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Satthakarn S, Panyasai S. α-Globin mutations and Genetic Variants in γ-globin Promoters are Associated with Unelevated Hemoglobin F Expression of Atypical β 0-thalassemia/HbE. Arch Med Res 2024; 55:103055. [PMID: 39029212 DOI: 10.1016/j.arcmed.2024.103055] [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: 12/13/2023] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Excessive expression of hemoglobin F (HbF) is a characteristic feature and important diagnostic marker of β0-thalassemia/HbE disease. However, some patients may exhibit low-HbF levels, leading to misdiagnosis and precluding genetic counseling. The genetic factors influencing these differences in HbF expression in this atypical disease are not completely understood. AIMS To investigate determinants contributing to the non-elevation of HbF expression in β0-thalassemia/HbE disease. METHODS We studied 231 patients with β0-thalassemia/HbE confirmed by DNA analysis; classified them into the low-HbF (n = 62) and high-HbF (n = 169) groups; analyzed hematological parameters and hemoglobin levels in both groups; and characterized mutations in β- and α-globin genes and genetic variants in γ-globin promoters. RESULTS Both groups showed similar rates of type β0-thalassemia mutations but significantly different proportions of α-globin mutations: approximately 88.7% (95% confidence interval [CI] = 66.8-115.5) and 39.1% (95% CI = 30.2-49.7) in the low- and high-HbF groups, respectively. The results revealed single-nucleotide polymorphisms (SNPs) at -158 (C>T) in the Gγ-globin promoters and novel SNPs at the 5' untranslated region position 25 (G>A) in Aγ-globin promoters. The distribution of CC genotypes of the Gγ-globin promoter in the low-HbF group was significantly higher than that in the high-HbF group. CONCLUSIONS Cases with HbE predominance with low-HbF levels and undetectable HbA may not be as conclusive as those with homozygous HbE until DNA analysis is performed. Concomitant inheritance of α-thalassemia is an important inherent factor modifying HbF expression in a typical β0-thalassemia/HbE, and SNPs with the CC genotype in the Gγ-globin promoter may indicate unelevated HbF expression in patients with this disease.
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Affiliation(s)
- Surada Satthakarn
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Sitthichai Panyasai
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand.
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Hamzah R, Mohamad AS, Mohd Yasin N, Esa E, Chen G, Selvaratnam V. The Characteristics of Compound Heterozygosity for Hemoglobin G-Makassar with Hb E in Malaysia. J Blood Med 2024; 15:255-264. [PMID: 38828362 PMCID: PMC11144427 DOI: 10.2147/jbm.s432849] [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: 10/03/2023] [Accepted: 03/16/2024] [Indexed: 06/05/2024] Open
Abstract
Background Human hemoglobin of G-Makassar and hemoglobin E (Hb E) are hemoglobin variants that affect Beta (β) globin. Hb G-Makassar is a very rare variant while Hb E is estimated to affect at least one million people worldwide. Both Hb G-Makassar and Hb E can be inherited in the heterozygous, homozygous or compound heterozygous state. This case series describes the characteristics of four individuals with compound heterozygosity for Hb G-Makassar/Hb E cases in Malaysia. To the best of our knowledge, these are the only four individuals with this genotype reported in the literature. Case Series We present four cases of compound heterozygosity for Hb G-Makassar/Hb E identified from October 2014 to January 2021. All the cases were incidental findings whereby the screening Hb analysis showed the presence of peaks in both Hb S and Hb E zones on capillary electrophoresis (CE) and cation-exchange high-performance liquid chromatography (HPLC). Molecular analysis confirmed the findings of compound heterozygous Hb G-Makassar/Hb E. Two cases had a history of anemia secondary to unrelated conditions that resolved with treatment of the underlying cause. The other two cases were asymptomatic individuals who were detected through Malaysia's National Thalassemia Screening program. On the last follow-up, all the individuals were well, non-transfusion dependent, and had no reported history of chronic anemia, bleeding, hemolysis or thromboembolism complications. Conclusion The cases reported here highlight the possibilities for rare compound heterozygous states in multi-ethnicity populations such as Malaysia. Compound heterozygous Hb G-Makassar/Hb E individuals are clinically silent with laboratory values suggesting microcytic and hypochromic red blood cells. Further local epidemiology or population studies with genotyping tests are required for a better understanding of the diversity of its clinical phenotype.
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Affiliation(s)
- Roszymah Hamzah
- Hematology Department, Ampang Hospital, Ampang, Selangor, Malaysia
| | - Ahmad Sabry Mohamad
- Medical Engineering, Universiti Kuala Lumpur-British Malaysian Institute, Gombak, Selangor, Malaysia
| | - Norafiza Mohd Yasin
- Institute for Medical Research, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Ezalia Esa
- Institute for Medical Research, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Guo Chen
- Beam Therapeutics Inc., Cambridge, MA, USA
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Phannasil P, Sukhuma C, Nauphar D, Nuamsee K, Svasti S. Up-regulation of microRNA 101-3p during erythropoiesis in β-thalassemia/HbE. Blood Cells Mol Dis 2023; 103:102781. [PMID: 37478523 DOI: 10.1016/j.bcmd.2023.102781] [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: 03/02/2023] [Revised: 06/18/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
Ineffective erythropoiesis is the main cause of anemia in β-thalassemia. The crucial hallmark of ineffective erythropoiesis is the high proliferation of erythroblast. microRNA (miR/miRNA) involves several biological processes, including cell proliferation and erythropoiesis. miR-101 was widely studied and associated with proliferation in several types of cancer. However, the miR-101-3p has not been studied in β-thalassemia/HbE. Therefore, this study aims to investigate the expression of miR-101-3p during erythropoiesis in β-thalassemia/HbE. The results showed that miR-101-3p was upregulated in the erythroblast of β-thalassemia/HbE patients on day 7, indicating that miR-101-3p may be involved with high proliferation in β-thalassemia/HbE. Therefore, the mRNA targets of miR-101-3p including Rac1, SUB1, TET2, and TRIM44 were investigated to determine the mechanisms involved with high proliferation of β-thalassemia/HbE erythroblasts. Rac1 expression was significantly reduced at day 11 in severe β-thalassemia/HbE compared to normal controls and mild β-thalassemia/HbE. SUB1 gene expression was significantly lower in severe β-thalassemia/HbE compared to normal controls at day 9 of culture. For TET2 and TRIM44 expression, a significant difference was not observed among normal and β-thalassemia/HbE. However, the high expression of miR-101-3p at day 7 and these target genes was not correlated, suggesting that this miRNA may regulate ineffective erythropoiesis in β-thalassemia/HbE via other target genes.
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Affiliation(s)
- Phatchariya Phannasil
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Chanyanat Sukhuma
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Donny Nauphar
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand; Doctoral Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat 10430, Indonesia; Department of Genetics, Faculty of Medicine, Universitas Swadaya Gunung Jati, Cirebon 45132, West-Java, Indonesia
| | - Khanita Nuamsee
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Saovaros Svasti
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand; Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok 10400, Thailand.
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Jomoui W, Satthakarn S, Panyasai S. Molecular understanding of unusual HbE-β +-thalassemia with Hb phenotype similar to HbE heterozygote: simple and rapid differentiation using HbE levels. Ann Med 2023; 55:2267054. [PMID: 37816374 PMCID: PMC10732225 DOI: 10.1080/07853890.2023.2267054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Low HbF expression in HbE-β+-thalassemia may lead to misdiagnosis of HbE heterozygosity. We aimed to characterize the β- and α-globin genes and the modifying factors related to HbF expression in patients with an Hb phenotype similar to that of HbE heterozygotes. Furthermore, screening tools for differentiating HbE-β+-thalassemia from HbE heterozygotes have been investigated. PARTICIPANTS AND METHODS A total of 2133 participants with HbE and HbA with varying HbF levels were recruited. Polymerase chain reaction-based DNA analysis and sequencing were performed to characterize β- and α-globin genes. DNA polymorphism at position -158 nt 5' to Gγ-globin was performed by XmnI restriction digestion. Receiver operating characteristic (ROC) curves were constructed using the area under the curve (AUC). Cutoff values of HbA2, HbE, and HbF levels for the differentiation of HbE-β+-thalassemia from HbE heterozygotes were determined. RESULTS Five β+-thalassemia mutations trans to βE-gene (β-87(C>A), β-31(A>G), β-28(A>G), β19(A>G), and β126(T>G)) were identified in 79 patients. Among these, 54 presented with low HbF levels, and 25 presented with high HbF levels. ROC curve analysis revealed an excellent AUC of 1.000 (95% confidence interval:1.000-1.000) for HbE levels, and a cut-off point of ≥35.0% had 100.0% sensitivity, specificity, and Youden's index for differentiating HbE-β+-thalassemia from HbE heterozygotes. The proportion of α-thalassemia mutations was 46.3 and 8.0% among HbE-β+-thalassemia patients with low and high HbF levels, respectively. Two rare α-thalassemia mutations (Cap +14(C>G) and initiation codon (ATG>-TG)) of α2-globin genes were identified. The genotype and allele of the polymorphism at -158 nt 5' to Gγ-globin was found to be negatively associated with HbF expression. CONCLUSIONS HbE-β+-thalassemia cannot be disregarded until appropriate DNA analysis is performed, and the detection of α-thalassemia mutations should always be performed under these conditions. An HbE level ≥35.0% may indicate screening of samples for DNA analysis for HbE-β+-thalassemia diagnosis.
