene mutation HBG2:C.290T>C, p.Leu97Pro (hemoglobin Wareham). Pediatr Blood Cancer 2023; 70:e30067. [PMID: 36250986 DOI: 10.1002/pbc.30067] [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: 07/12/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 12/25/2022]
Abstract
Unstable gamma globin variants can cause transient neonatal hemolytic anemia. We have identified a novel variant in a newborn who presented with jaundice and anemia requiring phototherapy and red blood cell transfusion. The patient was found to be heterozygous for the mutation HGB2:c.290T>C, p.Leu97Pro, which we have termed hemoglobin (Hb) Wareham. This substitution is expected to generate an unstable hemoglobin with increased oxygen affinity based on the homologous mutation previously described in the beta globin gene, which is termed as Hb Debrousse. The patient fully recovered by 9 months of age as expected with the transition from fetal to adult hemoglobin.
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Affiliation(s)
- Lev Gorfinkel
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Franziska Wachter
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Hong-Yuan Luo
- Departments of Medicine, Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eileen Hansbury
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Williams
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Archana Agarwal
- Department of Pathology, University of Utah Health Sciences, Salt Lake City, Utah, USA
| | - David H K Chui
- Departments of Medicine, Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alan B Cantor
- Division of Pediatric Hematology-Oncology, Boston Children's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Stem Cell Institute, Cambridge, Massachusetts, USA
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40
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Patterson S, Sandercock N, Verhovsek M. Understanding pulse oximetry in hematology patients: Hemoglobinopathies, racial differences, and beyond. Am J Hematol 2022; 97:1659-1663. [PMID: 36074079 DOI: 10.1002/ajh.26721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 01/31/2023]
Abstract
Pulse oximetry (SpO2 ) is a widely used, non-invasive method of estimating arterial oxygen saturation. Measurement of SpO2 relies on comparing the relative absorption of light in the red and infrared regions with the expected absorption pattern of oxygenated and deoxygenation adult hemoglobin. As this screening tool has entered common clinical use, test limitations have emerged, including concern about the risk of overestimation of oxygen saturation by pulse oximetry in a disproportionate number of people with dark skin pigment, leading to potential for underdiagnosis of true hypoxemia. In addition, a range of challenges may arise in patients with increased levels of methemoglobin - whether acquired or inherited - carboxyhemoglobin, or in patients with a subset of inherited variant hemoglobins. It is important for Hematologists, and indeed all clinicians who rely on pulse oximetry, to understand the principles and limitations of this ubiquitous test.
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Affiliation(s)
- Sarah Patterson
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nick Sandercock
- Molecular Hematology, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Madeleine Verhovsek
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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41
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Sakamoto A, Nakadate H, Iguchi A, Tsumura Y, Tsuruta T, Yamashiro Y, Hattori Y, Ishiguro A. Unstable hemoglobin Bicêtre, NM_000518.4(HBB):C.191A>C (p.His64Pro), with slightly decreased P50 and no polycythemia after splenectomy. Pediatr Blood Cancer 2022; 69:e29777. [PMID: 35561058 DOI: 10.1002/pbc.29777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Atsushi Sakamoto
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan.,Children's Cancer Center, NCCHD, Tokyo, Japan
| | | | | | - Yusuke Tsumura
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Toshihisa Tsuruta
- Department of Advanced Medicine, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Aichi, Japan
| | - Yasuhiro Yamashiro
- Division of Clinical Laboratory Science, Faculty of Health Sciences, Graduate School of Medicine, Yamaguchi University School of Medicine, Ube, Japan