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Affiliation(s)
- Wittaya Jomoui
- Department of Pathology, Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand
- Clinical Research Centre, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Surada Satthakarn
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Sitthichai Panyasai
- Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
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Bhattarai U, Adhikari D, Gautam A, Anand A, Shah B, Sharma SK. Severe homozygous HbE disease: the first case report from Nepal. Oxf Med Case Reports 2023; 2023:omad062. [PMID: 37377720 PMCID: PMC10292636 DOI: 10.1093/omcr/omad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/08/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Hemoglobin E (HbE) is the most prevalent hemoglobinopathy in the eastern Indian subcontinent. We presented the case of a 53-year-old male from Nepal with a history of multiple blood transfusions who presented with abdominal fullness for 15 years and easy fatigability for 2 months. He had pallor and massive splenomegaly. Laboratory parameters showed pancytopenia with microcytic anemia, indirect hyperbilirubinemia, target cells in the peripheral smear and iron overload. A computed tomography scan of the abdomen showed multiple splenic infarcts. Hemoglobin electrophoresis was suggestive of HbE homozygous disease. Based on these findings, we made a diagnosis of HbE homozygous disease. We provided symptomatic treatment and folic acid supplementation and counseled him for splenectomy and genetic screening. Our case highlighted the uncommon presentation of Hb E disease.
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Affiliation(s)
- Urza Bhattarai
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dibasha Adhikari
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Arun Gautam
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ayush Anand
- Correspondence address. B.P. Koirala Institute of Health Sciences, Dharan 56700, Nepal. Tel: +9779824381743; E-mail:
| | - Bhupendra Shah
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Dahlsgaard-Wallenius SE, Juul-Jensen K, Nielsen AL, Hildebrandt MG. Extramedullary Hematopoiesis Visualized on FDG-PET/CT in a Patient with Beta-Thalassemia. Nucl Med Mol Imaging 2022; 56:328-330. [PMID: 36425274 PMCID: PMC9679092 DOI: 10.1007/s13139-022-00773-3] [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: 05/24/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022] Open
Abstract
Beta-thalassemia is an inherited blood disorder caused by reduced or absent synthesis of the beta chains of hemoglobin, resulting in decreased hemoglobin production. Symptoms depend on the type of beta-thalassemia ranging from no symptoms to severe illness. Ineffective erythropoiesis leads to a sequence of events responsible for bone marrow expansion, anemia, hemolysis, splenomegaly, increased iron absorption, and sometimes extramedullary hematopoiesis (EMH). We report an interesting case with EMH visualized on FDG-PET/CT and where FDG-PET/CT has also found the focus of a severe infection in a patient with beta-thalassemia.
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Affiliation(s)
| | - Karen Juul-Jensen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | | | - Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology (CIMT), Odense University Hospital, Odense, Denmark
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Khan D, Sharma A, Sagar S, Thayumanavan T, Kumar R. A Curious Case of Suspicious Lymphadenopathy in a Hereditary Spherocytosis Patient Reported as Extramedullary Hematopoiesis. Indian J Nucl Med 2022; 37:293-294. [PMID: 36686299 PMCID: PMC9855240 DOI: 10.4103/ijnm.ijnm_10_22] [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: 01/12/2022] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 01/24/2023] Open
Abstract
We present a case of a 23-year-old male patient with complaints of fever, cough, and persistent anemia for the past 6 months and with a known history of hereditary spherocytosis. Computed tomography (CT) thorax demonstrated multiple paravertebral lesions in the bilateral thoracic cavities, suggestive of lymphadenopathy; subsequently, 18Flurodeoxyglucose PET/CT was done with suspicion of lymphoma, which showed no significant metabolic activity in those lesions. Thus, in view of clinical and metabolic status, lesions were considered extramedullary hematopoiesis (EMH). This case highlights the importance of considering EMH, while interpreting suspicious lymphadenopathy in cases of chronic anemia and also possible scan findings in the same.
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Affiliation(s)
- Dikhra Khan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anshul Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sambit Sagar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - T. Thayumanavan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Nuinoon M, Rattanaporn P, Benjchareonwong T, Choowet A, Suwanno K, Saekoo N, Lekpetch K, Thipthara O, Svasti S, Fucharoen S. Genetic predictions of life expectancy in southern Thai patients with β0‑thalassemia/Hb E. Biomed Rep 2022; 16:52. [PMID: 35620315 PMCID: PMC9112403 DOI: 10.3892/br.2022.1535] [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: 02/08/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
The types of β-thalassemia mutations, α-thalassemia interactions, and Hb F-associated SNPs have been described in association with variable disease phenotypes. This study aimed to determine the updated spectrum of β-thalassemia mutations and evaluate the contribution of primary and secondary genetic modifiers and SNPs to disease severity, age at onset, and predicted life expectancy in southern Thai β-thalassemia patients. A total of 181 β-thalassemia patients were enrolled and 135 β0-thalassemia/Hb E patients without α-thalassemia interactions were divided into three categories according to disease severity, age at onset, and predicted life expectancy. A total of 16 β-thalassemia mutations were identified in this study, and the three most common β-thalassemia mutations accounted for 61.4% of all mutations. It was also found that the XmnI polymorphism and rs2071348 were associated with age at onset and the predicted life expectancy. More than 82% of β0-thalassemia/Hb E patients with CC genotype (XmnI) were 3 years old or younger at onset. Additionally, >90% of the higher predicted life expectancy in β0-thalassemia/Hb E patients had the T allele of XmnI. Therefore, genetic prediction for age at onset and life expectancy is beneficial and practical during prenatal diagnosis or newborn screening for better genetic counseling and optimal management.
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Affiliation(s)
- Manit Nuinoon
- Hematology and Transfusion Science Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Patchara Rattanaporn
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Thongchai Benjchareonwong
- Department of Clinical Pathology and Anatomy, Chumphon Ket‑Udomsak Hospital, Chumphon 86000, Thailand
| | - Anuchit Choowet
- Department of Pediatrics, Vachira Phuket Hospital, Phuket 83000, Thailand
| | - Komsai Suwanno
- Department of Internal Medicine, Hatyai Hospital, Songkhla 90110, Thailand
| | - Ngamta Saekoo
- Department of Internal Medicine, Hatyai Hospital, Songkhla 90110, Thailand
| | - Krongjit Lekpetch
- Department of Pediatrics, Suratthani Hospital, Suratthani 84000, Thailand
| | - Orapan Thipthara
- Department of Pediatrics, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat 80000, Thailand
| | - Saovaros Svasti
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
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Mandani S, Rezaei B, Ensafi AA, Rezaei P. Ultrasensitive electrochemical molecularly imprinted sensor based on AuE/Ag-MOF@MC for determination of hemoglobin using response surface methodology. Anal Bioanal Chem 2021; 413:4895-4906. [PMID: 34236471 DOI: 10.1007/s00216-021-03453-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/30/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
Considering the importance of determining the levels of hemoglobin (Hb) as a vital protein in red blood cells, in this work a highly sensitive electrochemical sensor was developed based on a gold electrode (AuE) modified with Ag metal-organic framework mesoporous carbon (Ag-MOF@MC) and molecularly imprinted polymers (MIPs). To that end, the MIP layer was formed on the Ag-MOF@MC by implanting Hb as the pattern molecule during the polymerization. The modified electrode was designed using electrochemical approaches including differential pulse voltammetry (DPV), electrochemical impedance spectroscopy (EIS), and cyclic voltammetry (CV). Using a response level experimental design method, the most important parameters affecting the reaction of the sensing system including pH, incubation time, and scanning rate were optimized. Following the same route, the Hb concentration, pH, temperature, and elution times were optimized to prepare the imprinted polymer layer on the Ag-MOF@MC surface. By exploiting DPV techniques based on the optimal parameters, the electrochemical response of the AuE/Ag-MOF@MC-MIPs for Hb determination was recorded in a wide linear dynamic range (LDR) of 0.2 pM to 1000 nM, with a limit of detection (LOD) of 0.09 pM. Moreover, the Ag-MOF@MC-MIP sensing system showed good stability, high selectivity, and acceptable reproducibility for Hb determination. The sensing system was successfully applied for Hb determination in real blood samples, and the results were compared with those of the standard methods for Hb determination. Acceptable recovery (99.0%) and RDS% (4.6%) confirmed the applicability and reliability of the designed Hb sensing system.
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Affiliation(s)
- Sudabe Mandani
- Department of Chemistry, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Behzad Rezaei
- Department of Chemistry, Isfahan University of Technology, Isfahan, 84156-83111, Iran.
| | - Ali Asghar Ensafi
- Department of Chemistry, Isfahan University of Technology, Isfahan, 84156-83111, Iran
| | - Parisa Rezaei
- Department of Medical Laboratory Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, 81745-33871, Iran
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Hatairaktham S, Masaratana P, Hantaweepant C, Srisawat C, Sirivatanauksorn V, Siritanaratkul N, Panichkul N, Kalpravidh RW. Curcuminoids supplementation ameliorates iron overload, oxidative stress, hypercoagulability, and inflammation in non-transfusion-dependent β-thalassemia/Hb E patients. Ann Hematol 2021; 100:891-901. [PMID: 33388858 DOI: 10.1007/s00277-020-04379-7] [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: 08/03/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Curcuminoids, polyphenol compounds in turmeric, possess several pharmacological properties including antioxidant, iron-chelating, and anti-inflammatory activities. Effects of curcuminoids in thalassemia patients have been explored in a limited number of studies using different doses of curcuminoids. The present study aims to evaluate the effects of 24-week curcuminoids supplementation at the dosage of 500 and 1000 mg/day on iron overload, oxidative stress, hypercoagulability, and inflammation in non-transfused β-thalassemia/Hb E patients. In general, both curcuminoids dosages significantly lowered the levels of oxidative stress, hypercoagulability, and inflammatory markers in the patients. In contrast, reductions in iron parameter levels were more remarkable in the 1000 mg/day group. Subgroup analysis revealed that a marker of hypercoagulability was significantly decreased only in patients with baseline ferritin ≤ 1000 ng/ml independently of curcuminoids dosage. Moreover, the alleviation of iron loading parameters was more remarkable in patients with baseline ferritin > 1000 ng/ml who receive 1000 mg/day curcuminoids. On the other hand, the responses of oxidative stress markers were higher with 500 mg/day curcuminoids regardless of baseline ferritin levels. Our study suggests that baseline ferritin levels should be considered in the supplementation of curcuminoids and the appropriate curcuminoids dosage might differ according to the required therapeutic effect. Thai Clinical Trials Registry (TCTR): TCTR20200731003; July 31, 2020 "retrospectively registered".
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Affiliation(s)
- Suneerat Hatairaktham
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Patarabutr Masaratana
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Chattree Hantaweepant
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatchawan Srisawat
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Vorapan Sirivatanauksorn
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Noppadol Siritanaratkul
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narumol Panichkul
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Ruchaneekorn W Kalpravidh
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
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11
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Polprasert C, Wongprachar P, Suksusut A, Settapiboon R, Amornsirivat S, Sophonphan J, Uaprasert N, Sucharitchan P, Rojnuckarin P. Comprehensive screening for coexisting heterozygous α 0-thalassemia in hemoglobin E trait. ACTA ACUST UNITED AC 2020; 25:276-279. [PMID: 32633642 DOI: 10.1080/16078454.2020.1786972] [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: 10/23/2022]
Abstract
Objectives: A sensitive screening for the coexistence of α0-thalassemia and the hemoglobin E (Hb E) trait is important to identify at-risk couples for hydrops fetalis. However, previous cutoff values have shown a positive predictive value (PPV) of only 50% or less. This study aimed to define more specific indicators to reduce the need for DNA tests. Methods: Patients with Hb E trait, as diagnosed by high performance liquid chromatography (HPLC) and/or isoelectric focusing (IEF) techniques, were tested for α0-thalassemia and α+-thalassemia deletions using multiplex gap polymerase chain reaction. Iron deficiency anemia (IDA) were excluded using a red cell distribution width (RDW) of more than 14.5%. Results: From 390 specimens, suitable cutoff values showing a 100% sensitivity for detection of heterozygous α0-thalassemia were an Hb E level of less than 22% by HPLC, a mean corpuscular volume (MCV) of less than 72 fL, and a mean corpuscular hemoglobin (MCH) level of less than 22.5 pg. Comparable results were obtained in the validation cohort (N = 179). Using a combination of Hb E with either MCV or MCH cutoff points gave a PPV of 76.2% and 77.4%, respectively. Discussion: IDA was reported to interfere with Hb E level. In this study, we excluded IDA using RDW of more than 14.5% to enhance the test specificity. Conclusion: Lower cutoff screening values can be used to exclude α0-thalassemia in the Hb E trait yielding a higher specificity in a normal RDW condition. This can save the cost and labor of DNA testing.
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Affiliation(s)
- Chantana Polprasert
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Faculty of Medicine, Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
| | - Piroonrut Wongprachar
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Amornchai Suksusut
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rung Settapiboon
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Supaporn Amornsirivat
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jiratchaya Sophonphan
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
| | - Noppacharn Uaprasert
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pranee Sucharitchan
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Faculty of Medicine, Department of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Faculty of Medicine, Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand
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12
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Abdullah UYH, Ibrahim HM, Mahmud NB, Salleh MZ, Teh LK, Noorizhab MNFB, Zilfalil BA, Jassim HM, Wilairat P, Fucharoen S. Genotype-Phenotype Correlation of β-Thalassemia in Malaysian Population: Toward Effective Genetic Counseling. Hemoglobin 2020; 44:184-189. [PMID: 32586164 DOI: 10.1080/03630269.2020.1781652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Effective prevention of β-thalassemia (β-thal) requires strategies to detect at-risk couples. This is the first study attempting to assess the prevalence of silent β-thal carriers in the Malaysian population. Hematological and clinical parameters were evaluated in healthy blood donors and patients with β-thal trait, Hb E (HBB: c.79G>A)/β-thal and β-thal major (β-TM). β-Globin gene sequencing was carried out for 52 healthy blood donors, 48 patients with Hb E/β-thal, 34 patients with β-TM and 38 patients with β-thal trait. The prevalence of silent β-thal carrier phenotypes found in 25.0% of healthy Malaysian blood donors indicates the need for clinician's awareness of this type in evaluating β-thal in Malaysia. Patients with β-TM present at a significantly younger age at initial diagnosis and require more blood transfusions compared to those with Hb E/β-thal. The time at which genomic DNA was extracted after blood collection, particularly from patients with β-TM and Hb E/β-thal, was found to be an important determinant of the quality of the results of the β-globin sequencing. Public education and communication campaigns are recommended as apparently healthy individuals have few or no symptoms and normal or borderline hematological parameters. β-Globin gene mutation characterization and screening for silent β-thal carriers in regions prevalent with β-thal are recommended to develop more effective genetic counseling and management of β-thal.
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Affiliation(s)
- Uday Y H Abdullah
- Department of Pathology, Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Hishamshah M Ibrahim
- Paediatric Haematology, Oncology and Haemopoietic Stem Cell Transplant Unit, Hospital Kuala Lumpur (HKL) Jalan Pahang, Kuala Lumpur, Malaysia
| | - Noraesah Binti Mahmud
- Department of Pathology, Hospital Kuala Lumpur (HKL) Jalan Pahang, Kuala Lumpur, Malaysia
| | - Mohamad Zaki Salleh
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi Mara (UiTM), Bandar Puncak Alam, Malaysia
| | - Lay Kek Teh
- Integrative Pharmacogenomics Institute (iPROMISE), Universiti Teknologi Mara (UiTM), Bandar Puncak Alam, Malaysia
| | | | - Bin Alwi Zilfalil
- Department of Paediatric, School of Medical Science, Health Campus, Univesiti Sains Malaysia (USM), Kelantan, Malaysia
| | - Haitham Muhammed Jassim
- Department of Emergency, Rockingham Peel Group, South Metropolitan Health Service, Rockingham, Australia
| | - Prapin Wilairat
- National Doping Control Centre, Mahidol University, Bangkok, Thailand
| | - Suthat Fucharoen
- Thalassaemia Research Centre, Institute of Molecular Biosciences, Mahidol University, Nakornpathom, Thailand
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13
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Iron status and inherited haemoglobin disorders modify the effects of micronutrient powders on linear growth and morbidity among young Lao children in a double-blind randomised trial. Br J Nutr 2020; 122:895-909. [PMID: 31303184 PMCID: PMC7672373 DOI: 10.1017/s0007114519001715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes, but modifying factors are unknown. We aimed to investigate whether Fe status and inherited Hb disorders (IHbD) modify the impact of MNP on growth and diarrhoea among young Lao children. In a double-blind controlled trial, 1704 children of age 6–23 months were randomised to daily MNP (with 6 mg Fe plus fourteen micronutrients) or placebo for about 36 weeks. IHbD, and baseline and final Hb, Fe status and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrolment, 55·6 % were anaemic; only 39·3 % had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhoea prevalence. Baseline Hb modified the effect of MNP on length-for-age (LAZ) (P for interaction = 0·082). Among children who were initially non-anaemic, the final mean LAZ in the MNP group was slightly lower (–1·93 (95 % CI –1·88, –1·97)) v. placebo (–1·88 (95 % CI –1·83, –1·92)), and the opposite occurred among initially anaemic children (final mean LAZ –1·90 (95 % CI –1·86, –1·94) in MNP v. –1·92 (95 % CI –1·88, –1·96) in placebo). IHbD modified the effect on diarrhoea prevalence (P = 0·095). Among children with IHbD, the MNP group had higher diarrhoea prevalence (1·37 (95 % CI 1·17, 1·59) v. 1·21 (95 % CI 1·04, 1·41)), while it was lower among children without IHbD who received MNP (1·15 (95 % CI 0·95, 1·39) v. 1·37 (95 % CI 1·13, 1·64)). In conclusion, there was a small adverse effect of MNP on growth among non-anaemic children and on diarrhoea prevalence among children with IHbD.
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14
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Thiengtavor C, Siriworadetkun S, Paiboonsukwong K, Fucharoen S, Pattanapanyasat K, Vadolas J, Svasti S, Chaichompoo P. Increased ferritin levels in non-transfusion-dependent β°-thalassaemia/HbE are associated with reduced CXCR2 expression and neutrophil migration. Br J Haematol 2019; 189:187-198. [PMID: 31884679 DOI: 10.1111/bjh.16295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/14/2019] [Indexed: 01/11/2023]
Abstract
Severe bacterial infection is a major complication causing morbidity and mortality in β-thalassaemia/HbE patients. Innate immunity constitutes the first line of defence against bacterial infection. This study aimed to comprehensively investigate the innate immune phenotype and function related to factors predisposing to infection in non-transfusion-dependent (NTD) β°-thalassaemia/HbE patients. Twenty-six patients and 17 healthy subjects were recruited to determine complement activity (C3, C4, mannose-binding lectin and CH50) and surface receptor expression including markers of phagocytosis (CD11b, CD16 and C3bR), inflammation (C5aR) and migration (CD11b, CXCR1 and CXCR2) on neutrophils and monocytes. In addition, phagocytosis and oxidative burst activity of neutrophils and monocytes against Escherichia coli and neutrophil migration were examined. Decreased C3 and surface expression of CD11b and C3bR on neutrophils were found in patients. However, phagocytosis of neutrophils in patients was still in the normal range. Interestingly, patients displayed a significant reduction of surface expression of CXCR2 [1705 ± 217 mean fluorescent intensity (MFI)] on neutrophils, leading to impaired neutrophil migration (9·2 ± 7·7%) when compared to neutrophils from healthy subjects (2261 ± 627 MFI and 27·8 ± 9% respectively). Moreover, surface expression of CXCR2 on neutrophils was associated with splenectomy status, serum ferritin and haemoglobin levels. Therefore, impaired neutrophil migration could contribute to the increased susceptibility to infection seen in NTD β°-thalassaemia/HbE patients.