| | - Yukio Hattori
- Division of Clinical Laboratory Science, Faculty of Health Sciences, Graduate School of Medicine, Yamaguchi University School of Medicine, Ube, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan.,Division of Hematology, NCCHD, Tokyo, Japan
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42
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Chen Z, Shao L, Jiang M, Ma R, Ping H, Wang Z, Ba X, Ma B, Zhou T. Identification of a rare compound heterozygous hemoglobin variant β0-thal [β17(A14) Lys>Stop, HBB: c.52A>T] and Hb J-Lome [β59(E3) Lys>Asn, HBB: c.180G>C]. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:946-950. [PMID: 36004523 DOI: 10.1080/16078454.2022.2114672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND HbA1c is the validated biomarker for glycemic management in diabetic individuals. Here, we report a compound heterozygote for β0-thal and Hb J-Lomeand evaluate its effect on HbA1c measurements. METHODS A 51-year-old female was suspected of harboring a hemoglobin variant following no value of HbA1c levelby Arkray HA-8180 V (48s HbA1c mode), abnormal hematological data, and abnormalhemoglobin analysison capillary electrophoresis (Capillarys 2 Flex Piercing, Hb program). Sanger sequencing of the α and β genes was subsequently performed on the proband.HbA1c was reanalyzed using D10 (Bio-Rad), Capillarys 2 Flex Piercing (Sebia), and Roche Cobas c501 (Roche Diagnostics). RESULTS Sanger sequencing identified a compound heterozygote for β0-thal [β17(A14) Lys > Stop, HBB: c.52A > T] and Hb J-Lome [β59(E3) Lys > Asn, HBB: c.180G > C].HbA1c values determinedby D10, Capillarys 2 Flex Piercing (HbA1c program), and Roche Cobas c501were 2.3%, no HbA1c value, and 5.1 (32 mmol/mol), respectively. During pedigree analysis, the son of the proband was found to have normal blood glucose (5.55 mmol/L), decreased HbA1c (3.6%, 16 mmol/mol)by Arkray HA-8180 V (48s HbA1c mode), an abnormal band on the electrophoretogram of Capillarys2 (Hb program), and the Hb J-Lome mutation in the β globin gene.Subsequently, HbA1c values determinedby D10, Capillarys 2 Flex Piercing (HbA1c program), and Roche Cobas c501 were4.0% (20 mmol/mol), no HbA1c value, and 5.0 (31 mmol/mol), respectively. CONCLUSION Atypically low HbA1c levels or a discrepancy between blood glucose and HbA1c levels should raise concerns about hemoglobin variations.
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Affiliation(s)
- Zixin Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Limei Shao
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Mingfeng Jiang
- Department of Clinical Laboratory, Sichuan Center for Disease Control and Prevention, Sichuan, People's Republic of China
| | - Run Ma
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Hongfen Ping
- Department of Clinical Laboratory, The People's Hospital of Wuhua District, Kunming, People's Republic of China
| | - Zuo Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Xuejiao Ba
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Bingjie Ma
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Tao Zhou
- Department of Clinical Laboratory, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
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43
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Ropero Gradilla P, Raya JM, González FA, Rochas S, Ferrer-Benito S, Nieto JM, Martín-Santos T, Barrios M, Gutiérrez-Murillo L, Villegas A, Benavente C. Hb Nivaria: A New Hemoglobin Variant with a Shortened α-Globin Chain [ α139(HC1)Lys →Stop; HBA1: c.418A>T]. Hemoglobin 2022; 46:344-346. [PMID: 36847654 DOI: 10.1080/03630269.2023.2172430] [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: 03/01/2023]
Abstract
We report a novel hemoglobin (Hb) variant found in a Spanish individual from Santa Cruz de Tenerife, the Canary Islands in Spain. The proband was a 39-year-old male. High performance liquid chromatography (HPLC) displayed an unknown peak (19.3%) at a retention time of 1.3 min. eluting before Hb A0. Capillary zone electrophoresis (CZE) showed an abnormal peak (20.0%) in zone 12. Direct DNA sequencing of the α-globin genes revealed heterozygosity for a nonsense mutation at codon 139 (AAA>TAA), causing a lysine to stop codon substitution [α139(HC1)Lys→Stop; HBA1: c.418A>T]. We decided to name the variant Hb Nivaria (Tenerife) for the place of birth and residence of the proband.
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Affiliation(s)
- Paloma Ropero Gradilla
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - José María Raya
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Fernando Ataúlfo González
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Sara Rochas
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Sara Ferrer-Benito
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Jorge M Nieto
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
| | - Taida Martín-Santos
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Marcelo Barrios
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Lorena Gutiérrez-Murillo
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Islas Canarias, España
| | - Ana Villegas
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España
| | - Celina Benavente
- Servicio de Hematología y Hemoterapia. Hospital Clínico San Carlos, Madrid, España.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, España
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44
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Suali L, Mohammad Salih FA, Ibrahim MY, Jeffree MSB, Thomas FM, Siew Moy F, Shook Fe Y, Suali E, Sudi S, Sunggip C. Genotype-Phenotype Study of β-Thalassemia Patients in Sabah. Hemoglobin 2022; 46:317-324. [PMID: 36815306 DOI: 10.1080/03630269.2023.2169154] [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: 02/24/2023]
Abstract
β-thalassemia is a serious public health problem in Sabah due to its high prevalence. This study aimed to investigate the effects of different types of β-globin gene mutations, coinheritance with α-globin gene mutations, XmnI-Gγ, and rs368698783 polymorphisms on the β-thalassemia phenotypes in Sabahan patients. A total of 111 patients were included in this study. The sociodemographic profile of the patients was collected using a semi-structured questionnaire, while clinical data were obtained from their medical records. Gap-PCR, ARMS-PCR, RFLP-PCR, and multiplex PCR were performed to detect β- and α-globin gene mutations, as well as XmnI-Gγ and rs368698783 polymorphisms. Our data show that the high prevalence of β-thalassemia in Sabah is not due to consanguineous marriages (5.4%). A total of six different β-globin gene mutations were detected, with Filipino β°-deletion being the most dominant (87.4%). There were 77.5% homozygous β-thalassemia patients, 16.2% compound heterozygous β-thalassemia patients, and 6.3% β-thalassemia/Hb E patients. Further evaluation on compound heterozygous β-thalassemia and β-thalassemia/Hb E patients found no concomitant α-globin gene mutations and the rs368698783 polymorphism. Furthermore, the XmnI-Gγ (-/+) genotype did not demonstrate a strong impact on the disease phenotype, as only two of five patients in the compound heterozygous β-thalassemia group and two of three patients in the β-thalassemia/Hb E group had a moderate phenotype. Our findings indicate that the severity of the β-thalassemia phenotypes is closely related to the type of β-globin gene mutations but not to the XmnI-Gγ and rs368698783 polymorphisms.
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Affiliation(s)
- Latifah Suali
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Falah Abass Mohammad Salih
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Mohammad Yusof Ibrahim
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Mohammad Saffree Bin Jeffree
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Fiona Macniesia Thomas
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Fong Siew Moy
- Likas Women's and Children's Hospital, Kota Kinabalu, Malaysia
| | - Yap Shook Fe
- Likas Women's and Children's Hospital, Kota Kinabalu, Malaysia
| | - Emma Suali
- Faculty of Engineering, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Suhaini Sudi
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Caroline Sunggip
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
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45
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Shrestha AK, Rijal A, Belbase K, Shrestha A, Shah S, Chaudhary S, Kunwar S, Yadav SK, Dhital R, Gyawali P. Hemoglobin J in a patient with severe anemia, a case report from Nepal. Ann Med Surg (Lond) 2022; 82:104703. [PMID: 36268370 PMCID: PMC9577591 DOI: 10.1016/j.amsu.2022.104703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Hemoglobin J is defined by a faster movement towards anode when compared with the normal hemoglobin A. Though a pathologically distinct entity from the normal HbA, it remains clinically silent due to little physiological difference as exemplified by a similar oxygen binding capacity between the two. Though cases of symptomatic HbJ have been reported, it is uncommon. Hence, further explanations should be sought in such cases. Case presentation Our case report exemplifies the presence of an alpha thalassemia trait along with HbJ in a symptomatic case of anemia from rural Nepal. Discussion CE-HPLC complemented by electrophoresis, is the method of choice for characterizing various hemoglobin variants including Hb J. Hb J presents as elevated P3 peak on HPLC while thalassemia is detected by the presence of eluted proteins at the retention time between 0 and 1 minutes. P3 peak up to 6% is considered normal, values 6%–12% indicates suboptimal specimen and values greater than 15% indicates Hb J. Conclusion Variants of hemoglobin including HbJ variant is detected using HPLC technique. Mostly clinically silent, if HbJ is associated with anemia, search for a concomitant cause should be sought one of them being alpha thalassemia when iron deficiency has been ruled out by a serum iron profile. HbJ is rare variant of hemoglobin with 71 nrw variants till date. CE-HPLC stands as a standard for these hemoglobin variants differentiation where Hb J presents as a P3 peak. Anemia when associated with HbJ should be searched for concomitant hemoglobinopathy