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Affiliation(s)
- Chayada Thiengtavor
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand.,Faculty of Optometry, Ramkhamhaeng University, Bangkok, Thailand
| | - Sirikwan Siriworadetkun
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand.,Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Kittiphong Paiboonsukwong
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Kovit Pattanapanyasat
- Siriraj Center of Research Excellence for Microparticle and Exosome in Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jim Vadolas
- Centre for Cancer Research, Hudson Institute of Medical Research, Melbourne, Australia.,Department of Molecular and Translational Science, Monash University, Melbourne, Australia
| | - Saovaros Svasti
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand.,Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Pornthip Chaichompoo
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
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15
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Satirapod C, Sukprasert M, Panthan B, Charoenyingwattana A, Chitayanan P, Chantratita W, Choktanasiri W, Trachoo O, Hongeng S. Clinical utility of combined preimplantation genetic testing methods in couples at risk of passing on beta thalassemia/hemoglobin E disease: A retrospective review from a single center. PLoS One 2019; 14:e0225457. [PMID: 31751397 PMCID: PMC6872132 DOI: 10.1371/journal.pone.0225457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022] Open
Abstract
Thalassemia and hemoglobinopathy is a group of hereditary blood disorder with diverse clinical manifestation inherited by autosomal recessive manner. The Beta thalassemia/Hemoglobin E disease (HbE/βthal) causes a variable degree of hemolysis and the most severe form of HbE/βthal disease develop a lifelong transfusion-dependent anemia. Preimplantation genetic testing (PGT) is an established procedure of embryo genetic analysis to avoid the risk of passing on this particular condition from the carrier parents to their offspring. Preimplantation genetic testing for chromosomal aneuploidy (PGT-A) also facilitates the selection of embryos without chromosomal aberration resulting in the successful embryo implantation rate. Herein, we study the clinical outcome of using combined PGT-M and PGT-A in couples at risk of passing on HbE/βthal disease. The study was performed from January 2016 to December 2017. PGT-M was developed using short tandem repeat linkage analysis around the beta globin gene cluster and direct mutation testing using primer extension-based mini-sequencing. Thereafter, we recruited 15 couples at risk of passing on HbE/βthal disease who underwent a combined total of 22 IVF cycles. PGT was performed in 106 embryos with a 3.89% allele drop-out rate. Using combined PGT-M and PGT-A methods, 80% of women obtained satisfactory genetic testing results and were able to undergo embryo transfer within the first two cycles. The successful implantation rate was 64.29%. PGT accuracy was evaluated by prenatal and postnatal genetic confirmation and 100% had a genetic status consistent with PGT results. The overall clinical outcome of successful live birth for couples at risk of producing offspring with HbE/βthal was 53.33%. Conclusively, combined PGT-M and PGT-A is a useful technology to prevent HbE/βthal disease in the offspring of recessive carriers.
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Affiliation(s)
- Chonthicha Satirapod
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Matchuporn Sukprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bhakbhoom Panthan
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Angkana Charoenyingwattana
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wasun Chantratita
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wicharn Choktanasiri
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Objoon Trachoo
- Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Nuinoon M, Thipthara O, Fucharoen S. Compound Heterozygote for a Novel Elongated C-Terminal β-Globin Variant (HBB: c.364delG) and Hb E (HBB: c.79G>A) with Heterozygous α-Thalassemia-2. Hemoglobin 2019; 43:52-55. [DOI: 10.1080/03630269.2019.1599907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Manit Nuinoon
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Orapan Thipthara
- Department of Pediatrics, Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
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17
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Chaichompoo P, Qillah A, Sirankapracha P, Kaewchuchuen J, Rimthong P, Paiboonsukwong K, Fucharoen S, Svasti S, Worawichawong S. Abnormal red blood cell morphological changes in thalassaemia associated with iron overload and oxidative stress. J Clin Pathol 2019; 72:520-524. [PMID: 31010830 DOI: 10.1136/jclinpath-2019-205775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 12/20/2022]
Abstract
AIMS Iron overload is a major factor contributing to the overall pathology of thalassaemia, which is primarily mediated by ineffective erythropoiesis and shorter mature red blood cell (RBC) survival. Iron accumulation in RBCs generates reactive oxygen species (ROS) that cause cellular damage such as lipid peroxidation and RBC membrane deformation. Abnormal RBCs in patients with thalassaemia are commonly known as microcytic hypochromic anaemia with poikilocytosis. However, iron and ROS accumulation in RBCs as related to RBC morphological changes in patients with thalassaemia has not been reported. METHODS Twenty-one patients with thalassaemia, including HbH, HbH with Hb Constant Spring and β-thalassaemia/HbE (splenectomy and non-splenectomy) genotypes, and five normal subjects were recruited. RBC morphology was analysed by light and scanning electron microscopy. Systemic and RBC iron status and oxidative stress were examined. RESULTS Decreased normocytes were observed in the samples of patients with thalassaemia, with RBC morphological abnormality being related to the type of disease (α-thalassaemia or β-thalassaemia) and splenic status. Target cells and crenated cells were mainly found in splenectomised patients with β-thalassaemia/HbE, while target cells and teardrop cells were found in non-splenectomised patients. Patients with thalassaemia had high levels of serum ferritin, red cell ferritin and ROS in RBCs compared with normal subjects (p<0.05). Negative correlations between the amount of normocytes and serum ferritin (rs=-0.518, p=0.011), red cell ferritin (rs=-0.467, p=0.025) or ROS in RBCs (rs=-0.672, p<0.001) were observed. CONCLUSIONS Iron overload and its consequent intracellular oxidative stress in RBCs were associated with reduce normocytes in patients with thalassaemia.
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Affiliation(s)
- Pornthip Chaichompoo
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Ariz Qillah
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Pornpan Sirankapracha
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Jirada Kaewchuchuen
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Poramate Rimthong
- Electron Microscopy Unit, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittiphong Paiboonsukwong
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
| | - Saovaros Svasti
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand.,Department of Biochemistry, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Electron Microscopy Unit, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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18
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Wahidiyat PA, Sastroasmoro S, Fucharoen S, Setianingsih I, Putriasih SA. Applicability of a clinical scoring criteria for disease severity of ß-thalassemia/hemoglobin E in Indonesia. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v27i1.1779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Background: β-thalassemia/HbE presents with a variety of clinical symptoms, from asymptomatic to severe, requiring routine transfusion. However, there is currently no agreed classification system to stratify patients based on clinical severity of β-thalassemia/HbE in the Indonesian population. Thailand has already established a classification system, and this study aimed to identify the applicability of the Thailand clinical scoring criteria to determine the severity of β-thalassemia/HbE in the Indonesian population.Methods: This descriptive study was conducted by evaluating patients with β-thalassemia/HbE, who were classified into mild, moderate, or severe groups based on the Thailand clinical scoring criteria.Results: A total of 293 subjects with β-thalassemia/HbE were included. Based on this clinical scoring criteria, it was found that only 21.5% of patients were classified as mild, and the remaining 35.5% and 44% were classified as moderate and severe respectively. Approximately 68.2% of the subjects in the severe group received transfusion at <4 years old, while only 10% of those in the mild group were transfused at the same age. In the mild group, only 10% of the subjects underwent routine transfusion, compared to 98.4% of the subjects in the severe group. In addition, only 27% of the subjects in the mild group showed stunted growth, while that in the moderate and severe groups were 54.5% and 86.8%, respectively.Conclusion: Thailand clinical scoring criteria is able to determine the severity of Indonesia thalassemia patient which needs further management, i.e. transfusion and observation of stunted growth. This scoring system will help provide the provision of the most ideal management for the groups of patients based on their requirements.
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19
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Chapin J, Giardina PJ. Thalassemia Syndromes. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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20
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Ekwattanakit S, Riolueang S, Viprakasit V. Interaction between Hb E and Hb Yala (HBB:c.129delT); a novel frameshift beta globin gene mutation, resulting in Hemoglobin E/β 0 thalassemia. Hematology 2017; 23:117-121. [PMID: 28768465 DOI: 10.1080/10245332.2017.1359899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES There are more than 200 known mutations found in patients with β-thalassemia, a possibility to identify an unknown or novel mutation becomes less possible. Here, we report a novel mutation in a patient from Thailand who presented with chronic hemolytic anemia. METHODS A comprehensive hematology and DNA analysis was applied in the index patient and her mother. RESULTS Hematological and hemoglobin analyses were consistent with the clinical diagnosis of Hb E/β0-thalassemia. However, we could find only Hb E heterozygous mutation using our common polymerase chain reaction-based mutation detection of the β-globin genes. Furthermore, the molecular analysis demonstrated a novel T-deletion at codon 42 of the second exon of the β-globin gene which we named 'Hb Yala' according to the origin of this index family. DISCUSSION This mutation was assumed to generate a truncated β-globin chain terminating at codon 60 with possible unstable variant leading to a 'null' or β0-thalassemia. However, the clinical phenotype was surprisingly mild and no other ameliorating genetic factors, including co-inheritance of α-thalassemia and high propensity of Hb F by Xmn I polymorphism, were found. CONCLUSION This report has provided evidence that genotype-phenotype correlation in thalassemia syndromes is highly complex and a correct clinical severity classification of thalassemia should be mainly based on clinical evaluation.