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46
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Liu Y, Yeung WSB, Chiu PCN, Cao D. Computational approaches for predicting variant impact: An overview from resources, principles to applications. Front Genet 2022; 13:981005. [PMID: 36246661 PMCID: PMC9559863 DOI: 10.3389/fgene.2022.981005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
One objective of human genetics is to unveil the variants that contribute to human diseases. With the rapid development and wide use of next-generation sequencing (NGS), massive genomic sequence data have been created, making personal genetic information available. Conventional experimental evidence is critical in establishing the relationship between sequence variants and phenotype but with low efficiency. Due to the lack of comprehensive databases and resources which present clinical and experimental evidence on genotype-phenotype relationship, as well as accumulating variants found from NGS, different computational tools that can predict the impact of the variants on phenotype have been greatly developed to bridge the gap. In this review, we present a brief introduction and discussion about the computational approaches for variant impact prediction. Following an innovative manner, we mainly focus on approaches for non-synonymous variants (nsSNVs) impact prediction and categorize them into six classes. Their underlying rationale and constraints, together with the concerns and remedies raised from comparative studies are discussed. We also present how the predictive approaches employed in different research. Although diverse constraints exist, the computational predictive approaches are indispensable in exploring genotype-phenotype relationship.
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Affiliation(s)
- Ye Liu
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - William S. B. Yeung
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Philip C. N. Chiu
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- *Correspondence: Philip C. N. Chiu, ; Dandan Cao,
| | - Dandan Cao
- Shenzhen Key Laboratory of Fertility Regulation, Reproductive Medicine Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- *Correspondence: Philip C. N. Chiu, ; Dandan Cao,
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47
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Calcagno L, Ciriello MM, Maccarini M, Mogni M, Maffei M, Barberio G, Maoggi S, Coviello D, Ivaldi G. Hb Alessandria [β37(C3)Trp→Leu; HBB: c.113G>T]: a Novel Variant on the β-Globin Chain with Slightly Increased Affinity for Oxygen Detected by Capillary Electrophoresis. Hemoglobin 2022; 46:240-244. [DOI: 10.1080/03630269.2022.2118605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lara Calcagno
- Laboratorio Analisi Chimico Cliniche ed Ematologiche, Azienda Ospedaliera “SS. Antonio e Biagio e C. Arrigo,” Alessandria, Italia
| | - Maria M. Ciriello
- Laboratorio Analisi Chimico Cliniche ed Ematologiche, Azienda Ospedaliera “SS. Antonio e Biagio e C. Arrigo,” Alessandria, Italia
| | - Monica Maccarini
- Laboratorio Analisi Chimico Cliniche ed Ematologiche, Azienda Ospedaliera “SS. Antonio e Biagio e C. Arrigo,” Alessandria, Italia
| | - Massimo Mogni
- Laboratorio di Genetica Umana, IRCCS, Istituto Giannina Gaslini, Genova, Italia
| | - Massimo Maffei
- Laboratorio di Genetica Umana, IRCCS, Istituto Giannina Gaslini, Genova, Italia
| | | | | | - Domenico Coviello
- Laboratorio di Genetica Umana, IRCCS, Istituto Giannina Gaslini, Genova, Italia
| | - Giovanni Ivaldi
- Laboratorio di Genetica Umana, IRCCS, Istituto Giannina Gaslini, Genova, Italia
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48
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Cario H. [Diagnostics and treatment of alpha- and beta-thalassemias]. Dtsch Med Wochenschr 2022; 147:1250-1261. [PMID: 36126923 DOI: 10.1055/a-1767-8379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thalassemias are a heterogeneous group of genetic diseases based on a quantitative disorder of globin chain synthesis. They are among the most frequent monogenic hereditary diseases worldwide. Migration during recent years led to a profoundly increasing number of patients in countries where the indigenous population has not been affected. The complex treatment of the patients represents a medical and socioeconomic challenge with the need for structured interdisciplinary clinical care and close collaboration among healthcare providers, regulatory authorities, and health care insurance companies. The following article provides an overview of the causes, pathogenesis, clinical presentation, and treatment of alpha- and beta-thalassemias.
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49
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Yin ZZ, Yao J, Wei FX, Chen CY, Yan HM, Zhang M. Targeted Next-Generation Sequencing Reveals a Large Novel β-Thalassemia Deletion that Removes the Entire HBB Gene. Hemoglobin 2022; 46:290-295. [PMID: 36412578 DOI: 10.1080/03630269.2022.2145964] [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: 11/23/2022]
Abstract
β-Thalassemia (β-thal) is one of the most common monogenic recessive inherited diseases worldwide. The mutation spectrum of β-thal has been increasingly broadened by various genetic testing methods. The discovery and identification of novel and rare pathogenic thalassemia variants enable better disease prevention, especially in high prevalence regions. In this study, a Chinese thalassemia family with an unclear etiology was recruited to the Thalassemia Screening Program. Blood samples collected from them were primarily screened by hematology analysis and clinical routine genetic screening. Subsequently, targeted next-generation sequencing (NGS) and Sanger sequencing were performed to find and identify a novel deletion variant. The deletion, discovered by targeted NGS, was validated through real-time quantitative polymerase chain reaction (qPCR). First, a large novel β-thal deletion (3488 bp) related to a high Hb F level, NC_000011.9: g.5245533_5249020del (Chongqing deletion) (GRCh37/hg19), was found and identified in the proband and her mother. The deletion removed the entire β-globin gene and led to absent β-globin (β0). We then validated this large novel deletion in the proband and her mother by qPCR. We first discovered and identified a large novel β-thal deletion related to elevated Hb F level, it helps broaden the spectrum of pathogenic mutants that may cause β-thal intermedia (β-TI) or β-thal major (β-TM), paving the way for effective thalassemia screening. Next-generation sequencing has the potential of finding rare and novel thalassemia mutants.
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Affiliation(s)
- Zhen-Zhen Yin
- Nanfang College, Guangzhou, People's Republic of China
| | - Jian Yao
- Nanfang College, Guangzhou, People's Republic of China
| | - Feng-Xiang Wei
- The Genetics Laboratory, Shenzhen Longgang District Maternity and Child Healthcare Hospital, Shenzhen, People's Republic of China
| | - Chu-Yan Chen
- Nanfang College, Guangzhou, People's Republic of China
| | - Hong-Mei Yan
- Guangzhou Development District Hospital, Guangzhou, People's Republic of China
| | - Ming Zhang
- Nanfang College, Guangzhou, People's Republic of China
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50
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Nair SB, Athalye AS, Panphalia M, Parikh FR. First Report of an α Chain Variant [Hb Coombe Park ( HBA2: c.382A>G)] from India, Coinherited with a Novel SERPINC1 Gene Mutation: A Double Whammy? Hemoglobin 2022; 46:269-271. [PMID: 36120956 DOI: 10.1080/03630269.2022.2122497] [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: 01/06/2023]
Abstract
Coinheritance of a high oxygen affinity structural hemoglobin (Hb) variant along with a thrombophilia marker is a rare occurrence. This may lead to a multi fold increase in the risk of thrombosis in patients. We report here a first case of Hb Coombe Park (HBA2: c.382A>G; p.Lys128Glu) from India, coinherited with a novel mutation (c.839C>G; p.Ser280Ter) on the SERPINC1 gene. This coinheritance has not been reported before. Though the patient is presently asymptomatic, identification of these variants will help in genetic counseling and to decide the future course of action in case of any clinical complications.
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Affiliation(s)
- Sona B Nair
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Arundhati S Athalye
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Madhavi Panphalia
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Firuza R Parikh
- Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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