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Affiliation(s)
- Supachai Ekwattanakit
- a Division of Hematology, Department of Internal Medicine , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Suchada Riolueang
- b Siriraj Integrated Center of Excellence for Thalassemia (SiiCOE-T) , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Vip Viprakasit
- b Siriraj Integrated Center of Excellence for Thalassemia (SiiCOE-T) , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.,c Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
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21
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Affiliation(s)
- Viroj Wiwanitkit
- Dr DY Patil University, Pune, India.,Hainan Medical University, Haikou, China.,Joseph Ayobabalola Univerity, Ikeji-Arakeji, Nigeria.,Faculty of Medicine, University of Nis, Nis, Serbia
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22
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Leecharoenkiat K, Tanaka Y, Harada Y, Chaichompoo P, Sarakul O, Abe Y, Smith DR, Fucharoen S, Svasti S, Umemura T. Plasma microRNA-451 as a novel hemolytic marker for β0-thalassemia/HbE disease. Mol Med Rep 2017; 15:2495-2502. [PMID: 28447765 PMCID: PMC5428399 DOI: 10.3892/mmr.2017.6326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/06/2016] [Indexed: 01/13/2023] Open
Abstract
In Southeast Asia, particularly in Thailand, β0-thalassemia/hemoglobin E (HbE) disease is a common hereditary hematological disease. It is associated with pathophysiological processes, such as the intramedullary destruction of immature erythroid cells and peripheral hemolysis of mature red blood cells. MicroRNA (miR) sequences, which are short non-coding RNA that regulate gene expression in a suppressive manner, serve a crucial role in human erythropoiesis. In the present study, the plasma levels of the erythroid-expressed miRNAs, miR‑451 and miR‑155, were analyzed in 23 patients with β0-thalassemia/HbE and 16 control subjects. Reverse transcription‑quantitative polymerase chain reaction analysis revealed significantly higher levels of plasma miR‑451 and miR‑155 in β0‑thalassemia/HbE patients when compared to the control subjects. Notably, among the β0‑thalassemia/HbE patients, a significant increase in miR‑451 levels was detected in severe cases when compared with mild cases. The levels of plasma miR‑451 correlated with reticulocyte and platelet counts. The results suggest that increased plasma miR‑451 levels may be associated with the degree of hemolysis and accelerated erythropoiesis in β0‑thalassemia/HbE patients. In conclusion, miR‑451 may represent a relevant biomarker for pathological erythropoiesis associated with β0-thalassemia/HbE.
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Affiliation(s)
- Kamonlak Leecharoenkiat
- Department of Clinical Microscopy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Yuka Tanaka
- Division of Medical Technology, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka 812‑8582, Japan
| | - Yasuko Harada
- Division of Medical Technology, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka 812‑8582, Japan
| | - Porntip Chaichompoo
- Department of Pathobiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Orawan Sarakul
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Yasunobu Abe
- Department of Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812‑8582, Japan
| | - Duncan Richard Smith
- Molecular Pathology Laboratory, Institute of Molecular Biosciences, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
| | - Suthat Fucharoen
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
| | - Saovaros Svasti
- Thalassemia Research Center, Institute of Molecular Biosciences, Mahidol University, Salaya, Nakhon Pathom 73170, Thailand
| | - Tsukuru Umemura
- Division of Medical Technology, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka 812‑8582, Japan
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23
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Chiasakul T, Uaprasert N. Iron deficiency anemia interfering the diagnosis of compound heterozygosity for Hb constant spring and Hb Paksé: The first case report. J Clin Lab Anal 2017; 32. [PMID: 28244614 DOI: 10.1002/jcla.22187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/29/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diagnosis of thalassemia or hemoglobinopathy concomitant with iron deficiency anemia (IDA) is challenging. METHOD We report a case of 43-year-old female whose diagnosis of compound heterozygosity for hemoglobin Constant Spring (HbCS) and Hb Paksé became apparent after the treatment of IDA. RESULTS Prior to treatment, Hb analysis using isoelectric focusing (IEF) showed HbA 95.6%, HbA2 2.7%, and HbCS 1.7% compatible with heterozygous HbCS. After 4 months of oral iron therapy resulting in an improved Hb level, her HbCS level was substantially increased to 8.7% on IEF suggesting homozygous HbCS. Subsequent DNA analysis using multiplex amplification refractory mutation system analysis revealed compound heterozygosity for HbCS and Hb Paksé. CONCLUSION This case demonstrated that IDA can significantly reduce HbCS/Hb Paksé levels and probably mask the diagnosis of homozygous HbCS, homozygous Hb Paksé or the compound heterozygosity for both hemoglobinopathies by hemoblogin analysis. The test should be repeated after resolution of IDA, or molecular testing should be performed to confirm the diagnosis.
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Affiliation(s)
- Thita Chiasakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Noppacharn Uaprasert
- Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Sripichai O, Fucharoen S. Fetal hemoglobin regulation in β-thalassemia: heterogeneity, modifiers and therapeutic approaches. Expert Rev Hematol 2016; 9:1129-1137. [PMID: 27801605 DOI: 10.1080/17474086.2016.1255142] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Stress erythropoiesis induces fetal hemoglobin (HbF) expression in β-thalassemias, however the level of expression is highly variable. The last decade has seen dramatic advances in our understanding of the molecular regulators of HbF production and the genetic factors associated with HbF levels, leading to the promise of new methods of the clinical induction of HbF. Areas covered: This article will review the heterogeneity and genetic modifiers of HbF and HbF induction therapy in β-thalassemia. Expert commentary: One promising curative β-thalassemia therapy is to induce HbF synthesis in β-thalassemic erythrocytes to therapeutic levels before clinical symptom occurs. Further understanding of HbF level variation and regulation is needed in order to predict the response from HbF-inducing approaches.
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Affiliation(s)
- Orapan Sripichai
- a Thalassemia Research Center, Institute of Molecular Biosciences , Mahidol University , Nakhonpathom , Thailand
| | - Suthat Fucharoen
- a Thalassemia Research Center, Institute of Molecular Biosciences , Mahidol University , Nakhonpathom , Thailand
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Matched sibling donor hematopoietic stem cell transplantation for thalassemia. Curr Opin Hematol 2016; 23:508-514. [DOI: 10.1097/moh.0000000000000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lithanatudom P, Smith DR. Analysis of protein profiling studies of β-thalassemia/Hb E disease. Proteomics Clin Appl 2016; 10:1093-1102. [DOI: 10.1002/prca.201600086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/29/2016] [Accepted: 08/08/2016] [Indexed: 12/14/2022]
Affiliation(s)
| | - Duncan R. Smith
- Institute of Molecular Biosciences; Mahidol University; Nakorn Pathom Thailand
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Natesirinilkul R, Charoenkwan P, Nawarawong W, Boonsri S, Tantivate P, Wongjaikum S, Manowong S, Sanguansermsri T. Hypercoagulable state as demonstrated by thromboelastometry in hemoglobin E/beta-thalassemia patients: Association with clinical severity and splenectomy status. Thromb Res 2016; 140:125-131. [DOI: 10.1016/j.thromres.2016.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/16/2016] [Accepted: 02/12/2016] [Indexed: 01/12/2023]
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Pathirage LPMMK, Wijeweera I, Jayasinghe C, Jayabahu S, Wickramasinghe HR. Episodic spastic paraparesis successfully treated with unaided blood transfusions: a case report. BMC Res Notes 2016; 9:123. [PMID: 26915434 PMCID: PMC4766688 DOI: 10.1186/s13104-016-1918-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extramedullary haemopoiesis is a common compensatory phenomenon in most haemolytic anaemias. However, spinal cord compression due to extramedullary spinal epidural haemopoiesis is an extremely rare complication of thalassemia. In such situation patients present with paraplegia with a sensory level. Usual treatment options are surgery and/or radiotherapy. CASE PRESENTATION Here we report a 27 year old Sri Lankan Muslim male with haemoglobin E-Beta thalassaemia presented with episodic spastic paraparesis when he was anaemic which was dramatically responded to blood transfusion therapy. CONCLUSION Most of the reported cases with paraplegia have been treated with surgery with or without radiation therapy or radiation therapy alone. Our patient makes dramatic recovery after blood transfusion in each presentation.
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Affiliation(s)
| | | | - Chandrika Jayasinghe
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Saumya Jayabahu
- Department of Radiology, Teaching Hospital - Peradeniya, Peradeniya, Sri Lanka.
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Jayasree D, Shaji RV, George B, Mathews V, Srivastava A, Edison ES. Clinical, Hematological and Molecular Analysis of Homozygous Hb E (HBB: c.79G > A) in the Indian Population. Hemoglobin 2015; 40:16-9. [PMID: 26554862 DOI: 10.3109/03630269.2015.1086880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Homozygous Hb E [β26(B8)Glu→Lys; HBB: c.79G > A] is a clinically mild disease with no significant symptoms. Very few studies are available on clinical variability in Hb E disorders. We report the profile of a series of homozygous Hb E patients in the Indian population. We analyzed various genetic factors that contribute to the heterogeneity in the phenotype of homozygous Hb E patients. Analysis of these parameters further enhances our understanding of the Hb E syndrome.
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Affiliation(s)
- Divya Jayasree
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Ramachandran V Shaji
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Biju George
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Vikram Mathews
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Alok Srivastava
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Eunice S Edison
- a Department of Haematology , Christian Medical College , Vellore , Tamil Nadu , India
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Chatterjee T, Chakravarty A, Chakravarty S, Chowdhury MA, Sultana R. Mutation Spectrum ofβ-Thalassemia and Other Hemoglobinopathies in Chittagong, Southeast Bangladesh. Hemoglobin 2015; 39:389-92. [DOI: 10.3109/03630269.2015.1078810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mandal PK, Ghosh MK, Bhattacharyya M. Does Profile of Hemoglobin Eβ-thalassemia Patients Change After Splenectomy? Experience of a Tertiary Thalassemia Care Centre in Eastern India. Indian J Hematol Blood Transfus 2015; 31:446-52. [PMID: 26306069 DOI: 10.1007/s12288-014-0498-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 12/30/2014] [Indexed: 11/26/2022] Open
Abstract
Hemoglobin Eβ-thalassemia is by far the commonest form of thalassemia intermedia. Its phenotype ranges from mild anemia to severe transfusion-dependency necessitating splenectomy in many patients. The present study aimed to systematically analyze both clinical as well as laboratory parameters in profile of Eβ-thalassemia patients after splenectomy in terms of transfusion requirement, infections and other complications. Retrospective study conducted over a period of 3 years included 72 cases of splenectomized Eβ-thalassaemia patients, considering decrease in transfusion requirements, new complications, antibiotic, anti-malarial prophylaxis and iron chelation therapy. Out of 1380 registered Eβ-thalassemia patients, 618 (44.78 %) were regularly transfused and 72(5.22 %) underwent splenectomy. Mean age of diagnosis was 10.3 years. Nineteen patients (26.4 %) underwent splenectomy between 5 and 10 years, 38 cases (52.7 %) between 10 and 20 years. The leading cause (51.39 %) for splenectomy was mechanical discomfort. Mean steady state hemoglobin raised from pre-splenectomy level of 5.43-6.8 gm/dl after splenectomy. Mean transfusion requirement reduced from 18.1 to 7.8 units/year. Mean serum ferritin level increased from 907.58 to 1,091.6 ng/ml. Post-splenectomy; 21 (29.17 %) patients developed facial deformities, 17 (23.6 %) delayed pubertal growth, 11 (15.28 %) venous thromboembolism, five (6.94 %) pulmonary hypertension and four (5.5 %) had extramedullary hematopoiesis. Five (6.96 %) patients had documented bacterial infections and two (2.78 %) suffered from malaria. Forty eight patients (66.67 %) started with iron chelation therapy; but majority (52.7 %) stopped. Major advantage of splenectomy is reduced transfusion requirement, though it cannot prevent skeletal abnormalities and delayed pubertal growth. In resource constraint countries like India, routine anti-malarial and antibacterial prophylaxis is not desirable; iron chelation therapy should be encouraged and ensured.
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Affiliation(s)
- Prakas Kumar Mandal
- Department of Hematology, Nilratan Sircar Medical College, Kolkata, 700014 West Bengal India ; 8C/1/N, Roy Para Road, Kolkata, 700050 West Bengal India
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Palasuwan A, Soogarun S, Suksom D, Pitaksathienkul C, Rousseau AS. Antioxidant status in haemoglobin E carriers after acute and chronic strenuous exercises. Res Sports Med 2015; 23:351-66. [PMID: 26268260 DOI: 10.1080/15438627.2015.1076412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Haemoglobin E (HbE), an unstable haemoglobin, is highly susceptible to oxidative damages. We examined how acute or chronic physiological challenge induced by exercise affects antioxidant response in HbE carriers. Two independent studies were conducted in individuals with HbE trait and paired normal Hb. In study 1, sedentary participants were tested in a graded maximal exercise and blood samples were collected before, immediately after, and 45 minutes after an acute exercise. Our data showed that erythrocyte glutathione peroxidase (GPx) activity failed to recover in HbE carriers after 45 minutes of rest. In study 2, athletes were trained in a 10-week strenuous training and blood samples were collected before and after training period. We found that athletes with HbE carriers showed a larger increase in plasma GPx activity compared to those with normal Hb. These data suggest that HbE carriers could cope with exercise-induced oxidative stress by adjusting endogenous antioxidant markers.
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Affiliation(s)
- Attakorn Palasuwan
- a Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
| | - Suphan Soogarun
- a Faculty of Allied Health Sciences , Chulalongkorn University , Bangkok , Thailand
| | - Daroonwan Suksom
- b Faculty of Sports Science , Chulalongkorn University , Bangkok , Thailand
| | | | - Anne-Sophie Rousseau
- d Faculty of Sport Sciences (UFR STAPS) , University of Nice-Sophia Antipolis , Nice , France
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Goswami BK, Pramanik R, Chakrabarty S, Pal PP, Banerjee S, Bandyopadhyay A. Spectrum of hemoglobin variants in the population of northern region of west bengal: an ethnogenetic proposition. J Family Med Prim Care 2014; 3:219-23. [PMID: 25374858 PMCID: PMC4209676 DOI: 10.4103/2249-4863.141614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Context: The birth of transfusion-dependent states of hemoglobinopathies including thalassemias is preventable by population screening and genetic counseling. Magnitude is not addressed in the Northern Region of West Bengal where many ethnic variants inhabit. Aims and Objectives: The aim of the following study is to find out the burden of different entities of hemoglobinopathies, their correlation with ethnicity and the “at risk” groups. Subjects and Methods: A descriptive study was conducted from the Hematology Unit of North Bengal Medical College over 1 year on the subjects underwent screening for hemoglobinopathies for detection of abnormal hemoglobin (Hb) variants by “cation-exchange high-performance liquid chromatography” principle along with other relevant tests. Statistical Analysis: Data was analyzed by frequency distribution and Chi-square test assuming P value as 95% of the level of significance using the SPSS version 16 (SPSS Inc., Chicago, Illinois, U.S.A). Result: Abnormal Hb variant was 47.5% among 1872. Hb E trait (34.4%) was most common followed by Hb E disease (25.3%) and others. Hb E disorders (92.7%) were observed mostly among Rajbangsi population while E-β-thalassemias (40%) in the Muslims and a heterogeneous pattern noted among tribal and mongoloid. Conclusion: Hb E hemoglobinopathies was high among Rajbangsi and Muslims with identification of some other hemoglobinopathies involving tribal and mongoloid.
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Affiliation(s)
- Bidyut Krishna Goswami
- Department of Pathology, Regional Blood Transfusion Centre, North Bengal Medical College, Dist. Darjeeling, West Bengal, India
| | - Raghunath Pramanik
- Department of Pathology, Regional Blood Transfusion Centre, North Bengal Medical College, Dist. Darjeeling, West Bengal, India
| | - Sudipta Chakrabarty
- Department of Pathology, Regional Blood Transfusion Centre, North Bengal Medical College, Dist. Darjeeling, West Bengal, India
| | - Partha Pratim Pal
- Department of Community Medicine, Regional Blood Transfusion Centre, North Bengal Medical College, Dist. Darjeeling, West Bengal, India
| | - Sarama Banerjee
- Department of Immune-Hematology Medical Officer, Regional Blood Transfusion Centre, North Bengal Medical College, Dist. Darjeeling, West Bengal, India
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Is hemoglobin e gene widely spread in the state of madhya pradesh in central India? Evidence from five typical families. Mediterr J Hematol Infect Dis 2014; 6:e2014060. [PMID: 25237473 PMCID: PMC4165497 DOI: 10.4084/mjhid.2014.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/05/2014] [Indexed: 11/25/2022] Open
Abstract
Background Red cell inherited hemoglobin (Hb) anomalies are commonly encountered in the central region of India. These cause a public health concern due to high level of morbidity, mortality, and fetal loss in the backward, underprivileged, and vulnerable people. Purpose To report five typical families of Hb E disorders for the first time detected and identified from various districts of the state of Madhya Pradesh in central India. Methods Out of a total of 447 couples/families referred from a tertiary hospital in central India for investigations of anemia/hemoglobinopathies during the period from March 2010 to February 2014, we came across five typical rare couples/families of Hb E disorders (1.1%) worthy of detailed investigations that we have reported here. Laboratory investigations were carried out following the standard procedures after cross checking for quality control from time to time. Results For the first time, out of total 27 cases studied, we have encountered nine cases of heterozygous Hb E trait (33.3%), two members (7.4%) with Hb E-β-thalassemia (double heterozygosity), two cases (7.4%) of sickle cell-Hb E disease (double heterozygosity), two β-thalassemia traits (7.4%), three sickle cell traits (11.1%), 9 normal (33.3%), and none with homozygous Hb E disease. Cases of Hb E trait, Hb E-β-thalassemia, and sickle cell-E disease showed moderate to severe anemia, and target cells, and reduced values of red cell indices like red blood cell count, Hb level, hematocrit, mean cell volume, mean cell Hb and mean cell Hb cencentration, describing abnormal hematological profile and clinical manifestations before blood transfusion. Conclusions Double heterozygosity of β-thalassemia with Hb S and Hb E is a rare entity, but occurs with severe clinical manifestations, testifying either migrations and/or genetic admixture. Co-occurrence of Hb E/β-thalassemia in different districts indicates that these anomalies along with other hemoglobinopathies are wide spread in Madhya Pradesh and posing a major genetic burden on vulnerable people of central India.
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Lou JW, Wang T, Liu YH, He Y, Zhong BM, Liu JX, Zhao Y, Ye WL, Li DZ. Prevalence and molecular characterization of structural hemoglobin variants in the Dongguan region of Guangdong province, southern China. Hemoglobin 2014; 38:282-6. [PMID: 24985555 DOI: 10.3109/03630269.2014.928779] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the present study was to find the most prevalent structural hemoglobin (Hb) variants in southern China and to present hematological and molecular data of abnormal Hbs in the population from southern China. The type and frequency of structural Hb variants and their hematological and molecular characteristics were identified in 131 individuals from 30,848 unrelated partners who were referred to the prenatal clinic of Dongguan Maternal & Children Health Hospital, Dongguan, Guangdong, People's Republic of China (PRC) from 2011 to 2013. α-Globin or β-globin chain variants were screened using a capillary electrophoresis (CE) system, and α-globin or β-globin gene mutations were confirmed using sequencing techniques. The gene frequency of Hb variants was 0.4% (131/30,848). The most common α-globin variants were Hb Constant Spring (Hb CS, HBA2: c.427T > C) (0.2%), followed by Hb Q-Thailand (HBA1: c.223G > C) and Hb G-Honolulu (HBA2: c.91G > C). The most common β-globin variant was Hb E (HBB: c.79G > A) (0.09%), followed by Hb New York (HBB: c.341T > A). Our results provide a detailed prevalence and molecular characterization of abnormal Hbs in the population of the Dongguan region. These findings have important implications for a region with a high frequency of α- and β-thalassemias.
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Affiliation(s)
- Ji-Wu Lou
- Prenatal Diagnostic Center, Dongguan Maternal & Children Health Hospital , Dongguan, Guangdong , People's Republic of China and
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Atichartakarn V, Chuncharunee S, Archararit N, Udomsubpayakul U, Aryurachai K. Intravascular hemolysis, vascular endothelial cell activation and thrombophilia in splenectomized patients with hemoglobin E/β-thalassemia disease. Acta Haematol 2014; 132:100-7. [PMID: 24525823 DOI: 10.1159/000355719] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/18/2013] [Indexed: 01/27/2023]
Abstract
The relationship between asplenia and thrombophilia in β-thalassemia disease patients is not yet completely understood. One hundred and ten adult hemoglobin (Hb) E/β-thalassemia (E/β-Thal) disease outpatients, dichotomized according to the presence or absence of the spleen, were prospectively studied for evidence of intravascular hemolysis (IVH) and vascular endothelial cell (EC) activation. Biomarkers of IVH (serum cell-free Hb), EC [soluble E-selectin (sE-selectin) and soluble vascular cell adhesion molecule 1 (sVCAM-1)], platelet and EC [soluble P-selectin (sP-selectin)], inflammation [high-sensitivity C-reactive protein (hs-CRP)], and coagulation [thrombin-antithrombin complexes (TAT)] activation, as well as other selected blood tests were determined. The 61 splenectomized patients had a more severe hemolytic disease and higher levels of cell-free Hb and ferritin (p = 0.003), sE-selectin, sP-selectin, hs-CRP, and TAT (p < 0.05). However, serum levels of sVCAM-1 were not different between the two groups. The findings suggested IVH and EC activation. Together with chronic iron overload and chronic low-grade inflammation activation, the findings extend our understanding of the mechanism of thrombophilia in splenectomized E/β-Thal disease patients.
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Affiliation(s)
- Vichai Atichartakarn
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Chatterjee T, Dewan K, Ganguli P, Das S, Sharma A, Sahni AK, Nath P. A Rare Case of Hemoglobin E Hemoglobinopathy with Gaucher's Disease. Indian J Hematol Blood Transfus 2014; 29:110-2. [PMID: 24426351 DOI: 10.1007/s12288-012-0153-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/21/2012] [Indexed: 10/28/2022] Open
Abstract
Hemoglobin (Hb) E mutation is common in north-east part of our country. The natural history of Hb E thalassemia is highly variable. The phenotype, for patients with similar mutations, can range from asymptomatic to transfusion dependent. Our patient presented at 2 years of age with failure to thrive and hepatosplenomegaly. Routine work up revealed microcytic, hypochromic red blood cells. Hb E homozygous was indicated on electrophoresis and hemoglobin HPLC. Evaluation of parents revealed Haemoglobin E trait in both. Therapeutic splenectomy revealed Gaucher-like cells. β-Glucocerebrosidase levels were low. Presence of Gaucher-like cells with normal β-glucocerebrosidase (pseudo-Gaucher cells) are known in leukemia, multiple myeloma, thalassemia and mycobacterial infections. Co-existence of Gaucher's disease with Hb E mutation is not reported to the best of our knowledge.
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Affiliation(s)
| | | | - P Ganguli
- Army Hospital R and R, Delhi Cantt, India
| | | | | | - A K Sahni
- Army Hospital R and R, Delhi Cantt, India
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Pandey SK, Pandey S, Ranjan R, Shah V, Mishra RM, Sharma M, Saxena R. Phenotypic effect of α-globin gene numbers on Indian sickle β-thalassemia patients. J Clin Lab Anal 2014; 28:110-3. [PMID: 24395608 DOI: 10.1002/jcla.21652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 06/03/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sickle cell β-thalassemia is a compound heterozygous state of β-thalassemia and sickle cell anemia. Patient with these conditions showed mild-to-severe clinical phenotype. OBJECTIVES The objective of this study was to evaluate the effects of α-globin gene numbers on the phenotype of sickle cell β-thalassemia patients. MATERIALS AND METHODS Seventy-five sickle cell β-thalassemia patients were characterized. Clinical, hematological, and molecular characterization was performed in all subjects. Amplified refectory mutation system-polymerase chain reaction was applied for β-thalassemia mutation study while α-genotyping was conducted by Gap-PCR. RESULTS Highest frequency of IVS1-5 (33 out of 75 patients) β-thalassemia genotype was recorded. Twenty-eight patients were reported with α-globin chain deletion while four had α-triplications (Anti α-3.7kb). Sickle β-thalassemia patients with α-chain deletions ameliorate hematological and clinical variables. CONCLUSIONS This study indicates that the coexistence of α-globin chain deletions showed mild phenotype instead of absence of α-chain deletions while the patients with triplication of α-genes express severe phenotype.
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Affiliation(s)
- Sanjay Kumar Pandey
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Akrawinthawong K, Chaowalit N, Chatuparisuth T, Siritanaratkul N. Effectiveness of deferiprone in transfusion‐independent beta‐thalassemia/HbE patients. Hematology 2013; 16:113-22. [DOI: 10.1179/102453311x12940641877768] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Nithima Chaowalit
- Division of CardiologyDepartment of Internal Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Thanasaporn Chatuparisuth
- Division of HematologyDepartment of Internal Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Noppadol Siritanaratkul
- Division of HematologyDepartment of Internal Medicine, Siriraj Hospital, Mahidol University, Thailand
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Tyagi S, Pati HP, Choudhry VP, Saxena R. Clinico-haematological Profile of HbE Syndrome in Adults and Children. Hematology 2013; 9:57-60. [PMID: 14965869 DOI: 10.1080/10245330310001638983] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Haemoglobin E beta thalassemia (HbE beta thalassemia) has a remarkable variability in clinical expression ranging from a mild form of thalassemia intermedia to a transfusion dependent condition. An overlap between the mild variety of HbE beta thalassemia and homozygous HbE disease is common, however, differentiation is required for early institution of therapy and for predicting the later clinical course. Fifty cases of Hb E syndrome comprising of 43 cases of Hb E beta thalassemia and 7 cases of homozygous HbE disease were studied. Their clinico- haematological features and results of high performance liquid chromatography (HPLC) were analysed.
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Affiliation(s)
- S Tyagi
- Department of Haematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
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Muanprasat C, Wongborisuth C, Pathomthongtaweechai N, Satitsri S, Hongeng S. Protection against oxidative stress in beta thalassemia/hemoglobin E erythrocytes by inhibitors of glutathione efflux transporters. PLoS One 2013; 8:e55685. [PMID: 23383265 PMCID: PMC3561311 DOI: 10.1371/journal.pone.0055685] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/28/2012] [Indexed: 02/07/2023] Open
Abstract
In beta thalassemia/hemoglobin E (Hb E), abnormally high levels of oxidative stress account for accelerated senescence and increased destruction of erythrocytes. The present study aimed to investigate the role of glutathione efflux transporters, namely cystic fibrosis transmembrane conductance regulator (CFTR) and multidrug resistance-associated protein 1 (MRP1), in the control of glutathione levels and protection against oxidative challenges in beta thalassemia/Hb E erythrocytes. We found that CFTR protein was expressed in the erythrocytes of beta thalassemia/Hb E patients. Treatments with GlyH-101 (50 µM), a small molecule CFTR inhibitor, and MK571 (50 µM), an MRP1 inhibitor, reduced H2O2-induced free radical generation in the erythrocytes by ∼80% and 50%, respectively. Furthermore, combined treatment with GlyH-101 and MK571 completely abolished the induction of reactive oxygen radicals. Increased oxidative stress in the erythrocytes following H2O2 challenges was accompanied by a decrease in intracellular level of reduced glutathione (GSH), which was prevented by treatments with GlyH-101 and MK571. CMFDA-based assays revealed that GlyH-101 and MK571 reduced H2O2-induced glutathione efflux from the erythrocytes by 87% and 66%, respectively. Interestingly, H2O2-induced osmotic tolerance of erythrocytes, a sign of erythrocyte aging, was ameliorated by treatment with GlyH-101. Our study indicates that oxidative stress induces glutathione efflux via CFTR and MRP1 in beta thalassemia/Hb E erythrocytes. Pharmacological inhibition of glutathione efflux represents a potential therapy to delay aging and premature destruction of erythrocytes in beta thalassemia/Hb E.
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Affiliation(s)
- Chatchai Muanprasat
- Research Center of Transport Protein for Medical Innovation, Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
- * E-mail: (CM); (SH)
| | - Chokdee Wongborisuth
- Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nutthapoom Pathomthongtaweechai
- Research Center of Transport Protein for Medical Innovation, Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Saravut Satitsri
- Research Center of Transport Protein for Medical Innovation, Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail: (CM); (SH)
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Abstract
It is common knowledge that thalassemic patients are under significant oxidative stress. Chronic hemolysis, frequent blood transfusion, and increased intestinal absorption of iron are the main factors that result in iron overload with its subsequent pathophysiologic complications. Iron overload frequently associates with the generation of redox-reactive labile iron, which in turn promotes the production of other reactive oxygen species (ROS). If not neutralized, uncontrolled production of ROS often leads to damage of various intra- and extracellular components such as DNA, proteins, lipids, and small antioxidant molecules among others. A number of endogenous and exogenous defense mechanisms can neutralize and counteract the damaging effects of labile iron and the reactive substances associated with it. Endogenous antioxidant enzymes, such as superoxide dismutase, catalase, glutathione peroxidase, and ferroxidase, may directly or sequentially terminate the activities of ROS. Nonenzymatic endogenous defense mechanisms include metal binding proteins (ceruloplasmin, haptoglobin, albumin, and others) and endogenously produced free radical scavengers (glutathione (GSH), ubiquinols, and uric acid). Exogenous agents that are known to function as antioxidants (vitamins C and E, selenium, and zinc) are mostly diet-derived. In this review, we explore recent findings related to various antioxidative mechanisms operative in thalassemic patients with special emphasis on protein antioxidants.
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Affiliation(s)
- Samir Awadallah
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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Association of xmn I polymorphism and hemoglobin e haplotypes on postnatal gamma globin gene expression in homozygous hemoglobin e. Adv Hematol 2012; 2012:528075. [PMID: 23049556 PMCID: PMC3459260 DOI: 10.1155/2012/528075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/14/2012] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives. To explore the role of cis-regulatory sequences within the β globin gene cluster at chromosome 11 on human γ globin gene expression related to Hb E allele, we analyze baseline hematological data and Hb F values together with β globin haplotypes in homozygous Hb E. Patients and Methods. 80 individuals with molecularly confirmed homozygous Hb E were analyzed for the β globin haplotypes and Xmn I polymorphism using PCR-RFLPs. 74 individuals with complete laboratory data were further studied for association analyses. Results. Eight different β globin haplotypes were found linked to Hb E alleles; three major haplotypes were (a) (III), (b) (V), and (c) (IV) accounting for 94% of Hb E chromosomes. A new haplotype (Th-1) was identified and most likely converted from the major ones. The majority of individuals had Hb F < 5%; only 10.8% of homozygous Hb E had high Hb F (average 10.5%, range 5.8–14.3%). No association was found on a specific haplotype or Xmn I in these individuals with high Hb F, measured by alkaline denaturation. Conclusion. The cis-regulation of γ globin gene expression might not be apparent under a milder condition with lesser globin imbalance such as homozygous Hb E.
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Payen E, Colomb C, Negre O, Beuzard Y, Hehir K, Leboulch P. Lentivirus Vectors in β-Thalassemia. Methods Enzymol 2012; 507:109-24. [DOI: 10.1016/b978-0-12-386509-0.00006-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kochan G, Stephenson H, Breckpot K, Escors D. Human Gene Therapy with Retrovirus and Lentivirus Vectors. SPRINGERBRIEFS IN BIOCHEMISTRY AND MOLECULAR BIOLOGY 2012. [DOI: 10.1007/978-3-0348-0402-8_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Leecharoenkiat A, Wannatung T, Lithanatudom P, Svasti S, Fucharoen S, Chokchaichamnankit D, Srisomsap C, Smith DR. Increased oxidative metabolism is associated with erythroid precursor expansion in β0-thalassaemia/Hb E disease. Blood Cells Mol Dis 2011; 47:143-57. [PMID: 21783389 DOI: 10.1016/j.bcmd.2011.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/22/2011] [Accepted: 06/25/2011] [Indexed: 10/18/2022]
Abstract
Erythropoiesis in β0-thalassaemia/Hb E patients, the most common variant form of β-thalassaemia in Southeast Asia, is characterized by accelerated differentiation and over-expansion of erythroid precursor cells. The mechanism driving this accelerated expansion and differentiation remain unknown. To address this issue a proteomic analysis was undertaken to firstly identify proteins differentially expressed during erythroblast differentiation and a second analysis was undertaken to identify proteins differentially expressed between β0-thalassaemia/Hb E erythroblasts and control erythroblasts. The majority of proteins identified as being differentially expressed between β0-thalassaemia/Hb E and control erythroblasts were constituents of the glycolysis/TCA pathway and levels of oxidative stress correlated with the degree of erythroid expansion. A model was constructed linking these observations with previous studies showing increased phosphorylation of ERK1/2 in thalassemic erythroblasts which predicted the increased activation of PKA, PKB and PKC which Western analysis confirmed. Inhibition of PKA or PKC reduced β0-thalassaemia/Hb E erythroblast differentiation and/or expansion. We propose that increased expansion and differentiation of β0-thalassaemia/Hb E erythroblasts occur as a result of feedback loops acting through increased oxidative metabolism.
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Affiliation(s)
- Amporn Leecharoenkiat
- Molecular Pathology Laboratory, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, Thailand
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Tubsuwan A, Munkongdee T, Jearawiriyapaisarn N, Boonchoy C, Winichagoon P, Fucharoen S, Svasti S. Molecular analysis of globin gene expression in different thalassaemia disorders: individual variation of βE pre-mRNA splicing determine disease severity. Br J Haematol 2011; 154:635-43. [DOI: 10.1111/j.1365-2141.2011.08770.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Limenta LMG, Jirasomprasert T, Jittangprasert P, Wilairat P, Yamanont P, Chantharaksri U, Fucharoen S, Morales NP. Pharmacokinetics of deferiprone in patients with β-thalassaemia: impact of splenectomy and iron status. Clin Pharmacokinet 2011; 50:41-50. [PMID: 21028920 DOI: 10.2165/11536630-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Iron-rich transfusions and/or a compensatory increase in iron absorption ultimately result in iron loading in patients with β-thalassaemia. Hence, without iron chelation, iron accumulates relentlessly. Deferiprone has been shown to be capable of reducing the iron burden in patients with β-thalassaemia. However, there is wide interpatient variation in deferiprone-induced urinary iron excretion (UIE). We hypothesized that splenectomy and iron status might influence the pharmacokinetic profiles of deferiprone in patients with β-thalassaemia/haemoglobin E, and the present study was aimed at examining this hypothesis. STUDY PARTICIPANTS AND METHODS Thirty-one patients with β-thalassaemia/haemoglobin E (20 splenectomized and 11 non-splenectomized patients) were enrolled in the study. After an overnight fast, the subjects received a single oral dose of deferiprone 25 mg/kg of bodyweight. Blood samples were collected pre-dosing and at 15, 30, 45, 60, 90, 120, 180, 240, 300, 360 and 480 minutes after dosing. Urine output was pooled and collected at 0-2, 2-4, 4-8, 8-12 and 12-24 hour intervals. Serum and urine concentrations of deferiprone and its metabolite deferiprone glucuronide were determined using a validated high-performance liquid chromatography method. Serum deferiprone-chelated iron and UIE were determined using a validated colourimetric method. RESULTS No significant difference in the pharmacokinetic parameters of non-conjugated deferiprone was observed between splenectomized and non-splenectomized patients. However, the maximum serum concentration (C(max)) and the area under the serum concentration-time curve (AUC) from time zero to infinity (AUC(∞)) values of deferiprone glucuronide were significantly lower (both p < 0.05) in splenectomized patients (median 53.2 μmol/L and 12 634 μmol • min/L, respectively) than in non-splenectomized patients (median 70.5 μmol/L and 20 601 μmol • min/L, respectively). The C(max) and the AUC from time zero to the time of the last measurable concentration (AUC(last)) values of serum deferiprone-chelated iron, as well as UIE, were significantly higher (p < 0.001) in splenectomized patients (median values 7.1 μmol/L, 1645 μmol • min/L and 77.1 μmol, respectively) than in non-splenectomized patients (median values 3.1 μmol/L, 545 μmol • min/L and 12.5 μmol, respectively). Urinary excretion of non-conjugated deferiprone and deferiprone glucuronide did not differ between the two groups. Further analyses using multiple linear regressions indicated that the iron profiles (non-transferrin-bound iron and ferritin) were significant predictors of the pharmacokinetic parameters of non-conjugated deferiprone, deferiprone-chelated iron and UIE. In addition, splenectomy status was identified as the strongest predictor of the AUC(last) of deferiprone-chelated iron and UIE. CONCLUSION Both iron and splenectomy status have significant effects on the pharmacokinetics and iron chelation efficacy of deferiprone. A greater degree of iron overload in splenectomized patients results in alterations in pharmacokinetic parameters (the C(max) and AUC) of deferiprone glucuronide and deferiprone-chelated iron, as well as a significant increase in UIE.
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50
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Cavazzana-Calvo M, Payen E, Negre O, Wang G, Hehir K, Fusil F, Down J, Denaro M, Brady T, Westerman K, Cavallesco R, Gillet-Legrand B, Caccavelli L, Sgarra R, Maouche-Chrétien L, Bernaudin F, Girot R, Dorazio R, Mulder GJ, Polack A, Bank A, Soulier J, Larghero J, Kabbara N, Dalle B, Gourmel B, Socie G, Chrétien S, Cartier N, Aubourg P, Fischer A, Cornetta K, Galacteros F, Beuzard Y, Gluckman E, Bushman F, Hacein-Bey-Abina S, Leboulch P. Transfusion independence and HMGA2 activation after gene therapy of human β-thalassaemia. Nature 2010; 467:318-22. [PMID: 20844535 DOI: 10.1038/nature09328] [Citation(s) in RCA: 960] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/28/2010] [Indexed: 12/12/2022]
Abstract
The β-haemoglobinopathies are the most prevalent inherited disorders worldwide. Gene therapy of β-thalassaemia is particularly challenging given the requirement for massive haemoglobin production in a lineage-specific manner and the lack of selective advantage for corrected haematopoietic stem cells. Compound β(E)/β(0)-thalassaemia is the most common form of severe thalassaemia in southeast Asian countries and their diasporas. The β(E)-globin allele bears a point mutation that causes alternative splicing. The abnormally spliced form is non-coding, whereas the correctly spliced messenger RNA expresses a mutated β(E)-globin with partial instability. When this is compounded with a non-functional β(0) allele, a profound decrease in β-globin synthesis results, and approximately half of β(E)/β(0)-thalassaemia patients are transfusion-dependent. The only available curative therapy is allogeneic haematopoietic stem cell transplantation, although most patients do not have a human-leukocyte-antigen-matched, geno-identical donor, and those who do still risk rejection or graft-versus-host disease. Here we show that, 33 months after lentiviral β-globin gene transfer, an adult patient with severe β(E)/β(0)-thalassaemia dependent on monthly transfusions since early childhood has become transfusion independent for the past 21 months. Blood haemoglobin is maintained between 9 and 10 g dl(-1), of which one-third contains vector-encoded β-globin. Most of the therapeutic benefit results from a dominant, myeloid-biased cell clone, in which the integrated vector causes transcriptional activation of HMGA2 in erythroid cells with further increased expression of a truncated HMGA2 mRNA insensitive to degradation by let-7 microRNAs. The clonal dominance that accompanies therapeutic efficacy may be coincidental and stochastic or result from a hitherto benign cell expansion caused by dysregulation of the HMGA2 gene in stem/progenitor cells.
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Affiliation(s)
- Marina Cavazzana-Calvo
- Clinical Investigation Center in Biotherapy, Groupe Hospitalier Universitaire Ouest, Inserm/Assistance Publique-Hôpitaux de Paris, Paris 75015, France
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